Table 2.2 Waste Composition (Cross et al.

, 1990)

Types of % % % % % % %
Operation Food
Paper Plastic Pathological Glass Metal Other
waste
Administrative/
100 - - - - - -
Clerical
Cafeteria 20 20 - 60 - - -
Surgery 60 30 10 - - - -
Emergency
60 35 5 - - - -
Room
Intensive Care 60 35 5 - - - -
Renal Dialysis 10 85 5 - - - -
Laboratory 35 30 25 - 10 - -
Nursery 45 35 - 5 15 - -
Pharmacy 50 30 - - 20 - -
General Patient
60 35 - 5 - - -
Care
Research 50 - 30 - - - 20*
Sharps - 90 - - - 10 -
(*Animal Bedding)
Table 2.3 Chemical Characteristics of Healthcare Waste (Roteb, 1998)

Moisture Incombustible Heating Value

Waste Component
(%) Solid (%) (MJ/kg)
Type no. 1 Rubbish and garbage 50 7 10.4
Type no. 2 Wet waste of hospital 70 5 6.2
Type no. 3 Pathological waste of
85 5 2.1
hospital and laboratory
Table-2.5: Bangladesh health facility distribution by division and health facility type

Division CC USC/ UHFWC UHFW UHC MCWC D NHSD Othe Hospita PH Total
RD C H P r l

Barishal 1061 58 208 28 34 10 6 14 34 1 13 1467

Chattogram 2400 238 468 203 89 18 11 101 55 0 164 3747
Dhaka 2431 308 422 184 75 14 14 114 167 3 215 3947
Khulna 1640 133 345 99 51 14 10 50 44 1 47 2434
Mymensing 1147 114 195 45 30 4 3 20 22 0 14 1594
h
Rajshahi 1900 321 378 40 61 13 7 33 60 0 42 2855
Rangpur 1777 198 306 71 50 12 7 33 26 0 34 2514
Sylhet 855 75 114 86 31 6 4 33 15 0 34 1253
Bangladesh 1321 1445 2436 756 421 91 62 398 423 5 563 1981
1 1
 6% 7%
13%
19%

14%

8% 20%

12%

Barishal Chattogram Dhaka Khulna

Mymensingh Rajshahi Rangpur Sylhet

Figure 2.1 Numbers of Healthcare Facilities in Bangladesh

No. of bed per 10,000 population

1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
KMCH
KGH
KSH
IBH
GNCDGHC
KSMH
CIC
SSANSH
KC

Figure 2.2 Comparisons of Bed Capacities According to WHO

Table 2.6: Healthcare Waste Generation in Various Countries According to Institutional
Category (WHO/EUROPE Publications ERS 1997)

Type of Hospital Norway Spain UK France USA Netherlands

University 3.9 4.4 3.3 3.35 5.24 4.2 to 6.5
General Hospital - - - 2.5 4.5 2.7
Maternity - 3.4 3.0 - - -
Mental Hospital - 1.6 0.5 - - 1.3
Geriatric - 1.2 9.25 - - 1.7

Table 2.7: Healthcare Waste Generation in Various Countries (Monreal, 1991)

Generation (kg/bed/day)
Country Year of study
Minimum Median Maximum
Chile 1973 0.97 - 1.21
Venezuela 1976 2.56 3.10 3.71
Brazil 1978 1.20 2.63 3.80
Argentina 1982 0.82 - 4.20
Peru 1987 1.60 2.93 6.00
Argentina 1988 1.85 - 3.65
Paraguay 1989 3.00 3.80 4.50
 Plate-2.1: Healthcare Waste Generation in Various Countries

Table 2.8: Hazardous Waste Generation in Various Countries (United Nations Statistics
Division. 2011)

Name of the Country Generation of Hazardous Waste (1000 tonnes)

Bangladesh 75.95
China 14300
France 2.47
India 8140
Japan 2883
Russian Federation 141019.1
UAE 272.922
USA 34788.425
2.12 Healthcare Waste Generation in Asian Countries

Estimated amounts of healthcare waste generated in some Asian countries/cities have been
graphically represented in Figure-2.3.

City/Country kg/bed/day
Dhaka 1.25
Bhutan 0.27
India 1
Malaysia 1.9
Nepal 0.5
Pakistan 1.06
Sri Lanka 0.36
Thailand 0.68
Hanoi 2.27

Figure 2.3: Estimated Avg. Healthcare Waste Generation in a Few Asian Countries/Cities
(Visvanathan, 2006)
Table 2.8 Color-coding of Healthcare Wastes

Types of Waste Color

Infectious waste Yellow marked "INFECTIOUS"
Sharps Yellow marked "SHARPS"
Pharmaceutical waste Brown
General Non hazardous 8lack
Source: WHO. 1999

Table 2.10 Recommended Color-coding for Healthcare Waste for Bangladesh (Waste
Concern, 2005)

Types of Waste Container Specifications Color Code

General Waste Plastic Container Green
Sharps Paper/wooden rigid box Yellow
Infectious Waste Plastic bins/polythene bags Red
Radioactive Waste Special lead proof container Red
approved by Atomic Energy
Commission Bangladesh.
Cytotoxic and Polythene Bags Red
Pharmaceutical Waste
Liquid Waste Plastic bowl/container Red
 Figure 2.4: International Infectious Substance Symbol

Exhaust gas. to atmosphere

Ashes
Flue gas cleaning (optional)
Wastewater (optional)

Flue gas Steam

Heat recovery

Air
Furnace
Waste

Waste Water
Wastewater treatment Water discharge
(optional)
Sludges (require
treatment)
Ashes
(to disposal and possibly stabilization)

Figure 2.5 Simplified Flow Scheme of Incinerator

Table 2.12 Combustion Criteria of Incinerator

Parameter Design / Performance Criteria

Burnout ≥95%
Combustion Efficiency ≥95%
Primary Chamber Temperature ≥1500˚F
Secondary Chamber Temperature ≥1800˚F
Secondary Chamber Gas Retention / >1.0 to 2.0 sec
Residing Time
Source: Cross et al. 1990

Healthcare / Medical Waste Incinerator Age Data

The estimated age of existing incinerators, which based on information, is presented in the
Table-2.13

Table 2.13 Available Healthcare / Medical Waste Incinerator Age Data

Medical facilities Age (years)

Range Average
Hospitals 1-33 14
Laboratories 10-20 16
Veterinary Facilities 3-21 16
Nursing Homes 3-21 13
Commercial Facilities 18-33 24
Other/Unidentified Facilities 7-30 16
Source: Turnberg. 1996
Table 2.15 Parameter and Performance Criteria of Available Models of Autoclaving
System (Turn berg, 1996)

Parameter Performance criteria

Use Suitable for 150 to 500 bed hospitals
Size (overall) Approximately 511 ft 2; allow a 6 ft all around; minimum
ceiling height, 16 ft.
Weight 8800 lb.
Electrical requirements 100 kilovolt-amperes (kVA), three phase
Power consumption Approximately 80 kWh for the entire process; energy
consumption is estimated at 0.7 to 1.6 kWh per pound of
waste treated
Water requirements 5 gpm at psig
Steam requirements 400 to 30000 lb/day
Load capacity 400 to 2400 lb/day
Decontamination time Up to 2 hours
Total cycle time Shredded waste is exposed to superheated steam (up to
1200˚F in the evaporator: vapors formed in the evaporator
are heated to about 2100˚F in the detoxification reactor)
Exhaust air requirements 25 standard cubic foot / minute (scfm) at 100 psig
FiIter system Vapors from the detoxification reactor are passed through
adsorber beds to remove acid gases. Trace metals and
organic
Table 3.1 List of Health Care Establishments Surveyed
SL. No. Health Care Establishments No. of Category
bed
01 Khulna Sadar Hospital (KSH) 250 Government
02 Khulna Medical College & Hospital (KMCH) 600 Government
03 Shaheed Sheikh Abu Naser Specialized Hospital 400 Government
(SSANH)
04 Khulna Shishu Hospital (KSH) 100 Private
05 Gorib Newaz Clinic & Diagnostic Center 50 Private
(GNCDC)
06 Islami Bank Hospital (IBH) 40 Private
07 Khulna Surgical & Medical Hospital Pvt. Ltd 80 Private
(KSMH)
08 Khalishpur Clinic (KC) 40 Private
09 Khulna City Medical College Hospital 200 Private
(KCMCH)
10 City Imaging Center (CIC) - Private
11 Padma Diagnostic Center (PDC) - Diagnostic centre

Table 3.2 Different Types of Existing Health Care Facilities in Khulna City.
Type of facilities Number of facilities
Government hospital/clinic 11
Private hospital/clinic 72
Family planning center 21
Diagnostic center and dental clinic 31
EPI center Out reach center 168
Fixed center 64
OPD (Out Patient Department) 40
Maternity clinic 6
Total 413
Source: Field surve and UCHP (Urban Community Health Programme)
Table 4.1 Healthcare Establishments in Khulna City

Total Surveyed
Type of HCEs Size No. of No. of
No. of beds No. of beds
HCEs HCEs
Above 100
3 1450 3 1450
beds
50-100
1 50 0 0
Govt. Hospital beds
Below 50
7 110 0 0
beds
Total 11 1610 3 1450
Above 100
2 250 2 250
beds
50-100
Private 3 250 3 250
beds
clinics/Hospital
Below 50
66 1000 0 0
beds
Total 71 1500 5 500
Diagnostic
- 31 - 3 -
centers
Grand Total - 113 3110 11 1950
Table 4.2 Generation Rate of Healthcare Waste in the Study Area

Hospitals / Total Haz.

Mean Mean %
Clinic/ generated Waste %
No. kg/bed/ kg/bed/ General
Diagnostic waste(kg)/ (kg)/bed Hazardous
day day Waste
Center bed/day / day
1 KMCH 0.68 0.14 25.5 74.5
2 KGH 0.83 0.2 22.32 77.68
3 KSH 0.65 0.12 18.7 81.3
4 IBH 1.15 0.2 14.97 85.03
GNCDGH
5 1.3 0.24 19.10 80.89
C
0.64 0.18
6 KSMH 0.14 0.3 19.1 80.9
7 CIC 1.3 0.23 18.8 81.2
8 SSANSH 1.5 0.23 25.35 74.65
9 KC 1.13 0.2 19 81
10 PDC 0.27 0.08 32.3 67.7
11 KCMCH 0.63 0.12 19.4 80.6

1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
SH C C SH C C
CH G
H
K IB
H H M
H
CI N K PD CH
M K DG S A M
K K C
NC SS K
G

Total generated waste(kg)/ bed/day

Haz. Waste (kg)/bed/ day

Figure 4.1 Generation of Hazardous Healthcare Waste (Field Survey, 2023)

Table 4.3 Different Categories of Healthcare Waste (% by weight) in Study Area

HCEs General Infectious Reusable Sharps

KGH 74.5 19 3.84 2.66
KMCH 77.68 17 2.5 2.82
KSH 81.3 16 1.2 1.5
IBH 85.03 12 1.5 1.47
GNCDGHC 80.89 13.65 2.5 2.96
PDC 67.7 18 9 5.3
KSMH 80.9 13 3.1 3
CIC 81.2 13.2 2.8 2.8
SSANSH 74.65 20 2.35 3
KC 81 15 2.51 1.49
KCMCH 80.6 12 3.4 4
% of Haz. and 78.67 15.35 3.15 2.81
Non- hazardous
waste
Plate 4.1 Transportation of Healthcare Waste by Open Truck Creates Public Nuisance and
Causes Unpleasant Odor

Table 4.4 Vehicles Used by KCC for Waste Management.

Type of vehicle Capacity Number

Truck 5 tons 17
3 tons 10
Trolley 5 tons 5
Wheel cart -- 170
 Plate 4.2 Photograph Showing Final Disposal Site of Waste at Rajbandh of Khulna City

Health centre Secondary dustbin Wheel cart Primary dustbin

Dumping ground Truck/Trolley

Figure 4.2 Disposal Method of Waste by KCC

Table 4.5 Persons Engaged in Waste Management of KCC

Serial no. Designation Number

01 Conservancy officer
02 Assist. Conservancy officer
03 Supervisor
04 Driver
05 Waste handler
Total --
Table-4.6 Health Centers Served by Prodipan

Ownership Served by 'Prodipan'

Govt. Hospital 1

Private Hospital (registered and non-

106
registered)

Total 107
Table 4.7 Disposal Method of Healthcare Waste Adopted by 'Prodipan'

Serial no. Waste type Disposal Method

1 Gauge, bandage, human organ etc Burned after washing
2 Needle and all other sharp types Disposed in concrete pit
material
3 Syringe, vial, ample, saline bags etc. Crushed in a shredder machine
and disposed in a concrete pit

Plate 4.3 Pick-up Vans Used for Transportation of Healthcare Waste

 Plate 4.4 Segregated Saline bags, Syringes and Tubes by Prodipan in Treatment plant

Table 4.8 Stuffs of 'Prodipan' Engaged in Healthcare Waste Management

Serial no. Designation Number

01 Supervisor 1
02 Driver 2
03 Waste collector 6
04 Treatment worker
Total -- 9
 HCEs

Medical waste generation

Temporary storage in large bin

Municipal dustbin Collection by NGO

near the hospital
boundary
Transportation by NGO

Segregation

General Infectious Recyclable Sharp

wastes wastes wastes wastes

Air dry Cleaning Encapsuling

Dumping as
landfill or
composting
Burning Shedding Burial pit
treatment

Ash Dumping

Dumping Ash

Figure 4.3 Flow Diagram of Existing Healthcare Waste Management in Khulna city
 Plate-4.7: Clogs sewers in Khulna

Plate-4.8: Collection of Waste in a Private HCE

Table 4.9 General Profile of the Respondents in the Studied HCEs

Number of respondent Level of Education / Training

Occupation Up to Medical/
Male Female Total Illiterate B.Sc Nursing
HSC Training

Patients 17 7 24 8 12 4 - -
Nurse 2 18 20 1 19
Cleaners 12 7 19 16 3
Technicians 10 - 10 10
Doctors 12 3 15 15
Administrators 9 - 9 9
Grand Total 62 35 97 24 16 4 19 34

Plate 4.9 Nurses got Training on Healthcare Waste Management System

 Plate-4.10 Recommended Protective Clothing for Health-Care Waste Transportation

Table 4.10 Description of the Inputs Required for the Treatment and Transportation of
Waste

Inputs Description No. required

Incinerator /Microwave/
100 Kg/hr capacity 1
Autoclave
Around 200 sq. feet concrete
Building for incinerator 1
building
Operator -- 1
Helper Waste handler 3
2ton capacity, four
Covered Truck 2
compartments
Driver -- 2
Helper Waste collector 6
 Individual Point of Waste Generation

Separation Collection of Non-hazardous

and Hazardous Waste

Handling and Storage of Waste Safety

inside Hospital

Hauling on Small Push Hauling on Small Push Cart

Transport to Municipal KCC Collection Truck to Incineration

Carriage by City Corporation Truck Incineration

Land fill Land burial

Figure 4.4 Flow Diagram of Improved System of Healthcare Waste Management