Biomedical waste has become an emerging problem in Bangladesh amid COVID-19. A huge amount of wastes are produced in a hospital setting and also from households which is hazardous in most cases. PRISM is an organization that regulates the biomedical waste disposal from hospitals by incineration and color-coded separation techniques and separate disposal of medical instruments and waste products. However, domestic household wastes also contain biomedical waste due to inappropriate disposal and this is creating havoc for cleaners and municipalities. It is creating environmental pollution through blockade of waterways by the excessive use of plastic and its inappropriate discard in the waterways and thus leading to flooding. It can also cause water pollution by seeping into the ground to WASA pipelines. Furthermore, many blood borne diseases are spreading by exposure of biomedical waste to the cleaners and also sometimes by criminal trafficking of such discarded waste products back to hospitals without prior sterilization. There is also a scarcity of waste plants in many districts of Bangladesh. A huge amount of PPE and plastic medical waste are produced every day. Hence environmentally friendly alternatives like plasma pyrolysis and gasification may be considered for adequate disposal of biomedical waste as well as co-operations between WHO and NGOs like Healthcare Without Harm can help combat COVID-19 in Bangladesh more effectively.
Biomedical waste refers to the health-care waste that is produced from hospitals, laboratories, and research centers, mortuary and autopsy centers, nursing homes, blood banks, animal research and testing labs. These wastes may be infectious, pathological, sharp instruments, chemicals, pharmaceutical, cytotoxic, radioactive or may even be sometimes non-hazardous elements. The amount of biomedical waste generated has increased a lot during the COVID-19 pandemic. Project in Agriculture, Rural Industry, Science and Medicine (PRISM Bangladesh) is an NGO that works along with the Canadian International Development Agency (CIDA) to combat this problem. However, biomedical waste is getting mixed with domestic waste due to a lack of responsibility and it has become one of the methods by which people can get infected by COVID-19, and hence biomedical waste amid COVID-19 is an emerging problem in Bangladesh.
Safe Healthcare Biomedical Waste Management in Bangladesh
According to the medical waste management and processing rules 2008 , guidelines for segregation of biomedical waste suggest that wastes must be categorized according to color-coded containers: red, yellow, blue, white, and black. The red bag contains syringes without needles, catheters, IV tubes, and soiled gloves while the white container bears sharp instruments. The blue box has discarded glassware like vials and ampules. The yellow bag is the container for cotton swabs, bandages, and dressings. However, non-biomedical waste also has a separate black container for stationery, packaging from medicines, disposable masks, kitchen waste in a hospital setup.
Biomedical waste disposal and segregation
PRISM (Preferred reporting items for systematic reviews and meta-analyses) is engaged in disposing medical waste in Bangladesh. According to the New England Journal of Medicine, COVID-19 stays on plastics for 3days. Hence medical wastes are incinerated by PRISM. Incineration means temperatures over 850 degrees centigrade are used to kill pathogenic organisms. This is done in a two-step way. The first chamber uses 850 degrees while the second chamber incinerates at 1050 degrees centigrade. There are three subtypes of incineration: controlled air (also called starved air incineration), excess air, and rotary kiln. The excess air method differs from the controlled air method in that its moisture and volatile components in the waste are vaporized. Rotary kiln is the most environmentally friendly method and has the added advantage of being able to mix both wet and dry waste components. Thus infectious objects are incinerated. On the other hand, sharp instruments are stored in a concrete tank for complete burial. Plastics that can be re-used are chlorinated in a green tank and shredded and then undergo further processing in the effluent treatment plant.
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Perspective from Bangladesh Amid COVID-19 about Biomedical Waste
Toxic waste produced after incineration is dumped in landfills. The residues can seep into underground water and has caused huge problems for WASA in terms of providing clean water for household use.
Now, used PPEs are getting mixed with domestic waste causing detrimental effects on cleaners. However, PRISM is not responsible for taking into account medical waste present among domestic waste and this has taken a huge toll on our lives in Bangladesh as many masks, gloves, and medical clothing are seen discarded in the streets without proper management. It is the duty of Dhaka South City Corporation (DSCC) and Dhaka North City Corporation (DNCC) to handle the domestic waste. “Tokais” are bound to collect waste without having neither the liberty to stay at home if they fall sick nor they are protected from the hazards of biomedical waste if they intermix with household waste. Many cleaners work in landfills- Matuail in the south and Amina Bazar in the north in hazardous conditions .
Statistics show that Dhaka alone contributed to 206 tons of medical waste per day . The average biomedical waste generation rate is 1.63-1.99 kg per day per bed in charges of recycling used masks and hand gloves that had been collected from hospitals in Tongi, Uttara, and Gazipur Dhaka . Currently, well-equipped medical waste plants under the authority of PRISM are situated in Dhaka, Sylhet, Rangpur, Rajshahi, and Jashore only . According to the Medical Waste (Management and Processing) Rules 2008, “medical wastes could not be mixed with other wastes at any stage — while producing inside hospitals, while collecting from hospitals, while transporting, and would be processed separately based on classification”.However, a man was caught by the police for charges of recycling used masks and hand gloves collected from hospitals in Gazipur, Tongi and Uttara . Allegedly, rag-pickers collect recyclable syringes and saline bags and pay a syndicate of hospital employees who again sell these to scarp dealers. Such criminals then sell the infected products back to hospitals without sterilization. Hence it contributes to the spread of bloodborne diseases like Hepatitis-B and C, malaria, dengue, and HIV .
The surge in Medical Plastic Pollution Amid COVID-19 Lockdowns
Over 85% of all plastics are being used to make medical instruments. Plastic is non-biodegradable. Its inappropriate discard has led to environmental pollution. Sea animals swallow plastics in the seashore mistakenly considering them as food and hence these plastics cause death of many animals by becoming trapped in their esophagus. Incinerated plastic also releases toxic gases causing air pollution. Air pollution depletes the ozone layer and thus causes skin cancer through excessive exposure to UV light and furthermore, through climate change, it contributes to damage to plants and global warming. Chemical leaks can also cause food to become poisonous and inedible.
Personal protective equipment (PPE), N95 respirators, surgical masks, and face shields are all single-use plastics that are extensively used in this present time of COVID-19 pandemic. Nowadays, one of the emerging problems is the improper disposal of face masks. Their constituent is polypropylene which is more difficult to recycle compared to plastic. These plastics can clog waterways and increase the chances of flooding. According to a study by ICIMOD (International Centre for Integrated Mountain Development)’s South Asian Network for Development and Environmental Economics, 22.3% of Sylhet is at risk of flooding due to improper solid waste management system .
In the study, “Breaking the Plastic Wave: A Comprehensive Assessment of Pathways Towards Stopping Ocean Plastic Pollution”, it is mentioned that the number of plastics dumped into the ocean will triple by 2040 . According to the United Nations, a staggering 100 million tonnes of plastic are dumped into the ocean annually in the world . This is because, in this pandemic of COVID-19, oil prices have declined. Hence petroleum has become much more affordable. Using this as an economic advantage, plastic manufacture has vastly increased since petroleum is a key component when producing plastic products. According to a report published by the Environment and Social Development Organization (ESDO), Bangladesh produced 14,500 tonnes of PPE in March 2020. On the other hand, several recycling businesses closed down because of the risk of contracting COVID-19 from plastic waste .
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Biosafety and Waste Management
Biosafety levels refer to the precautions necessary by the Centers for Disease Control and Prevention (CDC) for laboratory work with infectious materials. Such rules provide restrictions in the production of biomedical waste. Another solution to the increasing amount of biomedical waste in COVID times is the use of environmentally friendly alternatives to incineration. Autoclaving, microwave irradiation, chemical disinfection with 1% hypochlorite, plasma pyrolysis, and gasification are some of the noteworthy alternatives. Among these methods, plasma pyrolysis can dispose of both municipal solid waste as well as biomedical waste because of the intense heat generated by the plasma. It also converts organic waste into economically useful byproducts. Gasification is also a good solution as it reduces the carbon footprint of biomedical waste treatment. There is an international non-governmental organization (NGO) called Health Care Without Harm (HCWH) that works alongside with WHO for sustainable waste management in Ukhia and Teknaf in Cox’s Bazar .
Around 5million people die due to unmanaged medical waste in the world annually . Amid COVID-19, there has been an increase in the amount of biomedical waste. Therefore, it is an important global health problem that needs to be managed. To prevent further hazards due to exposure to COVID-19, incineration, and segregation of biomedical waste must be done according to the guidelines provided by PRISM both in a hospital setting as well as in households. Hence it is possible to reduce both environmental pollutions and also prevent the spread of infectious diseases, climate change, waterlogging in riverbanks, and damage to trees due to burning plastic. Therefore, biomedical waste amid COVID-19 in Bangladesh is a vital aspect that needs to be dealt with care to prevent further infections and jeopardizing lives.
Writer Moumita Moazzem Medical student of Ibrahim Medical College (BIRDEM)
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