Task Brief:
Write a 6000 words Literature Review(LR) that would going to be publish in Q1/Q2 high impacting journals for the requirement of PhD.
SOLUTION
A systematic literature review on biomedical waste management in Dhaka City through successful practices worldwide.
1 Abstract
This article presents a comprehensive examination of current research trends and future prospects in medical waste management in Dhaka, Bangladesh, aiming to provide practical insights for sustainable treatment methods. Through bibliometric analysis, key publication trends, influential nations, and research focuses, including circular economy and COVID-19 are found. Notably, some developed and developing countries have emerge as prominent contributors to medical waste research. A review of regulatory implementations across these nations reveals disparities between scientific advancements and policy frameworks, with developed countries demonstrating stricter guidelines. Various WtE methods, such as biochemical, chemical, and thermochemical conversion technologies, are systematically introduced to promote sustainable practices. Thermochemical treatment methods, particularly gasification, pyrolysis, incineration, and carbonization, are highlighted as viable options, with a comparative analysis of their characteristics and limitations. The article further explores the alignment between regulations and technologies, emphasizing the need for stricter laws and regulations in developing countries to enhance effectiveness, while advanced technologies like gasification are recommended for sustainable goals in developed nations. This study provides valuable insights into the current status and future directions of medical waste management, facilitating informed decision-making for stakeholders in the field.
Keywords: Biomedical waste management, Incineration, pyrolysis and circular economy.
2 Introduction
Effective management of biomedical waste is a crucial aspect of healthcare administration, given that inappropriate disposal of waste from healthcare facilities can directly affect both human health and the environment (USEPA, 2009). Defining biomedical waste (MW) lacks concrete consensus, varying based on perspectives and economic conditions of countries (Windfeld & Brooks, 2015a) (Minoglou et al., 2017). The economic growth propelled by advancements in social networks, transportation, and trade has led to the expansion of hospital systems and an increased demand for biomedical equipment and supplies (Singh et al., 2022). However the lack of hospital waste management guidelines and legislation at the national level, coupled with the absence of suitable treatment and disposal options, can present significant obstacles to effective waste management efforts. As the world’s population continues to grow, and the demand for biomedical services rises, the management of biomedical waste has become a complex challenge. Biomedical waste (BMW) refers to waste generated during the treatment, or immunization of any living being, as well as due to any research experiments, and in the generation or experimentation of biological materials or in medical camps. The BMW management follows a cradle-to-grave approach, encompassing its characterization, transport, storage, and treatment. The fundamental principle of sound BMW management is rooted in the rule of the 3Rs: reduce, reuse, and recycle (Zhao et al., 2009).
The casual handling and improper disposal of biomedical waste have direct and indirect consequences on both staff, patients, and the environment. Hospitals, serving as both healthcare providers to patients and workplaces for biomedical and other personnel, represent a distinctive environment where these impacts are particularly pronounced. It is crucial to acknowledge that not all biomedical waste from hospital settings is hazardous or more difficult to manage than normal household waste. Globally, the most commonly used methods for biomedical waste management are incineration and sanitary landfills (Dihan et al., 2023).
This study aims to offer an in-depth examination of the challenges surrounding the disposal of biomedical waste. It will investigate the composition and origins of Biomedical waste in various regions worldwide, with a particular focus on Bangladesh. Additionally, the study will analyze the existing legislative frameworks and guidelines governing biomedical waste management in these areas. At present practices concerning the handling of biomedical waste within hospital facilities will be thoroughly scrutinized. The study will delve into the drawbacks associated with common incineration techniques for waste disposal, while also exploring alternative treatment options. Special attention will be given to the importance of reducing the volume of non-infectious biomedical waste(Haque et al., 2021). Lastly, the study will propose strategies for improvement, highlighting the significance of educating healthcare professionals and standardizing waste disposal practices within healthcare facilities. Through this review, we aim to underscore the effectiveness of implementing better waste segregation practices, establishing standardized waste disposal protocols, and enhancing healthcare worker education in order to minimize the production of infectious waste and mitigate associated risks. . The core questions which will be answered in this study are: 1. How does the implementation of improved waste segregation practices affect the reduction of infectious waste production in healthcare facilities? 2. What are the effects of enhanced education for healthcare workers on minimizing the generation of infectious waste and mitigating associated risks?
3 Methodology
3.1 Literature selection criteria
Our study aimed to evaluate the present condition and methodologies employed in biomedical waste management within Bangladesh, with a particular focus on Dhaka. The overarching goal was to gain insight into how these practices impact the environment health. To achieve this goal, we conducted a comprehensive review of published articles on biomedical waste management from January 2000 to February 2024. Information was diligently gathered from reputable sources, including ProQuest health , Web of Science, and biomedical databases (such as customer health, health & biomedical collection, nursing, hospital administration and allied health, psychology, Medline, and public health), Gray
literature and Google Scholar from esteemed global organizations like the World Bank and the Environmental Performance Center at Yale University.
Utilizing a combination of keywords and Boolean functions, our search strategy encompassed terms such as “medical waste,” “hazardous waste,” “biomedical waste,” “healthcare waste,” “infectious waste,” “healthcare settings,” “Dhaka,” “Bangladesh,” “developing countries,” “public health,” and “health hazards.” The preliminary search resulted a total of 331 articles, which underwent screening based on their relevance to biomedical waste management utilizing the PRISMA 2020 methodology.
During the screening process, titles and abstracts were assessed to identify articles warranting their evaluation. The inclusion criteria primarily targeted articles pertaining to biomedical waste management, while exclusion criteria were applied to exclude articles discussing non-biomedical waste practices or addressing unrelated topics. Furthermore, articles were removed if errors were detected in their findings, if the research methodology lacked rigor, or if the objectives did not align with our topic. It’s noteworthy that publications from countries with transitioning economies and low-income nations often relied on secondary data, and lacked confirmness regarding the classification of biomedical waste generated. This meticulous selection process ensured the inclusion of high-quality articles relevant to our study objectives.
Table 1 Criteria used for selection of studies
| Inclusion Criteria | Exclusion Criteria |
| IC1: Journal articles, book and book chapter | EX1: Conference papers, proceedings of congresses, and other nonpeer-reviewed publications |
| IC2: The article is written in English | EX2: The article is not written in English |
| IC3: The article is peer-reviewed | EX3: The article is not peer-reviewed |
| IC4: The study considered waste management for Bangladesh | EX4: The study does not considered waste management for Bangladesh |
| IC5: The study considered medical waste management | EX5: The study does not consider medical waste management |
4 Results and discussion
Bangladesh is a south Asian country with a exceeding population of its land area. This demographic reality necessitates a considerable number of healthcare facilities to meet the healthcare needs of its people, consequently leading to a significant generation of biomedical waste. Studies indicate that under normal circumstances, biomedical waste produced in Bangladesh is calculated at approximately 0.5 kg per patient per day (Arafat et al., 2007; Biswas et al., 2020). However, at the COVID-19, this figure soared to 3.4 kg per/person/day, representing a staggering increase of around 6.8 times the usual amount. Even prior to the pandemic, biomedical waste management was a pressing issue in Bangladesh (Barua & Hossain, 2021). The reviewed studies are summarized in table-2.
4.1 Current Practices in Biomedical Waste Management, Covering In-Facility Collection, Segregation, Transportation, and Disposal Approaches
Despite efforts such as the publication of the first environmental assessment and plan for biomedical waste management in 2004, followed by an upgrade in 2011, and the introduction of MWM rules in 2008, adequate implementation of these regulations remains elusive. While some Non-Governmental Organizations (NGOs) have stepped forward to address biomedical waste management from 2009 onwards, Bangladesh still grapples with the challenges of ensuring proper implementation of MWM protocols. The failure to effectively manage biomedical waste poses a significant threat to Bangladesh’s ecology and biodiversity. Current biomedical waste handling practices in Bangladesh encompass various stages. However, the effectiveness and consistency of these practices vary across different healthcare facilities and regions of the country. Within healthcare facilities, biomedical waste is commonly collected and segregated at the source of generation. This process entails separating various types of waste, including infectious, sharp, pathological, pharmaceutical, and non-infectious waste, with the aim of reducing contamination and simplifying appropriate disposal procedures. Transportation: Once segregated, biomedical waste is usually transported from healthcare facilities to designated disposal sites. Transportation methods may include the use of specially designed waste collection vehicles or outsourcing to waste management companies. However, challenges such as inadequate transportation infrastructure and lack of dedicated vehicles can impede efficient waste transport. Disposal methods: Disposal of biomedical waste in Bangladesh primarily involves methods such as incineration, autoclaving, landfilling, and sometimes chemical treatment. Incineration, although widely used, has raised concerns due to its potential environmental and health impacts, such as air pollution and emission of hazardous substances. Autoclaving, which involves steam sterilization, is another common method used to treat infectious waste before disposal. However, the availability and accessibility of advanced treatment technologies remain limited in many parts of the country. Informal waste handling: Despite existing regulations, informal waste handlers, including scavengers and waste pickers, often play a role in collecting, sorting, and recycling biomedical waste. However, their involvement raises health and safety concerns, as they may not have adequate protective gear or training to handle hazardous waste properly. Waste produced from hospital sector comprises a mixture of toxic materials, posing risks to the environment and human health. Inadequate management of hospital waste can jeopardize the safety of hospital workers, patients, and the wider environment. While developed countries have established mechanisms for handling and processing hospital waste, it is often overlooked as a special problematic waste flow in countries like Cameroon.
Table 2 Summary of reviewed studies on biomedical waste management
| S.N. | Title | Summarized Objective | location | Year of study | Reference |
| 1 | Healthcare workers’ Knowledge about the segregation process of Infectious Waste Management in a Hospital | Assess personnel’s knowledge about infectious biomedical waste and segregation practices. | Cyprus | 2024 | Miamiliotis 2024 |
| 2 | An Investigation into the Conversion of Non-Hazardous Biomedical Wastes into Biogas—A Case Study from the Health and Family Planning Sector in Bangladesh | Investigate potential bioenergy production from non-hazardous waste in health facilities. | Bangladesh | 2023 | Rahman and Milville 2023 |
| 3 | Modernizing Biomedical Waste Management: Unleashing the Power of the Internet of Things (IoT) | Utilize IoT for biomedical waste management using the PRISMA approach. | UK | 2023 | Mohamed et al 2023 |
| 4 | Healthcare waste in Bangladesh: Current status, the impact of Covid-19 and sustainable management with life cycle and circular economy framework | Predict MW generation, assess Covid-19 impact, propose circular economy model. | Bangladesh | 2022 | Dihan et al 2023 |
| 5 | An emerging concern of biomedical waste management in Rohingya refugee camps at Cox’s Bazar, Bangladesh: existing practice and alternatives | Quantify and improve biomedical waste management practices in refugee camps. | Chattogram, Bangladesh | 2022 | Haque et al 2023 |
| 6 | Assessment of COVID-19 vaccination-related biomedical waste management practices in Bangladesh | Evaluate vaccination waste management practices. | Daka, Bangladesh | 2022 | Rahyan et al 2022 |
| 7 | Estimation of the healthcare waste generation during COVID-19 pandemic in Bangladesh | Estimate healthcare waste generated during the pandemic. | bangladesh | 2022 | Chaudhary et al 2022 |
| 8 | A review of the biomedical waste management system at Covid-19 situation in Bangladesh | Review MWM system amidst Covid-19, explore policy impact assessment. | bangladesh | 2021 | Barua and Hussain 2021 |
| 9 | Biomedical waste: Current challenges and future opportunities for sustainable management | Review global healthcare waste management challenges and opportunities. | china | 2021 | Singh et al 2021 |
| 10 | Perception and Attitudes Toward PPE-Related Waste Disposal Amid COVID-19 in Bangladesh: An Exploratory Study | Assess attitudes towards PPE waste disposal amid Covid-19. | bangladesh | 2020 | Islam et al 2020 |
| 11 | A review on healthcare waste management system in Dhaka city | Evaluate healthcare waste management in Dhaka. | Daka, Bangladesh | 2018 | Hossain 2018 |
| 12 | Knowledge, attitude and practices on bio biomedical waste management among the health care personnel of selected hospitals in dhaka city | Assess KAP regarding biomedical waste management among healthcare personnel. | Daka, Bangladesh | 2018 | Jahan et al 2018 |
| 13 | Healthcare Waste Management Practices in Bangladesh: A Case Study in Dhaka City, Bangladesh | Investigate HCW management in Dhaka City. | Daka, Bangladesh | 2017 | Nuralam et al 2017 |
| 14 | Quantitative assessment of biomedical waste generation in the capital city of Bangladesh | Quantify hazardous and non-hazardous waste in Dhaka City. | Daka, Bangladesh | 2014 | Patwary et al 2014 |
| 15 | Evaluation of Knowledge, Practices, and Possible Barriers Among Healthcare Providers Regarding Biomedical Waste Management in Dhaka, Bangladesh | Assess HCPs’ KAP and identify barriers to MWM in Dhaka. | Daka, Bangladesh | 2014 | Sarkar et al 2014 |
| 16 | Striving for scientific management of biomedical waste: Challenge for Dhaka City | Investigate scientific MWM methods in Dhaka. | Daka, Bangladesh | 2013 | Hamid et al 2013 |
| 17 | Biomedical Waste Management (MWM) in Dhaka, Bangladesh: It’s a Review | Review MWM practices in Dhaka. | Daka, Bangladesh | 2012 | Sayed et al 2012 |
| 18 | Assessment of occupational and environmental safety associated with biomedical waste disposal in developing countries: A qualitative approach | Assess safety risks in biomedical waste disposal in Dhaka. | Daka, Bangladesh | 2011 | patwary et al 2011 |
| 19 | An illicit economy: Scavenging and recycling of biomedical waste | Explore illicit biomedical waste recycling and its consequences. | Daka, Bangladesh | 2011 | patwary et al 2011 |
| 20 | Health and safety perspective on biomedical waste management in a developing country: A case study of Dhaka city | Investigate health and environmental risks of biomedical waste mismanagement in Dhaka. | Daka, Bangladesh | 2009 | patwary et al 2009 |
| 21 | Pattern of biomedical waste management: existing scenario in Dhaka City, Bangladesh | Document biomedical waste generation and management in Dhaka. | Daka, Bangladesh | 2008 | Hassan et al 2008 |
| 22 | Current State, Development and Future Directions of Biomedical Waste Valorization | Provide comprehensive overview of biomedical waste valorization. | china | 2023 | Chu et al 2023 |
In low income countries, the most common methods for hospital waste management include dumping in uncontrolled landfills and incineration with insufficient quantity to address emissions to environment. This study categorizes hospital waste into two main components: a common waste stream comprising relatively non-hazardous materials with potential for recycling such as cardboard, plastics, and paper, and an toxic level component including sharps and pathological wastes. Effective management of both hazardous and non-hazardous hospital wastes necessitates the execution of integrated solid waste management options.
4.1.1 Collection and Segregation of Biomedical Waste
In Bangladesh, the collection and segregation of biomedical waste represent pivotal initial stages in the management process, aimed at guaranteeing safe disposal and mitigating environmental and public health hazards. Nonetheless, there exist challenges and discrepancies in practices observed across diverse healthcare systems. Typically, this type of waste is segregated at the source within healthcare facilities, involving the separation of various waste categories including infectious, sharp, pathological, pharmaceutical, and non-infectious waste. Ensuring proper segregation is imperative to forestall cross-contamination and ensure the secure handling and disposal of waste materials.
Color-coded bins or bags: Healthcare facilities often use color-coded bins or bags to facilitate the segregation of biomedical waste. Each color represents a specific type of waste, helping staff easily identify and sort different categories of garbage. For example, red bins or bags may be used for hazardous waste, while yellow bins or bags are designated for sharp waste.
To enhance the aesthetic appeal and efficiency of waste management, it is recommended to initiate the collection of both non-infectious and infectious waste at the patient/visitor areas. This approach ensures that trolleys with less waste traverse these areas, maintaining cleanliness and orderliness. Specifically, infectious waste should be segregated and collected separately from areas like laboratories and operating theaters. Moreover, it is advisable for infectious waste to bypass patient areas entirely and be transported directly to the incinerator. This measure minimizes the risk of contamination and ensures the safe disposal of infectious waste.
Training and awareness: Training programs are essential to educate healthcare workers about the importance of proper biomedical waste segregation. Training covers topics such as waste classification, segregation techniques, use of PPE, and handling procedures. Increasing involvement of healthcare staff helps promote compliance with segregation protocols and reduce the risk of errors.
Monitoring and supervision: Regular monitoring and supervision are necessary to ensure compliance with segregation practices. Healthcare facilities should establish monitoring mechanisms to assess segregation performance, identify areas for improvement, and provide feedback to staff. Supervisors play a crucial role in overseeing segregation activities and addressing any issues or concerns promptly.
Challenges and gaps: Despite efforts to promote proper segregation, challenges persist in healthcare facilities across Bangladesh. Common issues include inadequate infrastructure and resources, limited training opportunities, lack of awareness among staff, and high staff turnover rates. Addressing these challenges requires ongoing support, investment, and collaboration between healthcare authorities, professionals, and stakeholders.
In healthcare settings, biomedical waste is commonly organized into bins with color-code, with container designating a specific waste type. The allocation of colors to different waste types, as well as the specific categorization of waste within the waste stream, changed according to location to location. While specific areas sort waste based on its source, others determine its disposal stream considering its pathogenicity (Mühlich et al., 2003). The absence of global standards presents hurdles for healthcare workers in effectively sorting waste, often prompting a tendency to exercise caution. Consequently, items may be find its way into the biomedical waste stream unnecessarily, thereby contributing to the generation of avoidable biomedical waste (Almuneef & Memish, 2003). Although, large number of publications in literature consistently demonstrate that the bulk of garbage generated by biomedical facilities is non-hazardous. This suggests that such waste could be adequately find its way to the municipal engineered landfills (Garcia, 1999) (B. K. Lee et al., 2004). Likewise, in the United Kingdom, the standard disposal costs for infectious waste are notably high, averaging around £0.45 per kilogram (Blenkharn, 2006). An additional concern in biomedical waste disposal revolves around the necessity to prevent individuals from inadvertently or deliberately coming into contact with disposed infectious items. In numerous regions, biomedical settings are legally obligated to ensure that both patients and staff are protected from any interaction with infectious waste (Blenkharn, 2006).
This deficiency not only presents a risk of infection but also establishes a legal responsibility for biomedical facilites, particularly if patients become ill due to substandard practices of waste management. Highlighting the critical need for robust safety within biomedical settings, the EPA has determined that the potential disease-caused by hospital biomedical waste is most significant at the point of generation, gradually diminishing thereafter. Hence, prioritizing the protection of infectious biomedical waste within biomedical settings is paramount for effective waste management.
4.1.2 Transportation of Biomedical Waste
Biomedical waste management (BMWM) has garnered increasing attention due to its potential health risks and adverse environmental impact. Improper handling of biomedical waste (BMW) can serve as a significant diseases source such as HIV, and other bacterial infections, posing a serious threat to human health. Therefore, ensuring safe and proper disposal of biomedical waste is of paramount importance, requiring prime attention to mitigate associated risks. In Bangladesh, the transportation of biomedical waste entails several processes to ensure the secure and appropriate transfer of hazardous waste from healthcare facilities to disposal sites. Nonetheless, numerous challenges persist in this domain of
biomedical waste management. (Windfeld & Brooks, 2015). Firstly, before transportation, biomedical waste must be securely packaged and labeled according to regulations. Various waste types, such as hazardous, sharp, or pharmaceutical waste, require specific containers and labels to indicate their contents and hazards accurately. Within healthcare facilities, waste collection points need to be strategically located for easy access and efficient waste segregation. Dedicated collection bins or areas are typically designated for different types of biomedical waste to facilitate separation at the source. Specialized vehicles are then used for transporting biomedical waste to disposal sites, designed to prevent leakage or spillage during transit and equipped with appropriate safety features. Efficient route planning is essential to minimize transportation time and costs while ensuring timely waste removal. Moreover, compliance with national and local regulations governing the handling and transportation of hazardous materials is crucial, requiring proper documentation, permits, and licenses (Windfeld & Brooks, 2015b). Personnel involved in biomedical waste transportation should receive adequate training on handling, loading, and unloading procedures, as well as emergency response protocols. Regular monitoring and supervision of transportation activities are necessary to ensure adherence to protocols and regulations, including inspections of vehicles, documentation, and waste handling practices. Despite these measures, challenges such as inadequate infrastructure, limited resources, and insufficient regulatory enforcement continue to impact biomedical waste transportation in Bangladesh. Addressing these challenges requires concerted efforts from government authorities, healthcare facilities, waste management companies, and other stakeholders to improve infrastructure, enhance training and awareness, and strengthen regulatory frameworks (Tata & Beone, 1995). Typically, these firms collect the waste from centralized points within a biomedical facility and subsequently transfer it to a disposal settings equipped to handle biomedical waste safely. Nevertheless, there are challenges associated with outsourcing waste disposal. Relying on third-party for disposal of biomedical waste poses an issue from an incentives standpoint, as these organizations or their employees may stand to benefit significantly from improperly handling the waste. Biomedical waste disposal fees are notably high in developed countries, with biomedical facilities in the UK often paying over £450/t for companies to manage their biomedical waste. Similarly, biomedical facilities in the US generally face costs of $790/t for biomedical waste disposal. This major cost creates a potential financial incentive for improper disposal practices (Blenkharn, 2006; Jang et al., 2006).
The elevated prices indeed incentivize biomedical waste transportation company to contemplate disposing of the biomedical waste without undergoing proper treatment, opting instead for illegal methods. Instead of transporting the waste to a suitable facility for sterilization, there is a risk that these firms might resort to improper disposal practices. In certain instances, such as in Ireland, biomedical waste truck operators could potentially earn over $2000 by unlawfully dumping a truck of biomedical waste instead of adhering to the proper procedure of transporting it to a designated disposal location. This financial motivation creates a significant incentive for engaging in illegal dumping practices (Windfeld & Brooks, 2015b). Developed nations are grappling the issue of unscientific biomedical waste dumping, especially in situations where the nations lacks a robust tracking system for biomedical waste. Inappropriate disposal becomes particularly chronic under such circumstances. This presents a major problem, as without treated biomedical waste disposal pose a risk to the locals due to the discharge of dangerous pathogens. Additionally, illegal dumping places a financial strain on government money, as the sanitation costs for biomedical waste are exceptionally large (Windfeld & Brooks, 2015b).
4.1.3 Methods of Biomedical Waste Disposal
Bangladesh has undertaken numerous initiatives aimed at bolstering the health of its expanding population, channeling investments into health infrastructure development, change management, and policy interventions. However, these efforts have coincided with a significant surge in the establishment of clinics and hospitals, leading to a rapid increase in healthcare waste generation. This escalating volume of waste poses a considerable threat to public health due to environmental pollution. Consequently, healthcare waste management (HCWM) has emerged as a pressing concern for the country. Disposal of biomedical waste methods in Bangladesh encompass various techniques aimed at safely and effectively managing the hazardous materials generated by healthcare facilities. These methods face significant challenges due to limited resources, infrastructure, and regulatory enforcement.
Incineration is one of the primary disposal methods used for biomedical waste in Bangladesh. Despite its effectiveness in reducing the volume of waste and destroying pathogens, incineration poses environmental and health risks due to emissions of pollutants such as dioxins, furans, and heavy metals. Additionally, many healthcare facilities lack access to modern incineration facilities, leading to the continued use of outdated and inefficient incinerators.
Autoclaving, or steam sterilization, is another common method employed to treat infectious biomedical waste before disposal. This process effectively kills pathogens and reduces the volume of waste, making it safer for landfill disposal. However, the availability of autoclaving facilities is limited in Bangladesh, particularly in rural areas, which hampers widespread adoption of this method.
Landfilling is often used as a final disposal option for biomedical waste that has been treated or rendered non-infectious. However, inadequate landfill infrastructure and poor management of waste practices makes the environmental contamination and pose problem to public. Biomedical waste may be mixed with MSW in landfills, increasing the capacity for exposure to hazardous materials.
Chemical treatment methods, such as chemical disinfection or encapsulation, offer alternatives to traditional disposal techniques. However, the use of chemicals can introduce additional environmental concerns and may require specialized facilities and expertise for safe implementation.
The effective disposal of infectious biomedical wastes presents a substantial challenge, WHO indicating that “at present, there are practically no sustainable, low-cost options for the proper disposal of hazardous wastes” (Windfeld & Brooks, 2015b) (Bosmans et al., 2013; Rutala & Mayhall, 1992; Zhao et al., 2009). Although, problem regarding air pollution have brought into question the availability of incineration as a method of treatment for biomedical waste. Furthermore, biomedical waste contains a substantially amount of plastic compared to general type of waste from municipality, which results in the combustion of biomedical waste leading to the generation of toxic substances such as polychlorinated dibenzo-p-dioxins (dioxins) and polychlorinated dibenzofurans (furans) (Jang et al., 2006). Consequently, there has been a heightened emphasis on alternative methods of treatment such as microwaving and autoclaving to effectively eradicate any contaminant present. Overall, the implementation of improved waste segregation practices in healthcare facilities plays a crucial role in reducing the production of infectious waste and mitigating associated health risks for healthcare workers, patients, and the wider community.
4.2 Challenges Related to the Disposal of Biomedical Waste
This study represents a pioneering effort in estimating medical waste generation in Dhaka by employing a comprehensive and representative sampling approach. It is notable to fully account for the help of non-residential localities, which seems to significantly help to waste generation. The reliability of this estimate is expected to facilitate informed planning decisions. Additionally, the study reveals unprecedented relationships between the residential Healthcare Establishments (HCEs) and the quantity of toxic waste per bed, as well as the composition of toxic waste generated. These findings hold potential significance for future planning endeavors.
Disposing of biomedical waste poses significant challenges in Bangladesh, stemming from various factors ranging from inadequate infrastructure to regulatory gaps. One of the primary challenges is the limited availability of appropriate disposal facilities capable of handling the volume and diversity of biomedical waste generated across healthcare facilities. Existing disposal sites may lack proper containment measures or fail to meet environmental standards, leading to potential contamination of soil, water, and air. Furthermore, the lack of advanced treatment technologies exacerbates the problem, as traditional methods like incineration may not effectively neutralize hazardous components, resulting in harmful emissions and health risks. This is particularly concerning given the rise in biomedical waste production during events like the COVID-19 pandemic, which further strains already overstretched disposal capacities. Regulatory deficiencies also contribute to the difficulty to surrounding biomedical waste disposal. While guidelines and rules exist, enforcement mechanisms may be weak, leading to non-compliance and improper waste management practices. Moreover, the absence of comprehensive monitoring systems makes it difficult to track the entire waste disposal process, increasing the likelihood of illegal dumping or improper handling.
Additionally, socio-economic factors such as limited financial resources and competing priorities within the healthcare sector further impede efforts to address biomedical waste disposal challenges. Without adequate funding and investment in infrastructure and technology, sustainable solutions remain elusive.
Addressing these challenges needs a multiple method involving coordinated help from government agencies, healthcare institutions, waste management companies, and community stakeholders. This involves bolstering regulatory frameworks, investing in modern disposal technologies, raising public awareness and education, and fostering collaboration among relevant sectors to guarantee the sensible and environmentally responsible disposal of biomedical waste in Bangladesh (Kilgroe, 1996; Liberti et al., 1996; Pacyna et al., 2006; Schecter et al., 2006).
Biomedical waste disposal poses a complex challenge for healthcare facilities worldwide, and ensuring proper management is crucial for safeguarding public health and the environment. However, numerous hurdles can impede effective biomedical waste disposal, as indicated by various studies. Challenges include inadequate infrastructure and resources, particularly in developing countries, a lack of information and training among healthcare workers regarding segregation and handling protocols, and difficulties in navigating the complexities of regulations and enforcement. Even in developed countries, choosing appropriate treatment and disposal methods is a complex decision, with methods like incineration raising concerns about potential air pollution if not properly managed. Addressing these challenges requires ongoing efforts to improve biomedical waste management practices globally (Haque et al., 2021).
In developed nations, the primary method for disposing of infectious biomedical waste is incineration, a process in which the waste undergoes combustion at elevated temperatures, leaving behind residual ash. The ash is then transported to a landfill for burial. Incineration presents several advantages, including sterilization by converting infectious waste into ash and reducing volume of the waste, consequently minimizing transportation cost and environmental impacts (C. C. Lee & Huffman, 1996). Nevertheless, a notable disadvantage of biomedical waste incineration is the discharge of hazardous into the environment. Given the composition, hospital waste produces significant amounts of hazardous gases during incineration, resulting in stringent regulations on incinerator emissions in high income countries. The primary toxins of concern in biomedical waste incineration plants are furans, dioxins, and mercury. (Insa et al., 2010).
In Canada, despite tightening air quality standards, waste incineration remains a significant contributor to atmospheric dioxin emissions. The passage underscores that large-scale emission data may not fully capture the effect of emissions from incineration plants, especially concerning the increased exposure experienced by individuals residing in close proximity to these plants. Developing nations burning biomedical waste in uncontrolled conditions are cited as a cause for high dioxin emissions, leading to elevated exposure levels for nearby populations. The text also addresses mercury emissions from waste incineration, which represent a notable proportion of anthropogenic mercury emissions. The potential health risks associated with atmospheric mercury emissions, particularly in North America, are discussed. Emission control methods, such as fabric filter bag houses and dry scrubbers, are mentioned as effective means to mitigate dioxin emissions. Additionally, the injection of powdered activated carbon is highlighted as a common method for controlling mercury emissions from incineration facilities (Kilgroe, 1996; Prem Ananth et al., 2010; Schecter et al., 2006). Overall, enhanced education for healthcare workers plays a crucial role in minimizing the generation of infectious waste and mitigating associated risks by fostering awareness, promoting adherence to best practices, optimizing resource utilization, enhancing infection control measures, and ensuring compliance with regulations.Top of Form
5 Future Directions of Biomedical Waste Management:
The subsequent section explores the potential of autoclave biomedical waste processing method as a feasible substitute to incineration for biomedical waste management. It also suggests replacing biomedical products with less harmful alternatives that have reduced effects when incinerated. Moreover, it emphasizes the importance of enhancing hospital waste sorting practices for future improvement. These options are proposed as effective strategies to tackle the growing challenge of disposing of hazardous biomedical waste.
5.1 Waste-to-Energy using thermochemical treatment
The energy recovery efficiencies (EREs) and environmental impact of various Medical Waste Treatment Technologies (MWTTs) can be evaluated through methods such as ERA, life cycle assessment (LCA), and life cycle costing (LCC). Technologies including incineration have been studied extensively. Combining sterilization and incineration MWTTs with co-incineration method has shown improved energy recovery potential. ERA analysis revealed a high ERE of 83.4% for ‘steam and microwave sterilization + incineration’ and a low ERE of 19.2% for plasma melting. LCA results favored ‘microwave sterilization + landfill’ but discouraged plasma melting. As per to LCC, incineration and pyrolysis had the lowest cost, while plasma had the highest. Co-incineration of sterilized medical waste with municipal solid waste showed promising cost-efficiency. These findings suggest that pyrolysis incineration is economically advantageous, whereas plasma melting incurs higher operating costs. However, efficient utilization of heat energy from waste remains a challenge due to the lack of appropriate recovery methods. In Northern China, MWTT-generated energy is utilized for heating purposes, while Southern China employs electrical power production to use the heat generated by MWTT, albeit with limitations in power generation efficiency. Several techniques proposed for converting biomedical waste into resource, but most are still in the initial stages of development. Methods such as fermentation, liquefaction, hydrogenation, and esterification lack global ratification and are not widely established for waste management. Given the difficult characteristics of biomedical waste and the need for disinfection before recycling, thermal, chemical treatments are considered effective for energy recovery, assisting in effective disinfection. Experimental evidence has demonstrated that thermal disinfection can efficiently sterilize contaminated materials and the COVID-19 virus. However, liquefaction and hydrogenation are studied at the laboratory level, making chemical treatment through thermal energy source such as gasification, pyrolysis, incineration, and carbonization more feasible and economically viable options for biomedical WtE conversion at present (Jang et al., 2006; Klangsin & Harding, 1998).
5.2 Importance of Policy and Technology
Globally, a significant proportion of healthcare facilities (HCFs), ranging from 18% to 64%, exhibit inadequate biomedical waste management (BMWM) facilities. Factors contributing to this deficiency include limited awareness, insufficient resources, and ineffective disposal mechanisms. In countries within the South-East Asian region, approximately 56% of facilities face challenges associated with inadequate waste disposal and treatment infrastructure. The challenge due the escalating volume of biomedical waste, it’s imperative to implement clearer and more stringent laws and regulations, particularly in developing nations. This would facilitate the adoption of effective biomedical waste disposal and management method. Governments should establish comprehensive infrastructure for waste collection to valorization (Buekens & Huang, 1998; Jang et al., 2006; O’Brien, 2000). Initially, the choice of WtE technologies should be guided by the volume of biomedical waste produced. Policy makers are encouraged to assess the processing capability of each method of treatment, enabling decision-makers to choose the suitable technique while taking into account environmental, and social economic benefits into considerations. In regions facing substantial biomedical waste challenges, established technologies like incineration may be more feasible due to their efficiency. Conversely, in areas with lower volumes of biomedical waste, environmentally sustainable methods should be promoted within policy frameworks (Cheng et al., 2009; C. C. Lee & Huffman, 1996; Verma & Kumar, 2015).
6 Conclusions
This article provides a comprehensive overview of current research and future directions in biomedical waste management, aiming to offer practical guidance on sustainable treatment methods. It begins with a bibliometric evaluation, analyzing publication trends, influential nations, and research hotspots. The article then reviews regulation implementations in these countries to identify gaps between scientific advancements and policy frameworks. Developed countries like the UK and Italy were found to have stricter regulations compared to developing nations like India and China. Various WtE methods, encompassing thermochemical and chemical treatment technologies, are systematically introduced to foster a circular economy amidst the growing biomedical waste challenge. Thermochemical treatment methods, notably incineration and gasification, are emphasized as viable options, with their attributes and constraints compared and deliberated upon. The article explores the potential alignment between regulations and technologies, emphasizing the need for effective policies and laws in developing nations to enhance effectiveness, while advanced technologies like gasification are recommended for sustainable goals in developed nations, considering the amount of biomedical waste generated and present regulatory frameworks.
The field of biomedical waste disposal need detailed exploration to address the increasing world demand for effective biomedical waste management. Increased utilization of hospital services has resulted in a surge in biomedical waste generation, placing strain on existing disposal systems. Current approaches involve segregating waste within hospital facilities and transferring infectious biomedical waste to designated landfill sites for treatment, typically through incineration or autoclaving, with the residue subsequently landfilled. However, both methods have their drawbacks. Incineration can lead to undesirable atmospheric emissions, posing environmental risks. The autoclave method of treatment may not effectively manage complete waste and could produce a output that is not globally received at landfills. To mitigate the impact of biomedical waste, it is vital to prioritize reducing waste generation. One effective approach is to assure that only biomedical waste undergoes a particular treatment, while remaining biomedical waste is managed in a manner similar to municipal household waste.
Achieving this objective involves providing enhanced training for healthcare workers and implementing standardized biomedical waste flows and disposal bin colors. Governments play a crucial role in reducing excessive generation of infectious biomedical waste and improving treatment and disposal methods. They can establish clear, standardized definitions for infectious and non-infectious biomedical waste, regulate infectious waste disposal to deter illicit dumping, and incentivize healthcare facilities for waste minimization efforts.
Incentives, whether monetary or non-monetary, are crucial to motivate local hospital facility management to prioritize waste reduction, especially in the generation of infectious biomedical waste. Furthermore, governments should allocate resources to research grants and foster industry partnerships to advance research in biomedical waste reduction and treatment. It is crucial to collaborate with biomedical equipment suppliers to develop products that emit minimal dioxins or mercury during incineration. These incineration-safe biomedical products would be especially beneficial in developing nations with limited pollution control technologies, mitigating the risk of harmful emissions from incinerating infectious biomedical waste and protecting public health.
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