thesis on biomedical waste management pdf

Biomedical Waste Management: A Study on Assessment of Knowledge, Attitude and Practices Among Health Care Professionals in a Tertiary Care Teaching Hospital

Divya Rao 1 , M. R. Dhakshaini 2 , Ameet Kurthukoti 3 and Vidya G. Doddawad 4

1 Department of Health System Management Studies, JSS University, Mysuru.

2 Department of Prosthodontics, Vice Principal, JSS Dental College, JSS University, Mysuru.

3 Dental Health Officer, Department of Health and Family Welfare, Government of Karnataka.

4 Department of Oral Pathology and Microbiology, JSS Dental College, JSS University, Mysuru.

Corresponding Author E-mail:  [email protected]

DOI : https://dx.doi.org/10.13005/bpj/1543

Biomedical waste (BMW) generated in our nation on a day to day basis is immense and contains infectious and hazardous materials.  It is crucial on the part of the employees to know the hazards of the biomedical waste in the work environment and make its disposition effective and in a scientific manner. It is critical that the different professionals engaged in the healthcare sector have adequate Knowledge, Attitudes and Practices (KAP) with respect to biomedical waste management. Many studies across the country have shown that there are still deficiencies in the KAP of the employees in the organizations and hence it is necessary to make the appraisal of the same. To ascertain the levels of and the expanse of gaps in knowledge, attitudes and practices among doctors, post graduates, staff nurses, laboratory technicians and house-keeping staffs in a tertiary care teaching hospital in Mysuru, Karnataka. A cross sectional study was carried out using questionnaire as the study tool among the health care professionals in a tertiary care teaching hospital. The study demonstrated gaps in the knowledge amongst all the cadres of the study respondents. The knowledge in relation to BMW Management including the hospital BMW protocols was more desirable among doctors, but practical facets were better in nurses and the lab technicians. Knowledge, Attitude and Practice amongst the different cadres of staff members were found to be significant statistically.

Attitude; Biomedical Waste; Healthcare personnel;   Knowledge; Practice

Introduction

Health care waste is a unique category of waste by the quality of its composition, source of generation, its hazardous nature and the need for appropriate protection during handling, treatment and disposal. Mismanagement of the waste affects not only the generators, operators but also the common people too. 1

‘Bio-medical waste’ (BMW) means any solid and/or liquid waste including its container and any intermediate product, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research pertaining thereto or in the production or testing thereof. 2

Due to the increase in the procedures that are carried out at the various health care setups, excessive amounts of waste have been generated at the centers of care.

India approximately  generates 2 kg/bed/ day 3 and this biomedical waste encompasses wastes like anatomical waste, cytotoxic wastes, sharps, which when inadequately segregated could cause different kinds of deadly infectious  diseases like Human immunodeficiency virus(HIV) hepatitis C and B infections, etc, 4   and also cause disruptions in the environment, and adverse impact on ecological balance. 5,6

Adequate knowledge amongst the health care employees about the biomedical waste management rules and regulations, and their understanding of segregation, will help in the competent disposal of the waste in their respective organizations. 7

Acceptable management of biomedical waste management begins from the initial stage of generation of waste, segregation at the source, storage at the site, disinfection, and transfer to the terminal disposal site plays a critical role in the disposal of waste. Hence adequate knowledge, attitudes and practices of the staff of the health care institutes play a very important role. 8,4,9

Teaching institutes play a critical role in the health care setup as it is from these places that the future health care professionals and all those persons involved in the care giving to the community are trained. 10

Studies documented from different parts of the country; still convey that there are gaps in the Knowledge, lacunae in the attitudinal component and inconsistency in the practice aspects which are matters of concern among the health care professionals. 8,11-15  With this background, the study was carried out to assess the current knowledge, attitude and practices of the health care workers like doctors, post graduates, interns, staff nurses, laboratory technicians and house-keeping staff in a tertiary care teaching hospital with regard to the management of BMW.

To assess the levels of knowledge, attitudes and practices among doctors, post graduates, interns, staff nurses, laboratory technicians and house-keeping staff in the different departments of a tertiary care teaching hospital.

To assess the gaps in knowledge, attitudes and practices among these health care workers in the different departments of a tertiary care teaching hospital.

Methodology

Study design

Cross-sectional study.

Study setting

Tertiary care teaching hospital

Study population

Staff working in the different departments of the hospital.

Eligibility Criteria

All consenting individuals amongst the different cadres of staff were included into the study. There were 2056 eligible participants, which was taken as the sampling frame.

Sample Size

Expecting that 50% of the study population had precise knowledge (considering the outcome variable) about the rules and legislation of biomedical waste management, 16  with an allowable error of 10%, at 95% confidence interval, and accounting for the finite population correction for 2,056 participants, a minimum sample size of 472 was calculated.

Sampling Strategy

The study population was classified according to the different strata based on their designation as doctors, postgraduates (junior residents), interns, staff nurses, laboratory technicians and house-keeping staff. Allocation of the population according to the strata.

Ethical Approval

The ethical clearance for the study was obtained from the Institutional Ethics Committee.

Materials and Methods

The tool used for the study was a pre-tested, semi-structured closed ended questionnaire which encompassed 42 questions on Knowledge, Attitudes and Practices.

The questions on knowledge appraised the participant’s knowledge on attributes related to the colour coding and their implications, identification of biomedical hazard symbol, waste categories, and hospital policies for biomedical waste management.

The questions on attitude were related to matters like, was biomedical waste hazardous, its management additional burden on their work or if their appropriate management burden on the finances of the hospital, and also on legislative measures for waste management.

The questions on practice appraised if the study respondents had received any training on biomedical waste management, if they were immunized against hepatitis B and if disinfection of sharps were carried out at the point of generation.

The literature review was done based on which the questionnaire was formulated according to the requirements of the study. The questionnaire was pretested and validated by a post-test and a pilot survey was conducted with a sample of 60 respondents, with representations from the various strata of the study respondents. The study tool consisted of 12 questions assessing the knowledge with yes/no/not sure responses, 10 questions assessing the attitude with agree/disagree/no comment as answers and 20 questions assessing the practices with yes/ no responses.

The participants filled up the self-administered questionnaires without scope for undue help.

The questionnaire was adapted from English to local language by an experienced professional who is involved in translating of health survey questionnaires to accommodate the housekeeping staff. The questionnaire was also back translated to English for checking of possible discrepancies and incorporating if any changes were required. The identity of the study respondents were maintained anonymous   at various stages of the study.

The results were evaluated across 3 domains for all the cadres of the study population.

The results are Displayed as Under

Statistical Methods

Data was analysed using MS-Excel and R version 3.4.3.  Percentages (with 95% confidence intervals) were calculated and the same are presented graphically. Chi-square test was performed to test the association between the different cadres related to their knowledge, attitude and practices towards BMW

Knowledge Score

The knowledge regarding general information about HCW was assessed, the mean score was highest in doctors (10) followed by nursing staff (9.3) and least in housekeeping staff (7.5). This is found to be statistically significant.

Table 1: The participant’s knowledge on biomedical waste management.

Overall, the study respondents showed satisfactory knowledge regarding biomedical waste management. The knowledge about BMW among doctors was the distinctively better, followed by that of nurses, technicians, post graduates, interns and housekeeping staff (in order). The gaps in knowledge were in the areas regarding the fate of the waste after it was segregated, and as well as who was the regulator for the safe transportation of biomedical waste from the hospital.

Table 2: The participant’s attitudes towards biomedical waste management.

The mean attitude score was 9.20 for the nurses and 9.18 out of 10 for the doctors. Favourable attitude was shown by most of the study respondents towards biomedical waste management. The best attitudes were displayed by the nurses showed, subsequently by doctors, interns, postgraduates, the laboratory technicians, and house keeping staff (in order). It was concerning that the lacuna in this domain was that biomedical waste management was considered as additional burden on work.

Table 3: The participant’s practices regarding biomedical waste management.

The mean practice score was 17.30 for the nurses and 16.50 for the housekeeping staff and 15.27out of 20 for the doctors, in the study. Though greater number of the study respondents displayed favourable biomedical waste management practices, it was noted that the nurses had the best practices, followed house keeping staff, doctors, technicians, interns and junior residents (in order). It was noted that the staff ware following the preventive measures of immunisation against Hepatitis B, and also routine health check-ups were conducted for the staff. Explicit training on BMW management was desired by most of the staff.

Chi-Square Test

The null hypothesis which was to be tested here was “The two attributes were independent”. Here three hypotheses were there to be tested:

Cadre and knowledge are independent.

(Chi-square = 160.8,  Degrees of freedom=10, p-value < 0.0001)

Cadre and attitudes are independent.

(Chi-square = 95.6, Degrees of freedom=10, p-value < 0.0001)

Cadre and practices are independent.

(Chi-square = 538.45, Degrees of freedom=15, p-value < 0.0001)

The present cross-sectional study recognized certain inadequacies in the knowledge component amongst the different cadres of health care workers, though greater than 50% of the study respondents, across cadres, demonstrated satisfactory or good knowledge, attitudes and practices. The knowledge component of the doctors was more desirable compared to their practices whereas visa versa was true for nurses and lab technicians. The knowledge component was low amongst the housekeeping staff; which was identical to the results from other similar studies conducted previously. 10,13,16 

The attitude towards BMW management of housekeeping staff was low. Low level of knowledge was mainly attributed to new staff coming on rotation to the hospital and also to comparably low educational levels of the housekeeping staff. Training of all cadres of staff will help in the analytical evaluations for suitable and applicable management of biomedical waste. 10,13,16 

The practice of recapping the needles was very low across cadres. Recapping of needles is one of the important risk factor for needle stick injuries; the prevalence was very low in the organization. This may be associated to the awareness of the staff and also due to the adequate number of needle cutters in the various patient care areas of the hospital.

Higher practice scores found in the house keeping staff and nursing staff in the present study may be due to higher responsibilities assigned to them in handling of BMW which was similar to findings of previous studies. 1,17 Overall 8.1 % of the study respondents attended the external training programmes on BMW management on their own accord, but others too (~ 59%) of them communicated their willingness to do the same if opportunities arose in the future. 10,13,16

Conclusions

Overall, the knowledge, attitudes and practices towards biomedical waste management among the study respondents was satisfactory.

Knowledge, attitudes and practices toward biomedical waste management were better among the nurses and doctors than the other cadre of staff.

Knowledge, Attitudes and Practices of the study respondents are dependent on the cadre that they belong too.

This study was a modest attempt to evaluate the KAP of the health care workers towards BMW. We recommend further studies on a larger stratum across hospitals to evaluate the awareness of health care workers towards BMW.

Recommendations

Training programs need to focus on empowering the healthcare professionals on biomedical waste management with broad scope and practical knowledge in all aspects. The ethical requirements and the institutional level policies form the directional pathway for the practical components in the organization. The right practices and other activities of BMW management and its ramifications in the form of avoiding of injuries, importance of vaccinations and following of universal precautions can be achieved when adequately supported by IEC (information, education and communication) strategies like handouts, stickers, charts, celebrations of various days like hand hygiene day and other days etc can help in bettering the practices of the employees of the organizations. Training the staff with checklists and regular inspections can bring about accountability in the staff.

All health care professionals regardless of their designation, experience and qualification , designation must be included in these interventions, so that it can avoid  cross infections among the professionals and patients in the health care sector.

Conflicts of Interest

There is no conflicts of interest.

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Assessment of Knowledge, Practice and Attitude about Biomedical Waste Management among Healthcare Professionals during COVID-19 Crises in Al-Ahsa

Sahbanathul missiriya jalal.

1 Department of Nursing, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia; as.ude.ufk@nimalaf (F.A.); as.ude.ufk@deemahledbaa (A.I.A.)

Fahima Akhter

Amal ismael abdelhafez, ahmed mansour alrajeh.

2 Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia; as.ude.ufk@hejarlama

Associated Data

The data presented in this study are available within the article.

Biomedical waste (BMW) management is an essential practice of healthcare professionals (HCPs) for preventing health and also environmental hazards. Coronavirus disease (COVID-19) has become a global pandemic, posing significant challenges for healthcare sectors. A cross-sectional study was performed to assess the knowledge, practice, and attitude on BMW management among HCPs when taking care of patients with COVID-19 and associated with demographic variables. From Al-Ahsa healthcare sectors, 256 HCPs were selected randomly, of which 105 (41%) had excellent knowledge, 87 (34%) had good knowledge, and 64 (25%) had poor knowledge with a mean score of 13.1 ± 3.6. A higher mean score was (14.4 ± 3.2) obtained by physicians, and (13.6 ± 3.8) nurses than the other HCPs. Regarding practice, 72 (28.1%) HCPs used and discarded PPE while handling biomedical wastes. Additionally, 88 (34.4%) followed proper hand hygiene before and after each procedure and whenever needed. Physicians, nurses, and respiratory therapists had a more favorable attitude than other HCPs. There was a statistically significant association found among knowledge level and educational qualification ( p < 0.0001), gender ( p < 0.001), and work experience ( p < 0.05). Emphasis is needed to train all HCPs regarding proper BMW management during this pandemic to prevent infection transmission.

1. Introduction

Biomedical waste (BMW) is healthcare wastes or hospital wastes generated from biological and medical activities, such as from the diagnosis, prevention, or treatment of diseases [ 1 ]. BMW must be managed by a safe and proper method, which should be known and practiced by every healthcare professional (HCP) to reduce the transmission of infection and to prevent various health and environmental hazards [ 2 ]. The international committee on the taxonomy of viruses termed the serious intense respiratory disease among people caused by coronavirus as coronavirus disease (COVID-19) on 11 February 2020. The World Health Organization (WHO) declared COVID-19 as the sixth public health emergency of international concern [ 3 ]. This severe pandemic crisis has been engendered a global health crisis in addition to its diverse impacts on the economy, society, and environment. Efforts taken to combat this pandemic have significantly increased the quantity of BMW generation. Moreover, the safe disposal of an increased quantity of BMW has been gradually posing a major challenge [ 4 ].

The possibility of confirmed COVID-19 cases and deaths has been increasing due to the continuous changing of the genome sequence of the coronavirus and its community transmission. Due to this pandemic, biomedical wastes (BMW) concerns not only to physicians or nurses, but to other HCPs such as pharmacists, technicians, interns, and therapists in hospitals and all healthcare sectors [ 5 , 6 ] as there was a paradigm shift in the form of the huge amount of wastes generated. There was an unexpected increase in the amount of disposable personal protective equipment (PPE), such as gloves, surgical mask, N-95 masks, air-purifying respirators, goggles, face shield, safety gowns or suits and shoe covers, as well as the use of plastic syringes and needles, high-flow nasal cannulas, and breathing circuits [ 7 ]. These have added a massive load to the waste management system.

In the eastern province of the Kingdom of Saudi Arabia, the generation rate of BMW is approximately 15 million tons per year with an average rate of 1.4 kg/capita/day and due to pandemics, this number is increasing dramatically [ 8 ]. BMW might act as a potential transmission source of infection and could likely be a hotspot to spread the infection, if waste is stored for a more extended period, especially in hospitals treating COVID-19 patients [ 9 ]. Again, as COVID-19 contaminated BMW is highly infective, it should not be disposed of in regular bins. Moreover, HCPs who handle such BMW should follow an adequate dress code, including wearing PPE, masks, splash-proof apron, gloves, gumboots, and safety goggles. As the virus has the potential ability to survive on face masks and gloves [ 10 ], adequate knowledge and proper techniques of handling these contaminated wastes and practice of safe disposal can protect the community from infection during this pandemic.

The World-Wide Fund for Nature (WWF), Italy, has stated that 10 million masks will be dispersed in the environment within a month, and if only one percent of the total masks are not disposed of properly, each mask weighing 4 g will add up to 40,000 kg of plastic [ 11 ]. In Indonesia, the scale of medical wastes reached 12,740 tons approximately 60 days after people were first infected by coronavirus [ 12 , 13 ]. Furthermore, India has been producing approximately six hundred metric tons of BMW daily, approximately 10% more than before [ 14 ]. Additionally, due to the lack of knowledge and poor practice on the proper disposal of medical waste at all levels of the healthcare sector, many countries dispose of their BMW in dustbins along with general household waste; some even reuse sharps items and syringes that eventually increase the risk of infection transmission, particularly in this current situation [ 15 ].

The improper practice of segregation at the site of origin has also been observed, which causes the mixing of infectious and non-infectious waste [ 16 ]. Color-coding schemes to segregate BMW should be strictly followed. Furthermore, wastes originating from COVID-19 wards should be collected, stored in separate records; and transported directly to treatment plants to avoid any cross-contamination [ 17 , 18 ]. In Europe, there is a trend among waste management sectors to provide separate collection services from households infected with COVID-19 and quarantine facilities [ 19 ].

Considering all these statistics, it is evident that a strategic guideline should be produced in Eastern province; Al-Ahsa, focusing on the current waste management knowledge, practice, and attitude (KPA) whilst handling, treating; and removing BMW produced during the identification, isolation; and management of COVID-19 patients. Additionally, the KPA should be updated from the regular processes of waste management by standardizing policy and organize awareness tracing programs on the BMW management system. The Al-Ahsa waste management authority should work together by formulating an extensive guideline involving the concerned ministry and other stockholders to fill and update the gaps in the knowledge, practice; and attitude among HCPs during this pandemic crisis. Therefore, the objectives of this study were to assess the knowledge, practice; and attitude regarding BMW management among HCPs during COVID-19 crises in Al-Ahsa healthcare sectors and to associate the knowledge level with the selected demographic variables.

2. Materials and Methods

2.1. study design.

A descriptive design-based cross-sectional study was conducted among HCPs from the period of December 2020 to April 2021 in the governmental and non-governmental healthcare sectors caring for patients with COVID-19 in Al-Ahsa, Saudi Arabia.

2.2. Study Area and Setting

The study was conducted to assess the knowledge, practice and attitude on BMW management among various healthcare employees, who are involved in caring for COVID-19 patients in healthcare sectors, such as government and private hospitals, health centers; and polyclinics in Al-Ahsa, which is in the eastern province region of the Kingdom of Saudi Arabia.

2.3. Sample Size and Sampling Method

Considering the variables and outcome of the study, assuming the expected 50% of the study population had precise knowledge, good practice and a favorable attitude on BMW management, with an allowable margin error of 5%, at a 95% confidence interval, and accounting for the finite population for 922 HCP, a minimum sample size of 272 was calculated. After the randomization sampling, a total of 256 professionals from various fields were included in the data collection.

2.4. Inclusion Criteria

All HCPs including physicians, nurses, pharmacists, laboratory technicians (LTs), medical interns, nurse interns, X-ray technicians, and respiratory therapists (RTs), who were aged 20 years and above, both males and females, worked at government or private healthcare sectors in Al-Ahsa with a minimum 6 months professional experience and cared for COVID -19 patients, were included as study participants. HCPs who provided informed consent and available during data collection were included in the study.

2.5. Data Collection Tool and Procedure

The data were collected using a structured self-administered questionnaire (through Google Forms) and an observational checklist reviewing the literature and international BMW management guidelines. The questionnaire consisted of four sections. The first section included the socio-demographic information of HCPs. The second section included knowledge related to BMW management. The third section was an observational questionnaire assessing the practice of HCPs on BMW management; and the fourth section included the rating scale related to attitudes towards BMW management. The tool used that was developed in English. The pilot study was performed among 10 HCPs to test the tool. The reliability of the questionnaire was tested (r = 0.923) using Cronbach’s alpha. The time used to fill in the questionnaire ranged from 20 to 25 min. The objectives of the study were explained clearly to the participants before data collection. The privacy of respondents was assured by not asking their identity information such as their name, employee identity numbers, in the questionnaire. We used all data for the purpose of the research, and they were encrypted and stored electronically in a secure location, with a password used by the principal investigator to ensure privacy and confidentiality. Written informed consent was obtained from each participant, and then a structured questionnaire was distributed to collect all the data, except the practice tool. After the completion of the tool, using an observational method, the practice questionnaire was filled by data collectors.

2.5.1. Demographic Information

The parameters of demographic data of HCPs included age, gender, educational qualification, occupation, professional experience; and working area.

2.5.2. Knowledge Questionnaire

This tool consisted of 20 multiple choice questions, each of which had four options in which there was three incorrect with one correct option. The structured knowledge questionnaire was scored as either one for a correct response or zero for an incorrect response. The total knowledge score was summed and computed for analysis. The score interpretations were counted from 75% to 100% (15 to 20) as excellent knowledge, from 50% to 74% (10 to 14) as good knowledge; and below 50% (less than 10) as poor knowledge.

2.5.3. Practice Questionnaire

The observation questionnaire was used to assess the practice of HCPs in healthcare sectors. It contained ten questions with the options “always”, “sometimes “, and “never”. The investigators observed the practice of HCPs and filled in the questionnaire directly. The overall practice was calculated and interpreted using the frequency distribution table in the results section.

2.5.4. Attitude Scale

The questionnaire on attitude towards BMW management comprised ten questions. A five-point Likert scale of measurement was used to represent the scores; “strongly agree;” “agree;” “neutral;” “disagree;” and “strongly disagree”, which was scored as 5, 4, 3, 2; and 1 respectively and for negatively phrased statements, scores were reversely coded during the data entry period as 1, 2, 3, 4; and 5, respectively. The overall score of attitude was calculated by adding all scores of HCPs and the mean was computed by dividing the overall attitude score by the number of study participants (256). Finally, attitude scores below the mean and above or equal to the mean score were assigned for unfavourable and favourable attitudes, respectively.

2.6. Ethical Considerations

Ethical approval was obtained from the Research Ethics Committee, Deanship of Scientific Research, King Faisal University, Al-Ahsa, Saudi Arabia (HAPO-05-HS-003). All HCPs gave consent before participation and were informed about confidentiality, the lack of risk, anonymity; and voluntary participation. The research protocol was also approved by the King Fahad Hospital, Hofuf, Institutional Review Board, Saudi Arabia (H-05-HS-055) with reference number 55-35-2020. During data collection, after assessing the inclusion criteria, the objectives of the study and the research purposes were explained to all study participants clearly, and written informed consent was obtained. They were permitted to withdraw from the study at any stage according to their interest. The participants were assured that their data would remain confidential. This study was conducted by the Declaration of Helsinki and followed ethical principles.

2.7. Statistical Analysis

Statistical Package for Social Sciences (SPSS), (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY, USA: IBM Corp.) was used to analyze the study data. The numbers and percentages were tabulated in the form of the frequency distribution, mean; and standard deviation calculated using descriptive analysis. Chi-square analysis was used to test the association between the knowledge of HCPs on BMW management and their demographic characteristics, and the p value was equal to 0.05 or less.

3.1. Demographic Characteristics of the HCP

Out of 256 HCPs included in the analysis ( Table 1 ), 123 (48.1%) were in the age of 20–30 years, and the majority of the participants, 172 (67.2%), were females. Most of the participants, 152 (59.4%), had bachelor’s degrees as their highest educational qualification. Few, 15 (5.9%), were doctorates. Regarding the occupational status of the HCPs, 57 (22.3%) were physicians, 92 (35.9%) were nurses, and 20 (7.8%) were RTs. Furthermore, 85 (33.2%) HCPs had a minimum of six months to one year of experience, 59 (23.1%) had 4 to 6 years of experience and 38 (14.8%) had 6 to 9 years of experience. Concerning the working area, most of the participants, 132 (51.6%), worked in a government hospital.

Demographic characteristics of the HCP (n = 256).

N—number; %—percentage.

3.2. Knowledge Level of the HCPs on BMW Management

The overall knowledge level of HCPs is shown in Figure 1 , in which; 105 (41%) had excellent knowledge, 87 (34%) had good knowledge and 64 (25%) had poor knowledge. The descriptive statistical report of the knowledge level of HCPs is evidenced in Table 2 . The overall mean score was 13.1 ± 3.6. A high mean score 14.4 ± 3.2 was obtained by physicians, then 13.6 ± 3.8 by nurses, 13 ± 3.8 by pharmacists, 13.1 ± 2.1 by LT, 12.8 ± 3.9 by interns (medical), 12.5 ± 3.4 by interns (nurse); and 13.1 ± 3.3 by RTs.

Knowledge level of HCP about BMW management.

Descriptive statistical report of knowledge of HCP about BMW management (n = 256).

SD—standard deviation.

3.3. Practice of HCPs in BMW Management

The practice of HCPs in BMW management is reported in Table 3 . Most of the HCPs 203 (79.3%), always followed the guidelines specified by the Ministry of Health (MOH) for BMW management. Approximately, 196 (76.6%) HCPs always adhered to the infection control policies while treating COVID-19 patients. Most of the HCPs, 163 (63.7%), sometimes used and discarded all PPE while handling BMW. Approximately, 177 (69.1%) HCPs followed the color coding of containers according to the type of waste during the disposal of BMW and 102 (39.8%) followed policies in separating the wastes into non-hazardous, hazardous; and sharp waste. Additionally, 181 (70.7%) maintained BMW records. Regarding preventing sharps related injury such as avoiding recapping used needles, 138 (53.9%) HCPs were cautious, and 192 (75%) HCPs prevented contamination while handling items of COVID-19 patients and other non-COVID-19 patients.

Practice of HCP about BMW management (n = 256).

3.4. Attitude of the HCPs towards BMW Management

The results showed that 187 (73.1%) had a favorable attitude, and 69 (26.9%) had an unfavorable attitude towards BMW management. Among them, most of the physicians (89%) and nurses (78%) had a more favorable attitude than others. As shown in Table 4 , 193 (75.4%) HCPs strongly agreed that the safe disposal of BMW was necessary for healthcare areas. Approximately 134 (52.3%) HCPs strongly agreed that BMW management required teamwork. However, only 63 (24.6%) strongly disagreed that BMW management created an extra burden on their work. Most of HCPs, 124 (48.3%), strongly disagreed that BMW management risked transmitting infectious diseases. However, 6 (2.3%) strongly disagreed that the segregation of hospital waste into different categories was time consuming. Approximately 112 (43.8%) HCPs strongly felt that PPE must be used while handling BMW, and 119 (46.5%) felt that decontamination and disinfection reduced infection. The majority, 141 (55.1%), strongly agreed that proper BMW management enhanced the quality assurance of healthcare sectors, and 128 (50%) felt strongly that upgraded knowledge on BMW management was mandatory.

Attitude of the HCPs towards BMW management (n = 256).

* Negatively phrased statements and reversely scored.

3.5. Association of the Knowledge of HCPs on BMW Management with Demographic Variables

Table 5 shows that there was a significant association between the level of knowledge and three demographic parameters; namely gender ( p < 0.001), educational qualification ( p < 0.0001) and work experience ( p < 0.05).

Association of the knowledge of HCPs with demographic variables (n = 256).

X 2 —Chi-square test; * significant; NS—non-significant; p < 0.05.

4. Discussion

Public health must be protected from environmental hazards by every healthcare sector through following proper BMW management. During this COVID-19 pandemic, many government agencies, including MOH, have published guidelines for the management of waste produced during the treatment, diagnosis; and isolation of COVID-19 patients. It must be managed properly to prevent the severe risk of contamination and disease transmission. Our study was conducted to assess the knowledge, practice; and attitude on BMW management among HCPs in the eastern region of Saudi Arabia. Our study reported that 41% had excellent knowledge, 34% had good knowledge and 25% had poor knowledge. This finding was supported by a study conducted in Saudi Arabia on the knowledge, attitude; and practices of healthcare workers regarding BMW of COVID-19 in the Aseer Region, where healthcare workers had sufficient knowledge on COVID-19 and infection control measures [ 20 ]. Another cross-sectional study was performed to analyze the knowledge, practices, and attitudes of healthcare workers regarding coronavirus disease 2019 (COVID-19) across 10 hospitals in Henan, China. In that report, 89% of HCPs had sufficient knowledge [ 21 ].

A survey study designed to investigate the knowledge, attitudes; and practices of doctors, nurses, laboratory technicians; and housekeeping staff, regarding medical waste management at a tertiary hospital in Gaborone, Botswana, proved that there was a significant agreement among the participants on the proper segregation of medical waste to be carried out at the point of generation, with a mean score 4.43 out of 5, and on the color-coding system, with a mean score of 4.59 out of 5 [ 22 ]. In the current study, the overall mean score was 13.1 ± 3.6 for the knowledge questionnaire regarding BMW management. An observational cross-sectional study was conducted on the awareness and practice of medical waste management among healthcare providers in National Referral Hospital, in which approximately 74.4% participants were aware of medical waste management, and 98.2% were aware of the importance of using proper PPE [ 23 ].

An observational study carried out to provide an overview of the management of BMW in a tertiary care teaching hospital showed that 30% to 35% of respondents did not practice this [ 24 ]. Another study evidenced that [ 25 ] regarding practice, 68% of HCPs knew that the most important step in waste management is waste segregation, and 82% of the participants working in this setup knew the different color-coded bins used for segregation [ 15 ]. In our study, most of the HCPs (79.3%) always followed the MOH guidelines for BMW management, and 69.1% of HCPs carried out the color coding of containers during the disposal of BMW according to the type of waste. Approximately 76.6% of HCPs always adhered to the infection control policies while treating COVID-19 patients. A study performed at the large hospitals in Bangalore; indicated that, although there was an absence of committees for infection control and hospital waste management, 20% of nursing homes had a policy for healthcare waste management [ 26 ].

Every HCP must be informed on the proper handling, disinfecting; and wearing of PPE. A study on the knowledge, attitude and practices of healthcare workers regarding BMW of COVID-19 in the Aseer Region showed a poor understanding of the protocols and policies of PPE disposal [ 20 ]. However, in this study, most of them, 163 (63.7%), sometimes used and discarded sometimes all personal protective equipment while handling biomedical waste, and 102 (39.8%) followed policies in separating BMW into non-hazardous, hazardous; and sharp waste.

A cross-sectional study conducted among healthcare personnel working at primary health centers; in Gujrat showed that the highest overall scores for attitudes to waste disposal were observed among housekeepers compared to physicians or LTs [ 27 ]. However, in our study, the results showed that 73.1% had a favorable attitude, and 26.9% had an unfavorable attitude towards BMW management. Among them, those with the highest number of favorable attitudes were physicians (89%) and nurses (78%). This was supported [ 22 , 28 , 29 ] by a study in India, at a tertiary level healthcare institution, where doctors (100%) were found to be more positive towards the need for actions for safe biomedical waste management than nurses (60%) and other healthcare workers [ 30 ].

A study performed in Alburaimi hospital, Oman, regarding the attitude of healthcare workers towards the safe management of BMW, proved that the majority of LTs (92.7%) considered BMW as an issue as compared to nurses (87.3%), doctors (80.5%); and housekeeping staff (80%), although it was statistically insignificant ( p = 0.639). Moreover, a significantly higher percentage of nurses (92.7%) than doctors (83.2%); and LTs (64.3%), agreed that BMW management requires teamwork, and no single class of people was responsible this ( p = 0.024) [ 31 ]. However, in this study, 75.4% of HCPs strongly agreed that the safe disposal of BMW was necessary for the healthcare areas. Approximately, 52.3% of HCPs strongly agreed that the BMW management required teamwork. However, only 24.6% strongly disagreed that BMW management created an extra burden on their work.

Research on attitude regarding BMW awareness proved that many of healthcare workers (93.3%–98.9%) were aware of improper waste management which was causing various health hazards; (79.8% to 97.9%), the importance of regular educational programs on BMW management; (75.7% to 82%), the amount of generated BMW in hospitals or clinics and (52.8% to 87.6%) that maintaining BMW records is mandatory in hospitals or clinics [ 32 , 33 ]. In this study, most HCP 48.3% disagreed strongly that BMW management was risks transmitting infectious diseases. However, the majority of HCPs (55.1%) agreed that proper BMW management enhanced the quality assurance of healthcare sectors and 50% strongly felt that upgraded knowledge on BMW management was essential.

Descriptive research was performed on the knowledge, attitude; and practices of healthcare staff regarding infectious waste handling at tertiary care health facilities in the metropolitan city of Pakistan, in which the sociodemographic information such as age, gender, level of education; and experience, when compared with the practices, was found to be statistically significant ( p < 0.05) [ 34 ]. In our study, there was also a significant association between the level of knowledge and demographic characteristics, such as educational qualification ( p < 0.0001), gender ( p < 0.001); and work experience ( p < 0.05). This impetuous COVID-19 situation changed healthcare systems, and the pandemic crisis forced many hospitals to reorganize their healthcare systems [ 35 ]. Hence, this study was performed to find the level of the knowledge, practice; and attitude of HCPs on BMW management during this pandemic.

This study also has some limitations. There was a chance for recall bias in this study due to memory recall for knowledge-related questions. However, randomization in the selection of samples was used to reduce the bias. The practice was observed directly, which could have been biased. The participating HCPs were mostly females which may have affected the association findings. We did not assess the culture and nationality of the participants, which we recommend in future studies. This study could be repeated as an interventional investigation with larger samples, including all kinds of healthcare workers.

5. Conclusions

HCPs are frontline workers in the COVID-19 crisis; they face a greater risk of contamination due to their direct contact with patients and specimens. In this situation, BMW must be considered a serious health concern. Accordingly, HCPs must have adequate knowledge regarding the proper handling of BMW, prevention of infection; and prevention of transmission of diseases. This study was intended to assess the KPA of HCPs on BMW management in this pandemic crisis. The present findings demonstrated the necessity to organize continuous training programs in the form of symposia, seminars; and workshops on BMW management to develop awareness among HCPs. A high level of practice regarding the proper handling of PPE is recommended in the present study. In the current scenario, training could be a key factor for HCPs for effective BMW management. Hence, the concerned authorities should assign significant importance to develop a nationally recognized standard guideline in all health sectors to manage BMW and reduce the risk of the pandemic spreading in the community.

Acknowledgments

The authors acknowledge the Deanship of Scientific Research at King Faisal University, Al-Ahsa, Saudi Arabia for the financial support under Nasher Track with reference to Research Grant Number 206147.

Abbreviations

Author Contributions

Conceptualization, S.M.J. and A.I.A.; methodology, F.A. and A.M.A.; software, S.M.J.; validation, A.I.A. and F.A.; formal analysis, S.M.J.; investigation, A.I.A.; S.M.J.; resources, A.M.A.; data curation, S.M.J. and F.A.; writing—original draft, A.I.A. and F.A.; writing—review and editing, S.M.J. and A.M.A.; visualization, A.I.A. and A.M.A.; supervision, S.M.J.; project administration, S.M.J. and F.A.; A.M.A.; funding acquisition, S.M.J. All authors have read and agreed to the published version of the manuscript.

This research was funded by Deanship of Scientific Research, King Faisal University, Al-Ahsa, Saudi Arabia for its financial support with reference to the Research Grant Number 206147 through Nasher Track and the article processing charge was funded by Deanship of Scientific Research, King Faisal University.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and the protocol was approved by the Research Ethics Committee, Deanship of Scientific Research, King Faisal University, Al-Ahsa, Saudi Arabia (HAPO-05-HS-003). The research protocol was also approved by the King Fahad Hospital, Hofuf, Institutional Review Board, Saudi Arabia (H-05-HS-055) with reference number 55-35-2020.

Informed Consent Statement

Informed consent was obtained from all HCPs involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Open Access

Peer-reviewed

Research Article

Biomedical waste management practices and associated factors among health care workers in the era of the covid-19 pandemic at metropolitan city private hospitals, Amhara region, Ethiopia, 2020

Roles Conceptualization, Formal analysis, Investigation, Software, Writing – original draft

Affiliation Debretabor Health Science College, Debre Tabor, South Gondar, Ethiopia

Roles Conceptualization, Formal analysis, Methodology, Software, Validation, Writing – original draft, Writing – review & editing

Affiliation Department of Environmental Health, Bahir Dar University, School of Public Health, Bahir Dar, Ethiopia

Roles Conceptualization, Formal analysis, Methodology, Software, Supervision, Writing – original draft

* E-mail: [email protected]

Roles Formal analysis, Software, Writing – review & editing

Affiliation Public Health Researcher, Addis Ababa, Ethiopia

• Getasew Mitiku, 
• Amha Admasie, 
• Amsalu Birara, 
• Wubante Yalew

• Published: April 6, 2022
• https://doi.org/10.1371/journal.pone.0266037
• Reader Comments

Biomedical waste management is an important precondition to safeguard the healthcare workers and community members, as well as the environment, from being contaminated with infectious substances. However, biomedical waste management practices during the pandemic era of COVID-19 were unknown.

This study was aimed to assess biomedical waste management practices and associated factors among health care workers during the COVID-19 pandemic era at metropolitan city private hospitals, Amhara Region, Ethiopia.

An institutional-based cross-sectional study was conducted at metropolitan city private hospitals in Amhara Region. Simple random sampling was used to select 431 study participants. Data were collected through a self-administered questionnaire and observational checklists. The data were cleaned, coded, and entered into the Epi-data version 4.6, and then exported to SPSS version 20. for analysis. Variables with a p-value less than 0.05 were considered as significant factors in multivariable logistic regression analysis and AOR with a 95% confidence level was used to measure the strength of association.

The proportion of health care workers who had good practices in biomedical waste management was 49.4%. Participants who had MSc education level, [AOR = 4.20, 95% CI (1.01, 17.40)], Bachelor degree [AOR = 3.52, 95% CI (2.13, 5.82)], got training on biomedical waste management [AOR = 4.33, 95% CI (2.71, 6.93)], access to color-coded three bins in their working department [AOR = 6.24.95% CI (3.84, 10.13)] and those who had good attitude (AOR = 2.64, 95% CI (1.65, 4.22), were significantly associated with biomedical waste management practices in private hospitals.

The practice of biomedical waste management in the study area was low. Level of education, taking training on biomedical waste management, availability of color-coded three bins, and attitude of health care workers were significantly associated with biomedical waste management practices. Hence, in-service training is recommended to improve biomedical waste management practices.

Citation: Mitiku G, Admasie A, Birara A, Yalew W (2022) Biomedical waste management practices and associated factors among health care workers in the era of the covid-19 pandemic at metropolitan city private hospitals, Amhara region, Ethiopia, 2020. PLoS ONE 17(4): e0266037. https://doi.org/10.1371/journal.pone.0266037

Editor: Jianguo Wang, China University of Mining and Technology, CHINA

Received: August 27, 2021; Accepted: March 13, 2022; Published: April 6, 2022

Copyright: © 2022 Mitiku et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: Bahir Dar University, College of Medicine and Health Sciences funded this research, and Getasew Mitiku received the award. The funder has no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: AIDS, Acquired Immunodeficiency Syndrome; BMW, Biomedical waste; BMWM, Biomedical waste management; HBV, Hepatitis B Virus; HCB, Hepatitis C Virus; HCWs, Health Care Workers; HIV, Human Immunodeficiency Virus; IPC, Infection Prevention and Control; NGOs, Non-Governmental Organization; PPE, Personal Protective Equipment; SOP, Standard Operating Procedure; WHO, World Health Organization

Introduction

Biomedical waste (BMW) is any waste that is generated during the diagnosis, treatment, or immunization of human beings or animals or from research activities, and contains potentially harmful microorganisms which will infect hospital communities and the general public [ 1 , 2 ].

BMW includes sharps, non-sharps, blood, body parts, chemicals, pharmaceuticals, medical devices, and radioactive materials [ 3 ]. Common sources of biomedical waste include hospitals, nursing homes, clinics, laboratories, offices of physicians, dental, and veterinarians, home health care, and funeral homes [ 4 , 5 ]. BMWs are considered because they represent the second hazardous waste globally after radiation waste [ 6 ].

Biomedical waste is a relevant problem for several countries and poses serious public health threats worldwide [ 7 ]. Nearly 3.2 million tons of biomedical waste is generated by hospitals alone annually and the Environmental Protection Agency (EPA.2019) estimates that 10% to 15% of all biomedical waste is potentially hazardous [ 8 ].

According to the World Health Organization (WHO), nearly 85% of waste generated by the hospitals is general waste and about 15% of waste is biomedical waste, composed of 10% of infectious wastes and 5% of non-infectious wastes like radioactive and chemical wastes [ 9 ]. In developing countries, especially in Africa, BMW has not received the attention it deserves [ 10 ].

Biomedical waste management (BMWM) is the process of segregation, collection, storage, treatment, transport and disposal, and other safety measures of waste in health institutions [ 11 ]. Proper BMWM includes vital steps, such as segregation, collection, storage, transportation, treatment, and final disposal, of waste generated in health care settings [ 12 ]. Improper BMWM, which includes hazardous wastes (10–25%) mixed with the non-hazardous waste (75–90%) can result in the whole bulk waste becoming potentially hazardous [ 13 ]. There are international agreements and Conventions which are particularly pertinent in BMWM, environment protection, and its sustainable development and thus they should be kept in mind by preparing waste management policies [ 14 ]. Adequate knowledge, attitude, and practice (KAP) of health care workers (HCWs) are key factors for having a successful BMWM system, as they are important preconditions to safeguard the community [ 15 ], and the environment from being contaminated with infectious substances [ 16 ].

In Ethiopia, public hospitals provide training associated with infection prevention and healthcare waste management to waste handlers, environmental professionals, and heads of departments, but there was no published evidence indicating that private hospitals provide any training associated with healthcare waste management and infection prevention for health care workers [ 17 ].

In the Ethiopian context, there was no separate regulation specific for the HCFs to enforce them for the proper management of hazardous waste. However there are three BWM guidelines prepared by the Federal Ministry of Health (FMoH), Food, Medicine and Healthcare Administration and Control Authority (FMHACA), and Federal Environmental Protection Authority (FEPA) independently which are not, updated and lacked proper compliance on their implementation[ 18 – 21 ].

COVID-19 has been reported to first begin in December 2019 [ 22 ] while the WHO announced a Global Pandemic in March 2020. COVID-19 has been rapidly spreading all over the world, forcing countries and governments to adopt strict and specific measures to contain the pandemic. According to the Federal Ministry of Health of Ethiopia, the first COVID-19 case was reported in March 2020, and measures for tackling the pandemic have been taken ever since. In this regard, proper disposal of the waste is strongly relevant, as it may lead to the spread of communicable diseases [ 23 ]. Abundant use of medical technologies in hospitals and safety measures to stop the dissemination of the COVID-19 have led to a tremendous increase in BMW generation [ 24 ]. The generation rate was reported about 9200 tons/day of PW, with a total generation of more than 3.3 million tons per year in India [ 25 ], and The total mean weight of waste generation rate in the hospital was 492.5 kg/day in Ethiopia [ 26 ]. Moreover, the waste generated in health care facilities during the treatment and laboratory tests is highly contagious and hazardous [ 23 ].

According to the WHO 2018 report, the biomedical waste generation rate in low-income countries was 0.2kg of hazardous waste per hospital bed per day [ 27 ]. However, the Biomedical waste generation rates vary across different hospitals in Ethiopia where the generation rate ranges from (0.164–1.94) kg/bed/ day, and (0.396–0.866) kg/bed day (0.92kg/bed/day and/or 0.75kg/) patient/day hazardous waste [ 28 – 31 ]. Health facilities in Ethiopia have chosen incineration to treat BMW [ 32 , 33 ], but 80% of hospital incinerators used low-temperature technology that generates air pollutants [ 34 ].

The BMW is often the source of over 30 dangerous blood-borne pathogens [ 35 ]. Worldwide, about 5.2 million people (including 4 million children) die each year due to exposure to BMW [ 36 ], The hazards of exposure to hospital waste can range from developing gastroenteritis, respiratory and skin infections, as well as more deadly diseases like Human Immunodeficiency Virus Acquired Immunodeficiency Syndrome (HIV/AIDS), and Hepatitis B (HBV); moreover, injections with contaminated syringes caused 21 million hepatitis B infections (32% of all new infections), 2 million hepatitis C (HCV) infections (40% of all new infections) and 260,000 HIV infections (5% of all new infections) [ 37 , 38 ].

In developing countries, the management of BMW is becoming a growing concern in urban areas [ 39 ]. However, Pathogens and toxic chemicals in BMW can pose serious health risks for waste collectors, patients, and health care workers. Among these risks, HIV/AIDS, HBV, and HCV can be mentioned. HIV, HCV, and HBV have the risk of transmission 0.3%, 1.8%, and 30%, respectively from one sharp injury [ 40 ].

Few studies conducted in Ethiopia indicated that lack of training, awareness, staff resistance, managerial poor commitment, lack of adequate resources, negligence, and unfavorable attitude of the healthcare staff were the main identified challenges of BMWM [ 21 , 28 , 41 , 42 ]. Therefore, assessing the practice of BWM and its associated factors among health care workers is a pivotal element to halting this burden. Accordingly, this study is planned to assess the practice of biomedical waste management and associated factors among health care workers in private hospitals of the metropolitan city of the Amhara region.

Amhara Region is found in Northwestern Ethiopia and has an estimated acreage of about 170000 square kilometers. The region borders Tigray within the North, Afar within the East, Oromiya within the South, Benishangul-Gumz within the Southwest, and also the country of Sudan to the West. The region has three metropolitan cities (Bahir Dar, Gondar, and Dessie). In line with the population size estimation of 2016, the total population was 1,937,081. (797,794 in Bahir Dar 740,859, in Gondar, and 398,428 in Dessie). In these metropolitan cities, there are eight private hospitals namely Gamby, Adinas, Afelas, Dreamcare, Ethiogeneral, Batty, Selam, and Ibex with six hundred ninety healthcare workers.

Study design and period

An institutional-based cross-sectional study was carried out from November 25 to December 25/2020.

The source and study population of the study were all health care workers who were working in private hospitals in metropolitan cities of the Amhara region (Bahir Dar, Dessie, and Gondar). The study unit was, randomly selected health care workers.

Inclusion and exclusion criteria

Health care workers in private hospitals who were employed 6 months or longer were included in the study, However, health care workers who were unable to communicate due to illness were not eligible for the study.

Sample size determination and sampling procedure

The sample size was determined using Epi-info version 7 considering (78.9%) biomedical waste management practice in Debre Markos Town Healthcare Facilities, Amhara region [ 43 ]; at 4% of the marginal error, 95% of confidence level (CL), and a 10% response rate. Therefore, the sample size was 440. Amhara Region has three metropolitan cities. All private hospitals in the metropolitan cities in the region were identified by name and included in the study. The sample size was allocated proportionally to each private hospital. Then simple random sampling was employed to select healthcare workers from each private.

Study variables

Biomedical waste management practice was our dependent variable. On the other side, socio-demographic characteristics of respondents, Healthcare facility-related factors, Knowledge of HCWs, and Attitude of HCWs were the independent variables of the study.

Data collection method and instruments

The data were collected using a self-administered questionnaire and observational checklist. The questionnaire was comprised of socio-demographic characteristics, knowledge, attitude, and healthcare facility-related factors. The questionnaire and observational checklist were first developed in English and then translated into Amharic, by English and Amharic language professionals to check its consistency. Data were collected by 5 trained clinical nurses and supervised by 3 trained BSC Environmental Health Professionals.

Quality control

The training was given to data collectors, and supervisors regarding the objective of the study, a basic skill of communication, how to conduct the self-administered questionnaire for one day. Before the actual data collection, pre-testing was conducted on 5% of the sample size at Debre Tabor Referral Hospital and the necessary correction was made based on the pre-testing findings. The completeness of the questionnaire was checked every day by the supervisors and principal investigator. These supervisors were available throughout the data collection period.

Data processing and analysis

Data were entered into Epi-data software version 4.6 and then exported to the SPSS software version 20 for analysis. Descriptive statistics were carried out to illustrate the means, standard deviations, and frequencies of the demographic profile, knowledge, attitude, and BMWM practice. Binary logistic regression analysis was made to identify variables having an association with the dependent variable. Then all independent variables with a p-value < 0.25 in the bivariable analysis were entered into multivariable logistic regressions to control the effect of confounding. Model fitness was checked using the Hosmer Lemeshow test. Finally, variables with a p-value less than 0.05 were considered as significant factors, and AOR with a 95% confidence level was used to measure the strength of association.

Ethical statement

Ethical clearance was obtained from the ethical review board of the college of medicine and health science, Bahir Dar University. Communication with different official administrators was done through a formal letter obtained from Bahir Dar University and the metropolitan cities health bureau. Before starting data collection, the participants had read the objective, benefits, and risks of the study to get informed verbal consent of participants. The right of the respondent to withdraw from the interview or not to participate was respected. To keep the confidentiality of any information provided by study participants, the data collection procedure was anonymous.

Operational definition of terms

Biomedical waste, medical waste, healthcare waste, and hospital waste are terms that have been used interchangeably [ 41 ]. However, healthcare waste has been more frequently used by published articles so far [ 44 ].

Biomedical waste management practice

The response to questions related to biomedical waste management practice was summed up and calculated the mean. The mean and above indicated good practice and the below mean indicated poor practice towards biomedical waste management practice [ 39 ].

The response of knowledge questions was summed up and a total score was computed with value and taken mean score. The mean and above indicated good knowledge and the below mean indicated poor knowledge towards biomedical waste management practice [ 43 ].

Attitude is a judgment of individual behavior as good or poor and was measured based on the 5 points Likert scale by summing the Likert questions. The mean and above indicated a good attitude and the bellow mean indicated a poor attitude towards biomedical waste management practice [ 43 ].

Health care workers

HCWs are people who are involved in the promotion, protection, and enhancement of population health. In this study, the term health care worker was standing for clinical staff and cleaners [ 43 ].

Socio-demographic and healthcare-related characteristics

A total of 431 HCWs have participated in the study and the response rate was 98%. About, 245 (56.8%) were females. The mean age of the respondents was 29 years (with SD±4.68). Regarding educational status, 256 (59.4%) were first degree, and 12 (2.8%) were certificate and bellow. More than half, (52%) of the HCWs had more than 5 years of work experience. ( Table 1 ).

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https://doi.org/10.1371/journal.pone.0266037.t001

Health care facility-related factors

Regarding training access, 201 (46.6%) of health care workers had taken BMWM training. About 388 (90%) workers were working 8 hours a day in different work environments such as 155 (36%) in OPD, 132 (30.6%) in Ward, and the rest in the laboratory, emergency, pharmacy, and others. In the working environment, only 223 (51.7%) of them had three bins for waste segregation. ( Table 2 )

https://doi.org/10.1371/journal.pone.0266037.t002

As stated in Fig 1 below, among the studied participants, 178 (41.3%), 63 (14.6%)), and 58 (13.2%) were nurses, doctors, and cleaners respectively ( Fig 1 ).

https://doi.org/10.1371/journal.pone.0266037.g001

Knowledge of health care workers

From the total health care workers, 290 (67.3%) HCWs knew the benefit of BMWM. About 269(62.4%), and 283(65.7%) were aware that infectious and general wastes, should be placed in yellow, and black, respectively. Besides, 233(54.1%) were aware of a safety box should be filled a maximum of 3/4 th . 168 (39%) health care workers knew the maximum storage time (48 hours) limit of infectious wastes before treatment or disposal. Based on the summary of knowledge questions the mean score of HCW’s knowledge in biomedical waste management was 7.96 with SD±1.50 on a range of 1 to 13 questions. More than half, (62.4%) of Health care workers had good knowledge about biomedical waste management ( Table 3 ).

https://doi.org/10.1371/journal.pone.0266037.t003

The attitude of health care workers

Among all Health care workers, 174 (40.4%) strongly agreed with the statement proper biomedical waste disposal is important and 167 (34.7%) health care workers strongly agreed with the statement BMWs should be segregated into different categories. Based on the summary of Attitude questions, the mean score of HCWs’ Attitude in biomedical waste management was 53.68 with SD±8.753 on a range of 1to 14 questions. More than half (53.4%) of Health care workers had a good attitude about biomedical waste management ( Table 4 ).

https://doi.org/10.1371/journal.pone.0266037.t004

The practice of Health care workers

This study revealed that 98 (22.7%) health care workers encountered sharp injury at their health care service delivery. Regarding PPE, 337 (78.2%) and 332 (77.0%) of HCWs always used gloves and gowns while handling or working with BMWs respectively. Based on the summary of practice questions, the mean score of HCWs practice in this study was 6.77with SD ±1.42 on a range of 1 to 12 questions. Less than half (49.4%) of health care workers had a good practice of biomedical waste management with (95% CI: 44.6%, 54.2%) ( Table 5 ).

https://doi.org/10.1371/journal.pone.0266037.t005

Among the studied participants, HCWs who had high scores of biomedical waste management practice 66% and 60.7% were medical doctors and nurses respectively. whereas HCWs who had list scores of BMWM practice 17.5% and 5.9% were cleaners and radiographers respectively ( Fig 2 ).

https://doi.org/10.1371/journal.pone.0266037.g002

Observation result

In the selected private hospital of each metropolitan city, observation was done at seven working departments such as OPDs, wards, laboratory, emergency, maternity, minor OR, pharmacy, and X-ray rooms of health care workers. Regarding the working department, more than half (62.5%) of departments had visual aid of biomedical waste containers. Gloves were available for each patient care cleaning device in all departments, except outpatient pharmacy departments. Three color-coding bins and leveled bins were available in Laboratory, Emergency, Maternity, and Minor OR departments, but not in other departments. The autoclave was available in some departments (maternity, Laboratory, and minor OR) but not in other departments rather it was available as a health care facility level in one fixed area. Personal protective equipment like heavy-duty gloves, aprons, and boots was available in maternity, emergency, laboratory, and minor OR rooms but not in others.

Regarding health care facilities, 37.5% of them had onsite storage rooms of biomedical wastes. The infection prevention and control committee was available only in two of them. All private hospitals had an incinerator, but it was not fenced (except one general hospital). Infection prevention and control guidelines were available in some hospitals’ infection prevention offices rather than in each working department. A placenta pit was available in all private hospitals.

Factors associated with biomedical waste management practice

In the bi-variable binary logistic regression analysis; age, attitude, knowledge of HCWs, level of education, training, availability of three bins, information about biomedical waste, information about biomedical waste management, and work experience were factors associated with biomedical waste management practice.

To start with the findings of socio-demographic factor, the odds of good biomedical waste management practice was found to increase by more than 4 times among health care workers who hold MSc and above the level of education when compared with a diploma and below [AOR = 4.20, 95% CI: (1.01, 17.40)].

Health care workers who took training on biomedical waste management had an association with biomedical waste management practice. Health care workers who took training [AOR = 4.33, 95% CI: (2.71, 6.93)] were 4.3 times more likely to practice good biomedical waste management than their counterparts.

The availability of three bins (black bin, yellow bin, and safety box) in the working department was associated with good biomedical waste management practice. Availability of three bins in the working department [AOR = 6.24. 95% CI (3.84, 10.13)] was 6.2 times more likely to practice good biomedical waste management than not the availability of three bins.

Health care workers who had a good attitude [(AOR = 2.64, 95% CI: (1.65, 4.22] were 2.6 times more likely to practice good biomedical waste management than those who had a poor attitude ( Table 6 ).

https://doi.org/10.1371/journal.pone.0266037.t006

In this study, 213 (49.4%) health care workers had a good practice of BMWM with (95% CI: 44.6%, 54.2%). This finding is in line with the finding of two previous studies done in South Africa and Biyem- Assi District Hospital in Yaoundé, which reported 53.9% and 50% respectively [ 45 , 46 ]. However, the finding of this study is found to be higher than the findings of three studies done in Rwanda, Jigjiga, and Gondar town, which reported 33.5%, 42.3%, and 31.5 of good practices respectively. [ 39 , 47 , 48 ]. This disagreement might be partly explained by a difference in health facility setup., since the above-mentioned studies (Jigjiga and Gondar) had a mixing of hospitals and health centers and the other study (in Rwanda) had only one district hospital. But the current study included only general hospitals. So, hospitals might have good practice of BMWM due to the presence of health care workers who had a high level of education than the health centers. But, the finding of this study is found to be lower than the finding of other previous studies done at Debre Markos Town in Ethiopia, in a tertiary hospital in Puducherry (Southern India) and Mahatma Gandhi Government Hospital of India, which reported 78.9%, 69.3%, and 54.7% were found respectively [ 43 , 49 , 50 ]. The low level of practice shown in this study might be due to the more availability of 3 bins in 81.4% of health care workers in their working department at Debre Markos Town than the current studied health care workers (51.7%) and cultural differences of Indian health care setup and this local area.

In the present study, there was a significant association between the level of education and biomedical waste management practices. Health care workers who held MSc and above education level were 4.20 times more likely to practice good biomedical waste management than those who were diploma and below and health care workers who were degree level of education also were 3.52 times more likely to practice good biomedical waste management than those who were diploma and below. This finding was similar to the finding of a study done in the Capital city of Uganda [ 51 ]. This indicates that educational status development helps to improve the practice of health care workers on biomedical waste management [ 52 ].

The other finding worth highlighting is related to training, a significant association between taking training and biomedical waste management practice was found. Health care workers who took training on BMWM had 4.33 times more likely to practice good biomedical waste management than those who didn’t take the training. This finding was in agreement with the previous studies conducted in Gondar town, Ethiopia, and the capital city of Uganda [ 48 , 51 ]. It is due to getting waste management training of all those who are responsible for handling wastes is important to improve BMWM [ 53 , 54 ].

Availability of color-coded three bins was significantly associated with biomedical waste management practice. Health care workers who had three bins in their working department were 6.24 times more likely to practice biomedical waste management than those who had no three bins. The finding was supported by the previous study done in Debre Markos town, Ethiopia [ 43 ]. This is due to the availability of three bins that make waste segregation being simple and safe to separate hazardous wastes from non-hazardous general wastes [ 55 ].

The attitude of health care workers was significantly associated with biomedical waste management practice. Health care workers who had a good attitude toward BMWM had 2.64 times more likely to practice good biomedical waste management than those who had a poor attitude toward BMWM. This finding was supported by the studies done in Biyem- Assi District Hospital in Yaoundé (Cameroon) and Agartala, Tripura (North-eastern India) [ 45 , 56 ]. The possible explanation might be due to a good attitude of health care workers helps to practice good biomedical waste management; because the level of attitude was one of the factors, which affect practice as seen in other studies. The study was conducted in all metropolitan cities’ private hospitals of the Amhara region, which covered all private hospitals in three cities. But there may be socially desirable bias for the practice of BMWM during data collection time. In this study, the quantification of the generation rate of biomedical wastes should have been measured.

Biomedical waste management practice was low among health care workers which is a risk of COVID 19 pandemic transmission. The level of education, taking training on BMWM, availability of three bins, and attitude of health care workers was found to have a significant association with biomedical waste management practice. Therefore, it was determined that it is better to provide in-service training programs on biomedical waste management and upgrade their educational level for health care professionals by regional health bureau and city administration health departments, as well as it is recommended to implement a three-bin system in the hospitals. Finally, all private hospitals should acknowledge the health care workers who practiced good biomedical waste management.

Although the study was conducted in private hospitals, the health tier system in Ethiopia both for private and public Hospitals is similar except for the ownership. Therefore, the finding can apply to other similar public hospitals within and across regions as well as in the least and middle-income countries.

Supporting information

S1 file. data collection tool english version..

https://doi.org/10.1371/journal.pone.0266037.s001

S2 File. Data collection tool Amharic version.

https://doi.org/10.1371/journal.pone.0266037.s002

S3 File. Data.

https://doi.org/10.1371/journal.pone.0266037.s003

Acknowledgments

We acknowledge data collectors and supervisors for their contribution to the overall success of this study and all respondents for their cooperation, time, and genuine response. Our great thanks go to Dr.Mesafint Molla and Francesco Giulietti for their support in editing the language of the manuscript.

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• DOI: 10.31031/SBB.2018.01.000522
• Corpus ID: 134379402

A Review on Biomedical Waste and its Management

• P. Sharma , A. Sharma , +1 author Somani Ps
• Published in Significances of… 6 June 2018
• Environmental Science, Medicine

15 References

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Biomedical Waste Management: A Questionnaire Study on Assessment of Knowledge, Attitude and Practices Among Health Care Professionals in Orange City Hospital Research Institute, Nagpur

2020, Journal of Biomedical and Pharmaceutical Research

Health care waste is a unique category of waste by the source of generation, the quality of its composition, its hazardous nature and the need for appropriate protection during handling, treatment and disposal. Little knowledge and inappropriate technique of handling of biomedical waste can lead to serious consequences on health of the individual handling the bio-medical waste, the community and environment. Biomedical waste management begins with sequential efforts from the early stage of waste generation, segregation at the source itself, storage at the site, disinfection and transfer to the terminal disposal site safely. A questionnaire study was conducted in a tertiary care hospital in Nagpur, India to assess the current knowledge, attitude and practices regarding Bio-medical waste management

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Background: Bio-medical waste is defined as any waste that is generated during the diagnosis, intervention, treatment, immunisation and research activities. Hospital waste refers to all waste generated in hospitals whether biological or non-biological. As per World Health Organization (WHO) fact sheet, total of waste generated by health care activities 20% are hazardous among them 18%–64% of waste from health care facilities have unsatisfactory management as per protocol because of improper segregation and gaps in knowledge and practice. To assess the level of knowledge, attitude and practices regarding management of bio-medical waste among medical personnel.Methods: A hospital based descriptive study was done over the period of one year (April 2019 to March 2020). On the basis of the eligibility criteria total 500 medical and paramedical personal were finally got enrolled. Pre-designed, pre-tested, structured questionnaires were used.Results: The majorities of participants were mal...

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Arun Adhikari

Lack of adequate knowledge regarding bio-medical waste management leads to health risks as well as environment apprehension. Proper handling and disposal of bio-medical waste is therefore very important. The waste produced in the course of healthcare activities carries a higher potential for infection and injury than any other type of waste. Inadequate and inappropriate knowledge of handling of healthcare waste may have serious health consequences and a significant impact on the environment as well. The present study aimed to assess the knowledge and practice of bio-medical waste management among the health care personnel in TU teaching hospital in kathmandu.

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Background: Bio medical waste collection and proper disposal has become a significant concern for both the medical and general community. Objective: To know the awareness and practice of biomedical waste management (BMW) among health care personnel working at a tertiary care centre. Methods: The study was conducted from January 2013 to June 2013. It was a descriptive observational hospital based cross sectional study. Study participants included the resident and intern doctors, nursing staff, laboratory technicians, sanitary staff (ward boys, aaya and sweepers) working in the P D U Government Medical College and Civil Hospital, Rajkot who are dealing with BMW. The study was conducted by using pretested, semi-structured pro forma. Results: Total 282 health care personnel participated, including 123 resident and intern doctors, 92 nursing personnel, 13 laboratory technicians and 54 sanitary staff. Only 44.3% study participants received training for bio medical waste management. Except...

Euro Asia International Journals

The waste produced in the course of healthcare activities carries a higher potential for the spreading of infection and injury, unawareness and inadequate knowledge of handling of health care waste can cause serious health consequences and a significant impact on the environment as well. The purpose of study was to assess the knowledge, attitude and practices of doctors, nurses and sanitary staff regarding biomedical waste management in the health care establishments. The study was conducted among hospitals of Srinagar city. Medical personnel included were doctors, nurses and sanitary staff. Doctors and nurses have better knowledge than sanitary staff regarding biomedical waste management.knowledege regarding the color coding and waste segregation at source was found very poor among sanitary staffs who were deeply involved in the process of collection and segregation of biomedical waste .The importance of training regarding biomedical waste management needs emphasis.

Scholar Science Journals

Introduction: Hospitals are the centers of cure and also of infectious waste generation. Improper waste management can be a threat to public health and environment. Staff that provide healthcare ought to be aware of the proper handling and the system of management. Aim: The aim of the study was to determine knowledge, attitude and practices towards BioMedical Waste (BMW) management among health care professionals, private practitioners and post graduate students in Davangere, Karnataka. Method: A cross-sectional study was conducted using a questionnaire with closed-ended questions. It was distributed to 458 health care workers including dental and medical post graduates, staff and private practioners. The questionnaire was used to assess their knowledge of biomedical waste disposal. The results were expressed as a number and percentage of respondents for each question. Descriptive tests and Chi square tests were used to perform the statistical analysis. Results: Around 540 questionnaires were distributed of which 458 were returned and analyzed. It was seen that though 91.70% of the participants were aware of the BMW generation and legislation however over 60% still unaware regarding the correct color were coding system. About 13.6% of participants were not vaccinated for HBV infection and only 65.9% of the study subjects were correctly able to identify the symbol for biohazard. Conclusion: It can be concluded from the present study that proper training and education regarding the BMW management is a must and needs to start at a much earlier level during the graduation of the healthcare workers so that it can be put into practice at the earliest.

National Journal of Community Medicine

Background: Every concerned health personnel are expected to have proper knowledge, practice and capacity to guide others for waste collection and management. Objectives: Objectives of this study was to assess the knowledge, attitude and practice regarding biomedical waste management among healthcare personnel. Materials and Methods: It was a cross-sectional study involving healthcare personnel of various PHCs & CHCs of the district. All the participants were interviewed personally by Predesigned and pretested questionnaire about various aspect of biomedical waste management. Results: Out of the total 167 participants, 94.01% of healthcare person were aware about colour code system of waste segregation but only 64.07% knows that they are responsible for waste segregation. It was found that 95.80% healthcare personnel like to attain training and 92.81% of them believe that there should be legal provision for safe waste management. However, only 58.08% of them were practice of waste segregation into proper colour code bag and with using protective device. Conclusion: knowledge and practice of various aspects of biomedical waste management are lacking in considerable amount in health personal and there is urgent need for regular on job training and enforcement of biomedical waste management rules at these levels.

IP Innovative Publication Pvt. Ltd.

IP Innovative Publication Pvt. Ltd. , Savita Mahajan

Introduction: Biomedical waste has a higher potential for infections and injuries. With an endeavor to reduce health problems, it is essential to have safe and reliable method of segregation and disposal of hospital waste. With this background the present study was conducted to assess the knowledge, attitude and practice of biomedical waste management among health care personal in Dr. Rajendra Prasad Government Medical College (DRPGMC) Tanda, Himachal Pradesh. Materials and Methods: A cross sectional questionnaire based survey containing 30 questions to assess the knowledge, attitude and practices on biomedical waste management. Results: The mean knowledge, attitude score were higher as compared to practices. Significant differences exist in relation to educational qualification of respondent in knowledge and practice score. Conclusion: The present study revealed that knowledge and attitude regarding biomedical waste management among health personal and students of the institute was higher as compare to practice. Keywords: Biomedical waste management.

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Assessment of knowledge, practice and attitude about biomedical waste management among healthcare professionals during covid-19 crises in al-ahsa.

1. Introduction

2. materials and methods, 2.1. study design, 2.2. study area and setting, 2.3. sample size and sampling method, 2.4. inclusion criteria, 2.5. data collection tool and procedure, 2.5.1. demographic information, 2.5.2. knowledge questionnaire, 2.5.3. practice questionnaire, 2.5.4. attitude scale, 2.6. ethical considerations, 2.7. statistical analysis, 3.1. demographic characteristics of the hcp, 3.2. knowledge level of the hcps on bmw management, 3.3. practice of hcps in bmw management, 3.4. attitude of the hcps towards bmw management, 3.5. association of the knowledge of hcps on bmw management with demographic variables, 4. discussion, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest, abbreviations.

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Jalal, S.M.; Akhter, F.; Abdelhafez, A.I.; Alrajeh, A.M. Assessment of Knowledge, Practice and Attitude about Biomedical Waste Management among Healthcare Professionals during COVID-19 Crises in Al-Ahsa. Healthcare 2021 , 9 , 747. https://doi.org/10.3390/healthcare9060747

Jalal SM, Akhter F, Abdelhafez AI, Alrajeh AM. Assessment of Knowledge, Practice and Attitude about Biomedical Waste Management among Healthcare Professionals during COVID-19 Crises in Al-Ahsa. Healthcare . 2021; 9(6):747. https://doi.org/10.3390/healthcare9060747

Jalal, Sahbanathul Missiriya, Fahima Akhter, Amal Ismael Abdelhafez, and Ahmed Mansour Alrajeh. 2021. "Assessment of Knowledge, Practice and Attitude about Biomedical Waste Management among Healthcare Professionals during COVID-19 Crises in Al-Ahsa" Healthcare 9, no. 6: 747. https://doi.org/10.3390/healthcare9060747

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