Awareness and practices regarding biomedical waste management among housekeeping staff of a tertiary care hospital in Western India

Harshal T Pandve; Shruti Rajendra Gaikwad; Bhagyashri Suryakant Bhure; Varsha Maroti Kadam; Jilu Justin

doi:10.4103/ed.ed_15_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 7 | Issue : 3 | Page : 65-69

Awareness and practices regarding biomedical waste management among housekeeping staff of a tertiary care hospital in Western India

Harshal T Pandve¹, Shruti Rajendra Gaikwad², Bhagyashri Suryakant Bhure², Varsha Maroti Kadam², Jilu Justin³
¹ Department of Community Medicine, PCMC's Postgraduate Institute and Yashwantrao Chavan Memorial Hospital, Pune, Maharashtra, India
² Department of Community Medicine, PCMC's Postgraduate Medical Institute and Yashwantrao Chavan Memorial Hospital, Pune, Maharashtra, India
³ Department of Hospital Management, Sancheti Healthcare Academy (SHA), Pune, affiliated to Savitribai Phule Pune University, Pune, Maharashtra, India

Date of Submission	30-Jun-2022
Date of Decision	04-Aug-2022
Date of Acceptance	09-Aug-2022
Date of Web Publication	29-Sep-2022

Correspondence Address:
Varsha Maroti Kadam
Flat No 8, 3^rd Floor, Prasun Plaza, Nehru Nagar, Pimpri, Pune - 411 018, Maharashtra
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/ed.ed_15_22

Abstract

Background: The World Health Organization biomedical waste guidelines of 2004 emphasizes the importance of the “human factor” over technology and equipment. Housekeeping staff members are directly involved in the collection, transport, and disposal of biomedical waste and are at high risk of acquiring infections. At the same time, they are usually unskilled, uneducated, and have little to no knowledge about the segregation and disposal of biomedical waste, which further compounds their health risk.
Objective: To assess the awareness and practices regarding biomedical waste management in housekeeping staff of a tertiary care hospital.
Subjects and Methods: A cross-sectional study was conducted among 100 housekeeping staff members of a tertiary teaching hospital in Pune, Maharashtra, from February to April 2022. A semi-structured, pretested questionnaire was used for data collection. Knowledge of the study participants was scored on a scale of 0–10 and the median score of all the study participants was taken as a cutoff for determining good and poor knowledge. The data were entered into MS Excel 2010 and analyzed using IBM SPSS software 16-trial version. The Chi-square test was used as a test of significance.
Results: In the present study, 73% of study participants had good knowledge regarding biomedical waste management. All the participants (100%) were following appropriate practices regarding biomedical waste management. Age and experience were found to be significantly associated with knowledge regarding biomedical waste management (P < 0.05).
Conclusion: There is a gap in the knowledge regarding biomedical waste management among the study subjects which needs to be addressed through repeated and diligent training exercises.

Keywords: Awareness, biomedical waste management, housekeeping staff, India, practice

How to cite this article:
Pandve HT, Gaikwad SR, Bhure BS, Kadam VM, Justin J. Awareness and practices regarding biomedical waste management among housekeeping staff of a tertiary care hospital in Western India. Environ Dis 2022;7:65-9

How to cite this URL:
Pandve HT, Gaikwad SR, Bhure BS, Kadam VM, Justin J. Awareness and practices regarding biomedical waste management among housekeeping staff of a tertiary care hospital in Western India. Environ Dis [serial online] 2022 [cited 2023 Jun 2];7:65-9. Available from: http://www.environmentmed.org/text.asp?2022/7/3/65/357449

Introduction

Biomedical waste is any waste produced during the diagnosis, treatment, or immunization of human or animal research activities pertaining thereto or in the production or testing of biological or in health camps.^[1] According to the World Health Organization (WHO 2018), the composition of biomedical waste is as follows: nonhazardous waste (85%) and hazardous waste (15%), with infectious waste accounting for (10%), and radioactive or chemical waste accounting for (5%). Every year, it is estimated that more than 5.2 million people, including 4 million children, die as a result of diseases caused by medical waste throughout the world.^[2] Many pathogens have been documented to be transmitted during biomedical waste handling, segregation, and disposal, of which human immunodeficiency virus, hepatitis B virus (HBV), and hepatitis C virus are often implicated.^[3],[4]

As per the information received from the State Pollution Control Board and Pollution Control Committee of Union Territories, about 4.16 tons of biomedical waste is generated per day in India.^[5] The government of India has promulgated “Bio-medical waste (Management and Handling) Rules, 1998” which is legally binding on all hospitals to ensure proper disposal of biomedical waste. Despite increased global awareness among health professionals about the health hazards due to biomedical waste and its disposal, the level of awareness among health-care workers in India, is found to be unsatisfactory.^[6],[7] Proper knowledge about the health hazards of hospital waste and its disposal, and sound practices of safety measures can lead to the safe disposal of biomedical waste and protect the community from its adverse effects.^[8]

The biomedical waste management practices are a collective effort of higher administration (policy and funding), biomedical engineering (technology and equipment), operation/housekeeping department (training and induction), and immediate health-care workers (doctors, nurses, and paramedics).^[9],[10] The WHO biomedical waste guidelines of 2004 emphasize the importance of the “human factor” over technology and equipment. Housekeeping staff members are directly involved in the collection, transport, and disposal of biomedical waste and are at high risk of acquiring infections. At the same time, they are usually unskilled, uneducated, and have little to no knowledge about the segregation and disposal of biomedical waste, which further compounds their health risk.

With this background, the present study was conducted to assess the knowledge and practices of the housekeeping staff of a tertiary care hospital regarding biomedical waste management.

Subjects and Methods

This cross-sectional study was conducted among housekeeping staff members of a tertiary teaching hospital in Pune, Maharashtra, from February to April 2022. We used the universal sampling method to select respondents for the study. Out of a total of 200 housekeeping staff members, 100 participants consented and were included in the study. A semi-structured pretested questionnaire was used for data collection. The questionnaire consisted of three parts: part 1 comprising of demographic data such as age, sex, level of general education, years of experience, HBV immunization status, and biomedical waste management training, part 2 comprising of ten questions regarding knowledge of biomedical waste management, and part 3, comprising of five practices regarding biomedical waste management. Data were collected by conducting face-to-face interviews after obtaining written informed consent. Knowledge of the study participants was scored on a scale of 0–10, 1 point being awarded for each correct answer, such that the participants answering all 10 questions regarding knowledge of biomedical waste management correctly scored 10 points. The median score of all the study participants was taken as a cutoff, and all the participants scoring at or above the cutoff score were considered to have good knowledge regarding biomedical waste management. The data were entered into MS Excel 2010 and analyzed using SPSS (Statistical Package for the Social Sciences) trial version 16 (International Business Machines Corporation (IBM), Armonk, New York). Frequency, percentage, and proportion were calculated. Data were represented in tabular and graphical format. The Chi-square test was used as a test of significance. Ethical Approval of IRB board name- PCMC's PGI YCMH Ethics committee, Approval number-YCMH/IEC/KAVI/1/50/2021, Date of approval- 14/07/2021.

Results

Of 100 study participants, 32% were between 31 and 40 years, 32% were between 41 and 50 years, 19% were between 20 and 30 years, and 17% of the participants were between 51 and 60 years of age group. Of 100 housekeeping staff members, 57% were male and 43% were female. Only 4% of the participants had completed higher secondary schooling, 48% of participants had completed high-school studies, 35% of them had completed secondary school, and 13% had completed primary school education. Fifty-two percent among 100 housekeeping staff members had 6–10 years of work experience, while 28% had 0–5 years of work experience, 16% had 11–15 years of work experience, and 4% had 16–20 years of work experience. All the study participants were vaccinated with the HBV vaccine and had received training regarding biomedical waste management.

[Table 1] reveals the knowledge of study participants regarding biomedical waste management. We found that all the study participants (100%) knew that biomedical waste should be segregated at the very source where it is generated. All the study participants (100%) could identify the appropriate color bags for the disposal of infectious and recyclable waste. All the study participants (100%) could recognize diseases that are not transmitted by biomedical waste. When asked about the appropriate method for disposing of used needles, all the study participants (100%) answered correctly. All the study participants (100%) responded correctly when asked about the postexposure prophylaxis protocol in case of a needlestick injury.

Table 1: Knowledge of study subjects regarding biomedical waste management (n=100)

Click here to view

The majority of the study participants (98%) knew where noninfectious waste should be disposed off. Nearly all participants (99%) could discern vulnerable groups at a high risk of acquiring infections from improper management of biomedical waste.

Our questionnaire contained 10 questions about knowledge regarding biomedical waste management. We scored the knowledge of the study participants on a scale of 0–10, 1 point being awarded for each correct answer. The knowledge scores of the participants ranged from 7% to 10, 6% of participants scored 7, 21% participants scored 8, 41% participants scored 9, and 32% participants scored 10 points. The mean and median score was found to be 9, which was taken as a cutoff and all participants scoring 9 points or above were considered to have good knowledge regarding biomedical waste management. In our study, 73% of study participants had good knowledge regarding biomedical waste management [Figure 1].

Figure 1: Knowledge regarding BMW in study subjects. BMW: Biomedical waste

Click here to view

[Table 2] denotes the association between sociodemographic characteristics of study subjects and their knowledge regarding biomedical waste management.

Table 2: Association of sociodemographic variable with knowledge regarding biomedical waste management (n=100)

Click here to view

Of 73 study subjects with good knowledge regarding biomedical waste management, 63 (86.30%) participants were 30 years or older while 10 (13.69%) were younger than 30 years. The age was found to be significantly associated with knowledge regarding biomedical waste management (χ² = 4.937, P < 0.05).

Of 73 study subjects with good knowledge regarding biomedical waste management, 57 (78.08%) participants had work experience of 5 years and above while 16 (21.19%) had work experience of <5 years. Work experience was found to be significantly associated with knowledge regarding biomedical waste management (χ² = 4.960, P < 0.05).

[Table 3] reveals the practice of biomedical waste management protocols among study subjects. We observed basic practices regarding biomedical waste management in study subjects. All the participants (100%) were following appropriate practices regarding biomedical waste management.

Table 3: Practices among housekeeping staff regarding biomedical waste management

Click here to view

Discussion

This cross-sectional study was conducted among housekeeping staff members of a tertiary teaching hospital in Pune, Maharashtra, from February to April 2022. In our study, all the study participants were vaccinated with the HBV vaccine and had received training regarding biomedical waste management while another study by Sehgal et al. conducted in 2015 in a similar setting showed all respondents except two nurses had been immunized against hepatitis B, and that majority (87.5%) of the subjects had undergone training program on biomedical waste management.^[11] However, in a 2017 study by Soyam et al. only 64.5% health-care workers were vaccinated against HBV.^[12] These findings imply that there is a lack of uniformity regarding mandatory prerecruitment vaccination and biomedical waste management training protocols in the country.

Ninety-six percent of the study population in a study by Madhukumar et al. knew about the color coding system applied in biomedical waste management, and all the respondents (100%) felt that hospital waste should be segregated into different categories.^[13] Fifty six percent of the study population in a study by Basu et al. knew about different biomedical waste categories.^[14] Knowledge regarding biomedical waste disposal was found to be low (30%) among Class IV employees in a study conducted by Anand et al. in 2016 which is pretty worrying as they are the people responsible for biomedical waste disposal.^[14]

In our study, 73% of study participants had good knowledge regarding biomedical waste management. In a similar study conducted by Ramkrishna and Satyanarayana in 2018, the housekeeping staff scored 77.08% in knowledge regarding biomedical waste management.^[15]

We found that the age and experience of the study participants were significantly associated with knowledge regarding biomedical waste management (P < 0.05). These findings were corroborated by another study conducted by Nagaraju et al. who reported that elderly and experienced health-care workers had better awareness regarding biomedical waste management compared to the younger and less experienced ones.^[16] Another study by Ajmera and Jayalakshmi revealed that newly appointed health workers used color-coded bins inappropriately.^[17] On the other hand, a study carried out by Motamed et al. in Mazandaran Provinces, Iran, found that knowledge regarding biomedical waste management was highest in the 30–40 years of age group and lowest in the more than 50 years' old age group.^[18] These differences may be attributed to the adequacy and frequency of training sessions conducted in respective study settings. However, most of the literature agrees that knowledge regarding biomedical waste management was better in older and more experienced staff.

We observed basic practices regarding biomedical waste management in study subjects. All the participants (100%) were following appropriate practices regarding biomedical waste management. Contrarily, poor practices were reported by a study conducted by Dwivedi et al. in 2021 which found that only 69.23% of sanitary staff had the habit of shredding the syringe and cutting the hub of the syringe while only 52.18% of staff practiced proper disposal of biomedical waste in the specific container in an urban hospital.^[19]

Conclusion

This study found that though the housekeeping staff members were correctly following the basic protocol while handling biomedical waste, their knowledge regarding the updated biomedical waste management regulations was found to be lacking. This needs to be addressed through repeated and diligent training exercises specifically oriented towards housekeeping staff members to fill their knowledge gaps and minimize their health risks.

Acknowledgment

The authors would like to thank Hon. Dr. Rajendra Wabale (Dean, PGI YCMH, Pimpri, Pune) for his support, the faculty of the Department of Community Medicine for their guidance, and all the participants for their cooperation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Datta P, Mohi GK, Chander J. Biomedical waste management in India: Critical appraisal. J Lab Physicians 2018;10:6-14. [PUBMED] [Full text]
2.	Rahman MM, Bodrud-Doza M, Griffiths MD, Mamun MA. Biomedical waste amid COVID-19: Perspectives from Bangladesh. Lancet Glob Health 2020;8:e1262.
3.	Prüss-Üstün, Annette. Safe management of wastes from health-care activities. World Health Organization, 1999.
4.	Health-Care Waste Who. int. 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/health-care-waste. [Last accessed on 2022 May 13].
5.	Waste Management \| The Official Website of Ministry of Environment, Forest and Climate Change, Government of India 2022. Available from: https://moef.gov.in/en/service/environment/waste-management/. [Last accessed on 2022 May 13].
6.	Pandit NB, Mehta HK, Kartha GP, Choudhary SK. Management of bio-medical waste: Awareness and practices in a district of Gujarat. Indian J Public Health 2005;49:245-7. [PUBMED] [Full text]
7.	Kishore J, Goel P, Sagar B, Joshi TK. 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.
8.	Mathur V, Dwivedi S, Hassan M, Misra R. Knowledge, attitude, and practices about biomedical waste management among healthcare personnel: A cross-sectional study. Indian J Community Med 2011;36:143-5. [PUBMED] [Full text]
9.	Hashmi SK, Shahab S. Hospital and Biomedical Waste Management. Community Medicine and Public Health. 4^th ed. Karachi: Time Publishers. 2003. p. 426-37.
10.	Horváth A. Management of waste disposal in medical institutions. Orv Hetil 1991;132:919-24.
11.	Sehgal RK, Garg R, Dhot PS, Singhal P. A study of knowledge, attitude, and practices regarding biomedical waste management among the health-care workers in a multispeciality teaching hospital at Delhi. Int J Med Sci Public Health 2015;4:1536-41.
12.	Soyam GC, Hiwarkar PA, Kawalkar UG, Soyam VC, 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.
13.	Madhukumar S, Ramesh G. Study about awareness and practices about health care waste management among hospital staff in a medical college hospital, Bangalore. Iran J Basic Med Sci 2012;3:7-11.
14.	Basu M, Das P, Pal R. Assessment of future physicians on biomedical waste management in a tertiary care hospital of West Bengal. Journal of natural science, biology, and medicine. 2012;3:38.
15.	Ramkrishna M, Satyanarayana P. Knowledge, attitude and practice (KAP) study regarding bio-medical waste management among staff in a tertiary care hospital at Andhra Pradesh. Asian J Manage 2018;9:267-71.
16.	Nagaraju B, Padmavathi GV, Puranik DS, Shantharaj MP, Sampulatha SP. A study to assess the knowledge and practice on bio-medical waste management among the health care providers working in PHCs of Bagepalli Taluk with the view to prepare informational booklet. Int J Med Biomed Res 2013;2:28-35.
17.	Ajmera V, Jayalakshmi LS. A study to assess the knowledge regarding biomedical waste management among B.sc nursing students of selected nursing colleges of Udaipur (Raj). Int J Sci Res 2016;5:1734-8.
18.	Motamed N, BabaMahmoodi F, Khalilian A, Peykanheirati M, Nozari M. Knowledge and practices of health care workers and medical students towards universal precautions in hospitals in Mazandaran Province. East Mediterr Health J 2006;12:653-61.
19.	Dwivedi G, Prakash S, Prakash G, Singh R, Anand D, Mishra R. A study on the knowledge, attitude and practice among health care personnel in secondary care hospital of Prayagraj district. International Journal Of Community Medicine And Public Health 2021;8:1950.