Medical Waste Management: An Assessment of District-Level Public Health Facilities in Bangladesh.

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.