Sujon Hasnat, Biswas Taposh Kumar, Chowdhury Aklima, Chowdhury Mahbub Elahi
Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, BGD.
Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, BGD.
Cureus. 2022 May 8;14(5):e24830. doi: 10.7759/cureus.24830. eCollection 2022 May.
Background Due to the huge patient load and different types of services, public health facilities produce a bulk of medical waste (MW) in Bangladesh. Improper disposal of MW increases the risk of infection among healthcare service personnel, patients, and attendants. To ensure quality services, this study aimed to assess the practices of MW management and quantify those to find out the shortcomings in the specific steps of waste management. Methodology As part of a larger interventional study, a facility assessment was conducted from February to April 2016 at a District Hospital (DH) and a Mother and Child Welfare Centre (MCWC) in one district. Non-participatory observation of MW management was done using a checklist that was developed following the Guideline for Medical Waste Management of Bangladesh. Scoring was applied for various activities of MW management performed in the study facilities. Results The overall scores for bin management, segregation, and collection of waste were 64.5%, 58.1%, and 62.0% in DH and 53.1%, 41.5%, and 48.0% in MCWC, respectively. The performance of operation theater in MCWC was the lowest among different corners (16.7% to 36.0%). Reusable waste was segregated poorly (32% in DH and 0% in MCWC), and almost none was shredded (4% in DH and 0% in MCWC). Waste was transported from in-house to out-house temporary storage area in an open bin without any trolley or specific route. The storage area was accessible to unauthorized persons, for example, a waste picker in DH. While DH segregated 84% of its infectious waste at the source, it eventually got mixed up with other waste in the storage area and delivered to the municipality to be dumped. MCWC could segregate only 40% of its infectious waste at the source and disposed of them using the pit method. Both the facilities disposed of sharp MW by open-air burning and liquid waste through sewerage without any treatment. Conclusions The performance of MW management was poor in both study facilities. Advocacy to the healthcare personnel and refresher training along with supportive supervision and monitoring may improve the situation. Moreover, a larger study is needed to find out the reasons behind such poor MW management.
背景 由于患者数量庞大且服务类型多样，孟加拉国的公共卫生设施产生了大量医疗废物。医疗废物处置不当会增加医护人员、患者及陪护人员的感染风险。为确保服务质量，本研究旨在评估医疗废物管理实践并对其进行量化，以找出废物管理具体步骤中的缺陷。
方法 作为一项更大规模干预性研究的一部分，2016年2月至4月在某一地区的一家区级医院（DH）和一家妇幼福利中心（MCWC）进行了设施评估。使用一份根据孟加拉国医疗废物管理指南制定的清单，对医疗废物管理进行非参与式观察。对研究设施中进行的各种医疗废物管理活动进行评分。
结果 在DH，垃圾桶管理、分类和废物收集的总体得分分别为64.5%、58.1%和62.0%；在MCWC，相应得分分别为53.1%、41.5%和48.0%。MCWC手术室在不同区域中的表现最差（16.7%至36.0%）。可重复使用的废物分类不佳（DH为32%，MCWC为0%），几乎没有进行粉碎处理（DH为4%，MCWC为0%）。废物通过敞口垃圾桶从室内运至室外临时存储区，没有使用手推车或特定路线。存储区域对未经授权的人员开放，例如DH的一名拾荒者。虽然DH在源头对84%的传染性废物进行了分类，但最终在存储区与其他废物混合，并交付给市政当局进行倾倒。MCWC在源头仅能对40%的传染性废物进行分类，并采用坑填法进行处置。两家设施均通过露天焚烧处理尖锐医疗废物，未经任何处理就将液体废物排入下水道。
结论 两家研究设施的医疗废物管理表现均较差。对医护人员进行宣传以及进行进修培训，同时辅以支持性监督和监测，可能会改善这种情况。此外，需要进行更大规模的研究以找出医疗废物管理如此糟糕的原因。
