Report: Healthcare waste characterization in Chittagong Medical College Hospital, Bangladesh

Healthcare waste management (HCWM) options are inconsistent in Bangladesh. One of the first critical steps in the process of developing a reliable waste management plan requires a comprehensive understanding of the quantities and characteristics of the waste that needs to be managed. This study took into consideration both the quantity and quality of the generated waste to determine the generation rates and physical properties of healthcare waste (HCW) in Chittagong Medical College Hospital (CMCH) and also to estimate the amount of infectious and non-infectious waste generated in different wards. CMCH, the second largest hospital in Bangladesh, comprises 34 wards, 12 of which were selected randomly. Waste materials were collected from these wards and then segregated and weighed. Waste generation per day was found to be 73.22 kg/ward, 1.28 kg/bed and 0.57 kg/patient. A total of 2490 kg of HCW was produced each day in CMCH (37% being infectious and the rest being non-infectious waste). Infectious waste was 27.07 kg per ward, 0.47 kg per bed and 0.21 kg per patient and the non-infectious waste was 46.15 kg per ward, 0.81 kg per bed and 0.36 kg per patient per day. HCW comprised eight categories of waste materials with vegetable/food waste being the largest component (50.21%) and varied significantly (P < 0.05) among the 12 different wards studied. The greatest amount of HCW was recorded (154 kg) in Orthopaedics followed by 96.66 kg in the Medicine Unit-3 and the smallest amount was recorded in Casualty (8.79 kg). The amount of HCW was positively correlated with the number of occupied beds (rxy = 0.79, P < 0.01). There is no structured form of medical waste treatment in CMCH and most waste materials are dumped in open areas for natural degradation or re-sold by scavengers. It is essential to develop a national policy and implement a comprehensive action plan for HCWM that will provide environmentally sound technological measures to improve HCWM in Bangladesh.     

Medical waste management in Ibadan, Nigeria: obstacles and prospects

Quantification and characterization of medical waste generated in healthcare facilities (HCFs) in a developing African nation has been conducted to provide insights into existing waste collection and disposal approaches, so as to provide sustainable avenues for institutional policy improvement. The study, in Ibadan city, Nigeria, entailed a representative classification of nearly 400 healthcare facilities, from 11 local government areas (LGA) of Ibadan, into tertiary, secondary, primary, and diagnostic HCFs, of which, 52 HCFs were strategically selected. Primary data sources included field measurements, waste sampling and analysis and a questionnaire, while secondary information sources included public and private records from hospitals and government ministries. Results indicate secondary HCFs generate the greatest amounts of medical waste (mean of 10,238 kg/day per facility) followed by tertiary, primary and diagnostic HCFs, respectively. Characterised waste revealed that only approximately 3% was deemed infectious and highlights opportunities for composting, reuse and recycling. Furthermore, the management practices in most facilities expose patients, staff, waste handlers and the populace to unnecessary health risks. This study proffers recommendations to include (i) a need for sustained cooperation among all key actors (government, hospitals and waste managers) in implementing a safe and reliable medical waste management strategy, not only in legislation and policy formation but also particularly in its monitoring and enforcement and (ii) an obligation for each HCF to ensure a safe and hygienic system of medical waste handling, segregation, collection, storage, transportation, treatment and disposal, with minimal risk to handlers, public health and the environment.     

Health-care waste management in Lao PDR: a case study.

This study investigated the health-care waste (HCW) management at each health-care facility level at two selected sites in the Lao People's Democratic Republic (Lao PDR): Vientiane Municipality; and Bolikhamxay province. It focused on the amount of HCW, its segregation and the factors influencing HCW management, particularly segregation procedures. A high proportion of incorrectly segregated medical waste was found at each level of health-care facility. Re-segregation revealed 39, 62, 57 and 37% at national hospital, provincial hospital, district hospital and health centre level, respectively, was poorly segregated. The mean of generated HCW was 0.62 kg/bed per day (Vientiane Municipality) and 0.38 kg/bed per day (Bolikhamxay) at two study sites. A higher proportion of medical waste (MW) from the inpatient department at the primary health-care level was found. Thus, HCW management at primary health-care facilities needs more attention and should be better understood.     

Characteristics of healthcare wastes

A comprehensive understanding of the quantities and characteristics of the material that needs to be managed is one of the most basic steps in the development of a plan for solid waste management. In this case, the material under consideration is the solid waste generated in healthcare facilities, also known as healthcare waste. Unfortunately, limited reliable information is available in the open literature on the quantities and characteristics of the various types of wastes that are generated in healthcare facilities. Thus, sound management of these wastes, particularly in developing countries, often is problematic. This article provides information on the quantities and properties of healthcare wastes in various types of facilities located in developing countries, as well as in some industrialized countries. Most of the information has been obtained from the open literature, although some information has been collected by the authors and from reports available to the authors. Only data collected within approximately the last 15 years and using prescribed methodologies are presented. The range of hospital waste generation (both infectious and mixed solid waste fractions) varies from 0.016 to 3.23kg/bed-day. The relatively wide variation is due to the fact that some of the facilities surveyed in Ulaanbaatar include out-patient services and district health clinics; these facilities essentially provide very basic services and thus the quantities of waste generated are relatively small. On the other hand, the reported amount of infectious (clinical, yellow bag) waste varied from 0.01 to 0.65kg/bed-day. The characteristics of the components of healthcare wastes, such as the bulk density and the calorific value, have substantial variability. This literature review and the associated attempt at a comparative analysis point to the need for worldwide consensus on the terms and characteristics that describe wastes from healthcare facilities. Such a consensus would greatly facilitate comparative analyses among different facilities, studies and countries.     

Prediction of household and commercial BMW generation according to socio-economic and other factors for the Dublin region

Both planning and design of integrated municipal solid waste management systems require accurate prediction of waste generation. This research predicted the quantity and distribution of biodegradable municipal waste (BMW) generation within a diverse ‘landscape’ of residential areas, as well as from a variety of commercial establishments (restaurants, hotels, hospitals, etc.) in the Dublin (Ireland) region. Socio-economic variables, housing types, and the sizes and main activities of commercial establishments were hypothesized as the key determinants contributing to the spatial variability of BMW generation. A geographical information system (GIS) ‘model’ of BMW generation was created using ArcMap, a component of ArcGIS 9. Statistical data including socio-economic status and household size were mapped on an electoral district basis. Historical research and data from scientific literature were used to assign BMW generation rates to residential and commercial establishments. These predictions were combined to give overall BMW estimates for the region, which can aid waste planning and policy decisions. This technique will also aid the design of future waste management strategies, leading to policy and practice alterations as a function of demographic changes and development. The household prediction technique gave a more accurate overall estimate of household waste generation than did the social class technique. Both techniques produced estimates that differed from the reported local authority data; however, given that local authority reported figures for the region are below the national average, with some of the waste generated from apartment complexes being reported as commercial waste, predictions arising from this research are believed to be closer to actual waste generation than a comparison to reported data would suggest. By changing the input data, this estimation tool can be adapted for use in other locations. Although focusing on waste in the Dublin region, this method of waste prediction can have significant potential benefits if a universal method can be found to apply it effectively.     

Assessment of medical wastes management practice: a case study of the northern part of Jordan

This study includes a survey of the procedures available, techniques, and methods of handling and disposing of medical waste at medium (between 100 and 200 beds) to large (over 200 beds) size healthcare facilities located in Irbid city (a major city in the northern part of Jordan). A total of 14 healthcare facilities, including four hospitals and 10 clinical laboratories, serving a total population of about 1.5 million, were surveyed during the course of this research. This study took into consideration both the quantity and quality of the generated wastes to determine generation rates and physical properties. Results of the survey showed that healthcare facilities in Irbid city have less appropriate practices when it comes to the handling, storage, and disposal of wastes generated in comparison to the developed world. There are no defined methods for handling and disposal of these wastes, starting from the personnel responsible for collection through those who transport the wastes to the disposal site. Moreover, there are no specific regulations or guidelines for segregation or classification of these wastes. This means that wastes are mixed, for example, wastes coming from the kitchen with those generated by different departments. Also, more importantly, none of the sites surveyed could provide estimated quantities of waste generated by each department, based upon the known variables within the departments. Average generation rates of total medical wastes in the hospitals were estimated to be 6.10 kg/patient/day (3.49 kg/bed/day), 5.62 kg/patient/day (3.14 kg/bed/day), and 4.02 kg/patient/day (1.88 kg/bed/day) for public, maternity, and private hospitals, respectively. For medical laboratories, rates were found to be in the range of 0.053-0.065 kg/test-day for governmental laboratories, and 0.034-0.102 kg/test-day for private laboratories. Although, based on the type of waste, domestic or general waste makes up a large proportion of the waste volume, so that if such waste is not mixed with patient derived waste, it can be easily handled. However, based on infections, it is important for healthcare staff to take precautions in handling sharps and pathological wastes, which comprises only about 26% of the total infectious wastes. Statistical analysis was conducted to develop mathematical models to aid in the prediction of waste quantities generated by the hospitals studied, or similar sites in the city that are not included in this study. In these models, the number of patients, number of beds, and hospital type were determined to be significant factors on waste generation. Such models provide decision makers with tools to better manage their medical waste, given the dynamic conditions of their healthcare facilities.     

Medical waste production at hospitals and associated factors

This study was conducted to evaluate the quantities of medical waste generated and the factors associated with the generation rate at medical establishments in Taiwan. Data on medical waste generation at 150 health care establishments were collected for analysis in 2003. General medical waste and infectious waste production at these establishments were examined statistically with the potential associated factors. These factors included the types of hospital and clinic, reimbursement payment by National Health Insurance, total number of beds, bed occupancy, number of infectious disease beds and outpatients per day. The average waste generation rates ranged from 2.41 to 3.26kg/bed/day for general medical wastes, and 0.19-0.88kg/bed/day for infectious wastes. The total average quantity of infectious wastes generated was the highest from medical centers, or 3.8 times higher than that from regional hospitals (267.8 vs. 70.3Tons/yr). The multivariate regression analysis was able to explain 92% of infectious wastes and 64% of general medical wastes, with the amount of insurance reimbursement and number of beds as significant prediction factors. This study suggests that large hospitals are the major source of medical waste in Taiwan. The fractions of medical waste treated as infectious at all levels of healthcare establishments are much greater than that recommended by the USCDC guidelines.     

Sustainable management measures for healthcare waste in China

This paper discusses actions aimed at sustainable management of healthcare wastes (HCW) in China, taking into account the current national situation in this field, as well as the requirements deriving from the Stockholm Convention on Persistent Organic Pollutants and the WHO recommendations. By the end of 2005, there were 149 low-standard HCW disposal facilities in operation in China, distributed throughout different areas. According to the National Hazardous Waste and Healthcare Waste Disposal Facility Construction Plan, 331 modern, high-standard, centralized facilities will be built up in China in municipal level cities. Although incineration is still the main technical option for HCW disposal in China, it is expected that, especially for medium and small size facilities, non-incineration technologies will develop quickly and will soon become the main technical option. The basic management needs – both from the point of view of pollution control and final disposal – have been defined, and a system of technical and environmental standards has been formulated and implemented; however, there are still some shortages. This is particularly true when considering the best available techniques and best environmental practices developed under the Stockholm Convention, with which the present technological and managing situations are not completely compliant. In this framework, the lifecycle (from generation to final disposal of wastes) of HCW and holistic approaches (technology verification, facilities operation, environmental supervision, environmental monitoring, training system, financial mechanism, etc.) towards HCW management are the most important criteria for the sustainable and reliable management of HCW in China.     

Healthcare waste management in the capital city of Mongolia

Inconsistencies are present in the management options for healthcare wastes in Mongolia. One of the first critical steps in the process of developing a reliable waste management plan requires the performance of a waste characterization analysis. The objectives of this study were an assessment of the current situation of healthcare waste management (HCWM) and characterization of healthcare wastes generated in Ulaanbaatar. A total about 2.65 tonnes of healthcare wastes are produced each day in Ulaanbaatar (0.78 tons of medical wastes and 1.87 tons of general wastes). The medical waste generation rate per kg/patient-day in the inpatient services of public healthcare facilities was 1.4-3.0 times higher than in the outpatient services (P<0.01). The waste generation rate in the healthcare facilities of Ulaanbaatar was lower than in some other countries; however, the percentage of medical wastes in the total waste stream was comparatively high, ranging from 12.5% to 69.3%, which indicated poor waste handling practices. Despite the efforts for the management of wastes, the current system of healthcare waste management in Ulaanbaatar city of Mongolia is under development and is in dire need of immediate attention and improvement. It is essential to develop a national policy and implement a comprehensive action plan for HCWM providing environmentally sound technological measures to improve HCWM in Mongolia.     

Solid waste management in Macao: practices and challenges

The rapid economic development and population growth in Macao have resulted in a large increase in refuse generated over the past decade. In 2003, the quantity of solid waste generated reached 249,255 tons, corresponding to 1.52 kg/day per capita. This figure has been gradually increasing. Domestic solid waste is the primary source of solid waste generation. The data showed that a considerable amount of the solid waste generated can be recycled and reutilized. Due to Macao's small geographic area and high cost of land, landfilling has the lowest priority for waste disposal. Solid waste incineration has been given a top priority over other waste disposal methods although it is much more expensive. In the last decade, more than 80% of the total waste in Macao was incinerated. However, the incineration capacity of the Macao Incineration Plant is going to reach its saturation earlier than expected. Waste minimization, the establishment of an effective waste collection and disposal fee system, and alternate ways dealing with the limited capacity of waste treatment facilities are regarded to be major challenges in the future.     

Modelling seasonal variation in biomedical waste generation at healthcare facilities

A mathematical model can help waste planners to optimize waste management systems related to environmental protection. It can also help government bodies set guidelines and regulations, and evaluate prevailing strategies for handling and disposal of waste. In this paper, a technique to develop a mathematical model to correlate the generation rate of biomedical waste (contaminated with blood and body fluid) as a function of bed occupancy and type of ailment (in terms of seasonal changes) using data for two consecutive years from three different healthcare facilities is presented. The data exhibit different trends in biomedical waste generation rates and number of beds occupied in two different years. However, the seasonal variation in biomedical waste production rate remained nearly the same during these 2 years. The fixed trend in biomedical waste generation rate in two consecutive years could be due to similar seasonal illnesses pattern and social factors.     

Hospital waste management in Libya: A case study

In Libya, as in many developing countries, little information is available regarding generation, handling and disposal of hospital waste. This fact hinders the development and implementation of hospital waste management schemes. The specific objective of this study is to present an appraisal of the current situation regarding hospital waste management in Libya. Procedures, techniques, methods of handling, and disposal of waste are presented, as well as the amounts and compositions of hospital waste. This research was conducted in the form of a case study. Fourteen different healthcare facilities in three cities, Tripoli, Misurata, and Sirt, all located in the northwestern part of Libya, were selected for investigation. The investigation showed that the hospitals surveyed had neither guidelines for separated collection and classification, nor methods for storage and disposal of generated waste. This deficiency indicates the need for an adequate hospital waste management strategy to improve and control the existing situation. The average waste generation rate was found to be 1.3 kg/patient/day, comprised of 72% general healthcare waste (non-risk) and 28% hazardous waste. The average general waste composition was: 38% organic, 24% plastics, and 20% paper. Sharps and pathological elements comprised 26% of the hazardous waste component.     

Solid waste management in Kolkata, India: practices and challenges

This paper presents an overview of current solid waste management (SWM) practices in Kolkata, India and suggests solutions to some of the major problems. More than 2920ton/d of solid waste are generated in the Kolkata Municipal Corporation (KMC) area and the budget allocation for 2007-2008 was Rs. 1590 million (US$40 million), which amounts to Rs. 265/cap-y (US$6.7/cap-d) on SWM. This expenditure is insufficient to provide adequate SWM services. Major deficiencies were found in all elements of SWM. Despite 70% of the SWM budget being allocated for collection, collection efficiency is around 60-70% for the registered residents and less than 20% for unregistered residents (slum dwellers). The collection process is deficient in terms of manpower and vehicle availability. Bin capacity provided is adequate but locations were found to be inappropriate, thus contributing to the inefficiency of the system. At this time, no treatment is provided to the waste and waste is dumped on open land at Dhapa after collection. Lack of suitable facilities (equipment and infrastructure) and underestimates of waste generation rates, inadequate management and technical skills, improper bin collection, and route planning are responsible for poor collection and transportation of municipal solid wastes.     

Sustainability analysis of organic fraction of municipal solid waste conversion techniques for efficient resource recovery in India through case studies

Worldwide solid waste generation is nearly 1.3 billion tonnes/year, whereas in India 62 million tonnes of solid waste is generated per year by 377 million urban people. The increasing amount of solid waste in India, nearly 50% of which is organic matter, is the major concern for treatment and waste management. Several technologies are already in practice for the treatment of organic fraction of municipal solid waste (OFMSW) in India. It is important to assess the sustainability of these processes. In this study, the existing OFMSW technologies in India were examined. Case-study approach was taken for this purpose along with some published secondary reports. It was found that the selection of technology quite depends on the composition of the OFMSW. Food waste rich fractions are recommended for biomethanation, whereas the fractions rich in market waste and household waste are suitable for composting. Fractions rich in lignin and lignocellulosic materials are suitable for pyrolysis and gasification, whereas the rejects are to be sent for RDF preparation. Based on the findings, a sustainable framework has also been proposed, implementation of which may result in better waste management.     

Municipal solid waste management in Pudong New Area, China

The increase in population, the rapid economic growth and the rise in community living standards accelerate municipal solid waste (MSW) generation in developing cities. This problem is especially serious in Pudong New Area, Shanghai, China. The daily amount of MSW generated in Pudong was about 1.11 kg per person in 2006. According to the current population growth trend, the solid waste quantity generated will continue to increase with the city's development. In this paper, we describe a waste generation and composition analysis and provide a comprehensive review of municipal solid waste management (MSWM) in Pudong. Some of the important aspects of waste management, such as the current status of waste collection, transport and disposal in Pudong, will be illustrated. Also, the current situation will be evaluated, and its problems will be identified.     

Biomedical waste management in nursing homes and smaller hospitals in Delhi

The management of biomedical waste is a crucial issue in health and environmental management. Rules in India were promulgated in 1998, originally with a deadline of December 2000 and extended to December 2002; however, the actual situation remains far from satisfactory. A study conducted in 2001 by CEE, New Delhi; indicated an implementation deficit. To gauge the present situation, a survey was undertaken during 2005-2006. A systematic analysis of current biomedical waste management practices in smaller nursing homes and hospitals in Delhi was carried out. A total of 53 nursing homes, with bed strengths ranging from 20 to over 200, were included. The survey results show that there is a marked improvement in the segregation practices of biomedical waste in small private hospitals and nursing homes. The majority of nursing homes and hospitals were found to be using a service provider for the collection, management, and disposal of healthcare wastes. Data was collected through a questionnaire and field visits. This paper discusses the relevant data indicative of current practices of healthcare waste management in the nursing homes and small healthcare facilities in Delhi.     

Seasonal characterization of municipal solid waste (MSW) in the city of Chihuahua,Mexico

Management of municipal solid waste (MSW) has become a significant environmental problem, especially in fast-growing cities. The amount of waste generated increases each year and this makes it difficult to create solutions which due to the increase in waste generation year after year and having to identify a solution that will have minimum impact on the environment. To determine the most sustainable waste management strategy for Chihuahua, it is first necessary to identify the nature and composition of the city’s urban waste. The MSW composition varied considerably depending on many factors, the time of year is one of them. Therefore, as part of our attempt to implement an integral waste management system in the city of Chihuahua, we conducted a study of the characteristics of MSW composition for the different seasons. This paper analyzes and compares the findings of the study of the characterization and the generation of solid waste from households at three different socio-economic levels in the city over three periods (April and August, 2006 and January, 2007).The average weight of waste generated in Chihuahua, taking into account all three seasons, was 0.592 kg capita^?1 day^?1. Our results show that the lowest income groups generated the least amount of waste. We also found that less waste was generated during the winter season. The breakdown for the composition of the waste shows that organic waste accounts for the largest proportion (45%), followed by paper (17%) and others (16%).     

Mathematical modeling to predict residential solid waste generation

One of the challenges faced by waste management authorities is determining the amount of waste generated by households in order to establish waste management systems, as well as trying to charge rates compatible with the principle applied worldwide, and design a fair payment system for households according to the amount of residential solid waste (RSW) they generate. The goal of this research work was to establish mathematical models that correlate the generation of RSW per capita to the following variables: education, income per household, and number of residents. This work was based on data from a study on generation, quantification and composition of residential waste in a Mexican city in three stages. In order to define prediction models, five variables were identified and included in the model. For each waste sampling stage a different mathematical model was developed, in order to find the model that showed the best linear relation to predict residential solid waste generation. Later on, models to explore the combination of included variables and select those which showed a higher R(2) were established. The tests applied were normality, multicolinearity and heteroskedasticity. Another model, formulated with four variables, was generated and the Durban-Watson test was applied to it. Finally, a general mathematical model is proposed to predict residential waste generation, which accounts for 51% of the total.     

Characterization of urban solid waste in Chihuahua, Mexico

The characterization of urban solid waste generation is fundamental for adequate decision making in the management strategy of urban solid waste in a city. The objective of this study is to characterize the waste generated in the households of Chihuahua city, and to compare the results obtained in areas of the city with three different socioeconomic levels. In order to identify the different socioeconomic trends in waste generation and characterization, 560 samples of solid waste were collected during 1 week from 80 households in Chihuahua and were hand sorted and classified into 15 weighted fractions. The average waste generation in Chihuahua calculated in this study was 0.676 kg per capita per day in April 2006. The main fractions were: organic (48%), paper (16%) and plastic (12%). Results show an increased waste generation associated with the socioeconomic level. The characterization in amount and composition of urban waste is the first step needed for the successful implementation of an integral waste management system.