Assessment of occupational and environmental safety associated with medical waste disposal in developing countries: A qualitative approach

A carefully designed survey of medical waste management was undertaken in Dhaka, the capital city of Bangladesh. A range of sampling strategies and data gathering techniques were used. The data gathering techniques included observation, formal structured interview and informal dialogue. Sampling strategies included formal representative sampling for fixed populations and adaptive sampling for roaming populations was developed. Data were collected from healthcare establishments (HCEs) and other waste disposal operatives. Operatives dealing with waste were frequently found to be untrained, and without even a basic understanding of the hazards involved. Personal protective equipment was inadequate in most cases which led to frequent accidental injuries. No HCE was found to have adequate storage facilities for hazardous waste. Thus scavengers were able to gain access to items such as syringes and expired medicines, which they repackaged and resold. The lack of correctly controlled internal storage may be linked to the observation that employees at many HCEs offered contaminated items for sale to scavengers and recycling operatives. In many cases there was no attempt at segregation, but in some cases there was segregation at the point of use, but subsequent remixing with general waste, indicating a lack of management and education rather than a lack of will. In either case, hazardous waste was dumped in city corporation bins, and disposed of on general landfill sites. As well as exposing the waste to scavengers, this could potentially contaminate ground water, especially as the dumps were located in areas subject to frequent flooding.