Medical Waste Management, MW in Covid - 19, Prism, Waste Management in BD, Incineration, Autoclave etc.

1. Technical Session – 3B : Health Risk and Related Issues

2. MEDICAL WASTE MANAGEMENT: A
PERSPECTIVE FROM BANGLADESH
Pronab Kumar Debnath
Paper ID: A92

3. Some Acronyms
• ADB = Asian Development
Bank
• BD = Bangladesh
• DC = Dhaka City
• DGHS = Directorate General
of Health Services
• DoE = Department of
Environment
• ECC = Environmental
Clearance Certificate
• HCE = Health Care
Establishments
• HCF = Health Care Facilities
• HCW = Health Care Waste
• MoHFW = Ministry of Health
and Family Welfare
• MW = Medical Waste
• MWM = Medical Waste
Management
• USAID = United States Agency
for International Development
• UNICEF = United Nations
International Children's
Emergency Fund
• WHO = World Health
Organization

4. Methodology
It’s a unsystematic descriptive review of national and
international articles/news/policies (related the Medical Waste
and its Management)
• First, selected the outline of the article
• Visit different secondary sources
• Sorting the articles/papers of last 5 years
• Different data & information has been collected from selected
• After data collection, a comparative analysis has been drawn
• All he data and information represent in the paper

5. Background
• According to ADB’s – MW contributes to the second-largest
volume of hazardous wastes in the country
• Recent (WHO) report – about 25.0% diseases in developing
countries are due to improper waste management.
• Almost 80% to 90% of all waste produced by the HCEs are
general or non-hazardous waste
• The remaining 10-20% of waste is considered as hazardous
• BRAC – Only 35 tons (14.1%) of waste are under proper
management (this management is limited within the capital
city Dhaka)
• Merely 6.6% of COVID-19-related health-safety and medical
waste are managed properly in Bangladesh
• Rest of the 93.4% waste remains out of proper treatment

6. MW Generation (in BD)
• In normal condition, MW generation in Bangladesh is
estimated around 0.5 kg/patient/day
• In Bangladesh, there are around 654 government hospitals
and 5055 private hospitals and clinics with 141,903 beds in
total, along with an additional 9061 diagnostic center beds
Table 1: MW Generation Calculation (in Normal Time)
• One study (BRAC) result shows – total 248 tons of MW
generates daily
Type of HCE’s No. of Beds
Waste
Generation
Total MW
Government Hospitals (654)
141,903 0.5
kg/patient/day
75482
kg/day
= 75.48 Ton
Private Hospitals & Clinics
(5055)
Diagnostic Center Beds 9061

7. • At the Covid-19 situation, this waste generation jumps to 3.4
kg/patient/day which is about 6.8 times higher than normal
conditions
Table 2: MW Generation Calculation (in Covid 19)
• One cumulative estimation of MW at Covid-19 situation in
Bangladesh (till 5 July 2020) is about 828,316.5 kgs or about
913 tons
• Rahman et al. (2020), in April, more than 14,500 tons of MW
were produced throughout the country due to COVID
MW Generation (in BD, at Covid – 19)
Type of HCE’s No. of Beds
Waste
Generation
Total MW
Government Hospitals (654)
141,903
3.4
kg/patient/day
(in the period
of Covid – 19)
513.27 Ton
Private Hospitals & Clinics
(5055)
Diagnostic Center Beds 9061

8. MW Generation in Dhaka City
• According to the DCC - Private & Public HCEs currently
operating – 174 hospitals, 164 clinics, 209 diagnostic/
pathology, and 465 dental clinics
• PRISM Bangladesh – that more than 1,200 HCEs, which
generate an estimated 200 tons of waste/day (and 40 tons are
infectious waste)
• The average medical waste generation rate is 1·63–1·99 kg per
bed per day in Dhaka, the capital of Bangladesh
• 206 tons of medical waste are produced because of COVID-19
per day in Dhaka alone (The Business Standard. July 5, 2020 )
• On an average – 6,180 tons/month of (MW) during this
COVID-19 pandemic in the Dhaka city (Faisal et al., 2021)

9. Table 3: Estimated Monthly Covid – 19 related waste generated in BD
Year Month
Infectious
Waste (ton)
ICU waste
ton
Deceased
Patient
Waste (ton)
Isolation
Waste
(ton)
Quarantine
Waste
(ton)
Total
Medical
Waste (ton)
2020 March 5.38 NA 0.53 37.84 614.33 658.08
April 777.04 NA 16.63 144.84 707.68 1,646.19
May 4161.82 NA 50.8 610.7 615.65 5,438.97
June 10,029.66 NA 115.57 801.92 640.2 11,587.35
July 10,123.46 34.9 137.02 1929.87 581.31 12,806.56
August 8009.66 31.73 122.8 2101.9 534.18 10,800.27
September 5224.54 29.9 99.04 1535.81 427.45 7,316.74
October 4509 8.87 68.54 476.95 206.43 5,269.79
November 5767.9 11.93 73.54 522.44 249.9 6,625.71
December 5120.12 13.71 96.44 535.85 251.72 6,017.84
2021 January 2279.7 16.86 59.87 29.87 148.34 2,534.64
February 1054.53 6.28 26.75 15.58 89.81 1,192.95
March 6859.33 26.67 67.25 44.47 223.56 7,221.28
April 15,079.37 47.33 245.21 178.25 614.58 16,164.74
May 4364.4 12.86 123.21 124.19 364.26 4,988.92
Total 100,270.03
Average/month 6,684.67
(Chowdhury et al., 2021)

10. • According to ESDO – 14165 tons of wastes from single-use
plastic was generated on 26 March to 25 April 2020
Chowdhury et al., 2021
Covid Related Waste Generation
0
0.5
1
1.5
2
2.5
3
3.5
4
Normal Time Covid Time
kg/patient/day
MW Generation
Rate of MW Generation in BD

11. Very Brief About MW
• HCW is a special type of waste – poses potential risks to either
human beings/natural environment – direct or indirect
contact
• generated from

12. Categories/Classifications
• Different authors introduce different ways of medical waste
classification
• Commonly
Hospital/Medical
Waste
Hazardous
Waste
General or
Nonhazardous
Waste

13. Categories/Classifications
Non-Hazardous
Waste (80-85%)
Chemical &
Pharmaceuticals
Non-Infectious
Waste
Hazardous Waste
(15-20%)
Liquid
Solid
Non-sharps
Infectious
Hospital
Waste
Sharps
Infectious
Waste
Source: WHO

14. According to the Medical Waste (Management &
Processing) rules 2008, the MW is classified as 13.
Type Typical Examples
Liquid
Biological Waste
Chemical Waste
Over-date Medicines
Radioactive Waste
Blood, Excrement, Body fluid etc.
Solutions, Inorganic salts, etc.
Unused drugs, Over drugs
Wastes from radiology (iodine 125, iodine 131
etc.)
Solid Wastes
Perforating & Cutting Wastes
Non-perforating & non-cutting
wastes
Needles, Syringes, Blades, Broken glass, Vials
Parts of the Body, Over-date medicines, Wastes
from treatment (dressings, stool, napkins,
plaster etc.)
Categories/Classifications
Nasima Akter, 2000
Table 4: Type and Example of MW

15. Small Healthcare Establishment:
- Physicians office
- Dental Clinics
- Acupuncturists
Specialized healthcare establishments
and institutions
- Psychiatric hospitals
- Disabled persons institutions
Non-health activities
- Cosmetic/Beauty parlor
Ambulance services
Home treatment
Hospitals:
- General Hospital (& clinics)
- Specialized Hospital (& clinics)
- University/Institutional Hospital
Other Healthcare Establishments:
- Pathology/Diagnostic Centers
- Dialysis Centers
- Obstetric & Maternity Clinics
- Military Medical Services
Laboratories and research centers
Animal Research & Testing
Blood Banks
Minor Sources Major Sources
Sources of Hospital
Source(s) of MW

16. Objectives (of the study)
• Present the scenario of medical waste management in
Bangladesh
• Drawn the terrible situation of MW miss-management in BD
• Show the possible ways to Medical Waste Management
• Demonstrating of the existing legislation and institutional
involvement
• Provide a brief role & opportunity of youth (initiatives)

17. A View of MW Management in BD
• Many researchers have studied MW management in
developing countries
• The results - that the management of MW is poor and has not
received adequate attention
• Authorities and owners of HCFs also lack interest and are not
bothered to improve their MWM (as there is a cost involved)
• 93% of MW is out of proper management (BRAC)
• Most of them dump their (unsegregated and untreated) MW
in open municipal bins and/or nearby the hospitals
• They even resale used infectious MW items like a syringe,
needle, saline bag, blood bag, test tube, etc.

18. Scenario of Poor MWM in BD
Collected from Google

19. Consequences of these poor management
• Leaches – contaminate soil
and groundwater through
toxicity
• The municipality generally
dumps the untreated MW
along with the general wastes
• One estimate shows – 5.2
million people in world
(including 4 million children)
die/year from waste-related
diseases
• Many untrained and unskilled
labor handle the MW = being
a victim of illness
Figure: Cycle of Poor MW Management

20. SL Risks due to Risks Detail
Health Hazards
1 Injuries & Accidents Many types of injuries due to handle the waste
Injuries like hand cut, skin disease etc.
2 Infectious MW Risks Bacterial, Viral, Fungal and Parasitic diseases
3 Hazardous Medical
Waste Risks
Cause of many disease like headache, headedness,
dizziness; irritate skin, eyes, & lungs due to vapor;
irregular heart beat; vomiting, gastro- intestinal,
irritation & bleeding etc.;
Environmental Hazards
1 Surface and ground water contamination, decrease in water quality
2 Bio-accumulation in organism's fat tissues, & bio-magnification – food chain
3 Wind blown dusts from dumping – carry hazardous particulates
4 Air pollution, odor and nuisance
5 combination of both degradable and non-degradable waste derease the rate of
habitat
Table 5: Consequences of these Poor Management

21. Hospital
Maintenance
Personnel
Persons at
Risk
Doctors,
Nurses,
Healthcare
Auxiliaries
Visitors
Workers in
laundry, MW
handling &
transports
Workers in
City Waste
Handling
Patient in
Hospitals
Consequences of these poor management
Figure: List of Persons at Risk for Poor MW Management

22. (Root) Causes of these poor management
• Lack of awareness, expertise
• Inadequate implementation of the legal provision
• Funding/budget allocation (both Gvt. & Pvt.)
• logistics (like storage in separate bins, transport facility or
even protective gears of cleaners), manpower
• Commercialization
• Lack of encouragement to create small entrepreneurship
• Proper research/analysis and implementation

23. History of MWM in BD so far
• 2004 – The DoE developed a hospital waste management
pocket book in
• 2005 – Training and awareness for MWM started being
developed
• 2008 – The first MWM Rules of Bangladesh was published
• 2009 – Some Non-Government Organizations (NGOs)
developed expertise and came forward for proper MWM
• 2010 – Revised of hospital waste management pocket book
• Later on NGO’s have been enhanced and increased their
operation
• JICA has been provided vehicle support to NGO
• From the Covid - 19 situation GoB have been enhanced MWM
through ECC process

24. Guidelines and Policies regarding MWM
• Medical Waste (Management and Processing) Rules – 2008
• DGHS – “Manual for Hospital Waste Management” – 2001
(updated in 2010)
• In 2018 – “Hospital Infection Prevention and Control
Manual” – developed by the Quality Improvement
Secretariat (QIS), Health Economics Unit, Health Services
Division, MoHFW, in collaboration with USAID’s
• In 2019 – “National Strategy for WASH in HCFs 2019–2023: A
Framework for Action” published – DGHS, MoHFW, funded
by UNICEF

25. All Possible Ways to MWM
MWM
On-Site
(Liquid & Solid)
Combination of
On-Site & Off-Site
(Liquid & Solid)
Off-Site
(Liquid & Solid)
# by Authority of
HCF’s
# by Authority of HCF’s
# Third Party
(NGO’s/Commercials)
# Government
Agencies
# Third Party
(NGO’s/Commercials)
# Government
Agencies
@ Technological Options (for treatment)
@ Vehicular Options (for transportation)
@ Containers (for collection and storage)
A single organization may not be licensed to dispose, transport, collect or remove the
medical wastes. Three or four different institutions may be vested and licensed with
different responsibilities (the daily stars).

26. All Possible Ways to MWM

27. 1% NaOcl
All Possible Ways to MWM

28. MW Management/Treatment Options
Class of Waste Category of Waste Sample Treatment and Destroy
Class No-1 General Waste (uninfected /
non harmful Waste)
(a) Removal of premises or public landfill.
(b) Ensure that plastic waste is cut off and reused.
Class No-2 Anatomical waste (a) Purification/destruction of concrete pit method in
premises / safe place.
(b) Deep soil cover (the amount is small)
(c) Use of steam autoclaving / microwave
treatment/incinerator.
Class No-3 Pathological waste Category No. II (Anatomical waste) like.
Class No-4 Chemical waste (a) Return to the expired chemical waste supplier (if quantity
is high).
(b) Disposal of sewage by diluting it with a large quantity of
water (if the quantity is small)
(c) Chemically purified/inactivated in the sewage system.
Table 6: MW Treatment Options
According to the MW(MP)R-2008

29. Class of Waste Category of Waste Sample Treatment and Destroy
Class No-5 Pharmaceutical Category No. -4 chemical waste) like.
Class No-6 Infectious/bacterial waste (a)Purification / destruction of concrete pit method in premises
/ safe place.
(b)Deep soil cover (the amount is small)
(c)Use of steam autoclaving / microwave treatment /
incinerator.
Class No-7 Radioactive waste (a)If the level of radioactivity per kg of waste exceeds 0.1 MBQ,
it must be treated and disposed of by the provisions of
Bangladesh Atomic Energy Commission.
Class No. 8 Sharp waste (a) Purification/destruction of concrete pit method in premises
/ safe place.
(b)Encapsulation
(c)Deep soil cover (the amount is small)
(d) Use of steam autoclaving / microwave
treatment/incinerator.
MW Management/Treatment Options

30. Class of Waste Category of Waste Sample Treatment and Destroy
Class No-9 Reusable General Waste (a) Purification and reuse by steam autoclaving.
(b) Chemical treatment and reuse.
Class No-10 Liquid waste
(Infected/Non-infected)
(a) Removal in drainage system by diluting with plenty of
water.
(b) Removal to the sewer by chemically purifying mixed
with 1% sodium hypochlorite solution.
Class No-11 Pressurized waste (a) Refund to the supplier (in excess)
(b) Methodically depressurized removal with
normal/recyclable waste (in small quantities)
MW Management/Treatment Options

31. Color Category of MW Class of MW MOC of
Pot/Container
BLACK সাধারণ বর্জ্য
GENERAL WASTE
Class – 1, 11 Non-perforated
Plastic Bin
YELLOW ক্ষতিকারক বর্জ্য
HAZARDOUS WASTE
Class – 2, 3, 4, 5,
& 6
Non-perforated
Plastic Bin
RED ধারাল া বর্জ্য
SHARP WASTE
Class – 8 Non-perforated,
tightly closed Plastic
Bin or Box
BLUE ির বর্জ্য
LIQUID WASTE
Class – 10, 4 Non-perforated
plastic bin or bowl
SILVER তির্জস্ক্রিয় বর্জ্য
RADIOACTIVE WASTE
Class – 6 Non-perforated lead
box
GREEN ঩ুনঃবযবহারল াগ্য
সাধারণ বর্জ্য
RECYCLEABLE GENERAL
WASTE
Class – 9 Non-perforated
Plastic Bin
MW Management/Treatment Options
Table 7: Color Code Bin for MW Collection & Disposal

32. MW Management/Treatment Options
According to the MW(MP)R-2008

33. Organizations that Playing Role in MWM in BD
Name of the
Organization(s)
Major Function(s)
1. Universities
2. DoE
3. DG Health
4. City Corporation
5. Civil Surgeon
6. NGO (Waste Concern/
ESDO/ Prism Bangladesh
Foundation)
7. Stakeholders (Owners of
HCF’s)
1. Research & Publications, Manpower
Generation
2. ECC, Publications, Punishment
3. Certification, Publications
4. Waste Collection, Treatment, Disposal
5. Passively force to MWM
6. Collection, Treatment, Disposal, Research &
Publications
7. On-site Management
Table 8: Name of the Organizations involving in MWM

34. SL Name of NGO’s District Cover
1 Prism Bangladesh
Foundation
Dhaka, Sylhet, Rangpur,
Narayanganj, Jashore,
Rajshahi
2 Prodipan Khulna
3 Nobo Waste
Management
Meymensingh
4 Chattagram Seba
Sangstha
Chattagram
5.
6.
7.
Palli Chetona
Swapno
BASA
Satkhira
Bagura
Tongi, Gazipur
Organizations that Playing Role in MWM in BD
Table 9: NGO’s involving in MWM
Collected from different sources
There are only 1121 hospitals, clinics
and diagnostic centers under the
PRISM HCW management program

35. MWM by PRISM Bangladesh Foundation

36. Scenario of MWM from HCF’s
1. On-site MWM
2. Combined On-site & Off-site MWM
A. On-site – both Solid & Liquid
B. Combined – Solid by third party & in-house management of Liquid MW
Medical Waste (On-site)
Solid
(medical)
Waste
Liquid
(medical)
Waste
Residual is
disposed in the
city bin
Treated by
Disinfection
Plant (own
site)
Collected
in Color
Bin
Burning by
Incinerator
Medical Waste
(Combined…)
Solid
(medical)
Waste
Liquid
(medical)
Waste
Treated by
Disinfection
Plant (own
site)
Collected
in Color
Bin
Carried
out by
Third
Party
Collected from an EMP Report of Authors

37. Captured from Site Visit

38. Scopes of Youth Initiatives
• Make your own Consultancy Service/firm
• Freelance Engineer/Individual Consultant
• Innovation and Entrepreneurship (trading)
• Import Business (related to MWM)
• Blog/Youtube Channel/Website
• And Many More

39. Pronab Kumar Debnath
Freelance Engineer
PGD-DM, M.Sc. In Engg
Khulna University of Engineering
and Technology (KUET)
pronab.pb@gmail.com
01924667576