Assessment of Waste Management Practices in

Healthcare Establishments of Khulna City

Abstract:

.. Healthcare waste management poses a growing public health and environmental

challenge in Bangladesh, with specific concerns cantered around Khulna city. This
research paper presents an assessment of waste management practices in
healthcare establishments within the city The study investigates healthcare
waste management in both public and private establishments, estimates total
medical waste production based on patient capacities, evaluates the overall
waste management cost, and emphasizes the significance of medical waste
management while exploring eco-friendly options. The methodology includes
a comprehensive analysis, data tables, and a comparison of the present and
proposed medical waste management systems.
1. Introduction : Healthcare waste management is a critical
concern for both public health and environmental
sustainability. Proper disposal and management of medical
waste are essential to prevent health hazards and reduce
environmental pollution. This research focuses on assessing
the current waste management practices in healthcare
establishments within the city, with a specific emphasis on
public and private healthcare facilities. Access to healthcare is
recognized globally as a fundamental human right. International
declarations and national constitutions affirm this right,
emphasizing the duty of states to ensure the well-being of their
citizens. However, the increasing trend of urbanization worldwide
has led to the proliferation of healthcare facilities, generating
substantial volumes of healthcare waste. This waste poses
significant threats to public health and the environment.
Improperly managed healthcare waste can transmit infectious
diseases, endangering both healthcare workers and the
community. Shockingly, millions of hepatitis B, hepatitis C, and
HIV infections occur annually due to the unsafe disposal of items
like syringes. The global impact of waste-related diseases is
staggering, with millions of lives lost each year (WHO, 1999).In
this context, Agenda 21, adopted in the United Nations
Conference on Environment and Development, set ambitious
goals for waste management in cities, recognizing the urgent
need for action. Unfortunately, the expansion of healthcare
facilities in Bangladesh and many other developing nations has
outpaced the establishment of effective waste management
systems. Inadequate disposal practices, including mixing
healthcare waste with household waste, create a hazardous
situation. Bangladesh is not exempt from this challenge. The
 prevalence of diseases transmitted through healthcare waste,
such as hepatitis B and HIV/AIDS, is alarming. While cases of
HIV/AIDS in Bangladesh remain lower than in neighbouring
countries, they are on the rise (Sinha, 2004). Most troubling is the
fact that healthcare waste, including syringes and needles, often
ends up in the hands of those who resell these items, despite the
grave health risks involved (Ecoaccess, 2004). Healthcare waste
management has remained a neglected aspect of Bangladesh's
healthcare system. Recent studies, primarily focused on Dhaka,
have highlighted the lack of proper handling and disposal
methods for medical waste. The rapid growth of the private
healthcare sector has exacerbated the problem, affecting not just
metropolises like Dhaka but also larger cities such as Khulna.
Sadly, Khulna, the third-largest city in Bangladesh, is grappling
with the consequences of inadequate healthcare waste
management. This research focuses on assessing the current
waste management practices in healthcare establishments
within the city, with a specific emphasis on public and
private healthcare facilities and explore sustainable, eco-
friendly waste management solutions. Urgent action is needed to
rectify this situation as urbanization continues at a relentless
pace, posing grave threats to both the environment and the
health of Khulna's residents.

2. Objectives

The primary objectives of this study are as follows:

1. To investigate healthcare waste management practices in selected public

and private healthcare establishments in the city.
 2. To estimate total medical waste production based on the patient
capacities of the selected healthcare facilities.
3. To assess the overall waste management cost, including waste reuse and
associated authority expenses.
4. To emphasize the significance of medical waste management and
explore eco-friendly waste disposal options.
3. Methodologies

1. Conceptualization of the Research

The research begins with a clear conceptualization of the study's objectives

and scope. This foundational step involves defining the key research questions
and the specific focus on hospital waste management in Khulna City
Corporation (KCC).

2. Literature Review

A comprehensive literature review is conducted to explore existing knowledge,

theories, and best practices related to hospital waste management. This review
provides valuable insights to inform the research process.

3. Selection of Health Care Establishments

The selection of health care establishments (HCEs) within Khulna City

Corporation is a crucial aspect of this study. Careful consideration goes into
choosing a representative sample of hospitals, clinics, and diagnostic centers.

4. Field Survey Design and Data Collection Planning

A robust field survey design is developed to collect primary data. This includes
planning for data collection methods, sampling techniques, and survey tools.

5. Consultation (Before Data Collection)

Consultations are held with relevant stakeholders, including healthcare facility

representatives and waste management authorities, to ensure alignment with
research objectives and to establish cooperation.
6. Building Rapport with Respondents

Building rapport with respondents is a critical step to facilitate data collection.

Establishing trust and understanding is essential for obtaining accurate
information.

7. Data Collection

Data collection encompasses both primary and secondary data sources:

• Primary Data: Collected through instrumental surveys and questionnaire

surveys from various stakeholders such as patients, administration,
nurses, technicians, cleaners, and doctors.
• Secondary Data: Sourced from journal reports, non-governmental
organizations (NGOs), the Department of Environment (DOE), KCC
records, and other relevant sources.

8. Data Analysis

Collected data are subjected to rigorous analysis. Quantitative data from

surveys and qualitative data from secondary sources are processed and
interpreted to draw meaningful insights.

9. Suggestion of Experts and Correction

The research benefits from expert input to validate findings and offer
suggestions for improvement. Corrections are made as needed to ensure the
research's validity and accuracy.

10. Final Report Preparation

The final report is meticulously prepared, incorporating all findings, data,

analysis, and expert recommendations. It is structured to provide a coherent
narrative of the research process and outcomes.

11. Report Presentation

The research findings are presented through a well-structured report that is
accessible to stakeholders and decision-makers. This presentation phase is
critical for disseminating the research's outcomes and encouraging informed
action.

These methodologies ensure a systematic and rigorous approach to

investigating hospital waste management in Khulna City Corporation. They
encompass various data collection techniques and expert input to provide a
comprehensive understanding of the issue.

3.1 Data Collection

The research methodology involved data collection from a variety of
healthcare establishments within the city. Data related to waste generation,
disposal practices, and costs were collected through surveys, interviews, and
site visits.

3.2 Present Disposal Scenario of Medical Waste

This section presents the current disposal practices of medical waste in the
city's healthcare establishments. It includes information on waste segregation,
collection, transportation, and disposal methods.
3.3 Inventory of Different Health Care Establishments (HCEs)
A comprehensive inventory of various healthcare establishments, including
hospitals, clinics, and diagnostic centers, is provided in this section. The
inventory includes data on the types of establishments, bed capacities, and
waste generation rates.
3.4 Comparative Analysis of Medical Waste Generation (%)
This section presents a comparative analysis of medical waste generation
percentages in the studied healthcare establishments. It highlights variations
in waste generation rates among different types of healthcare facilities.
3.5 Treatment Processes in Different Sectors
A detailed description of the treatment processes for medical waste in various
sectors, such as hospitals and clinics, is provided. This includes information on
methods such as incineration, autoclaving, and microwaving.
Medical Waste Treatment in Different Sectors

1. Hospitals and Healthcare Facilities:

• Autoclaving: Steam-based sterilization to render waste non-
infectious.
• Incineration: High-temperature burning to reduce waste volume.
• Chemical Treatment: Using disinfectants or chemicals to treat
waste.
• Segregation: Separating infectious waste from non-infectious
waste.
2. Municipal Waste Management:
• Landfill Disposal: Safe burial of treated medical waste in
designated landfills.
• Recycling: Segregating recyclable materials from medical waste.
• Composting: Transforming organic medical waste into compost.
3. Non-Governmental Organizations (NGOs):
• Collection and Transportation: NGOs often collect waste from
healthcare facilities.
• Centralized Treatment: Large-scale treatment facilities for
comprehensive waste management.
• Segregation and Sterilization: Ensuring safe handling, sterilization,
and disposal.
4. Infectious Waste Treatment:
• Incineration: High-temperature burning for complete sterilization.
• Microwave Treatment: Heat-based treatment to kill pathogens.
• Chemical Disinfection: Using chemicals to neutralize infectious
agents.
5. Recyclable Waste Management:
• Collection and Sorting: Identifying recyclable materials (e.g.,
plastics, glass).
• Cleaning and Shredding: Preparing recyclables for processing.
• Recycling Facilities: Facilities that process recyclables into new
products.
6. Sharp Waste Disposal:
• Encapsulation: Secure containment of sharp waste for safety.
 • Burial Pit Treatment: Safe disposal in dedicated burial pits.
7. Environmental Considerations:
• Eco-Friendly Practices: Promoting waste reduction, recycling, and
sustainability.
• Pollution Control: Measures to prevent air, soil, and water
pollution during waste treatment.
8. Legal and Regulatory Compliance:
• Adherence to local and national regulations for safe waste
management.
• Licensing and Monitoring: Oversight by government authorities to
ensure compliance.
9. Public Awareness and Education:
• Informing healthcare workers, waste handlers, and the public
about safe practices.
• Encouraging proper waste segregation and disposal.

This overview outlines various medical waste treatment methods employed in

different sectors to ensure the safe and environmentally responsible
management of healthcare waste.
3.6 Disposal
This section outlines the final disposal methods used for medical waste,
including landfilling, recycling, and eco-friendly disposal options. It evaluates
the environmental impact of different disposal practices.

4. Comparison of Present and Proposed Medical Waste

Management System
This section compares the existing medical waste management system with a
proposed system that incorporates eco-friendly waste disposal options. It
assesses the potential benefits of adopting more sustainable practices.

Present management system

Existing Medical Waste Management Process

1. Healthcare Establishments (HCEs):
• HCEs generate medical waste during daily operations.
2. Temporary Storage:
• Medical waste is temporarily stored in large bins, divided into two
sections:
• Municipal Dustbin near Hospital Boundary
• Collection by NGO (Non-Governmental Organization).
3. Collection by NGO:
• An NGO specializing in waste management collects medical waste
from healthcare facilities.
4. Transportation by NGO:
• The collected waste is transported by the NGO to a central
treatment facility.
5. Segregation:
• At the treatment facility, waste undergoes segregation into
different categories:
• General Wastes
• Infectious Wastes
• Recyclable Wastes
• Sharp Wastes
6. General Wastes:
• General waste may be further processed through:
• Dumping (Landfill)
• Composting (if suitable).
7. Infectious Wastes:
• Infectious waste is subjected to treatment that may include:
• Air Drying
• Burning
• Ash Generation
• Final Disposal of Ash.
8. Recyclable Wastes:
• Recyclable waste is prepared for recycling through steps like:
• Cleaning
• Shredding
• Final Disposal (if recycling is not feasible).
 9. Sharp Wastes:
• Sharp waste is managed through:
• Encapsulation for safety
• Burial Pit Treatment for disposal.

This existing process ensures the proper management of medical waste from
healthcare establishments to final disposal. It focuses on minimizing the
environmental and health risks associated with medical waste while
maximizing recycling and safe disposal practices.

Improved management system

1. Waste Segregation: At the source of generation (healthcare facilities), waste is
segregated into categories such as general waste, hazardous waste (e.g., sharps, cytotoxic
drugs), and infectious waste (e.g., contaminated gloves, dressings).
2. Proper Collection: Trained personnel collect segregated waste using color-coded bins
and containers. Hazardous and infectious waste is clearly marked.
3. Transportation: Waste is transported in dedicated, leak-proof, and secure vehicles to
prevent spillage and contamination during transit.
4. Waste Treatment: Different types of healthcare waste require specific treatment
methods. Common treatments include:
• Incineration: Hazardous and infectious waste is incinerated at high temperatures to
reduce volume and eliminate pathogens.
• Autoclaving: Some infectious waste is autoclaved (steam sterilized) before disposal.
• Chemical Treatment: Certain chemical waste, like cytotoxic drugs, may require chemical
treatment for safe disposal.
• Landfilling: Non-hazardous, non-infectious waste is safely disposed of in designated
landfills.
5. Monitoring and Compliance: Regular monitoring ensures that waste management
procedures comply with environmental and safety regulations.
6. Education and Training: Continuous training and awareness programs are conducted
for healthcare staff to promote proper waste handling.
7. Documentation: Detailed records are maintained, including the quantity and type of
waste generated, treatment methods used, and disposal processes.
8. Environmentally Friendly Practices: Emphasis on eco-friendly waste management
techniques, such as recycling or safe disposal of chemical waste.
9. Community Engagement: Engaging with the local community to raise awareness about
the importance of healthcare waste management and how to safely handle medical waste
at home.
10. Review and Improvement: Periodic reviews are conducted to assess the effectiveness of
the waste management system and identify areas for improvement.
 11. Regulatory Compliance: Ensure compliance with national and international regulations
related to healthcare waste management.
12. Emergency Response: Develop protocols for handling accidental spills or other
emergency situations to minimize risks.
13. Public Reporting: Transparency in reporting waste management practices to the public,
ensuring accountability.

Please note that this is a simplified textual representation of the steps involved in an improved
system of healthcare waste management. A visual flowchart would provide a more detailed and
graphical representation of this process. You may consider using specialized software or hiring a
graphic designer to create a flowchart based on these steps.

5. Conclusion
In conclusion, this research paper sheds light on the current state of
healthcare waste management in the city. It emphasizes the need for
improved waste management practices to protect public health and the
environment. The study proposes eco-friendly alternatives and highlights the
importance of adopting sustainable waste disposal methods.