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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 4  |  Page : 240-244

Awareness of biomedical waste management among health-care workers at a tertiary hospital of Kolkata, India: How much are they acquainted with the good practices?


Department of Community Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India

Date of Submission15-Mar-2022
Date of Decision29-Mar-2022
Date of Acceptance30-Mar-2022
Date of Web Publication04-Oct-2022

Correspondence Address:
Sukesh Das
Eden Horizon, Block 1, Flat 3A, 963 Uttar Purba Fartabad, South 24 Parganas, P.O. Garia, Kolkata 700 084, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcsr.jcsr_41_22

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  Abstract 


Background: Enormous volume of biomedical waste (BMW) is generated in health-care facilities with threat of multiple adverse consequences to human and environment. Proper BMW management is of utmost importance to get rid of those adverse effects.
Methods: This institution-based cross-sectional study, conducted between 1 February 2020 and 31 March 2020, among 151 health care workers (HCWs) (80 junior doctors and 71 nursing staff) was conducted to assess the knowledge and practice about BMW management among health-care workers (HCWs) at a tertiary hospital at Kolkata.
Results: All the nursing staff and 92.5% of junior doctors could identify biohazard symbol. About three-fourth of junior doctors were aware of the categories of BMW, while only 47.8% of nursing staff knew this. Only half of the HCWs knew the four colour-coded bags. About 79.5% of the HCWs knew the use of hub cutters. About three-fourth of the HCWs used colour-coded bags correctly while 90% used white puncture-proof containers for sharps. Only one-third of the HCWs were trained on BMW management. There were no significant differences in knowledge and practice scores among the two groups.
Conclusions: The HCWs lacked in appropriate knowledge and practices on BMW management. BMW management rules should be strictly implemented through periodic training and monitoring of HCWs.

Keywords: Awareness, health personnel, medical waste, tertiary care centres


How to cite this article:
Chatterjee S, Das S. Awareness of biomedical waste management among health-care workers at a tertiary hospital of Kolkata, India: How much are they acquainted with the good practices?. J Clin Sci Res 2022;11:240-4

How to cite this URL:
Chatterjee S, Das S. Awareness of biomedical waste management among health-care workers at a tertiary hospital of Kolkata, India: How much are they acquainted with the good practices?. J Clin Sci Res [serial online] 2022 [cited 2022 Dec 5];11:240-4. Available from: https://www.jcsr.co.in/text.asp?2022/11/4/240/357841




  Introduction Top


Biomedical waste (BMW) or health-care waste is defined as 'waste generated in 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] With the increase in population and health-care facilities, enormous volume of BMW is generated every day. It is estimated that 614 tons of BMW was generated per day in India in 2018 and that for West Bengal, it was 34.1 tons/day.[2] The rate of generation of hospital waste in India is 1.6 kg to 2.2 kg/day/bed.[3] About 75%–90% of BMW is non-risk or general waste, while the rest, i.e., 10%–25% is hazardous with potential to cause a variety of health risks including environmental pollution.[1] Hazards may be injuries, infections, namely, hepatitis B, hepatitis C, HIV or genotoxic or radio-active damage.[1] People at risk are health--care workers (HCWs) who generate it, those who handle this and those who get exposed to this inadvertently. Hence, proper knowledge and practice about BMW management are crucial for people at risk, especially for HCWs. In this connection, the Government of India launched BMW (management and handling) Rule in 1998 which was superseded by BMW Management Rules, 2016 which laid guidelines for segregation, treatment and disposal of BMWs.[1],[2],[3],[4],[5]

With this backdrop, and considering the fact that not many studies have been done in this part of our country on BMW management, this study was conducted to assess the knowledge and practice about BMW management among HCWs in a tertiary health-care institution of Kolkata.


  Material and Methods Top


This was an institution-based observational study with cross-sectional design. The study was done in College of Medicine and Sagore Dutta Hospital, Kamarhati among Junior doctors (Interns and Junior Residents) and Nursing staff. The study period was 1 February 2020–31 March 2020. The hospital is located at the outskirt of Kolkata and a significant number of patients attend this medical college as well as referred from the districts adjacent to Kolkata, both for outpatient department and inpatient department services.

At the outset approval from Institutional Ethics Committee of the institution was sought for this study. After getting the approval the study was initiated according to ICMR ethical guideline of conducting biomedical research. Then, informed written consent was taken from each of the study participants before including them in the study. In that process, they were explained the purpose and procedure of the study in detail; the participants were also ensured confidentiality and anonymity.

Departments chosen for the study were - General Medicine, Surgery, Gynaecology and Obstetrics and Paediatric Medicine As the maximum amount of BMWs are generated from these departments of a hospital. All the junior doctors, who were posted in these departments during the period of data collection, i.e., 90 were approached. Out of them pre-testing of the questionnaire was done among 5 junior doctors - they were excluded from the study, whereas another 5 refused to participate. Thus finally 80 junior doctors were selected for the study. Among 110 nursing staff of the above departments during the data collection period, 85 could be contacted. Pre-testing of the questionnaire was done among 5 of them and excluded from the study; another 9 of them refused to participate in the study citing personal reasons and busy work-schedule. Finally, 71 nursing staffs were included in the study. Finally, the sample size for the study came to be 151 (80 junior doctors + 71 nursing staff). Thus, a complete enumeration method was followed and no sampling was done.

Data were collected using a pre-designed, pre-tested, self-administered, structured questionnaire (in English and Bengali). The questionnaire comprised three parts. In the first part, socio-demographic information was there, second part comprised the information regarding the assessment of knowledge and in the third part of the questionnaire, information regarding practice with the BMW were included. Ten items were there for assessing the knowledge domain of the participants and 7 items were included for the assessment of practice domain. For scoring purpose, we have fixed one score for each item of both the domain. Therefore, for the assessment of knowledge part maximum 10 score and for practice part maximum 7 scores could be recorded. The total scores were divided into three groups both for knowledge and practice domain. The knowledge domain was categorised as good (7–10), average (4–6) and poor (0–3) knowledge and for the practice domain, it was categorised as good (5–7), average (3–4) and poor (0–2).

Statistical analysis

The distribution of the knowledge and practice scores, generated from the responses of the study participants were checked by Kolmogarov-Smirnov test and significant P <0.001 indicated skewed distribution. Hence, the scores were represented by median and interquartile range, respectively. Statistical significance of the categorical values were checked by Pearson's Chi-square test. A P ≤ 0.05 was considered statistically significant. The data were entered in the MS Excel Spreadsheet (Microsoft Corp, Redmond, WA) and Statistical Package for Social Sciences (SPSS), Version 20 (IBM Corp Somers NY, USA), was used for statistical analysis.


  Results Top


The study included 80 (52.9%) junior doctors and 71 (47.1%) nursing staff. Socio-demographic profile of the study participants (n=151) is shown in [Table 1]. Majority of the study participants, i.e., 82.8% belonged to the 20–30 years age group. Knowledge and practice about bio-medical waste is shown in [Table 2]. Eighty per cent of the study participants knew what BMW is. All the nursing staff could identify biohazard symbol, though 7.5% of junior doctors failed to recognise it. About three-fourth of junior doctors cited correctly categories of BMW; while only 47.8% of nursing staff knew this. About fourth-fifth of the study participantsknew primary sources of BMW generation. About one-fourth of the HCWs knew that among all the waste generated in health-care facilities, only 15%–20% is hazardous or BMW. Only half of the HCWs knew the four colour-coded bags designated for the collection of BMW. Infections were cited most commonly as hazards of BMW by both the groups of HCWs. Majority (79.5%) of the HCWs knew the use of hub cutters, whereas only one-third knew the maximum storage time of BMW as 48 h. Majority of the study participantspractise correctly different colour-coded bags - about three-fourth of HCWs use yellow and red-coloured bags correctly, while 90% use white puncture-proof containers for sharps. Only one-third of the HCWs were trained in BMW management - far less for junior doctors (16.2%) compared to nurses (49.3%). About one-fourth of the HCWs were not vaccinated against hepatitis B.
Table 1: Socio-demographic profile of the study participants (n=151)*

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Table 2: Knowledge and practice about bio-medical waste management (n=151)

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Comparison of knowledge and practice score of the junior doctors and nursing staff about BMWM is shown in [Table 3]. About 42.3% of the nursing staff had good knowledge scores compared to 36.2% of junior doctors, though the difference in knowledge scores among the two groups was not statistically significant. Furthermore, the difference in practice scores among the two groups was not statistically significant.
Table 3: Comparison of knowledge and practice score of the study participants about BMWM (n=151)

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  Discussion Top


In the present study, about fourth-fifth of the study participants knew correctly the primary sources of BMW generation, whereas another study reported more than 90% of HCWs were aware of this.[4] In this study, 61.6% of HCWs knew correctly the number of categories of BMW, while another study from Haryana reported better knowledge of HCWs (91.6% for doctors, 72.7% for nurses) in this regard.[4] On the contrary, another study[5] from Karnataka found HCWs less aware only 43% knew the categories correctly. Only half of the HCWs in this study knew the four colour-coded bags designated for collection of BMW while studies[4],[6] from Haryana and Ethiopia found better knowledge among HCWs in this regard. Another study from West Bengal reported poor knowledge on colour-coded segregation of wastes among HCWs.[7] About one-third of the HCWs (35.1%) were aware that BMW can be stored for 48 h, consistent with findings of studies[4],[8],[9] from Himachal Pradesh and Haryana. Another study[6] from Ethiopia found that only around 10% of HCWS knew this. In a study[10] only 37.6% knew about the maximum time limit for medical waste to be kept in hospital premises is 48 hours. Almost all the participants (96.1%) in the study could identify the biohazard symbol while another study[8] from Himachal Pradesh found it as 83%.

In this study, proper use of black, yellow, red and white puncture-proof containers was found among 94%, 74.8%, 76.8% and 90.1% of participants, respectively. Similar practices were reported by other studies.[4],[6],[8],[11] More than three-fourth of the HCWs (77.5%) use hub cutters for destroying used needles. Similar practices for needles were found in studies from Haryana (80%) and Himachal Pradesh (66%).[4],[8] On the contrary, another study[12] found a very promising picture in their study done in a dedicated COVID hospital in Bangalore. They found all the treating doctors and nurses were using puncture-proof plastic containers to collect waste sharps. Training of HCWs on BMW management is neglected, as reflected in the current study as well as other studies which reported wide variation, i.e., 1.5%–80% of HCWs exposed to training.[5],[6],[7],[8],[11] About three-fourth of the study participants were vaccinated against hepatitis B, consistent with the finding of studies from Haryana and Lucknow, UP, though the study from Ethiopia found it 30.7%.[4],[6],[11]

The HCWs lacked in appropriate knowledge and practices on BMW management in this study. Nurses were marginally ahead in knowledge score compared to junior doctors; the difference in knowledge and practice score among the two groups were not statistically significant. Some studies reported good knowledge among the HCWs, particularly doctors while nurses had better practices on BMW management,[9],[13],[14],[15],[16],[17] whereas other studies found poor knowledge among HCWs on BMW management.[5],[6] BMW management rules should be strictly implemented through periodic training and monitoring of HCWs.

Awareness and regular practice of handling BMWs are still lacking even among the most high-risk group, i.e., HCWs. Appropriate authority should be well vigilant to this issue and regular training of this group should be organised with proper importance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Park K. Park's Text book of Preventive and Social Medicine. 26th ed. Jabalpur: Bhanot Publishers; 2021.  Back to cited text no. 1
    
2.
Central Pollution Control Board. Annual Report on Biomedical Waste Management as per Biomedical Waste Management Rules, 2016 for the Year 2018. Available from: https://cpcb.nic.in/uploads/Projects/Bio-Medical-Waste/AR_BMWM_2018.pdf. [Last accessed on 2021 Jan 06].  Back to cited text no. 2
    
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Centre for Environment Education and Technology. Bio-medical waste management-Burgeoning Issue. Available from: http://www.ceetindia.org/bio medical_waste_management_burgeoning_issue.html. [Last accessed on 2021 May 12].  Back to cited text no. 3
    
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Anand P, Jain R, Dhyani A. Knowledge, attitude and practice of biomedical waste management among health care personnel in a teaching institution in Haryana, India. Int J Res Med Sci 2016;4:4246-50.  Back to cited text no. 4
    
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Golandaj JA, Kallihal KG. Awareness, attitude and practises of biomedical waste management amongst public health-care staff in Karnataka. J Humanit Appl Soc Sci 2021;3:49-63.  Back to cited text no. 5
    
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Deress T, Hassen F, Adane K, Tsegaye A. Assessment of knowledge, attitude, and practice about biomedical waste management and associated factors among the healthcare professionals at Debre Markos town healthcare facilities, Northwest Ethiopia. J Environ Public Health 2018;2018:7672981.  Back to cited text no. 6
    
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Das SK, Biswas R. Awareness and practice of biomedical waste management among healthcare providers in a tertiary care hospital of West Bengal, India. Int J Med Public Health 2016;6:19-25.  Back to cited text no. 7
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8.
Abrol A, Mahajan S, Chauhan M, Kumar N. Awareness and practices regarding biomedical waste management among health care workers in a tertiary care hospital in Himachal Pradesh. Indian J Microbiol Res 2019;6:92-6.  Back to cited text no. 8
    
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Sharma N, Kumar N, Malik JS, Singh S, Jangra A. Study to assess the knowledge, attitude and practices of biomedical waste management among healthcare personnel at a tertiary care hospital in Haryana. J Adv Res Med Sci Tech 2017;4:34-9.  Back to cited text no. 9
    
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Letho Z, Yangdon T, Lhamo C, Limbu CB, Yoezer S, Jamtsho T, et al. Awareness and practice of medical waste management among healthcare providers in National Referral Hospital. PLoS One 2021;16:e0243817.  Back to cited text no. 10
    
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Imchen T, Kumari R, Singh JV, Srivastava K, Singh A. Study of biomedical waste management among healthcare personnel at a tertiary hospital in Lucknow District. Int J Community Med Public Health 2017;4:1483-7.  Back to cited text no. 11
    
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Basavaraj TJ, Shashibhushan BL, Sreedevi A. To assess the knowledge, attitude and practices in biomedical waste management among health care workers in dedicated COVID hospital in Bangalore. Egypt J Intern Med 2021;33:37.  Back to cited text no. 12
    
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Rao D, Dhakshaini MR, Kurthukoti A, Doddawad VG. Biomedical waste management: A study on assessment of knowledge, attitude and practices among health care professionals in a tertiary care teaching hospital. Biomed Pharmacol J 2018;11:1737-43.  Back to cited text no. 13
    
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Sekar M, Swapna M, Easow JE. A study on knowledge, attitude and practice of biomedical waste management among health care workers in a tertiary care hospital in Puducherry. Indian J Microbiol Res 2018;5:57-60.  Back to cited text no. 14
    
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Rajiv BS, Shouri S. Assessment of knowledge, attitude, practices of biomedical waste management among healthcare personnel. Sch J Appl Med Sci 2017;5:3427-31.  Back to cited text no. 15
    
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Bhattacharjee S, Saha B. Study of knowledge, attitude and practices regarding biomedical waste management among healthcare personnel in Gazipur, Bangladesh. Life Sci Int J 2015;1:1-6.  Back to cited text no. 16
    
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Ranu R, Santosh K, Manju L. Knowledge, attitude and practice regarding biomedical waste management amongst health care personnel in a medical college hospital in Trivandrum. Natl J Community Med 2016;7:457-60.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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