Magnifying the microscopic danger with a prodigious effect.
By Sohana Nasrin
edical waste is defined as any solid or liquid waste that is generated from treatment of human beings in a hospital or clinic, from clinical diagnosis and pathological testing and from medical research, compromising of sharps, bodily fluids, dressing materials surgically removed body tissues, chemicals, pharmaceuticals, medical devices and radioactive materials.
Although we are often too busy to realize it, the microorganisms from bodily fluids that are left in the pathology lab, can be more devastating than any weapon of mass destruction. Yersinia pestis is a disease causing bacterium that has killed as many as 75 to 100 million people during the Black Plague The death toll, overall damages, and economic cost will undoubtedly conclude that biohazards are the biggest threads to human kind.
Given that, even health-professionals have difficulty comprehending the dynamics, the general population has never been bothered. Infectious diseases outbreaks are an everyday occurrence from avian influenza virus, HIV, Hepatitis viruses, Norovirus (Norwalk virus), Salmonella typhimurium, Mycobacterim tuberculosis, Vibrio cholera, MRSA superbugs, Plasmodium vivax and hundreds of other bacteria and viruses. According to World Health Organization (WHO), a bulk of 18.4 million people died worldwide from non-communicable diseases caused by bacteria, viruses and parasites. Pathogens still infect billions of people, with trends indicating a rise in their numbers and lethality in developing countries. Unplanned urbanization, poor sanitation, scarcity and poor planning in waste management, broken water infrastructure, reduced food safety, globalization, international travel, extreme weather and rising cost of new drugs, vaccines and antibiotics have made all developing countries vulnerable to biohazards due to the lack of biorisk management initiatives. A comprehensive biosafety and biosecurity program with efforts to sensitization and raise awareness against unacceptable manner of dealing with
with biohazard is absolutely pertinent in developing countries.
Dr. Asadulghani is a researcher and a biosafety professional who has been working in the field of Molecular Microbiology for more than 23 years. He suggests that biomedical waste can be divided into two categories: infectious waste and non-infectious waste that includes pharmaceutical waste. According to him, indiscriminate use of antibacterials and their release into the environment develops antibiotic resistance bacteria in the environment, which eventually has hazardous impacts on our environment. In his opinion, the situation will continue to deter unless and until we specially focus on medical waste management.
According to Dr. Asadulghani, 100 to 200 kg of waste is produced in icddr,b facilities alone on a daily basis. He mentions PRISM, which is an entity, funded by Japan International Cooperation Agency (JICA), authorized by the Environmental Ministry. Operating in Dhaka City Corporation provided land, it is the only specialized common biomedical waste treatment facility (CBWTF) in Bangladesh. According to PRISM, they receive 6 to 7 tons of biomedical waste that is produced by diagnostic and research laboratories and health care facilities, which is only a portion of the waste generated throughout the whole city. For total management of medical waste, we need to expand this biomedical waste treatment capacity largely for the whole nation.
Dr. Asadulghani has participated in the train-the-trainer program for Biosafety professionals organized by NIH in association with the Singapore REDI center.
Being a certified trainer and biosafety professional in the Asia-Pacific region to biosafety professionals, scientists, researchers, and diagnosticians, Dr. Asadulghani, is currently working to develop and implement policies and procedures of biosafety and biosecurity in labs and field activities of icddr,b and in Bangladesh, as well. He informs icddr,b has the MoU with PRISM, to manage biological waste. He also informs that PRISM is the only CBWTF for treating and managing all biomedical waste in Bangladesh. Dr. Asadulghani supports a centralized system to manage biomedical waste; it is a common and cost effective trend worldwide to manage the waste through CBWTF to minimize the risk of spreading infectious diseases by minimizing the number of treatment sites.
Starting his career as a researcher in 1993 with the isolation and characterization of extracellular protease, Dr. Asadulghani received MSc in Biochemistry and Molecular Biology in 1995. While working at icddr,b (1995-2001), under the supervision of renowned Scientist Dr. Shah M. Faruque, he discovered the satellite filamentous phage RS1 in Vibrio cholerae (V.c.)genome and explained the molecular mechanism of horizontal gene transfer among V.c. strains. He contributed substantially in the demonstration of a novel mechanism of how pathogenic V.c. originates from non-pathogenic progenitor strains and received MPhil in the field of Molecular Microbiology in 2001.
During his PhD program (2001-4), with of Professor Dr. Hitoshi Nakamoto, at Saitama University, Japan, he analyzed posttranscriptional regulation of Heat Shock Protein (HSP) genes and discovered the role of light in the modulation of HSP gene expression. During his postdoc and while working as an Assistant Professor (2004-9) at the Faculty of Medicine, University of Miyazaki, Japan, with Professor Dr. Tetsuya Hayashi (Chairman, Microbial Whole Genome Sequencing Group, Japan), he demonstrated the novel mechanism of disseminating virulence genes by defective prophages.
While stating the limitations, Dr. Asadulghani informs that Bangladesh is not manufacturing waste packaging materials, which are expensive and requires a long lead-time to purchase from overseas. However, packaging of segregated waste is the crucial part of medical waste management. Dr. Asadulghani informs that icddr,b is going to pilot a project to combat this matter where they are planning to produce locally low-cost waste packaging materials like biohazard bags and sharp containers. The organization will distribute the containers to different hospitals, free of cost, and negotiate with the government for advocacy at the same time.
He sheds light on medical waste management activities and says that there are two major ways of treating biomedical waste – autoclaving and incineration. Autoclave is a high temperature and pressure treatment machine, which is used for sterilizing. Treatment with chemical like sodium hypochlorite is also effective and acceptable; however, consideration should be given in the type of waste being treated that otherwise may lead to a false sense of sterility. Sufficient incubation period is necessary to release the chlorine from sodium hypochlorite to avoid its unwanted effect. Additionally the chemical is corrosive and can damage pipelines if disposed before an insufficient incubation period.
Incineration also demonstrates its strength and weaknesses, which deter its usage by the developed world. Incineration is popular in countries with limited natural resources. According to Dr. Asadulghani, incineration is a waste treatment process that involves the combustion of organic substances contained in waste materials. Incineration of waste materials converts the waste into ash, flue gas, and heat. The ash is mostly formed by the inorganic constituents of the waste, and may take the form of solid lumps or particulates carried by the flue gas.
Thus inside the incinerator we are losing organic substances and concentrating heavy metals and right now we have no way of managing this heavy-metal-waste properly. Additionally, combustion of plastics containing chlorine may produce highly toxic chemicals known as dioxins and furans at 300°C to 500°C temperature. These reactions are an important consideration to dispose of chlorinated plastics such as polyvinyl chloride (PVC). Thus, consideration should be given to segregate all chlorinated plastics materials before incineration.
Although Dr. Asadulghani is a researcher and educator in the fields of Molecular Microbiology, Biotechnology, and Genetic Engineering, right now he is investing his full time in the advancing Biosafety and Biosecurity status at icddr,b and for the whole nation as well. He is managing the Biosafety and Biosecurity program in all the eight divisions in Bangladesh. The program is supported by Centers for Disease Control and Prevention (CDC), Atlanta and Biosecurity Engagement Program (BEP), United States Department of State. He is closely working with the International Federation of Biosafety Associations (IFBA). Under his leadership, Bangladesh Biosafety & Biosecurity Association (BBBA) was formed in November 2011 and he worked as “Pro Tem President” for the association until December 2012. He was given the responsibility to run the BBBA for 2013-4 as the President. After the successful completion of the first term, he was selected for the second term until December 2016. Let’s hope that under his leadership, Bangladesh can develop a strategy where the biomedical waste management is the most effective, both resource and finance wise, and least hazardous to the environment. Best of luck Dr. Asadulghani.
With contribution from Dr. Fahad Hossain & Irad Mustafa.
