Knowledge of Biomedical Waste Management Amidst the Clinical Students of Dental College, Tamilnadu State, India – A Cross Sectional Observational Study

ABSTRACT

Background:

The objective of study was to assess the knowledge and awareness of the management of biological waste (BMW) among undergraduate students of Dental College, Tamilnadu state.

Materials and Methods:

Among the students of Dental College in Tamilnadu state, India, a cross-sectional observational research was conducted. A pre-designed questionnaire was distributed to the students. Their expertise and awareness of managing biomedical waste were the variables that were investigated.

Results:

One hundred and eighty students were participated. The male to female ratio was 1:2, and the average age of responders was 19.76 ± 1.03 years. When it comes to information concerning the management of biomedical waste, an average of 60.33% were correct and 39.57% were incorrect. For their knowledge of the same, 81.35% were correct and 18.65% were incorrect.

Conclusion:

The findings indicated that students had a high degree of knowledge and understanding regarding the management of biomedical waste.

INTRODUCTION

Biomedical waste generated by dental practices comes in both large and small amounts, and both must be managed with equal care. The amount and type of trash produced by a dental office are both very important. But a smaller amount of biological waste always results in cost savings and a better disposal method.

The waste materials that are produced during the diagnostic procedure, in the treatment and immunisation to “person” or to “animal” are referred to as biomedical waste (BMW). This waste material might seriously endanger both human health and the environment if it is handled carelessly. All hospital staff members run the risk of catching lethal diseases including HIV, HBV, and HCV as well as becoming hurt by these dangerous substances. Implementing a selected waste management system in hospital infrastructure is necessary to minimize these worries.[1]

There are many different types of waste that dental offices generate, including plastic, latex, cotton, glass, amalgam waste, mercury, X-ray processing solutions, lead foils, disinfectants, chemicals, dental casts and impressions, waste sharps like surgical needles and blades, extracted teeth, human tissues, discarded, expired medications, and dental materials.[2] Due to their contamination with bacteria from blood and saliva that can spread illnesses, all of these objects present a major risk.

Most of this waste doesn’t pose a greater threat than standard home waste. However, some forms of medical waste pose a higher risk to public health. In addition to the total volume of medical trash, this also comprises infectious waste (15-25%), sharps waste (1%), body part waste (1%), chemical or pharmaceutical waste (3%), radioactive and cytotoxic waste (3%), and broken thermometers (less than 1%). Biohazardous waste and nonhazardous waste are the two main categories of BMW produced by hospitals.[3] Materials like clean plastic, cardboard, packing peanuts, paper, and other items make up nonhazardous waste. There are once again divided into two categories as biohazardous waste: (a) Contaminated waste which includes liquid waste, throw-away plastic items, sharp and blunt objects, etc., and (b) Non-contagious waste such as burned garbage, radioactive waste, used glass, chemical waste, and cytotoxic waste.

The Biomedical Waste Rules of India from 1998 define biomedical waste as “any solid, fluid, or liquid waste, including its container and any intermediate product, which is generated during the diagnosis, treatment, or immunization of humans or animals, in research pertaining thereto, or in the production or testing of biological and the animal waste from slaughter houses or any other like establishments.”[4]

The hazardous portion of medical waste, which can cause a number of health issues, makes up about 10 to 25 percent of it. This is due to the risk of infectious diseases [like HIV, hepatitis C, and B infections] as well as the disruption of the ecological balance posed by BMW, which includes infectious wastes, pathological wastes, chemicals, sharps, pharmaceutical waste, genotoxic waste, heavy metal waste, and radiologic waste.[5]

The 11 Southeast Asian nations collectively generate over 350,000 tonnes of medical waste annually, according to the World Health Organization (WHO). A total of 15% of the waste generated by the healthcare business is classified as hazardous material, while the remaining 85% is general, non-hazardous waste, some of which may be infectious, toxic, or radioactive.[5] Even though less hazardous waste is produced than overall medical waste, this is because ineffective waste processing procedures mix the two types of trash, which causes contamination.

Health risks are more likely to affect people who handle and are exposed to BMW. They consist of dental professionals, nurses, doctors, patients, waste management personnel, and treatment personnel.

The Biomedical Waste (Management and Handling) Rules provide that every occupier of a facility that generates biomedical waste is responsible for taking all reasonable precautions to ensure that the waste is handled in a way that protects human health and the environment.[5] The central government updated the BMW Management Rules of 2016 and released the BMW Management (amendment) Rules of 2018, which were printed in the Indian Gazette.[6] At all stages of production, collection, transit, storage, treatment, and disposal, strict adherence to the guidelines, and standards for BMW management is required.[7]

The inadequate application of biowaste legislation, which causes some hospitals to dispose of waste wrongly, randomly, and without care, is a serious problem for present BMW management in many hospitals. The following procedures must be followed in order to manage BMW in any setting safely and scientifically: handling, segregation, mutilation, disinfection, storage, transportation, and final disposal.[3] Increased length of stay, mortality, and healthcare costs are caused by infections related to health care.[8] The objective of this current study was to evaluate the knowledge and awareness of hospital waste management practices among undergraduate students of Dental College, Tamilnadu state.

MATERIALS AND METHODS

The present cross-sectional observational study was conducted amid the students of Dental College, Tamilnadu in 2018. The study involved 180 students who voluntarily took part, and all participants received thorough information about the study’s methodology and goals. Each subject provided their written informed consent, and their anonymity was protected throughout the whole study. In the classroom, these pupils were handed a pretested structured questionnaire, which they were told to fill out using the information. The purpose of the questionnaire was to determine the respondents’ level of experience with and familiarity with BMW management. The difference between the means and standard deviations (SD) of two proportions was tested statistically using the Z-test.

RESULTS

The questionnaire was completed by 180 students, of whom 66.37% female and 33.63% male. As shown in Table 1, the male to female ratio was 1:2, and the mean age of all respondents was 19.76 years (for male: 20.24 years and for females: 19.28 years).

Table 1.

Participants’ data presentation

Statistics	Number of students	Percentage	Mean and standard deviation (SD) of age
Male	60	33.63	21.12±1.03
Female	120	66.37	20.20±1.17
Total	180	100	20.64±1.01

The investigation discovers a statistically significant difference between male and female patients’ age in years patients (P < 0.01). As demonstrated in Table 2, after using the Z-test for difference between two sample proportions, it was discovered that knowledge of BMW management differed significantly for all statements in terms of accurate and erroneous answers (i.e. P < 0.05). 70.40% the right answers was stated, and 29.50% the wrong answers were given. Although, after using the Z-test for difference between two sample proportions, there is a significant difference in awareness for the practise of BMW management for all claims with regard to accurate and inaccurate (i.e. P < 0.05).

Table 2.

Respondent’s understanding of BMW management was determined by the following findings

Statement regarding knowledge	Correct (%)	Incorrect (%)
Are you familiar with the definition of biomedical waste?	52	48
Are you familiar with the proper order for managing biological waste?	48	52
Do you know the proper way to dispose of biomedical waste?	57	43
Untreated biological waste is not permitted to be retained for more than 48 hours, according to Government Laws.	75	25
Can improper biomedical waste disposal pose a risk to one’s health?	56	44
Extra silver amalgam is stored in an airtight container with water.	80	20
Do you know which dental amalgam ingredient poses a risk to the environment?	94	06
Brackets and wires from orthodontic appliances are deformed and disposed of.	45	55
Old and contaminated medications are disposed of in a secure landfill.	72	28
Excess amalgam should be disposed of in the traditional spittoon attached to the dentist chair once the patient’s mouth has been filled.	84	16
Are you aware that items that are typically considered to be non-recyclable, including as syringes, needles, and IV sets, can really be recycled for other purposes?	94	06
Deactivating biological waste primarily involves using an incinerator and an autoclave.	71	29
Risks of contracting HBV increase by 30% after one needle-stick injury from a patient who was exposed to an infected source.	88	12
Average	70.40	29.60

According to Table 3, on average, 74.37% of respondents are aware of how BMW management is practised and 25.63% are unaware of BMW process.

Table 3.

Observations regarding the respondent’s understanding of the BMW management process

Results regarding the respondent’s familiarity with the BMW management process	Correct (%)	Incorrect (%)
Blue bags are used to dispose of infectious sharps and needles.	78	22
Extracted teeth, human tissues, membranes, cotton dressings, suture materials such black braided silk, vicryl, etc., that are infectious biodegradable are disposed of in red bags.	85	15
Yellow bags are used to dispose of infectious non-biodegradable items such as gloves, IV sets, syringes, nylon sutures, non-resorbable GTR membranes, etc.	72	28
Disposal of glassware and metal body implants is done in a blue bag.	65	35
Discarded medications are classified as biomedical waste under category 5.	45	55
Biomedical waste disposal under category 7.	69	31
The term “thermal treatment” can refer to incinerators and other high-temperature waste disposal methods.	64	36
At the point of generation, waste needs to be separated.	65	35
Average	74.37	25.63

DISCUSSION

In a teaching hospital in India, clinical dental students are the focus of this study’s discussion on BMW management knowledge, attitudes, and practice. The best way to manage BMW successfully, it is generally agreed, is to identify and separate waste.[9]

Unlike conventional dental clinics, dental schools have a number of operatories and clinical divisions, making them special. Since these are training facilities, it follows that students pick up on the finer points of patient care and other related tasks. They must be trained on administrative aspects of dental treatment, such as managing biological waste, during this period when knowledge and skills are also being developed.

According to the WHO, there are eight different categories of medical waste: general waste, pathological waste, radioactive waste, chemical waste, infectious to potentially contagious waste, sharps waste, pharmaceutical waste, and waste from pressurized containers.[10] The three types of dental waste, in Nancy Godwin’s opinion, are general (non-regulated), contaminated (regulated and infectious waste), and hazardous waste (regulated and toxic waste).[11]

In the current study, 70% of students were aware that BMW is a workplace danger, and 30% of participants said segregation were the most important step in waste management. According to the current study, 70% of students thought all medical waste were harmful, despite the fact that generally only 10-25% of it is unsafe. Nearly, 60% of respondents in a survey conducted in North India by Kumar et al. likewise viewed all medical waste as hazardous.[11] Eighty-eight percent of the students believe that hospital waste is related to risks like HIV, hepatitis B, injuries, etc., A thorough examination of the students demonstrates that they are generally well-informed about BMW and the diseases and risks that are connected to it. The overall average proportion of correct responses was 74.37%, showing that students understood BMW management procedures. The eighty five percent of students concur that human tissue, animal waste, blood, and bodily fluids are all should be disposed away in red bags. The 65 percent of students concur that used needles should be placed in blue bags.

According to the study that looked at this matter, 65% of the students knew that under national standards, BMW cannot be stored for longer than 24 hours and that waste must be segregated at the site of generation. Contrary to the current conclusion, only 71.3% of participants in a study by Kulkarni et al. among dental residents were aware of the same.[2]

CONCLUSION

In terms of understanding of BMW facts and awareness of its use, pupils’ general awareness was high. One could argue that because only 180 undergraduate students participated in this study, the results do not necessarily represent the knowledge and awareness of all undergraduate students. By means of carefully crafted seminars, programmes, and workshops, there should be a critical need for greater education to advance BMW management’s understanding.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.