Development of a hospital waste management index for major cities in Bangladesh

Abstract

Health care or medical solid wastes, if not managed properly, can pose serious health damage and spread various diseases. The main objective of this study was to develop a hospital waste management index (HWMI), which would indicate the overall condition of medical waste management in a hospital. A list of thirty three parameters having significant influence on medical waste management was identified from relevant national and international guidelines. The relative importance grading of these parameters was done to understand which parameters were more important with respect to overall hospital waste management. The grading values (from 5 to 1) were reflective of qualitative significance of parameters: „most important‟, „important‟ „essential (loss of life may not occur, but other losses and injuries are high)‟, „essential (damage of health and injuries are considerable)‟ and „not essential (but preferable)‟, respectively. Importance grading of the parameters were collected from eight experts from relevant Government (DGHS, DoE, DU) and non-government (Prism, ICDDR,B) authorities working in the field of hospital waste management. From the experts‟ evaluation, the parameters were ranked based on the weighted average of relative importance grading of each parameter. A total of 30 hospitals were physically surveyed (twenty four hospitals inside Dhaka city and six hospitals outside Dhaka city) to assess condition of the selected parameters and a rating of each parameter was done (on a scale of 0 to 5). Physical survey rating values (from 5 to 0) represented qualitative conditions of parameters like „excellent‟, „good‟, „average‟, „poor‟, „very poor‟ and „absent‟, respectively. Relative importance grading from experts and assessment of the parameters from physical survey were combined to produce a Hospital Waste Management Index (HWMI), which provided a dimensionless single value indicating overall waste management condition of a given hospital. Comparisons were made between hospitals having different management (Government. or non-government.) or locations (inside vs. outside of the capital city). Privately owned and operated hospitals showed better hospital waste management scenario compared to Government hospitals. The average HWMI for Government and private hospitals were found to be 2.85 and 3.07, respectively. From the comparison of hospitals inside and outside Dhaka it was found that, although hospitals inside Dhaka scored better points in most of the parameters, the average HWMI of hospitals inside and outside Dhaka are 2.98 and 2.86 respectively, which is not statistically significant. This close value of HWMI resulted due to high difference in some ratings of parameters in favor of hospitals outside Dhaka city.