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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 106-110

Assessment of knowledge, attitude and practices regarding awareness of biomedical waste management among health care professionals in a tertiary care center in Patna: A cross sectional survey


Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Date of Submission28-Oct-2020
Date of Decision28-May-2021
Date of Acceptance02-Aug-2021
Date of Web Publication17-Aug-2021

Correspondence Address:
Richa Sinha
Indira Gandhi Institute of Medical Sciences, Patna - 800 014, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jigims.jigims_3_20

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  Abstract 


Background and Objectives: Effective management of biomedical waste (BMW) is of paramount importance to avoid health hazards to care providers. The present study aimed to assess the knowledge, attitude, and practice of bio-medical waste management among the health care workers (HCWs) at a tertiary care center in North India.
Materials and Methods: We conducted a questionnaire-based cross-sectional survey with closed-ended questions between June 2019 and October 2019.
Results: Among 306 participants, 35% (107) were doctors, 52% (159) were nursing staff, 10% (31), and 3.26% (10) were laboratory technicians and cleaning staff, respectively. While >95% of doctors and nursing staff were aware of the BMW management, biohazard risks, categorization of waste, and personal protective measures, 55% of cleaning staff had not even heard about it. Less than half of the sanitation workers who segregate and transport the BMW were aware about the disinfection process (33%), transmission of HIV (44%), and permanent disposal of BMW (33%).
Conclusion: Disparity in awareness about BMW management exists among HCWs. The sanitation staffs who handle the maximum amount of BMW are the most ignorant. Frequent surveillance and focused teaching sessions may help to improve the knowledge of HCWs and inculcate healthy practice.

Keywords: Awareness, biomedical waste manage ment, environment, hazard, health care worker


How to cite this article:
Kumar R, Sinha R. Assessment of knowledge, attitude and practices regarding awareness of biomedical waste management among health care professionals in a tertiary care center in Patna: A cross sectional survey. J Indira Gandhi Inst Med Sci 2021;7:106-10

How to cite this URL:
Kumar R, Sinha R. Assessment of knowledge, attitude and practices regarding awareness of biomedical waste management among health care professionals in a tertiary care center in Patna: A cross sectional survey. J Indira Gandhi Inst Med Sci [serial online] 2021 [cited 2022 Aug 10];7:106-10. Available from: http://www.jigims.co.in/text.asp?2021/7/2/106/331745




  Introduction Top


The BMW is defined as any waste generated during the evaluation, management, or immunization of human beings/animals. It also includes wastes pertaining to research and production or testing of biologicals and including categories” {according to BMW (management and handling) rules, 1998}.

Improvement in health care facilities has resulted in the continuous generation of a large amount of biomedical waste (BMW). It is a major area of concern due to the recent trend of using plastic disposables and increase in medical and surgical interventions. The BMW has high potential for infection spread and is broadly categorized as general and hazardous waste. Of total generated waste, only 15%–20% is considered to be hazardous.[1] According to a study which involved 22 developing countries, it was observed that 18%–64% of health care facilities do not use proper waste disposal methods.[2]

According to the WHO, 0.5–2.0 kg of BMW is generated per hospital bed per year. This amounts to approximately 0.33 million tons of waste generated annually in India alone.[3] It includes syringes, needles, ampules, dressing materials, disposal plastics, microbiological waste, anatomical waste, glass slides, and blood bags. Managing such a massive and diverse burden of potentially hazardous eviscerate efficiently is a big challenge.[1] This prompted the Indian government to pass a law in 1998 called “BMW Management Rules”. It states that it shall be the duty of an institution generating BMW to take all steps to ensure that such waste is being handled without causing any adverse effect to human health and environment. Although the rules regarding BMW generation and handling have been clearly laid down, implementation in day-to-day practice is a prime issue. The hurdles that need to be addressed include:

  1. Lack of awareness about BMW
  2. Lack of the right attitude needed to handle BMW
  3. Logistic issues
  4. Lack of infrastructure.


Improper waste practice is attributed to a lack of awareness and training.

This study was conducted to assess the knowledge, attitude, and practices of BMW management among different tiers of healthcare providers.

Aim and objective

The aim of this study was:

To determine the awareness and practices regarding BMW management among the health care professionals working in a tertiary care center.

We intended to evaluate the following aspects:

  • The ways of dealing with the generated BMW
  • Their (health care providers) knowledge about BMW management and the risk imposed by improper handling.


As our center is in the heart of a metropolitan city, proper disposal of the waste becomes very important. The purpose of the study was also to sensitize or increase the awareness among the health care workers (HCWs) regarding the proper handling and disposal of BMW.


  Materials and Methods Top


Place of study

The study was conducted at a tertiary care center in the city of Patna, a metropolitan city in North India. It is 850 bedded multidisciplinary hospital with a team of more than 200 doctors and is one of the fastest-growing institutes.

Study period

This cross-sectional survey was carried out from June 2019 to October 2019.

Sample size

A total of 306 health care professionals working in a tertiary hospital, Patna were enrolled in the study. (Senior Residents (SRs), Junior Residents (JRs), Nursing Staff, Nursing Officers, lab Technician, Postgraduates (PG), cleaning staff).

Before the start of this survey, institutional ethical committee clearance was obtained (Ref ID– 2019-09495). No objection certificate was obtained from the medical superintendent of the institute to carry out the study within hospital premises. The cross-sectional survey included questionnaire with closed-ended questions. The data were collected by personally visiting the hospital and meeting the nursing staff, junior residents, lab technicians, and other health care providers working in the hospital. They were explained regarding the aims and objectives of the survey. They were enrolled by their willingness to participate in this study. Questionnaire consisting of 16 questions, each related to BMW management, was provided to the participants after taking written consent, and confidentiality was maintained for each. The response of the individuals and their personal information was evaluated and represented in appropriate graphs.


  Observation and Results Top


Among 306 participants who participated in the survey, 125 were males.

The mean age of the participants was 31.3 years (Range 20-56 years) [Figure 1].
Figure 1: Age distribution of participants

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All the participants were working at IGIMS and were engaged either in generation and handling or in the treatment of the BMW [Table 1].
Table 1: Respondent's profile

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It is evident from [Figure 2] that most of the participants (n = 260, 85%) had work exposure of <5 years, whereas only 23 (7.5%) had an exposure of >10 years.
Figure 2: Work experience of participants (years)

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According to our survey, all the doctors (JRs, SRs, and PGs) and laboratory technicians were aware about BMW, while majority of the cleaning staff (n = 5, 55.55%) had not even heard about it. It was observed that there is a lack of awareness about BMW Act among few nursing staff (n = 11, 6.92%), lab technicians (n = 6, 19.35%), and cleaning staff (n = 6, 66.66%). Lack of knowledge about the biohazard symbols was documented among 9.44% (n = 15) of nursing staff and 55.55% (n = 5) of cleaning staff. Most of the participants were well aware about the categories of BMW and color coding. Only 10% (n = 16) of nursing staff claimed that they lacked equipment as per color-coding for segregation of waste in their workplace. It was disheartening to note that the majority of cleaning staff were unaware of the transmission of deadly infectious diseases while handling BMW. Fifty percent of the cleaning staff were unaware about needle-stick injury and infections transmitted through it [Table 2].
Table 2: Number of correct responses for questions on knowledge regarding biomedical waste

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Residents and postgraduates (doctors) were well aware of their responsibility towards the management of BMW, its safe disposal and the use of personal protective measures. Most of the cleaning staffs (44%–55%) followed by lab technicians (10%–20%) and few nursing staffs (~5%) were found to be ignorant of the above responsibilities toward self [Table 3].
Table 3: Number of positive responses for questions on Attitude regarding biomedical waste

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Majority of doctors and nurses (80%–90%) were found to be well oriented regarding the practices (following color coding, disposal of sharps, and disinfection of BMW) of safe hospital waste handling [Table 4]. Around 87% (n = 27) of the laboratory technicians knew about disinfection of the wastes before its disposal and 90% (n = 28) were aware about the disposal technique of needles. However, a gross lack of knowledge and awareness was documented among the cleaning staff regarding disinfection and needle disposals. Around 80% (n = 7) of them were unaware of the safe practices. Most of the cleaning staff were not provided with appropriate personal protective equipment. At many places in the hospital area, strict segregation of wastes were not being practiced. Though the hospital staff knew about the concept of color coding, it did not reflect in the practice as the waste materials in the coded bins were often being mixed mainly in outpatient department and laboratory areas.
Table 4: Responses for questions on practice regarding biomedical waste

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  Discussion Top


Overall, 98% (n = 300) of the HCW knew about BMW and its rules, which reflects good level of awareness among the hospital staffs. During the survey, it was evident that the cleaning staff, who are involved in the process of collection and disposal of BMW waste and at the maximum risk of getting infected were the most ignorant. Similar findings were reported in various studies.[4],[5],[6] Doctors and nursing staffs on the other hand were well aware of the generation, categorization, color coding, and disposal of BMW. alike the report by Narang et al.[7] Positive attitude for safe handling and disposal of BMW was observed among majority (~95%) of HCWs comparable to the findings of Soyam et al. and Shafee et al.[8],[9] In the present study, it was found that segregation of the BMW at the point of generation and disposal in appropriate colour-coded bags was seldom practiced despite the knowledge of color coding and safe disposal among the HCWs in contrast to the report of Chudasama et al.[10] According to BMW rules, the individual involved in segregation, transport and treatment of such waste must use specialized gloves and cover their entire body.[11] They must wear special shoes when at work to prevent them from getting injured or infected. In our study, it was noted that the cleaning staff were not provided with gumboots and other necessary logistics. They used simple gloves and regular shoes. This practice is unsafe and dangerous for them as well as society. Few nursing staffs though have good knowledge about the BMW management could not practice the same in their wards. They were not provided with color-coded bins. Management of logistics should be prompt in this regard. Hospital administration should take care of avoidable injuries and should conduct regular surveillance to assess the compliance on the part of health care providers as well.

Nearly 25% of HCWs including doctors were unaware about the maximum duration (48 h) for which such wastes can be kept in the hospital premises. Keeping the BMW for prolonged time increases the risk of infection among the HCWs.[12] Hospitals and institutes in Delhi and other cities run regular teaching programs on BMW management. They have made it imperative for all the new recruits to attend the course after appointment.[13] Our institute has a separate bio-waste department to look after the disposal of BMW and it is taking good care of the activities, but regular assessment and analysis is the need of the hour. It is very important to inculcate the habit of segregation at the site of the generation of BMW to decrease the chances of infections and health hazards related to it.


  Conclusion Top


From the survey conducted at our institute, it can be concluded that the awareness about BMW among healthcare professionals is good but for the cleaning staff. There should be a continuous training program at regular intervals to impart complete knowledge about BMW management among all the health care providers, as this cannot be implemented without their cooperation.

Summary

The rules for BMW were formulated in India in 1998 and it is almost 21 years now. Since then, there have been various amendments to fix the loopholes. According to various surveys conducted across the country, the standards of BMW management in developing countries like India remain a major area of concern.[14] BMW management system (collection, segregation, and disposal) and its daily surveillance and frequent audits should be an integral part of the hospital management system to change the scenario.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Government of India, Ministry of Health and Family Welfare (MoHFW). National Guidelines on Hospital Waste Management Based Upon the Bio-Medical Waste (Management and Handling) Rules, 1998. New Delhi: MoHFW; 2002.  Back to cited text no. 1
    
2.
Nath PA, Prashanthini V, Visvanathan C. Healthcare waste management in Asia. Waste Manag 2010;30:154-61.  Back to cited text no. 2
    
3.
Patil AD, Shekdar AV. Health-care waste management in India. J Environ Manage 2001;63:211-20.  Back to cited text no. 3
    
4.
Malini A, Eshwar B. Knowledge, Attitude and Practice of Biomedical waste management among health care personnel in a tertiary care hospital in Puducherry. Int J Biomed Res 2015;6:172-6.  Back to cited text no. 4
    
5.
Anand P, Jain R, Dhyani A. Knowledge, attitude and practice of biomedical waste management among health care personnel in a teaching institution in Haryana, India. Int J Res Med Sci 2016;4:4246-50. [doi: 10.18203/2320-6012.ijrms20163115].  Back to cited text no. 5
    
6.
Das SK, Biswas R. Awareness and practice of biomedical waste management among healthcare providers in a Tertiary Care Hospital of West Bengal, India. Int J Med Public Health 2016;6:19. [doi: 10.4103/2230-8598.179755].  Back to cited text no. 6
    
7.
Narang RS, Manchanda A, Singh S, Verma N, Padda S. Awareness of biomedical waste management among dental professionals and auxiliary staff in Amritsar, India. Oral Health Dent Manag 2012;11:162-8.  Back to cited text no. 7
    
8.
Soyam GC, Hiwarkar PA, Kawalkar U, Soyam V, Gupta VK. KAP study of bio-medical waste management among health care workers in Delhi. Int J Community Med Public Health 2017;4:3332-7.  Back to cited text no. 8
    
9.
Shafee M, Kasturwar N, Nirupama N. Study of knowledge, attitude and practices regarding biomedical waste among paramedical workers. Indian J Community Med 2010;35:369-70.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Chudasama RK, Rangoonwala M, Sheth A, Misra SK, Kadri AM, Patel UV. Biomedical waste management: A study of knowledge, attitude and practice among health care personnel at tertiary care hospital in Rajkot. J Res Med Dent Sci 2013;1:17-22.  Back to cited text no. 10
    
11.
Prashanth VK, Jadhav HC, Dodamani AS, Dodamani GA, Kshirsagar MM, Vishwakarma AP. Assessment of knowledge, attitude, and practices regarding awareness of biomedical waste management among health care personnel: A cross-sectional survey. J Oral Health Community Dent 2017;11:8-12.  Back to cited text no. 11
    
12.
Deress T, Hassen F, Adane K, Tsegaye A. Assessment of knowledge, attitude, and practice about biomedical waste management and associated factors among the healthcare professionals at Debre Markos town healthcare facilities, northwest Ethiopia. J Environ Public Health 2018;2018:7672981.  Back to cited text no. 12
    
13.
Aanandaswamy TC, Rajappa GC, Venkatachala N, Kamath R. Assessment of knowledge, attitude, and practices regarding biomedical waste management among operation room personnel in a tertiary care centre. JOACP 2019;35:106-8.  Back to cited text no. 13
    
14.
Capoor MR, Bhowmik KT. Current perspectives on biomedical waste management: Rules, conventions and treatment technologies. Indian J Med Microbiol 2017;35:157-64.  Back to cited text no. 14
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