biomedical waste research studies

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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.

• View Article
• Google Scholar
• PubMed/NCBI
• 19. Food MaHAaCAF (2005) Healthcare waste management directive. Addis Ababa: Food, Medicine and Healthcare Administration and Control Authority (FMHACA).
• 25. Ministry of Environment FaCC, Govt. of India (2019) Annual report 2018–19, Plastic Waste Management Rules (As per Rule ‘17(4)’ of PWM Rules, 2018)
• 27. WHO (2018) Fact sheet on Health care waste managment. Available from: https://www.who.int/news-room/fact-sheets/detail/health-care-waste .
• 33. Kasahun AaFA (2014) A Public–Private Partnership Framework for a Common Health Care Waste Treatment Facility for Addis Ababa City. Arlington, VA: AIDSTAR-One. https://doi.org/10.1016/j.ympev.2014.07.023 pmid:25109650
• 37. Ethiopia FDRo, Health Mo (2019) Infection Control and Waste Management Plan (ICWMP) For Biosafety Level Three (BSL3) National Reference.
• 52. Ali (2000) Manual of waste management at medical centres.
• 54. Ethiopian Food MaHAa, Authority C (2005,Addis Abeba) Healthcare Waste Management Directive.

A roadmap for bio-medical waste management research

Affiliations.

• 1 Ramaiah Public Policy Center, Bengaluru, Karnataka, India.
• 2 University of Illinois at Chicago, Chicago, Illinois, USA.
• PMID: 33855739
• DOI: 10.1002/hpm.3170

Bio-Medical waste is solid or liquid waste generated from healthcare activities. Bio-Medical waste management (BMWM) is necessary to protect local community health and environment, to reduce its financial loss and to preserve its social and aesthetic values. BMWM encompasses the waste generation, segregation, collection, transportation, processing and disposal. The BMWM system is complex and challenging. The research on BMWM must address the complexity for the solutions to be effective. We present an ontology of BMWM to visualize the complexity of the system and analyse it systematically. The research corpus of all the 184 articles from Scopus on BMWM is mapped onto the ontology. Ontological and theme maps are generated to highlight the emphases and gaps in the research. The results show the roadmap of BMWM research with the dominant emphasis on its functional elements and outcomes. There is little emphasis on the composition of the waste, the stakeholders and the policy instruments that guide and regulate the system. Correcting the biases in the present research corpus will help develop effective research and practice. This review results can be used to develop a roadmap for research to improve the BMWM system.

Keywords: bio-medical waste; framework; healthcare; mapping.

© 2021 John Wiley & Sons Ltd.

Publication types

• Biomedical Research*
• Medical Waste*
• Transportation
• Waste Management*
• Medical Waste

Variability of the treated biomedical waste disposal behaviours during the COVID lockdowns

• Research Article
• Published: 05 March 2024
• Volume 31 , pages 24480–24491, ( 2024 )

Cite this article

• Preeti Kumari 1 ,
• Tanvir Shahrier Mahmud 1 ,
• Kelvin Tsun Wai Ng   ORCID: orcid.org/0000-0002-2045-9367 1 ,
• Rumpa Chowdhury 1 ,
• Arash Gitifar 1 &
• Amy Richter 1  

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Literature review suggests that studies on biomedical waste generation and disposal behaviors in North America are limited. Given the infectious nature of the materials, effective biomedical waste management is vital to the public health and safety of the residents. This study explicitly examines seasonal variations of treated biomedical waste (TBMW) disposal rates in the City of Regina, Canada, from 2013 to 2022. Immediately before the onset of COVID-19, the City exhibited a steady pattern of TBMW disposal rate at about 6.6 kg∙capita −1 ∙year −1 . However, the COVID-19 pandemic and its associated lockdowns brought about an abrupt and persistent decline in TBMW disposal rates. Inconsistent fluctuations in both magnitude and variability of the monthly TBMW load weights were also observed. The TBMW load weight became particularly variable in 2020, with an interquartile range 4 times higher than 2019. The average TBMW load weight was also the lowest (5.1 tonnes∙month −1 ∙truckload −1 ) in 2020, possibly due to an overall decline in non-COVID-19 medical emergencies, cancellation of elective surgeries, and availability of telehealth options to residents. In general, the TBMW disposal rates peaked during the summer and fall seasons. The day-to-day TBMW disposal contribution patterns between the pre-pandemic and post-pandemic are similar, with 97.5% of total TBMW being disposed of on fixed days. Results from this Canadian case study indicate that there were observable temporal changes in TBMW disposal behaviors during and after the COVID-19 lockdowns.

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Data availability

All data generated or analysed during this study are included in this article.

Abedin MJ, Khandaker MU, Uddin MR, Karim MR, Ahamad M, Islam MA, Arif AM, Hossain SMM, Sulieman A, Idris AM (2022) Amassing the Covid-19 driven PPE wastes in the dwelling environment of Chittagong Metropolis and associated implications. Chemosphere 297:134022. https://doi.org/10.1016/j.chemosphere.2022.134022

Article   CAS   Google Scholar  

Abubakar U, Al-Anazi M, Alanazi Z, Rodríguez-Baño J (2023) Impact of COVID-19 pandemic on multidrug resistant gram positive and gram negative pathogens: A systematic review. J Infect Public Health 16(3):320–331. https://doi.org/10.1016/j.jiph.2022.12.022

Article   Google Scholar  

Adusei KK, Ng KTW, Karimi N, Mahmud TS, Doolittle E (2022a) Modeling of municipal waste disposal behaviors related to meteorological seasons using Recurrent Neural Network LSTM models. Eco Inform 72:101925. https://doi.org/10.1016/j.ecoinf.2022.101925

Adusei KK, Ng KTW, Mahmud TS, Karimi N, Lakhan C (2022b) Exploring the use of astronomical seasons in municipal solid waste disposal rates modeling. Sustain Cities Soc 86:104115. https://doi.org/10.1016/j.scs.2022.104115

Airth A, Whittle JR, Dimou J (2022) How has the COVID-19 pandemic impacted clinical care and research in Neuro-Oncology? J Clin Neurosci 105:91–102. https://doi.org/10.1016/j.jocn.2022.09.004

Alakija A (2023) Leveraging lessons from the COVID-19 pandemic to strengthen low-income and middle-income country preparedness for future global health threats. Lancet Infect Dis 23(8):e310–e317. https://doi.org/10.1016/S1473-3099(23)00279-7

Al-Omran K, Khan E, Ali N, Bilal M (2021) Estimation of COVID-19 generated medical waste in the Kingdom of Bahrain. Sci Total Environ 801:149642. https://doi.org/10.1016/j.scitotenv.2021.149642

Aragaw TA, Mekonnen BA (2022) Understanding disposable plastics effects generated from the PCR testing labs during the COVID-19 pandemic. J Hazard Mater Adv 7:100126. https://doi.org/10.1016/j.hazadv.2022.100126

Aslani H, Taghipour H (2018) Seasonal characterization and quantification of municipal solid waste: Energy content and statistical analysis. J Adv Environ Health Res 6(1):34–43. https://doi.org/10.22102/jaehr.2018.105728.1053

Aung TS, Luan S, Xu Q (2019) Application of multi-criteria-decision approach for the analysis of medical waste management systems in Myanmar. J Clean Prod 222:733–745. https://doi.org/10.1016/j.jclepro.2019.03.049

Boldrin A, Christensen TH (2010) Seasonal generation and composition of garden waste in Aarhus (Denmark). Waste Manag 30(4):551–557. https://doi.org/10.1016/j.wasman.2009.11.031

Bruce N, Ng KTW, Vu HL (2018) Use of Seasonal Parameters and their Effects on FOD Landfill Gas Modeling. Environ Monit Assess 190:291. https://doi.org/10.1007/s10661-018-6663-x

Capoor MR, Parida A (2021) Current perspectives of biomedical waste management in context of COVID-19”. Indian J Med Microbiol 39(2):171–178. https://doi.org/10.1016/j.ijmmb.2021.03.003

Chand S, Shastry CS, Hiremath S, Joel JJ, Krishnabhat C, Mateti UV (2021) Updates on biomedical waste management during COVID-19: The Indian scenario. Clin Epidemiol Glob Health 11:100715. https://doi.org/10.1016/j.cegh.2021.100715

Chowdhury T, Chowdhury H, Rahman S, Hossain N, Ahmed A, Sait SM (2022) Estimation of the healthcare waste generation during COVID-19 pandemic in Bangladesh. Sci Total Environ 811:152295. https://doi.org/10.1016/j.scitotenv.2021.152295

City of Regina (2017) City Limits Live Map retrieved from https://open.regina.ca/dataset/city-limits/resource/f4ffc8c7-c886-4794-b19c-84850c544029?inner_span=True . Accessed on September 03, 2023

Etim M, Omole DO, Araoye O (2022) Impact of COVID-19 on medical waste management and disposal practices in Nigeria. Cogent Eng 9(1). https://doi.org/10.1080/23311916.2022.2038345

Fallah B, Richter A, Ng KTW, Salama A (2019) Effects of groundwater metal contaminant spatial distribution on overlaying kriged maps. Environ Sci Pollut Res 26(22):22945–22957. https://doi.org/10.1007/s11356-019-05541-z

Garfan S, Alamoodi AH, Zaidan BB, Al-Zobbi M, Hamid RA, Alwan JK, Ahmaro IY, Khalid ET, Jumaah FM, Albahri OS, Zaidan AA, Albahri AS, Al-Qaysi Z, Ahmed MA, Shuwandy ML, Salih MM, Zughoul O, Mohammed KI, Momani F (2021) Telehealth utilization during the Covid-19 pandemic: A systematic review. Comput Biol Med 138:104878. https://doi.org/10.1016/j.compbiomed.2021.104878

Goswami M, Goswami P, Nautiyal S, Prakash S (2021) Challenges and actions to the environmental management of Bio-Medical Waste during COVID-19 pandemic in India. Heliyon 7(3):e06313. https://doi.org/10.1016/j.heliyon.2021.e06313

Government of Canada (2022) Canadian Motor Vehicle Traffic Collision Statistics: 2020 retrieved from https://tc.canada.ca/en/road-transportation/statistics-data/canadian-motor-vehicle-traffic-collision-statistics-2020 . Accessed on September 03, 2023

Government of Canada (2023) Station Results – Historical Data retrieved from https://climate.weather.gc.ca/historical_data/search_historic_data_stations_e.html?searchType=stnName&timeframe=1&txtStationName=regina&searchMethod=contains&optLimit=yearRange&StartYear=1840&EndYear=2023&Year=2023&Month=10&Day=4&selRowPerPage=25 . Accessed on October 05, 2023

Government of Saskatchewan (2022) Saskatchewan's dashboard - Total Cases retrieved from https://dashboard.saskatchewan.ca/health-wellness/covid-19/cases?filter=regina . Accessed on September 03, 2023

Ilyas S, Srivastava RR (2020) Disinfection technology and strategies for COVID-19 hospital and bio-medical waste management. Sci Total Environ 749:141652. https://doi.org/10.1016/j.scitotenv.2020.141652

Kamran A, Chaudhry MN, Batool SA (2015) Effects of socio-economic status and seasonal variation on municipal solid waste composition: a baseline study for future planning and development. Environ Sci Eur 27:1–8. https://doi.org/10.1186/s12302-015-0050-9

Kendzerska T, Zhu DT, Gershon AS, Edwards JD, Peixoto C, Robillard R, Kendall C (2021) The Effects of the health system response to the COVID-19 pandemic on Chronic Disease Management: A Narrative review. Risk Manag Healthc Policy 14:575–584. https://doi.org/10.2147/rmhp.s293471

Kirsebom FCM, Andrews N, Stowe J, Ramsay M, Bernal JL (2023) Duration of protection of ancestral-strain monovalent vaccines and effectiveness of bivalent BA.1 boosters against COVID-19 hospitalisation in England: a test-negative case-control study. Lancet Infectious Diseases 23(11):1235–1243. https://doi.org/10.1016/S1473-3099(23)00365-1

Kouvara K, Papatheodorou G, Kosmopoulou A, Giovos I, Charitou A, Filippides A, Kaberi H, Kalaitzi L, Kyrkitsos F, Koundouri P, Triantafyllou C, Gletsos M, Fakiris E, Geraga M (2022) COVID-19-related litter pollution on Greek beaches and nearshore shallow water environments. Mar Pollut Bull 185:114250. https://doi.org/10.1016/j.marpolbul.2022.114250

Laurut T, Duran C, Pagès A, Morin M, Cavaignac E (2019) What is the cost burden of surgical implant waste? An analysis of surgical implant waste in an orthopedics and trauma surgery department of a French university hospital in 2016. Orthop Traumatol Surg Res 105(6):1205–1209. https://doi.org/10.1016/j.otsr.2019.06.010

Mahmoudnia A, Moussavi G, Kootenaei FG, Mehrdadi N, Al-E-Ahmad E (2022) Increased personal protective equipment consumption during the COVID-19 pandemic: An emerging concern on the urban waste management and strategies to reduce the environmental impact. J Hazard Mater Adv 7:100109. https://doi.org/10.1016/j.hazadv.2022.100109

Mahmud TS, Ng KTW, Karimi N, Adusei KK, Pizzirani S (2022) Evolution of COVID-19 municipal solid waste disposal behaviors using epidemiology-based periods defined by World Health Organization guidelines. Sustain Cities Soc 87:104219. https://doi.org/10.1016/j.scs.2022.104219

Mahmud TS, Ng KTW, Hasan MM, An C, Wan S (2023a) A cross-jurisdictional comparison on residential waste collection rates during earlier waves of COVID-19. Sustain Cities Soc 96:104685. https://doi.org/10.1016/j.scs.2023.104685

Mahmud TS, Ng KTW, Ray S, Lyu L, An C (2023b) The use of Google Community Mobility Reports to model residential waste generation behaviors during and after the COVID-19 lockdown. Sustain Cities Soc 99:104926. https://doi.org/10.1016/j.scs.2023.104926

Mamashli Z, Nayeri S, Tavakkoli-Moghaddam R, Sazvar Z, Javadian N (2021) Designing a sustainable–resilient disaster waste management system under hybrid uncertainty: A case study. Eng Appl Artif Intell 106:104459. https://doi.org/10.1016/j.engappai.2021.104459

Martin KD, Chen JJ, Thorndike J, McCormick W, Rota J, Berg B, Dulski A (2021) Trends in waste production at a community hospital during the COVID-19 pandemic. R I Med 104(9):38–42

Mensah D, Karimi N, Ng KTW, Mahmud TS, Tang Y, Igoniko S (2023a) Ranking Canadian waste management system efficiencies using three waste performance indicators. Environ Sci Pollut Res 30:51030–51041. https://doi.org/10.1007/s11356-023-25866-0

Mensah D, Ng KTW, Hasan MM, Jeenat R, Hurlbert M (2023b) Assessing non-hazardous solid waste business characteristics of Western Canadian provinces. Eco Inform 75:102030. https://doi.org/10.1016/j.ecoinf.2023.102030

Ojha PC, Satpathy SS, Ojha AK, Sukla LB, Pradhan D (2022) Overcoming challenges due to enhanced biomedical waste generation during COVID-19 pandemic. Sci Total Environ 832:155072. https://doi.org/10.1016/j.scitotenv.2022.155072

Padmanabhan K, Barik D (2019) Health Hazards of Medical Waste and its Disposal. In Elsevier eBooks, pp 99–118. https://doi.org/10.1016/b978-0-08-102528-4.00008-0

Pan C, Bolingbroke D, Ng KTW, Richter A, Vu HL (2019a) The Use of Waste Diversion Indices on the Analysis of Canadian Waste Management Models. J Mater Cycles Waste Manag 21(3):478–487. https://doi.org/10.1007/s10163-018-0809-3

Pan C, Ng KTW, Richter A (2019b) An Integrated Multivariate Statistical Approach for the Evaluation of Spatial Variations in Groundwater Quality near an Unlined Landfill. Environ Sci Pollut Res 26(6):5724–5737. https://doi.org/10.1007/s11356-018-3967-x

Parida VK, Sikarwar D, Majumder A, Gupta AK (2022) An assessment of hospital wastewater and biomedical waste generation, existing legislations, risk assessment, treatment processes, and scenario during COVID-19. J Environ Manag 308:114609. https://doi.org/10.1016/j.jenvman.2022.114609

Prata JC, Silva AL, Walker TR, Duarte AC, Rocha-Santos T (2020) COVID-19 pandemic repercussions on the use and management of plastics. Environ Sci Technol 54(13):7760–7765. https://doi.org/10.1021/acs.est.0c02178

Raghavan D, Tan AR, Story ES, Burgess EF, Musselwhite L, Kim ES, Clark PE (2020) Management changes for patients with endocrine-related cancers in the COVID-19 pandemic. Endocr Relat Cancer 27(9):R357–R374. https://doi.org/10.1530/ERC-20-0229

Requena-Sanchez NP, Carbonel D, Demel L, Moonsammy S, Richter A, Mahmud TS, Ng KTW (2023a) A multi-jurisdictional study on the quantification of COVID-19 household plastic waste in six Latin American countries. Environ Sci Pollut Res 30:93295–93306. https://doi.org/10.1007/s11356-023-28949-0

Requena-Sanchez N, Carbonel D, Moonsammy S, Demel L, Vallester E, Velasquez D, Toledo JA, Diaz VL, Vasquez R, Cruz MA, Visbal E, Ng KTW (2023b) Covid-19 impacts on household solid waste generation in six Latin American countries - a participatory approach. Environ Monit Assess 195:155. https://doi.org/10.1007/s10661-022-10771-9

Richter A, Ng KTW, Vu HL, Kabir G (2021a) Waste disposal characteristics and data variability in a mid-sized Canadian city during COVID-19. Waste Manag 122:49–54. https://doi.org/10.1016/j.wasman.2021.01.004

Richter A, Ng KTW, Vu HL, Kabir G (2021b) Identification of behaviour patterns in waste collection and disposal during the first wave of COVID-19 in Regina, Saskatchewan, Canada. J Environ Manag 290:112663. https://doi.org/10.1016/j.jenvman.2021.112663

Roberts K, Phang SC, Williams J, Hutchinson D, Kolstoe S, De Bie J, Williams I, Stringfellow A (2021) Increased personal protective equipment litter as a result of COVID-19 measures. Nat Sustain 5(3):272–279. https://doi.org/10.1038/s41893-021-00824-1

Romel MA, Kabir G, Ng KTW (2024) Prediction of Photovoltaic Waste Generation in Canada using Regression-based Model. Environ Sci Pollut Res. https://doi.org/10.1007/s11356-023-31628-9

Seif F, Noorimotlagh Z, Mirzaee SA, Kalantar M, Barati B, Fard ME, Fard NK (2021) The SARS-CoV-2 (COVID-19) pandemic in hospital: An insight into environmental surfaces contamination, disinfectants’’ disinfectants’ efficiency, and estimation of plastic waste production. Environ Res 202:111809. https://doi.org/10.1016/j.envres.2021.111809

Sharma HB, Vanapalli KR, Cheela VS, Ranjan VP, Jaglan AK, Dubey B, Goel S, Bhattacharya J (2020) Challenges, opportunities, and innovations for effective solid waste management during and post COVID-19 pandemic. Resour Conserv Recycl 162:105052. https://doi.org/10.1016/j.resconrec.2020.105052

Shekoohiyan S, Parsaee F, Ghayour S (2022) Assessment of knowledge, attitude and practice about biomedical waste management among healthcare staff of Fasa educational hospitals in COVID-19 pandemic. Case Stud Chem Environ Eng 6:100207. https://doi.org/10.1016/j.cscee.2022.100207

Singh M, Karimi N, Ng KTW, Mensah D, Stilling D, Adusei K (2022) Hospital waste generation during the first wave of COVID-19 pandemic: a case study in Delhi. Environ Sci Pollut Res 29(33):50780–50789. https://doi.org/10.1007/s11356-022-19487-2

Statistics Canada (2023a) Census Profile. 2021 Census of Population. Statistics Canada Catalogue no. 98–316-X2021001 retrieved from https://www12.statcan.gc.ca/census-recensement/2021/dp-pd/prof/index.cfm?Lang=E . Accessed on September 03, 2023

Statistics Canada (2023b) Table 11–10–0012–01 Distribution of total income by census family type and age of older partner, parent or individual retrieved from https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=1110001201 . Accessed on September 03, 2023

Thind PS, Sareen A, Singh DD, Singh S, John S (2021) Compromising situation of India’s bio-medical waste incineration units during pandemic outbreak of COVID-19: Associated environmental-health impacts and mitigation measures. Environ Pollut 276:116621. https://doi.org/10.1016/j.envpol.2021.116621

Vu HL, Ng KTW, Richter A (2017) Optimization of First Order Decay Gas Generation Model Parameters for Landfills located in Cold Semi-arid Climates. Waste Manag 69:315–324. https://doi.org/10.1016/j.wasman.2017.08.028

Vu HL, Ng KTW, Richter A, Karimi N, Kabir G (2021a) Modeling of municipal waste disposal rates during COVID-19 using separated waste fraction models. Sci Total Environ 789:148024. https://doi.org/10.1016/j.scitotenv.2021.148024

Vu HL, Ng KTW, Richter A, Kabir G (2021b) The use of a recurrent neural network model with separated time-series and lagged daily inputs for waste disposal rates modeling during COVID-19. Sustain Cities Soc 75:103339. https://doi.org/10.1016/j.scs.2021.103339

Wan S, Nik-Bakht M, Ng KTW, Tian X, An C, Sun H, Yue R (2023) Insights into the urban municipal solid waste generation during the COVID-19 pandemic from machine learning analysis. Sustain Cities Soc 105044. https://doi.org/10.1016/j.scs.2023.105044

Ye J, Song Y, Liu Y, Zhong Y (2022) Assessment of medical waste generation, associated environmental impact, and management issues after the outbreak of COVID-19: A case study of the Hubei Province in China. PLoS One 17(1):e0259207. https://doi.org/10.1371/journal.pone.0259207

Zamparas M, Kapsalis VC, Kyriakopoulos GL, Aravossis K, Kanteraki AE, Vantarakis A, Kalavrouziotis IK (2019) Medical waste management and environmental assessment in the Rio University Hospital, Western Greece. Sustain Chem Pharm 13:100163. https://doi.org/10.1016/j.scp.2019.100163

Zhao H, Wang L, Liu F, Liu H, Zhang N, Zhu Y (2021) Energy, environment and economy assessment of medical waste disposal technologies in China. Sci Total Environ 796:148964. https://doi.org/10.1016/j.scitotenv.2021.148964

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Acknowledgements

The research reported in this paper was supported by a grant from the Natural Sciences and Engineering Research Council of Canada (RGPIN-2019-06154) to the corresponding author. The lead author (P. Kumari) was also supported by a Mitacs Globalink research award. The authors are grateful for their support. The views expressed herein are those of the writers and not necessarily those of our research and funding partners.

The research reported in this paper was supported by a grant from the Natural Sciences and Engineering Research Council of Canada (RGPIN-2019–06154) to the corresponding author. The lead author (P. Kumari) was also supported by a Mitacs Globalink research award. The authors are grateful for their support. The views expressed herein are those of the writers and not necessarily those of our research and funding partners.

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Kumari, P., Mahmud, T.S., Ng, K.T.W. et al. Variability of the treated biomedical waste disposal behaviours during the COVID lockdowns. Environ Sci Pollut Res 31 , 24480–24491 (2024). https://doi.org/10.1007/s11356-024-32764-6

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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.

•  Kumar P.V.A.G, Kapate R et al, Knowledge, Attitude, and Practices of Health Care Waste Management amongst Staff of Nursing Homes of Gulbarga City. Journal of Pharmaceutical and Biomedical Sciences. 2012;19(19)1-3.
• Sharma A.K. Biomedical Waste (Management and Handling) Rules. First edition. Bhopal. Suvidha Law House. 12.
• Patil A.D, Shekdar A.V.  Health-care waste management in India. J Environ Manage. 2001;63:211-20. CrossRef
• Nath P.A, Prashanthini V, Visvanathan C.  Healthcare waste management in Asia. Waste Management. 2010;30:154-61. CrossRef
• Lakshmikantha H.  Report on waste dump sites near Bangalore. Waste management . 2006;26(6):640-50. CrossRef
• Misra V, Pandey S.D. Hazardous waste, impact on health and environment for development of better waste management strategies in future in India. Environment International. 2005;31:417-31. CrossRef
• Kini B.S, Kumar , Kumar S, Reddy M, Nabar A.S, Kamath V.G, Kamath A, Eshwari K.  Knowledge, Attitudes and Practices regarding Biomedical Waste Management among staff of a tertiary healthcare centre in coastal Karnataka. J Pub Health Med Res . 2014;2(1):20-4.
• Pattnaik S, Reddy M.V. Assessment of Municipal Solid Waste management in Puducherry (Pondicherry).  India. Resources, Conservation and Recycling . 2010;54:512-20. CrossRef
• Mathur V, Dwivedi S, Hassan M.A, Misra R.P.  Knowledge, Attitude, and Practices about Biomedical Waste Management among Healthcare Personnel: A Cross-sectional Study. Indian J Community Med. 2011; 36:143-5. CrossRef
• Radha R.  Assessment of existing knowledge, attitude, and practices regarding biomedical waste management among the health care workers in a tertiary care rural hospital. Int J Health Sci Res . 2012;2(7):14-19.
• Verma L.K, Mani S, Sinha N, Rana S. Biomedical waste management in nursing homes and smaller hospitals around Delhi. Waste Management. 2008;28:2723-34. CrossRef
• Kumar S, Bhattacharyya J.K, Vaidya A.N, Chakrabarti T, Devotta S, Akolkar A.B.  Assessment of the status of solid waste management in metro cities, state capitals, class I cities, and class II towns in India: An insight. Waste Management. 2009;29:883-95. CrossRef
• Pandit N.B, Mehta H.K, Kartha G.P, Choudhary S.k.  Management of biomedical waste: Awareness and practices in a district of Gujarat. Indian J Public Health . 2005;49:245-7.
• Rao P.H. Report: Hospital waste management – awareness and practices: A study of three states in India. Waste Manage Res . 2008;26:297-303. CrossRef
• Kishore J, Goel P, Sagar B, Joshi T.K.  Awareness about biomedical waste management and infection control among dentists of a teaching hospital in New Delhi, India. Indian J Dent Res . 2000;11:157-61.
• Saini S, Nagarajan S.S, Sarma R.K. Knowledge, Attitude and Practices of Bio-Medical Waste Management Amongst Staff of a Tertiary Level Hospital in India. Journal of the Academy of Hospital Administration. 2005;17(2).
• Yadavannavar M.C, Berad A.S, Jagirdar P.B. Biomedical waste management: A study of knowledge, attitude, and practices in a tertiary health care institution in Bijapur. Indian Journal of Community Medicine. 2010;35(1):170-71. CrossRef

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• Med J Armed Forces India
• v.57(2); 2001 Apr

AN INTRODUCTION TO ESSENTIALS OF BIO-MEDICAL WASTE MANAGEMENT

* Associate Professor, Department of Preventive Social Medicine

+ Reader, Department of Preventive Social Medicine

# Professor and Head, Department of Preventive Social Medicine

** Dean and Dy Commandant, Armed Forces Medical College, Pune – 411040

The issue of biomedical waste management has assumed great significance in recent times particularly in view of the rapid upsurge of HIV infection. Government of India has made proper handling and disposal of this category of waste a statutory requirement with the publication of gazette notification no 460 dated 27 July 1998. The provisions are equally applicable to our service hospitals and hence there is a need for all the service medical, dental, nursing officers, other paramedical staff and safaiwalas to be well aware of the basic principles of handling, treatment and disposal of biomedical waste. The present article deals with such basic issues as definition, categories and principles of handling and disposal of biomedical waste.

Introduction

The subject of biomedical waste management and handling has been assuming increasing significance for the past few years. The responsibility of medical administrators as regards proper handling and disposal of this category of waste has now become a statutory requirement with the promulgation of Government of India (Min of Environment and Forests) gazette notification no. 460 dated 27 Jul 1998 [ 1 ]. The provisions of the gazette are also applicable to Armed Forces hospitals. The present system of biomedical waste disposal system in Armed Forces is far from satisfactory [ 2 ]. It is therefore highly desirable that all service officers concerned with the administration of hospitals and other health care echelons take all steps to adhere to the laid down directives. It is equally important that all service medical, dental, nursing officers, other paramedical staff and waste handlers such as safaiwalas be well oriented to the basic requirements of handling and management of biomedical waste. It is with this objective of providing such basic information that the present article has been composed.

Biomedical waste is defined as any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals, or in research activities pertaining thereto, or in the production or testing of biologicals [ 1 ].

Categories of Biomedical Waste

There are ten defined categories (category code Nos 1 to 10) as follows [ 1 , 3 ].

• 1. Human anatomical waste: (tissues, organs, body parts)
• 2. Animal waste: (including animals used in research and waste originating from veterinary hospitals and animal houses).
• 3. Microbiological and biotechnology waste: (including waste from lab cultures, stocks or specimens of microorganisms, live or attenuated vaccines, wastes from production of biologicals, etc.)
• 4. Waste sharps: (used/unused needles, syringes, lancets, scalpels, blades, glass etc.)
• 5. Discarded medicines and cytotoxic drugs.
• 6. Soiled wastes: (items contaminated with blood and body fluids, including cotton dressings, linen, plaster casts, bedding etc.)
• 7. Solid wastes: (wastes generated from disposable items other than waste sharps such as tubing, catheters, i.v. sets, etc.)
• 8. Liquid waste: (waste generated from washing, cleaning, house keeping and disinfection activities including these activities in labs).
• 9. Incineration ash: (from incineration of any biomedical waste)
• 10. Chemical waste: (chemicals used in production of biologicals and disinfection).

Quantum of waste

The quantity of biomedical waste generated per bed per day will vary depending upon the type of health problems, the type of care provided and the hospital waste management practices. It varies from 1–2 kg in developing countries to 4.5 kg in developed countries such as USA [ 3 , 4 ]. 10–15% of the waste is infectious in developed countries whereas it varies from 45.5 to 50% in India, requiring special handling [ 4 ]. Infective waste was found to be only 6% at Command Hospital (Air Force) Bangalore [ 5 ].

The following properties of biomedical waste make it hazardous [ 6 ]:-

• a. Infectious
• b. Injurious
• c. Cytotoxic
• d. Chemical

Biomedical waste is hazardous since it has an inherent potential for dissemination of infection, both nosocomial within health care settings as well as risk of infection to persons working outside health care facilities, like waste handlers, scavenging staff and also to the general public. It is reported that 60% of all hospital staff sustain injuries from sharps during various procedures undertaken in health care facilities [ 7 ]. Cytotoxic and chemical waste is mutagenic and / or teratogenic [ 8 ]. Additional hazard includes recycling of disposables without being even washed [ 3 ].

Schedule for Waste Treatment Facilites

The schedule for complete establishment of waste treatment facilities is as follows:-[ 1 ]

• A. Hospitals in towns with a population of 30 lakhs and above: By 30 Jun 2000 or earlier.
• i. With 500 beds and above: By 30 Jun 2000
• ii. With 200 to 499 beds: 31 Dec 2000 or earlier
• iii. With 50 to 199 beds: 31 Dec 2001 or earlier
• iv. With less than 50 beds: 31 Dec 2002 or earlier
• C. All other institutions generating bio-medical waste not included in A and B above by 31 Dec 2002 or earlier.

Principles of bio-medical waste management

The principles of biomedical waste management are as follows:-

Observance of general principles of hygiene and sanitation such as cleanliness, good house keeping, adequate supply of safe water, sanitary facilities and proper ventilation are essential components of a good bio-medical waste management plan.

It is essential that every waste generated from the hospital should be identified and quantified. Hospitals should endeavour to reduce waste by controlling inventory, wastage of consumable items and breakages etc. Waste can also be minimized by recycling certain waste such as glassware, plastic material etc after proper cleaning and disinfection.

Segregation of waste at source and safe storage is the key to whole hospital waste management process. Segregation of various types of wastes into different categories according to their treatment/disposal options should be done at the point of generation in colour coded plastic bags/containers as per schedule II of the gazette notification. The needles and syringes should be disinfected and mutilated before segregation. The type of containers and their colour codes as stipulated in Govt of India notification are given in Table – 1 .

Category and colour code of waste disposal system

• Colour coding of waste categories with multiple treatment options as defined in schedule I, shall be selected depending on treatment option chosen

• Waste collection bags should not be made of chlorinated plastics

• Categories 8 and 10 (liquid) do not require container/bags

• Category 3 if disinfected locally need not be put in containers/bags

Microbiological and biotechnology waste being highly infectious should be treated on site by autoclaving/microwaving/chemical treatment. The guidelines for chemical disinfection of different categories of biomedical wastes are shown in Table 2 ,3 [ 3 , 9 ].

Chemical disinfection A. Chlorine releasing compounds (used for disinfection of materials contaminated with blood and body fluids)

The waste should be transported to kerb collection area in covered container. All containers should have biohazard label according to schedule III of the gazette notification. If a container is transported from the premises where biomedical waste is generated to any waste treatment facility outside the premises, the container shall, apart from the label prescribed in schedule III also carry information prescribed in schedule IV. The containers and the vehicles used for transportation of biomedical waste should not be used for any other purpose. Care should be taken to avoid spills.

Chemical disinfection B. Non-chlorine releasing compounds (used for disinfection of items which are adversely affected upon by chlorine)

• f. Waste treatment off site.
• i. Incinerator
• ii. Microwave
• iii. Autoclave
• iv. Hydroclave
• v. Plasma torch technology

All the above systems have certain limitations. Heavy metals and plastic cannot be burnt in incinerators. Microwave cannot take up large pieces of metals and body parts for disinfection. The autoclave does not reduce the volume and may increase the weight of the waste due to moisture. Plasma Torch Technology is prohibitively expensive. Hydroclaves are comparatively cheap to run but not suitable for large body parts. Hence one has to look for multiple options instead of basing the waste treatment system only on one option.

• g. Final disposal
• i. Chemical treatment – sharps, solid, liquid and chemical wastes
• ii. Autoclaving/Microwaving – microbiology/biotechnology, sharps, soiled and solid wastes.
• iii. Incineration – human, animal, microbiology/biotechnology and solid waste.
• iv. Deep burial in secured landfills – discarded medicines, incineration ash and chemical solid waste such as mercury.
• v. Drainage – liquid waste, chemical liquid waste, cytotoxic waste in addition to being toxic are mutagenic hence should never be diluted and discharged into the sewers [ 8

Storage of waste pending final disposal

The following points need to be considered

ii Bins can be of metal or plastic.

• iii. If bins are re-usable, ensure their cleaning and disinfection.
• iv. Containers should not be too large as they may be difficult to lift and there can be spillage.
• v. Each receptacle should be properly marked to show the ward or section where it is kept.
• vi. Bins preferably should be inner lined with polythene bags and provided with lids.
• vii. Move bins atleast once a day from all areas, twice or more from OTs, ICUs.
• viii. Bags for wastes needing incineration should not be made of chlorinated plastic.
• ix. Categories 8 and 10 (liquid waste) need not be put in containers.
• X. Category 3 if disinfected locally need not be put into containers.
• xi. Polythene bags carrying waste should be sealed/tied at the top whenever waste is being transported within or outside the hospital.
• xii. Disposable items should be shredded or mutilated to prevent reuse. Subsequently, they should be disinfected/disposed off as per guidelines.
• xiii. Bins or polythene bags placed in the containers to be changed with each shift or when they arc 3/4 full. At this point, they should be treated with suitable chemical disinfectant, collected in proper plastic bags from various wards and sections, and then despatched to the final disposal site as stipulated.

Maintenance of Records

All hospitals should maintain records regarding quantity and category of all biomedical waste, which are subject to inspection and verification by the Govt prescribed authority at any time.

Annual Report

Every hospital is required to submit an annual report as per prescribed proforma by 31 January every year regarding the quantity and category of waste handled during the preceding year to the prescribed authority who in turn will forward a consolidated report to Central Pollution Control Board of the state by 31 March every year.

Accident Reporting

When any accident occurs while handling or transportation of waste, the authorised person shall report the accident in prescribed form to the authority forthwith.

Training of personnel

The objectives of a waste management scheme should be to change a mind set through training [ 10 ]. Standard training modules/manuals for doctors, nursing staff, lab technicians, ward attendants, safaiwalas, patients and their attendants should be developed to create awareness and ensure efficient handling and management of biomedical waste [ 11 ].

Ongoing evaluation of the biomedical waste management programme in the hospital is very important to identify bottlenecks and to take remedial action. It is suggested that Hospital Infection Control Committee (HICCOM) should specifically look into this aspect.

Consequent to the gazette notification, it is now mandatory for all health care facilities to have sound bio-medical waste management and handling facilities as per prescribed standards and schedules. It may not be possible to achieve all the standards in one go. An incremental approach, which has been suggested by the WHO, is the best strategy [ 2 ]. The aim should be to make improvements and gradually move towards a sustainable system in order to achieve a healthier environment, mind and body. It is time that our service hospitals, which are eminently known for their high standards of hygiene, good maintenance and excellent administration, should take a lead in this vital area of health care.