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ORIGINAL ARTICLE
Year : 2018  |  Volume : 16  |  Issue : 3  |  Page : 213-216

Assessment of cognizance and execution of biomedical waste management among health care personnel of a dental institution in Bhubaneswar


Department of Public Health Dentistry, Institute of Dental Sciences, Bhubaneswar, Department of Dentistry, Govt. Medical College, Balangir, Odisha, India

Date of Submission09-Aug-2017
Date of Acceptance17-May-2018
Date of Web Publication6-Aug-2018

Correspondence Address:
Dr. Swati Patnaik
Department of Public Health Dentistry, Institute of Dental Sciences, K-8 Kalinga Nagar, Bhubaneswar - 751 003, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_114_17

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  Abstract 

Introduction: Inadequate knowledge of handling biomedical waste (BMW) may have serious health consequences and a significant impact on the environment as well. Judicious management of waste is not only a legal necessity but also a social responsibility. However, extreme laxity in the implementation of rules coupled with inadequate training of healthcare personnel leads to indiscriminate disposal of biomedical waste. Aim: The aim of this study is to assess knowledge, attitude, and practice (KAP) regarding BMW management and to determine the correlation between KAP and professional category. Materials and Methods: A cross sectional study was conducted among 168 healthcare personnel. A predesigned and pretested structured 34 item questionnaire was used for data collection. A self made scoring system was devised to categorize KAP as good, average, and poor. Data entry and analysis was performed using SPSS version 20. To determine whether there was any correlation between KAP and professional category Spearman's rank correlation coefficient was computed. Value of P < 0.05 was considered to be statistically significant. Results: KAP were found to have a significant positive correlation (P = 0.002, 0.04, and <0.001, respectively) with the professional category. Conclusion: The need for comprehensive training programs regarding BMW management is highly recommended to all hospital staff.

Keywords: Assessment, biomedical waste, dental, health personnel


How to cite this article:
Patnaik S, Sharma N. Assessment of cognizance and execution of biomedical waste management among health care personnel of a dental institution in Bhubaneswar. J Indian Assoc Public Health Dent 2018;16:213-6

How to cite this URL:
Patnaik S, Sharma N. Assessment of cognizance and execution of biomedical waste management among health care personnel of a dental institution in Bhubaneswar. J Indian Assoc Public Health Dent [serial online] 2018 [cited 2018 Nov 17];16:213-6. Available from: http://www.jiaphd.org/text.asp?2018/16/3/213/238577


  Introduction Top


Waste generation is a continuous process. Waste is accumulated from all sectors of life, but the most dangerous or harmful wastes are the hospital waste. The harmful nature of the waste can be attributed to their high infectious nature. Hospital waste can be termed as “biomedical waste (BMW),” which is further defined as “any waste that is generated during diagnosis, treatment or immunization of human beings or animals, or in the research activities pertaining to or in the production or testing of biological and includes categories mentioned in schedule I of the Government of India's BMW (Management and Handling) Rules 1998.”[1]

BMW can be of high risk to those who handle it, at any stage, be it segregation of waste or its disposal in specific color coded bags.[2] According to the WHO reports, improper management and disposal of medical waste continue to pose a significant threat to the rights of an adequate standard of living. 10%–15% of the BMW generated is infectious in nature. They can act as a focus of infection, greatly contributing to the rise of nosocomial infections, due to the high concentration of Shigella species,  Salmonella More Details typhi,  Escherichia More Details coli and hepatitis virus.[3] Handling of infectious waste callously; increase the risk of contamination, especially for the Class IV employees.[4]

Judicious management of waste is not only a legal necessity but also a social responsibility. Inadequate knowledge of handling BMW may have serious health consequences.[5] Personnel concerned with healthcare are not only expected to have understanding regarding proper segregation and disposal of BMW but should also have the aptitude to mentor others regarding the same. Due to inappropriate BMW management and scarcity of knowledge, hospitals are considered nucleus of infections spread.[6] Therefore, the present study aimed to assess the knowledge, attitude, and practices (KAPs) concerning BMW management and its handling among dental faculty, nursing staff, laboratory technicians, and Class IV employees working in one of the private dental teaching hospitals in Bhubaneswar (Odisha) and to determine the correlation between KAP and the professional category.


  Materials and Methods Top


An institutional, cross sectional study was conducted in one of the private dental teaching hospitals in Bhubaneswar, Odisha from May 2017 to June 2017.

The research instrument was a self administered questionnaire in English and Oriya language. Translation of the modified questionnaire to the Oriya language was essential since the participants included Class IV employees, who are not well versed in the English language. A 34 item questionnaire was adapted from previous studies and modified considering Indian context.[6],[7] Modifications were made to remove areas of ambiguity in the questionnaire. The original questionnaire had 40 questions, few questions were removed as they were considered unnecessary and did not hamper with the fluidity of the questions. Two questions about BMW legislation were removed from Section 1 of the original questionnaire as it was not very clear to the Class IV employees. From Section 2, two questions regarding the level of awareness about color coding segregation was not included as it was noticed that even though the answers were positive, the responses to the subsequent questions were contradictory. Hence, to eliminate any bias, the questions were eliminated. In Section 3, two questions related to the number of injuries and the authority for reporting of injuries was removed. The questions were found to be unnecessary as more weight was given to the practice of filing a report. The modified questionnaire was then pilot tested on a small group of staff that included five dentists, five nursing staff, five laboratory technicians and five Class IV employees. They were requested to complete it and indicate any questions that they found to be unclear. Test retest was used to check the reliability and internal consistency of the questionnaire before the study, among the pilot study population. The results thus obtained were subjected to statistical analysis. Cronbach's alpha value of 0.86 suggested good internal consistency of the questionnaire.

The questionnaire consisted of 34 questions and was designed to obtain information about knowledge of BM waste generation and waste management practices. The questions were grouped under three headings as follows: (a) Knowledge/Cognizance (K) concerning BMW generation, health hazards, and legislation on waste management practices (16 items), (b) Attitude (A) assessment toward BMW (11 items), and (c) Practices/Execution (P) concerning needle stick injuries (7 items). Questions to assess knowledge were of a multiple choice type where only one response was the correct one. Questions to assess attitude and practice were presented in the positive or negative response format (Yes/No). Each correct and incorrect response in the knowledge section and each yes and no for the attitude and practice question were given 1 and 0 mark, respectively. Thus, score for knowledge section was (maximum 16; minimum 0), attitude (maximum 11; minimum 0), and practice (maximum 7; minimum 0). KAP of each of the participants was measured by corresponding scores in each section of the structured questionnaire. A self made scoring system was devised to categorize KAP of the study participants as good, average, and poor. A score of <5 was categorized as poor, 5–10 as average, and >10 as good.

The study sample was collected using convenience sampling method and comprised 174 healthcare personnel's of the dental college hospital. The study population included 92 dentists, 34 nursing staff, 18 laboratory technicians, and 24 Class IV employees (cleaners and maintenance personnel). Two nursing staff and four Class IV employees did not complete the questionnaire; therefore, 168 subjects participated in the study.

The Institutional Review Board approved the study protocol (IRB/PHD/06/16), and written consent was taken from all the subjects before they were given the questionnaire.

Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 20 (IBM, Chicago Inc., IL USA). The levels of KAP of dentists, nurses, laboratory technicians, and Class IV employees regarding BMW were expressed in both frequency and percentages. To determine whether there was any correlation between KAP and professional category Spearman's rank correlation coefficient was computed. Vaue of P < 0.05 was considered to be statistically significant.


  Results Top


Out of 174 subjects, as mentioned above, two nurses and four Class IV employees failed to respond to the questionnaire. Therefore, 168 subjects participated in the study.

Among a total of 168 respondents, 42.8% (n = 72) were male and the rest 57.1% (n = 96) were females. About 54.7% were dentists, 19.7% (n = 34) were nurses, 10.4% (n = 18) were laboratory technicians and the rest 13.9% (n = 18) were Class IV employees [Table 1].

To find whether the knowledge level increased as the professional level increased, Spearman's rank correlation coefficient (rs) was computed. rs were obtained as 0.27 with a P = 0.002. Hence, there is a significant positive correlation between knowledge level and professional category. This implies that even though there is mild positive relationship (0.27). Although the strength of the relationship is low, a significant increase in knowledge level as the profession category level increases. The attitude of all the five groups was compared using Spearman's rank correlation coefficient which was observed to be statistically significant. (rs = 0.774, P = 0.04). This implies that there is a significant increase in attitude level as the profession category level increases. The type of practice followed by the five groups is computed using Spearman's rank correlation. The coefficient was obtained as 0.331 with a value of P < 0.001. This implies that there is a significant positive correlation between the type of practice followed and professional category. As professional level increases type of practice also becomes better [Table 2].


  Discussion Top


Management of hospital waste is a major challenge to the hospitals. This waste has become a risk factor to the health of patients, hospital staff extending beyond the boundaries of the medical establishments to the general public and to the environment. Improper handling, inadequate recycling, and un monitored reuse are increasing the hazardous effect of BMW, leading to the introduction of pathogenic bacteria, virulent viruses, which in turn increases the chances of infection, thus contributing to the disease burden of the nation.[8] Improper handling of BMW and its disposal, along with municipality waste is responsible for the exposure of health care workers, waste handlers, rag pickers and the general public to nosocomial infections and fatal diseases. Treating this problem as a priority, the Ministry of Environment and Forest (MoEF), Govt. of India, proposed the BMW rules (1998) under the Environment Protection Act 1986 which was amended in 2000, 2011 as well as 2016 and taken forward by the Central Pollution Control Board.[9]

The MoEF in 2011 indicated that 13,037 healthcare facilities in the country have been found to be in violation of BMW generation and disposal rules.[10] An article published in The Times of India in the year 2013 emphasized the issue of noncompliance of the norms of Orissa State Pollution Control Boards by the hospitals in Bhubaneswar.[11] It is a matter of serious concern that should be addressed to ensure optimal health and quality of life.

Knowledge regarding storage of BMW waste is essential as the infectious nature of the waste increases with storage for long hours. BMW rules have specified the maximum storage time to be 48 h. When the healthcare personnel was asked about the maximum duration of storage of BMW, 93.2% of the MDS faculty and 82% of the nursing staff gave a correct response. The findings are in contrast to studies done by Anand et al., Malini and Eshwar and Mathur et al.[12 14] In response to a question asked regarding the disposal of sharps 82.4% of MDS and 61% of BDS faculty answered correctly. However, it was alarming to note that only 33.3% of Class IV employees were aware of the correct corresponding codes. This is in accordance with a study done by Narang et al.[7] Dentists attend regular CDE programs which keep them updated, similarly, Class IV employees should be encouraged and given the opportunity to attend workshops concerning BMW management.

Waste management is a teamwork. This statement was agreed upon by only 22% of BDS and 24% of MDS faculty. This is in contrast to studies done by Malini and Eshwar and Ismail et al., where the majority of the doctors supported the statement.[13],[15] Patrick Lencioni, a renowned business management writer, while describing leadership roles and teamwork, rightly quoted “If you could get all the people in an organization rowing in the same direction, you could dominate any market, against any competition.”[16] Ironically in a developing country like India, genuine teamwork remains elusive as the team members' fall unknowingly to the dysfunctional pitfalls.

While the search for knowledge is a continuous process, acquiring knowledge and putting it into action is extremely important. Upgrading existing knowledge about BMW management through development education programs and training workshops is essential. Majority of the dentists, nurses, laboratory technicians and Class IV employees were in favor of conduction of such programmes. The findings are similar to studies done by Malini and Eshwar and Narang et al.[7],[13]

Percutaneous injuries (needle stick or cut with a sharp object) pose a greater risk of transmission of Hepatitis B virus. To decrease the burden of hepatitis in dental healthcare workers, it is recommended by the Dental Council of India that the dental professionals should receive immunization against hepatitis virus and should use the individual protective equipment. Despite the availability and recommendations on hepatitis B vaccination, the vaccination rate among dental professionals has remained consistently low in developing countries. On being inquired, only 56% of BDS and 77% of MDS faculty were sure about their vaccination/inoculation history. This is in accordance with studies done by Malini and Eshwar and Kalia Et al.[13],[17]

The current study is pristine and novel in nature and adds to a very limited body of literature which evaluates the BMW management in Odisha. However, our study had certain limitations. The data for the study relied heavily on the information received from the respondents, and hence may be biased by social desirability.


  Conclusion Top


A significant difference in KAPs of handling BMW was found among the study population, highlighting the need for a more rigid protocol with periodic training and reinforcement. Crucial areas, which need to be addressed for effective handling of bio medical waste, are capacity building by training and retraining, concern and commitment on the part of the healthcare providers, institutional and city level policies, occupational safety and personal protective devices, information dissemination and practical advocacy endeavors. For BMW management to be a successful initiative, BMW management should be a social responsibility, and everybody should get involved.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Questionnaire Top


Proforma for Data Collection

Data Entry Done ◻

(For Office Use only)

Sl. no. ◻

(For Office Use only)

Instructions

  1. Your name is not recorded and confidentiality will be maintained, so please give honest responses.
  2. Please fill up all the details and provide all information true to the best of your knowledge.
  3. If you don't understand any questions, please feel free to ask for clarifications.
  4. Check/Tick the answer you think is most appropriate using TICK Ρ mark only.


Your Position

  • Dentist MDS ◻ BDS ◻
  • Nurses ◻
  • Laboratory Technician ◻
  • Class IV Employee ◻


Section 1: Knowledge of Biomedical (BM) Waste Generation, Hazards And Legislation.

  1. Biomedical Waste (Management and Handling) Rules were first proposed in:

    ◻ 1997 ◻ 1998 ◻ 1999 ◻ 2000
  2. Amendments to the Biomedical Waste (Management and Handling) Rules were made in:

    ◻ 2000 ◻ 2001 ◻ 2003 ◻ 2004


  3. What agency(ies) regulate (s) wastes generated at health care facilities ?


  4. State ◻ Private ◻ Do not know ◻

  5. Which statement describes one type of BM waste:


  6. ◻ Materials that may be poisonous, toxic, or flammable and do not pose disease related risk.

    ◻ Waste that is saturated to the point of dripping with blood or body fluids contaminated with blood.

    ◻ Waste that does not pose a disease related risk.

  7. According to the Biomedical Waste (Management and Handling) Rules, waste should not be stored beyond:


  8. ◻ 12 hours ◻ 48 hours ◻ 72 hours ◻ 96 hours

  9. One gram of mercury (source from dental amalgam) is enough to contaminate the following surface area of a lake:


  10. ◻ 20 acres ◻ 30 acres ◻ 25 acres ◻ 15 acres

  11. Who regulates the safe transport of medical waste?


  12. ◻ Pollution Control Board of India.

    ◻ Transport Corporation of India.

    ◻ College Administration.

  13. Do you need a separate permit to transport biomedical waste?


  14. Yes ◻ No ◻ Cannot say ◻

  15. Objects that may be capable of causing punctures or cuts, that may have been exposed to blood or body fluids including scalpels, needles, glass ampoules, test tubes and slides, are considered biomedical waste. How should these objects be disposed of?


  16. ◻ Black bags ◻ Yellow bags ◻ Clear bags ◻ Blue/White bags

  17. Documents with confidential patient information are to be disposed of into the paper recycling bins.


  18. True ◻ False ◻ Do not know ◻

  19. Is there any segregation procedure at point of generation of waste or before disposal.


  20. Yes ◻ No ◻ Do not Know ◻

  21. The colour code for the BM waste to be autoclaved, disinfected is:


  22. ◻ Red ◻ Black ◻ Yellow ◻ Blue/white

  23. The approximate proportion of infectious waste among total waste generated from a health care facility is:


  24. ◻ 10 20% ◻ 30 40% ◻ 50 60% ◻ 80 90%

  25. The colour code for disposal of normal waste from the college is:


  26. ◻ Red ◻ Black ◻ Yellow ◻ Blue

  27. All the following steps should be followed after an exposure with infected blood/body fluid and contaminated sharps EXCEPT:


  28. ◻ Exposed parts to be washed with soap and water.

    ◻ Pricked finger should be kept in antiseptic lotion.

    ◻ Splashes to eyes should be irrigated with sterile irrigants.

    ◻ Splashes to skin to be flushed with water.

  29. All of the following statements about hazardous waste containers are true, except for:


  30. ◻ Containers must be closed except when removing or adding waste.

    ◻ Containers must be clean on the outside.

    ◻ Contents must be compatible with the type of waste containers.

    ◻ Any type of container, including food containers, can be used to contain hazardous waste.

    Section 2: Attitude/Behaviour Assessment towards Biomedical Waste

  31. Safe management of health care waste is not an issue at all.


  32. Yes ◻ No ◻ Cannot comment ◻

  33. Waste management is team work/no single class of people is responsible for safe management.


  34. Yes◻ No◻ Cannot comment ◻

  35. Safe management efforts by the hospital increase the financial burden on management.


  36. Yes◻ No◻ Cannot comment ◻

  37. Safe management of health care waste is an extra burden on work.


  38. Yes◻ No◻ Cannot comment ◻

  39. Do you think that the college should organise separate classes or a continuing dental education programme to upgrade existing knowledge about biomedical waste management?


  40. Yes ◻ No ◻ Cannot comment ◻

  41. Will you like to attend voluntarily programmes that enhance and upgrade your knowledge about waste management?


  42. Yes ◻ No ◻ Cannot comment ◻

  43. Do you think that infectious waste should be sterilised from infections by autoclaving before shredding and disposal?


  44. Yes ◻ No ◻ Cannot comment ◻

  45. Do you think that an effluent treatment plant for disinfection of infected water should be set up in dental colleges?


  46. Yes ◻ No ◻ Cannot comment ◻

  47. Do you think it is important to report to the Pollution Control Board of India about a particular institution if it is not complying with the guidelines for biomedical waste management?


  48. Yes ◻ No ◻ Cannot comment ◻

  49. Do you think that labelling the container before filling it with waste is of any clinical significance?


  50. Yes ◻ No ◻ Cannot comment ◻

  51. Is biomedical waste management, generation and legislation important ?


  52. Yes ◻ No ◻ Cannot comment ◻

    Section 3: Practice Assessment on Needle stick injuries.

  53. Is needle stick injury a concern?


  54. Yes ◻ No ◻ Do not know ◻

  55. Do you re cap the used needle?


  56. Yes ◻ No ◻ Do not bother ◻

  57. Do you discard the used needle immediately?


  58. Yes ◻ No ◻ Have not noticed ◻

  59. Are you aware of consequences of needle stick injury?


  60. Yes ◻ No ◻ Not concerned ◻

  61. Have you sustained a needle stick injury during the last 12 months?


  62. Yes ◻ No ◻ Do not remember ◻

  63. Did you fill in an incident report?


  64. Yes ◻ No ◻ Cannot remember ◻

  65. Have you been fully inoculated against hepatitis B?


  66. Yes ◻ No ◻ Not sure ◻


THANK YOU FOR YOUR VALUABLE TIME AND COOPERATION.

 
  References Top

1.
Gupta NK, Shukla M, Tyagi S. Knowledge, attitude and practices of biomedical waste management among health care personnel in selected primary health care centres in Lucknow. Int J Community Med Public Health 2016;3:309 13.  Back to cited text no. 1
    
2.
Nazli SN, Karuppannan SL, Omar D. Knowledge and awareness of clinical waste management among medical practitioners in hospital Batu Pahat, Johor. Int J Innovation Manag Technol 2014;5:139 42.  Back to cited text no. 2
    
3.
World Health Organization. A Hand Book on Health Care Waste Management – A Guide for Developing Countries. Safe management of waste from health care activities. WHO, Geneva: World Health Organization; 1999.  Back to cited text no. 3
    
4.
Saraf Y, Shinde M, Tiwari SC. Study of awareness status about hospital waste management among personnel and quantification. Indian J Community Med 2006;31:111.  Back to cited text no. 4
  [Full text]  
5.
Gupta V, Mohapatra D, Kumar V. Study to assess the knowledge, attitude and practices of biomedical waste management among health care personnel at tertiary care hospital in Haryana. Int J Basic Appl Med Sci 2015;5:102 7.  Back to cited text no. 5
    
6.
Sharma A, Sharma V, Sharma S, Singh P. Awareness of biomedical waste management among health care personnel in Jaipur, India. Oral Health Dent Manag 2013;12:32 40.  Back to cited text no. 6
    
7.
Narang RS, Manchanda A, Singh S, Verma N, Padda S. Awareness of biomedical waste management among dental professionals and auxiliary staff in Amritsar, India. Oral Health Dent Manag 2012;11:162 8.  Back to cited text no. 7
    
8.
World Health Organization. Safe Healthcare Waste Management: Policy Paper. Geneva: World Health Organization; 2004. p. 23 45.  Back to cited text no. 8
    
9.
Bio Medical Wastes (Management and Handling) Rules, 1997 98 Notified on 16th October and Gazetted on 27 October, 1997. Ministry of Environment and Forests, New Delhi; 20 July, 1998.  Back to cited text no. 9
    
10.
Ministry of Environment and Forests. Environment Management and Policy Research Institute, State of Karnataka Report; 2011.  Back to cited text no. 10
    
11.
Ramanath RV. Bio Waste Litters Bhubaneswar as Hospitals Flout Norms. The Times of India; 7 August, 2013.  Back to cited text no. 11
    
12.
Anand P, Jain R, Dhyani A. Knowledge attitude and practice of biomedical waste management among healthcare personnel in a teaching institution in Haryana India. Int J Res Med Sci 2016;4:4246 9.  Back to cited text no. 12
    
13.
Malini A, Eshwar B. Knowledge, attitude and practice of biomedical waste management among health care personnel in a tertiary care hospital in Puducherry. Int J Biomed Res 2015;6:172 6.  Back to cited text no. 13
    
14.
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.  Back to cited text no. 14
    
15.
Ismail IM, Kulkarni AG, Kamble SV, Borker SA, Rekha R, Amruth M. Knowledge, attitude and practice about bio medical waste management among personnel of a tertiary health care institute in Dakshina Kannada, Karnataka. Al Ameen J Med Sci 2013;6:376 80.  Back to cited text no. 15
    
16.
Lencioni P. The Five Dysfunctions of a Team: A Leadership Fable. United States: Jossey Bass Publishers; 2002.  Back to cited text no. 16
    
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Kalia M, Virk A, Gupta BP, Singh J. Biomedical waste management practices in a tertiary care hospital in Punjab. Int J Med Sci Public Health 2015;4:179 83.  Back to cited text no. 17
    



 
 
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