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Table of Content Volume 16 Issue 2 - November 2020
Study of ‘biomedical waste management’ with reference to knowledge, attitude and practices among healthcare workers in a multispecialty teaching hospital
P A Anchawale1*, A K Awari2
1Assistant Professor, 2Professor & HOD, Department of Microbiology, Dr. Vitthalrao Vikhe Patil Foundation’s Medical College And Hospital Ahmednagar, Maharashtra, INDIA. Email: anchawaleprachi@gmail.com
Abstract Background: Biomedical waste requires specific treatment and management prior to its final disposal. Management of healthcare waste is an integral part of infection control and hygiene programs in healthcare settings. Improper management of biomedical or hospital generated waste and exposure to such waste poses a significant threat to the patients and personnel who handle them as well as adverse environmental impact. The aim of the study was to assess the knowledge, attitude and practice (KAP) of health care personnel in D. V. V. P. F’s medical college and hospital, Ahmednagar regarding Biomedical Waste Management (BMW). Materials and Methods: This hospital based cross-sectional study, conducted from November 2019 to February 2020. The study consisted of 250 Health Care Workers as participants, which included 50 resident doctors, 175 nursing staff and 25 laboratory technicians. The data was collected using a predesigned, semi structured questionnaire containing questions on KAP regarding bio-medical waste management. Results: Awareness regarding legislation and disposal of BMW as per color coded bags was found in 99% and 96% of the participants respectively. Only 92% of the respondents knew that BMW should not be stored beyond 48 hours and 97% participants are agreed that waste management is a team work. Proportion of resident doctors, nurses and laboratory technicians immunized for Hep. B Vaccine was 96%, 96%, 88% respectively. 98.4% of the participants are using personal protective equipment’s while working and 98% are practicing segregation of waste at place of it’s generation. Conclusions: Knowledge regarding biomedical waste management among doctors is satisfactory as compared to other health care workers. It is imperative that waste should be segregated and disposed of in a safe manner to protect the environment as well as human health. Regular monitoring and training are required at all levels. Key Words: Biomedical waste, Health care personnel, Knowledge, Attitude and Practices
INTRODUCTION Healthcare activities like medical treatments, diagnostic tests, immunization, and laboratory examinations restore health and save lives. At the same time health services may generate large quantity of wastes and by products that need to be handled safely and disposed of properly1 Bio Medical Waste (BMW) is defined as any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining there to or in the production or testing of biological, and including categories mentioned in Schedule I of BMW Rules of 1998.2,3 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 BMW may have serious health consequences and a significant impact on the environment as well.4 All healthcare workers (HCWs) involved in dealing with BMW shoulder the responsibility of its proper segregation and disposal.5 In spite of increased awareness among health care providers about such hazards and also having its proper management techniques, still the level of awareness about BMW in India has been found to be unsatisfactory.6 Therefore, the present study was conducted to assess the level of knowledge, attitude and practice among HCWs in our hospital regarding Biomedical Waste Management (BMWM). Aims and objectives:
MATERIALS AND METHODS This hospital based cross sectional study was carried out from November 2019 to February 2020 in Dr. Vitthalarao Vikhe Patil Foundation’s Medical college and Hospital, Ahmednagar, Maharashtra. This study was approved by the ethical committee of the institute. A total of 250 health care providers working in the hospital were included as a study participants after a random selection which consisted of 50 resident doctors, 25 technicians working in laboratory and 175 nursing staff. Health care workers were interviewed using a predesigned questionnaire after obtaining their written consent. While HCWs who didn’t give the consent or who are working in the hospital for less than three months were excluded from the study. These questions are grouped under three headings:
RESULTS The data presented in table 1 depicts ‘Knowledge regarding various aspects of Bio Medical Waste Management’. It shows that 100% resident doctors, 99% nurses and 96% of technicians were aware about hazardous effect of BMW on health care personnel’s and 97% HCWs were knowing about risk to environment through BMW . The data also shows that awareness regarding legislation related to the BMW was found to be 99% and was found highest among resident doctors and technicians (i.e.100%) as compared to nurses i.e. 99%. Only 92% of the participants knew that the bio medical waste should not be stored beyond 48 hours as per Biomedical Waste (Management and Handling) Rules, 1998, which was found to be lowest among technicians. We found significant difference (0.02) between the answers given by HCWs for the question Correct statement describing one type of BMW’. The findings of ‘Attitude of health care workers towards biomedical waste management’ are given in table 2. It brings out that 98% of HCWs agrees with the fact that, It is important to know about BMW generation, hazards and legislation while 4% of the resident doctors and 12% of the technical staff disagree with the fact that BMW management is a team work. 43 (17%) of the respondents felt that safe management of bio medical waste increase the financial burden on hospital, which included12 (24% )of resident doctors,24(14%) of nurses and 7 (28%) of technicians. Majority of the respondents ( i.e., 100%, 97%,100% of resident doctors, nurses and technicians respectively) felt that infectious waste should be sterilized by autoclaving before shredding and disposal. Graph depicts the ‘Practice of health care personnel regarding BMW’. It shows that 92% of resident doctors, 98% of nurses and 92% of the technicians had undergone training regarding BMWM and 95% of the staff is vaccinated for Hepatitis B. Total 98.4% of the staff is using personal protective equipments while working and similar percentage of the staff( i.e. 98%) is practicing segregation of waste at place of generation. We found significant difference between the practices followed by HCWs in:
Table 1: Knowledge regarding various aspects of Bio Medical Waste Management
Table 2: Attitude towards Bio Medical Waste Management
Table 3: Practices regarding BMW management among participants
Figure 1:
DISCUSSION The success of a study based on questionnaire essentially depends on the manner in which the questions are formatted, their content, the analysis and the response rate. In order to avoid any recall bias, most of the questions were of closed-end type7. Such questions are easy to analyze and may achieve a quicker response from participants. A further advantage for this study was that all the participants were based at the same workplace, so all were following similar guidelines from a waste management protocol. This study was done to evaluate the Knowledge, Attitude and Practice regarding BMW management among HCWs who are working in Dr. Vitthalarao Vikhe Patil Foundation’s Medical college and Hospital, Ahmednagar, Maharashtra. In the current study the resident doctors overall, had the best knowledge as compared to the other groups regarding the various aspects of BMW management [Tables 1]. The correct respondents in the resident doctors on the various BMW management elements, that is, hazards caused by improper disposal, individuals at risk, etc., ranged from 92% to 100% which is similar to study conducted by Pinto, et al. i.e. 57.7 to 96.2% while in the study by Saini et al..,8 reported that 85% specialists had knowledge of the BMW management rules. In the study conducted by Yadavannavar et al.,9 the teaching staff gave more correct responses (97.4%) to questions on BMW management as compared to the nonteaching staff (80%). In our study, correct responses with regards to BMW color coding scheme were given by 94% resident doctors and 98% nursing staff and 92% technicians, and 95%, 93% and 96% resident doctors, nursing staff and technicians respectively had correct knowledge about disposal of various BMW [Table 1] Where as study conducted by Pinto et al. observed that correct responses with regards to BMW categories were given by 26.3% resident doctors and 26.2% interns1. While 49.1% residents, and 31.2% interns had correct knowledge about color coding . Whereas in the study carried out by Basu et al..,10 the awareness of the junior doctors about waste categories and color coding bags was 55.9 and 76.4%, respectively. Pandit et al. in their study observed that not a single doctor knew about the various categories of BMW.11. The resident doctors had more knowledge of the theoretical aspects (individuals at risk, waste disposal method etc.) of BMW management as compared to the nursing group and technicians, which could be attributed to the fact that they are taught this topic in their undergraduate microbiology curriculum. A higher percentage in the nursing group correctly matched biomedical waste categories with appropriate color-coded bags and identified the disposal methods per category as compared to the medical interns and resident doctors [Table 1]. The nursing students probably had more knowledge of the practical aspects as they frequently worked in the wards. The ‘Attitude of all health care provider towards BMW management’ was positive and favorable in the present study. As approximately 97% of the participants felt that BMW management requires a team work and no single member is responsible, which is similar to the study conducted by Pavan p et al.12. While in a study conducted by Sharma et al., it was found in 65% of workers.6 Sehgal et al.13 and Pavan P et al.12 in their study noted that 18.3% and 25% of the respondents respectively felt that BMW management efforts increase the financial burden on management, these was consistent with our study (17%). Regarding the ‘Practice related to BMW management’, we found 98% of the health care providers practicing segregation of BMW as per different color coded bags, which is nearly similar to the findings of study done by Basu and Radha et al. In our study we found 96 % of doctors, 96% of nurses and 88% technicians were vaccinated for Hepatitis B which is similar to the findings observed by Bhagawati et al. where 100% doctors, 90% nurses and 100% technicians were vaccinated for Hepatitis B
CONCLUSION AND RECOMMENDATIONS The study findings conclude that there is a good knowledge and positive attitude towards the biomedical waste management among the majority of staff members specifically in the resident doctors as compared to nurses and laboratory technicians. It also shows a minor gap between the knowledge and practice in respect to health care waste management. Following recommendations are proposed: (i) Strict implementation of biomedical waste management rules is the need of the hour, (ii) It should be made compulsory for healthcare facilities to get their healthcare personnel trained from accredited training centers. These training sessions should be a continuous process depending upon the patient input in different healthcare facilities.
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