Abstract
BACKGROUND:
Inappropriate handling of biomedical waste (BMW) may pose serious threats to the health of patients and hospital personnel. Among all healthcare workers, staff nurses play a vital role in BMW management (BMWM). Thus, the present study aimed to determine the predictors of BMWM practices among staff nurses of a tertiary care teaching hospital in India.
MATERIALS AND METHODS:
A prospective cross-sectional study was conducted among 150 staff nurses, working at a tertiary care teaching hospital in South India, from July to August 2018. Data were collected using a pretested, semi-structured, and self-administered questionnaire after taking their written informed consent. Regression analysis was carried out to identify the predictors of satisfactory BMWM practice status.
RESULTS:
Of the total 150 staff nurses, most of them were young females with a work experience of ≤ 5 years. Concerning knowledge scores, most staff nurses (63.3%) belonged to the moderate category, whereas a few (24%) were in the high category. Also, most of them (62.7%) were in the high category of attitude scores. For practice scores, half of the participants were in moderate and high categories, each. Female gender, attended training status, and moderate and high knowledge scores were significantly associated with satisfactory BMWM scores in unadjusted analysis. After adjusting for other independent variables, all these three factors were found significantly associated with satisfactory BMWM practice scores.
CONCLUSION:
The present study shows that the female gender, attending training in BMWM, and having a moderate and high knowledge of BMWM were significant predictors of satisfactory BMWM practice among staff nurses. Thus, all hospitals must periodically train their staff nurses to strengthen their BMWM practices. Safe BMWM leads to environmental protection and safeguards the health of patients, hospital personnel, and the public.
Keywords: Biomedical waste, hospital waste, infectious waste, medical waste, staff nurses
Introduction
Every day, healthcare facilities generate humongous amounts of waste termed “biomedical waste” (BMW). BMW refers to “any waste, which is generated during the diagnosis, treatment, or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps”.[1]
According to the Central Pollution Control Board (CPCB), India produced 656 tons/day of BMW in 2020. With the emergence of the COVID-19 pandemic, there was an incremental BMW generation of 84.61 tons/day from May 2020 to February 2022.[2] Of the total BMW generated, 15% are infectious and pose a health hazard to those exposed, such as healthcare personnel, patients, visitors, and multipurpose workers involved in collecting, transporting, treating, and disposing of the waste.[3]
Every year, BMW-related diseases contribute to around 5.2 million deaths, including 4 million deaths among children globally, the condition being further bleak in developing countries.[4] A single needle stick injury from an infected needle predisposes to contracting hepatitis B, hepatitis C, and HIV in 30%, 1.8%, and 0.3% of the cases, respectively.[5] Moreover, improper disposal of BMW leads to a risk of environmental damage.[6] Thus, safe BMW management (BMWM) is of paramount importance to safeguard public health.
The government of India enacted the BMW (management and handling) rules in 1998 (with an amendment in 2016) for strict enforcement of environmentally sound BMWM practices for human health protection.[1] However, it requires that healthcare personnel involved in BMW handling have adequate knowledge and the right attitude toward safe BMWM practices.
Nurses play a pivotal role in the generation, segregation, and disposal of hospital waste. They are more involved in direct patient care, manage various healthcare activities, and are also one of the main stakeholders responsible for the safe BMWM. Studies have shown that they work under stressful conditions and often fall short of satisfactory BMWM practices.[7,8,9,10,11,12] Thus, it is essential to identify the predictors of safe BMWM among staff nurses and strengthen them to curb the menace of inefficient BMW handling.
Materials and Methods
Study area and setting
This study was conducted at the Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), a 900-bedded, private multi-specialty teaching hospital located in Puducherry in the Southern part of India. It provides in-patient, out-patient, and emergency services. Every day, large amounts of biomedical waste are produced in the hospital.
Study design and population
We conducted a hospital-based, cross-sectional study among the staff nurses of our hospital for 2 months (July and August 2018).
Inclusion criteria: Staff nurses employed in various departments of SMVMCH, Puducherry.
Exclusion criteria: Staff nurses who were not available at the time of distribution of the questionnaire by the investigators.
Ethical considerations
Institutional Ethics Committee approval was obtained before the initiation of the study. The study was conducted following the principles of the Helsinki Declaration and Good Clinical Practice guidelines. The purpose of the study had been explained to the staff nurses and only those who were willing to participate in the study were included after obtaining written informed consent. Anonymity and confidentiality of the participant’s data were ensured.
Data collection tool and procedure
A self-administered structured questionnaire was developed in English based on previous studies.[9,10,12,13] Five subject experts checked for the content validity of the questionnaire, and a few questions were modified based on their suggestions. The questionnaire was pilot tested on 10 staff nurses, and the questions were revised to ensure relevance, comprehension, and feasibility. The data collected in the pilot study were not included in the final analysis of the results. The reliability of the questionnaire was assessed by the estimation of Cronbach’s alpha. A value of 0.88 suggests that the questionnaire was reliable.
The pretested, structured, and self-administered anonymous questionnaire was given to the participants. They were given an adequate time of 25–30 min to fill out the questionnaire. Once the participants returned the filled questionnaire, they were thanked for their valuable time.
The questionnaire elicited the self-reported practice of BMWM and its possible predictors such as age, gender, educational qualification, years of work experience, attended training in BMWM, knowledge, and attitude toward BMWM. Questions related to knowledge, attitude, and practice of BMWM were 15, 10, and 10, respectively. The questions related to knowledge were multiple-choice questions with one correct response. Those on attitude had pre-coded responses on a 5-point Likert scale (strongly disagree, moderately disagree, neutral, moderately agree, and strongly agree). The questions on practice were mainly closed-ended “yes/no” questions, except for one question (having 13 sub-questions) where a participant had to tick the color of the bag/container, in which a particular BMW/general waste was disposed of. The correct and wrong responses were scored “1” and “0,” respectively for knowledge and practice scores. Similarly, favorable responses reflecting positive attitudes such as agree and strongly agree (or disagree and strongly disagree) were scored “1” and the remaining unfavorable attitude responses were scored “0.” The knowledge, attitude, and practice scores were calculated for each participant. The maximum possible knowledge, attitude, and practice scores were 15, 10, and 22, respectively. Based on the scores obtained, it was possible to categorize them as having low, moderate, and high scores.
Categorization of knowledge scores
Score(s) of 0–5: Low
Scores of 6–10: Moderate
Scores of 11–15: High
Categorization of attitude scores:
Score(s) of 0–3: Low
Scores of 4–7: Moderate
Scores of 8–10: High
Categorization of practice scores:
Score(s) of 0–7: Low
Scores of 8–15: Moderate
Scores of 16–22: High.
Also, the questionnaire had two open-ended questions to assess the facilitating and hindering factors for safe BMWM among staff nurses.
Data analysis
Data were entered in a Microsoft Excel spreadsheet and analyzed using Statistical Package for Social Sciences (SPSS) version 24. Categorical data are summarized as frequency (percentage). For regression analysis, low-to-moderate practice scores were considered “unsatisfactory” and high scores as “satisfactory.” Unadjusted and adjusted binary logistic regression was carried out to identify the predictors of satisfactory BMWM practice status. The independent variables were age, gender, educational qualification, work experience, training in BMWM, and knowledge and attitude of BMWM. All tests were two-tailed, and a P-value <0.05 was considered statistically significant.
Results
A total of 150 staff nurses working in a private tertiary care hospital participated in this study. The majority of them were young female participants who had studied B.Sc nursing and with a work experience of 5 years or less. About 70.7% were in the age group of 21–25 years, 90% were females, 84.7% have studied B.Sc nursing, and 94% had work experience of 5 years or less. Among the study participants, 64 (42.7%) have attended training in BMWM [Table 1].
Table 1.
Baseline demographic characteristics of the study participants (n=150)
| Characteristics | Frequency (percentage) |
|---|---|
| Age (in years) | |
| 21–25 | 106 (70.7) |
| 26–30 | 41 (27.3) |
| ≥31 | 3 (2) |
| Gender | |
| Female | 135 (90) |
| Male | 15 (10) |
| Educational qualification | |
| B.Sc Nursing | 127 (84.7) |
| Diploma in Nursing | 23 (15.3) |
| Years of work experience | |
| ≤5 | 141 (94) |
| 6–10 | 8 (5.3) |
| >10 | 1 (0.7) |
| Attended training in biomedical waste management | 64 (42.7) |
Our study shows that concerning knowledge scores, most staff nurses (63.3%) belong to the moderate category, whereas a few (24%) were in the high category. Also, most of them (62.7%) were in the high category of attitude scores. For practice scores, half of the participants were in each moderate and high category [Figure 1].
Figure 1.
Categorization of knowledge, attitude, and practice scores of biomedical waste management among staff nurses (N=150)
Knowledge of BMWM
Based on a question-wise analysis of knowledge of BMWM [Table 2], more than 75% of the participants were aware of the definition of BMW (94%), the existence of a color coding system for BMWM (93.3%), and the need of following universal precautions while/after handling BMW (80.7%). Also, 50%–75% of the participants were acquainted with who is responsible for proper BMW handling and management (50%), the correct sequence of steps carried out in the handling and management of BMW (51.3%), color codes not used in the handling and management of BMW (63.3%), the duration of possible storage of BMW (69.3%), risks of improper handling and management of BMW (73.3%), and infection that cannot be spread through accidental needle stick injury (58.7%). However, only less than 50% of the participants provided correct answers for the proportion of infectious hospital-generated BMW (22%), people at risk of improper handling and management of BMW (34.7%), the time point at which segregation of BMW should happen (21.3%), persons designated to separate the wastes at the point of its production (24.7%), legislation found in India that takes care of BMW (35.3%), and logo of bio-hazard (26%).
Table 2.
Knowledge about biomedical waste management among staff nurses (n=150)
| Questions on knowledge | Frequency (percentage) of correct responses |
|---|---|
| Definition of bio-medical waste | 141 (94) |
| The proportion of hospital-generated bio-medical wastes, which are infectious | 33 (22) |
| People at risk of improper handling and management of bio-medical wastes | 52 (34.7) |
| Who are all responsible for proper biomedical waste handling and management | 75 (50) |
| The time point at which segregation of biomedical waste should happen | 32 (21.3) |
| The correct sequence of steps carried out in the handling and management of bio-medical wastes | 77 (51.3) |
| Persons designated to separate the wastes at the point of their production | 37 (24.7) |
| Legislation found in India that takes care of biomedical waste management | 53 (35.3) |
| Awareness of the existence of a color coding system for the collection and storage of bio-medical wastes | 140 (93.3) |
| Color code not used in the handling and management of bio-medical wastes | 95 (63.3) |
| Universal precautions (personal protective measures) to be followed while/after handling bio-medical waste | 121 (80.7) |
| The duration of possible storage of biomedical waste at the point of generation in any hospital | 104 (69.3) |
| Risks of improper handling and management of biomedical wastes | 110 (73.3) |
| Infection that cannot be spread through accidental needle stick injury | 88 (58.7) |
| Logo of bio-hazard | 39 (26) |
Attitude toward BMWM
On question-wise analysis of attitude toward BMWM [Table 3], it was found that the majority of the staff nurses agreed that BMW needs to be disposed of safely (81.3%), it is their duty (75.3%), and it requires a team effort (80%). Moreover, many of them did not think of BMWM as an extra burden on their job (64.7%) or as an unnecessary expenditure for the hospitals (66.7%). In addition, most of them agreed that they need to take personal protective measures while disposal of BMW (84.7%), diseases can be prevented by safe handling of BMW (78%), it improves the quality of patient care (78.6%) and helps in protecting our environment (80%). Further, in this study, 65.3% of the staff nurses wanted to undergo more training sessions in BMWM.
Table 3.
Attitude toward biomedical waste management among staff nurses (n=150)
| Questions on attitude | Frequency (percentage) of responses |
||||
|---|---|---|---|---|---|
| Strongly disagree | Moderately disagree | Neutral | Moderately agree | Strongly agree | |
| Do you think biomedical waste needs to be disposed of safely? | 10 (6.7) | 12 (8) | 4 (2.7) | 2 (1.3) | 120 (80) |
| Do you think you have a duty toward the safe disposal of biomedical waste? | 8 (5.3) | 6 (2) | 23 (15.3) | 11 (7.3) | 102 (68) |
| Do you think biomedical waste management is teamwork? | 5 (3.3) | 8 (5.3) | 8 (5.3) | 10 (6.7) | 110 (73.3) |
| Do you think biomedical waste management is an extra burden on your job?* | 73 (48.7) | 24 (16) | 11 (7.3) | 12 (8) | 30 (20) |
| Do you think the safe management of biomedical waste is an unnecessary expenditure for hospitals?* | 81 (54) | 19 (12.7) | 9 (6) | 4 (2.7) | 31 (20.7) |
| Do you think you need to take personal protective measures while disposal of biomedical waste? | 10 (6.7) | 10 (6.7) | 3 (2) | 18 (12) | 109 (72.7) |
| Do you think diseases can be prevented by the safe handling of biomedical waste? | 11 (7.3) | 16 (10.7) | 6 (4) | 24 (16) | 93 (62) |
| Do you think biomedical waste management improves the quality of patient care? | 6 (4) | 12 (8) | 13 (8.7) | 29 (19.3) | 89 (59.3) |
| Do you think the environment can be protected by the safe handling of biomedical waste? | 12 (8) | 7 (4.7) | 10 (6.7) | 32 (21.3) | 88 (58.7) |
| Do you think you need to improve your training regarding biomedical waste management? | 16 (10.7) | 20 (13.3) | 16 (10.7) | 32 (21.3) | 66 (44) |
*Negatively phrased statements and reversely scored
Practices of BMWM
Figure 2 reveals the safe BMWM practices among the staff nurses. The majority of them disposed of BMW in specific color-coded containers (98.7%) and discarded used needles using a needle destroyer (90.7%). Moreover, most of them followed universal precautions or personal protective measures while disposing of the BMW. Protective gloves (91.3%), gowns (87.3%), and masks (97.3%) were used by them while disposal of BMW. Also, 98% of them washed their hands after handling BMW.
Figure 2.
Safe biomedical waste management practices among staff nurses (N=150). BMW: biomedical waste
Figure 3 shows that the majority of the staff nurses disposed of various BMWs in the correct color-coded bag/puncture-proof container. All of them discarded Foleys’ catheter in the correct container. Also, more than 75% of the staff nurses disposed of BMW such as needles and blades (93.3%), syringes (95.3%), intravenous sets (95.3%), soiled cotton swabs (94%), placenta (92.7%), and broken ampoules (77.3%) in the appropriate containers. About 50–75% of them disposed of blood samples (57.3%), blood sets (66.7%), and sputum cups (60.7%) correctly. However, only a few of them discarded BMWs such as outdated medicines (36.7%) and culture plates (21.3%) in the correct color-coded bags. In addition, most of them (94.7%) disposed of general waste such as papers and tea cups appropriately in black bags.
Figure 3.
Percentage of correct responses regarding the practice of disposal of bio-medical/general waste in specific color-coded bag/puncture-proof container among staff nurses (N=150). IV: intravenous
Predictors of BMWM practices
In unadjusted binary logistic regression, it was found that females have 4.6 times higher odds (95% confidence interval [CI]:1.2–16.9; P = 0.02) to be in the satisfactory BMWM practice group compared to males. Similarly, staff nurses who attended training in BMWM have 3.8 times higher odds (95% CI: 1.9–7.5; P < 0.001) of being in the satisfactory BMWM practice group. Also, participants in the moderate and high category of knowledge scores had 4.5 (95% CI: 1.4–14.6; P = 0.01) and 4.2 (95% CI: 1.2–15.1; P = 0.03) times higher odds of being in satisfactory BMWM practice group [Table 4]. After adjusting for other independent variables, all these three factors were found significantly associated with satisfactory BMWM practice scores [Table 5].
Table 4.
Predictors of biomedical waste management practice by unadjusted binary logistic regression (n=150)
| Characteristics | BMWM practice score |
Unadjusted OR (95% CI) | P | |
|---|---|---|---|---|
| Satisfactory (n=75) | Unsatisfactory (n=75) | |||
| Age category in years | ||||
| 21–23 (n=51) | 22 (43.1) | 29 (56.9) | 1 (Reference) | NA |
| 24–26 (n=69) | 40 (58) | 29 (42) | 1.8 (0.9 – 3.8) | 0.10 |
| > 26 (n=30) | 13 (43.3) | 17 (56.7) | 1 (0.4 – 2.5) | 0.98 |
| Gender | ||||
| Male (n=15) | 3 (20) | 12 (80) | 1 (Reference) | NA |
| Female (135) | 72 (53.3) | 63 (46.7) | 4.6 (1.2 – 16.9) | 0.02* |
| Qualification | ||||
| B. Sc nursing (n=127) | 61 (48) | 66 (52) | 1 (Reference) | NA |
| Diploma in nursing (n=23) | 14 (60.9) | 9 (39.1) | 1.7 (0.7 – 4.2) | 0.26 |
| Work experience in years | ||||
| <3 (n=74) | 35 (47.3) | 39 (52.7) | 1 (Reference) | NA |
| 3–5 (n=66) | 34 (51.5) | 32 (48.5) | 1.2 (0.6 – 2.3) | 0.61 |
| > 5 (n=10) | 6 (60) | 4 (40) | 1.7 (0.4 – 6.4) | 0.45 |
| Training status | ||||
| Not attended (n=80) | 28 (35) | 52 (65) | 1 (Reference) | NA |
| Attended (n=70) | 47 (67.1) | 23 (32.9) | 3.8 (1.9 – 7.5) | <0.001* |
| Knowledge score | ||||
| Low | 4 (21.1) | 15 (78.8) | 1 (Reference) | NA |
| Moderate | 52 (54.7) | 43 (45.3) | 4.5 (1.4 – 14.6) | 0.01* |
| High | 19 (52.8) | 17 (47.2) | 4.2 (1.2 – 15.1) | 0.03* |
| Attitude score | ||||
| Low | 4 (33.3) | 8 (66.7) | 1 (Reference) | NA |
| Moderate | 26 (59.1) | 18 (40.9) | 2.9 (0.7 – 11) | 0.12 |
| High | 45 (47.9) | 49 (52.1) | 1.8 (0.5 – 6.5) | 0.34 |
BMWM: biomedical waste management; P-values are based on the unadjusted binary logistic regression model,*Statistically significant (P<0.05), NA- Not applicable
Table 5.
Predictors of biomedical waste management practice by adjusted binary logistic regression (n=150)
| Characteristics | Adjusted OR (95% CI) | P |
|---|---|---|
| Gender | ||
| Male | 1 (Reference) | NA |
| Female | 4.8 (1.2–19.2) | 0.03* |
| Training status | ||
| Not attended | 1 (Reference) | NA |
| Attended | 3.8 (1.8–7.8) | <0.001* |
| Knowledge score | ||
| Low | 1 (Reference) | NA |
| Moderate | 3.5 (1.0 – 12.2) | 0.05* |
| High | 4.3 (1.1 – 16.7) | 0.04* |
BMWM: biomedical waste management; P-values are based on the adjusted binary logistic regression model, *Statistically significant (P<0.05), NA- Not applicable
Various facilitating and hindering factors in safe BMWM were mentioned by the staff nurses. They felt that the availability of color-coded containers for BMW disposal (34.7%), personal protective equipment (9.3%), needle burner (8.7%), the educational poster on color coding for BMWM (5.3%), and adequacy of disinfecting materials (2.7%) as the facilitating factors in safe BMWM. They also felt fear toward the use of needle burners (4.7%) and shortage of time (2%) as hindering factors.
Discussion
This study investigated the knowledge, attitude, and practice of BMWM among staff nurses. Predictors of the BMWM practices were identified based on the participants’ self-reported responses.
It is very inspiring to find that the majority of the staff nurses had a moderate level of knowledge and a few of them had high knowledge of BMWM. Moreover, for attitude, most of them were in the high category. Furthermore, half of the respondents were in each moderate and high category of BMWM practices, respectively. These encouraging findings could be attributed to the fact that 42.7% of the respondents were trained in BMWM.
Knowledge of BMWM
In our study, the knowledge scores on BMWM were moderate and high among 63.3% and 24% of the staff nurses, respectively, which was much better than the findings observed in similar studies. The study conducted by Prashanth et al.,[13] in Maharashtra, showed that 47% of nurses had average to good knowledge and 13% scored excellent regarding BMWM. Congruent findings were observed in another study by Sharma et al.,[14] in Jaipur, which revealed that 48% and 16% of nurses had good to average and excellent scores on knowledge of BMWM, respectively.
It is optimistic to note that more than 50% of the staff nurses were aware of the definition of BMW, the color coding system, universal precautions while/after its handling, personnel responsible for its proper management, the correct sequence of steps in its management, its maximum duration of storage in hospital, and risks of its improper management. These observations are consistent with those of similar studies conducted in different parts of the country.[10,15]
On the contrary, a few other studies found a poor level of awareness and knowledge about BMWM among the study participants. A study conducted by Uddin et al.[12] on knowledge of hospital waste management among senior staff nurses working in a medical college hospital in Bangladesh showed that only 7.2% of them answered correctly all the questions regarding knowledge of BMW and only 46.4% of them knew about color-coded bins for BMW disposal.
However, in our study, only less than 50% of the participants responded correctly to a few of the questions in the knowledge domain. They had knowledge gaps in areas such as people at risk of its improper management, persons designated to separate the wastes at the point of its production, BMW (management and handling) rules, the logo of biohazard, proportion of infectious BMW, and the time point at which its segregation should happen. This was in contrast to studies by Haider et al.[16] and Malini et al.,[17] in which a greater percentage of nurses were aware of BMWM rules and the logo of biohazard. This could be the impact of better training programs, for their staff nurses with greater emphasis on these aspects, conducted before their knowledge assessment. However, the study by Mane et al.[18] showed that the knowledge of persons responsible for the disposal of biomedical waste was 18.1%, which was much lesser as compared to the present study (50%). These lacunae in knowledge need to be filled by imparting training to the staff nurses with greater emphasis on these aspects.
Attitude toward BMWM
Most participants (62.7%) in our study belonged to the high category in the attitude domain. They felt that BMW needs to be managed safely; it was their duty and requires a team effort. They did not consider it as an extra burden or unnecessary expenditure by the hospital. Further, it was encouraging to find that 65.3% of the staff nurses wanted to undergo more training sessions in BMWM. These findings were similar to the results of studies conducted by Malini et al.[17] in a government tertiary care teaching hospital in Puducherry and Anand et al.[19] in a teaching hospital in Haryana. On the contrary, a study by Mane et al.[18] revealed that more than half of the staff nurses who participated in their study perceived BMWM as an extra burden.
In our study, the staff nurses recognized the need to use personal protective measures while handling BMW and understood that proper BMWM aids in the prevention of hospital-acquired diseases, improves the quality of patient care, and ensures environmental protection. A similar level of positive attitude among staff nurses was observed in various studies.[20,21]
Practices of BMWM
It is highly encouraging to know that in the present study, 50% of staff nurses were in the moderate and high categories, respectively, and none of them belonged to the low category concerning practices of BMWM. In our study, the majority of the staff nurses (98.7%) segregated the wastes generated in the hospital in specific color-coded bins. This was much higher than that reported in other studies; 60% in Haider et al.[16] study and 73.3% in Mathur et al.[10] study. In our study, more than 75% disposed of wastes such as Foleys catheters, sharps (needles/blades, broken ampoules), syringes, IV sets, soiled cotton swabs, placenta, and paper tea cups in the correct bin. Around 50–70% disposed of blood samples, blood sets, and sputum cups correctly. However, only less than 40% of the staff nurses disposed of outdated medicines and culture plates in the correct color-coded bin. Thus, further training for our staff nurses must emphasize these aspects to strengthen our BMWM practices. Results of similar studies show that more than 75% of nurses disposed of soiled dressings and anatomical waste in the correct bin.[17,18] Disposal of sharps in the correct bin by nurses varied from 59.6 to 71.6%.[10,17,18] They were confused regarding the disposal of general plastic items[18] (34% disposed of in the correct bin) and expired or contaminated drugs[17] (46.8% discarded in the right bin). The discrepancies between our study results and those of other studies could be attributed to the differences in the study setting, experiences/training undergone by the study participants, and variations in the data collection instruments.
Our study participants also used needle destroyers and adhered to the use of personal protective measures (gloves, masks, gowns, hand washing) while handling BMW. These findings are congruent with similar studies conducted in various parts of the country.[16,17,18]
Predictors of BMWM practices
Our study shows that the female gender, attending training in BMWM, and having a moderate and high knowledge of BMWM were associated with satisfactory BMWM practice scores among staff nurses. However, a similar study conducted among healthcare workers in Saudi Arabia did not find any gender difference in hospital waste management.[22]
With regard to training, our findings were supported by similar studies conducted among healthcare workers, which showed that those who were trained in BMWM had better BMWM practices.[23,24] Also, a study conducted in Pakistan has proved that 3 days of structured training sessions among nurses regarding BMWM produced a significant improvement in their knowledge and practice of BMWM.[25]
Furthermore, our findings were similar to another study conducted in Iran, which showed a strong positive association between knowledge and practice of BMWM among their healthcare staff.[26]
Limitations
Because the data collection tool was a self-administered questionnaire, there is a possibility of social desirability bias. However, measures were taken to prevent the bias, such as anonymous data collection and informing participants that they need not mention their identifiers in the filled questionnaire. Direct observation of BMWM practices among staff nurses during their duty hours would have yielded more accurate results compared to self-reported practices. Another limitation is that the study was conducted in a single multispecialty hospital and the findings might not be generalizable.
Conclusion
The present study shows that the female gender, attending training in BMWM, and having a moderate and high knowledge of BMWM were significant predictors of satisfactory BMWM practice among staff nurses. Thus, periodic training programs need to be conducted for staff nurses to enrich their knowledge, and further improve their practices on BMWM. Also, future studies on designing innovative training programs and measuring their impact in large multicentric settings would be warranted.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
We acknowledge and thank the Indian Council of Medical Research (ICMR), New Delhi, India for providing short-term research studentship (STS) to the first author, under the guidance of the second author (STS Ref ID: 2018-0459). We also thank the management and administrators of our hospital for their support in conducting the research study. In addition, we extend our thanks to the staff nurses of our hospital for their time and effort in participating in this study.
References
- 1.Ministry of Environment, Forest and Climate change. Government of India Bio-Medical Waste (Management and Handling) Rules, 2016 Available from: https://dhr.gov.in/sites/default/files/Bio-medical_Waste_Management_Rules_2016.pdf. [Last accessed on 2022 Mar 01]. [Google Scholar]
- 2.Ministry of Environment, Forest and Climate Change Common Bio-medical Waste Treatment and Disposal Facility. Available from: https://moef.gov.in/en/common-bio-medical-waste-treatment-and-disposal-facility/ [Last accessed on 2023 Jan 21]. [Google Scholar]
- 3.Yadav M. Hospital waste-a major problem. JK-Practitioner. 2001;8:276–82. [Google Scholar]
- 4.Faisal GM, Hoque MN, Rahman MS, Islam T. Challenges in medical waste management amid COVID-19 pandemic in a megacity Dhaka. J Adv Biotechnol Exp Ther. 2021;4:106–13. [Google Scholar]
- 5.World Health organization Health-care waste. Available from: https://www.who.int/news-room/fact-sheets/detail/health-care-waste. [Last accessed on 2023 Jan 20]. [Google Scholar]
- 6.Mastorakis NE, Bulucea CA, Oprea TA, Bulucea CA, Dondon P. Environmental and health risks associated with biomedical waste management. Develop Energy Environ Economics. 2010;5:287–94. [Google Scholar]
- 7.Jamebozorgi MH, Karamoozian A, Bardsiri TI, Sheikhbardsiri H. Nurses burnout, resilience, and its association with socio-demographic factors during COVID-19 pandemic. Front Psychiatry. 2022;12:803506.. doi: 10.3389/fpsyt.2021.803506. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Heidarijamebozorgi M, Jafari H, Sadeghi R, Sheikhbardsiri H, Kargar M, Gharaghani MA. The prevalence of depression, anxiety, and stress among nurses during the coronavirus disease 2019: A comparison between nurses in the frontline and the second line of care delivery. Nurs Midwifery Stud. 2021;10:188–93. [Google Scholar]
- 9.Chudasama R, Rangoonwala M, Sheth A, Misra SKC, Kadri AM, Patel UV. Biomedical waste management: A study of knowledge, attitude, and practice among health care personnel at tertiary care hospital in Rajkot. JRes Med Dent Sci. 2017;1:17–22. [Google Scholar]
- 10.Mathur V, Dwivedi S, Hassan MA, Misra RP. Knowledge, attitude, and practices about biomedical waste management among healthcare personnel: A cross-sectional study. Indian J Community Med. 2011;36:143–5. doi: 10.4103/0970-0218.84135. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Sengodan VC, Amruth KH. Knowledge attitude and practice study on biomedical waste management among health care professionals and paramedical students in a Tertiary CareGovernment Hospital in South India. Int J Env Health Eng. 2014;3:11.. [Google Scholar]
- 12.Uddin MN, Islam MR, Yesmin K. Knowledge on hospital waste management among senior staff nurses working in a selected medical college hospital of Bangladesh. Journal of Waste Management. 2014;2014:5.. [Google Scholar]
- 13.Prashanth VK, Jadhav HC, Dodamani AS, Dodamani GA, Kshirsagar MM, Vishwakarma AP. Assessment of knowledge, attitude, and practices regarding awareness of biomedical waste management among health care personnel: A cross-sectional survey. J Oral Health Comm Dent. 2017;11:8–12. [Google Scholar]
- 14.Sharma A, Sharma V, Sharma S, Singh P. Awareness on biomedical waste management among health care personnel in Jaipur, India. Oral Health Dent Manag. 2013;12:32–40. [PubMed] [Google Scholar]
- 15.Parida A, Capoor MR, Bhowmik KT. Knowledge, attitude, and practices ofBio-medical Waste Management rules, 2016; Bio-medical waste management (amendment) rules, 2018; and Solid Waste Rules, 2016, amonghealth-care workers in a tertiary care setup. J Lab Physicians. 2019;11:292–9. doi: 10.4103/JLP.JLP_88_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Haider S, Kumari S, Kashyap V, Sunderam S, Singh SB. A study on knowledge and practice regarding biomedical waste management among staff nurses and nursing students of Rajendra Institute of Medical Sciences, Ranchi. Indian J Comm Health. 2015;27:135–8. [Google Scholar]
- 17.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. [Google Scholar]
- 18.Mane V, Nimbannavar SM, BY Y. Knowledge, attitude, practices on biomedical waste and its management among health workers at a tertiary care hospital in Koppal, Karnataka, India. Int J Community Med Public Health. 2016;3:2953–7. [Google Scholar]
- 19.Anand P, Jain R, Dhyani A. Knowledge, attitude and practice of biomedicalwaste management among health care personnel in ateaching institution in Haryana, India. Int J Res Med Sci. 2016;4:4246–50. [Google Scholar]
- 20.Dey P, Das B. Knowledge, attitude, and practices about biomedical waste management as per 2016 rules among resident doctors and nursing staff in a tertiary care specialty hospital: A cross-sectional study. J Med Soc. 2020;34:31–5. [Google Scholar]
- 21.Soyam GC, Hiwarkar PA, Kawalkar UG, Soyam VC, Gupta VK. KAP study ofbio-medical waste management among health careworkers in Delhi. Int J Community Med Public Health. 2017;4:3332–7. [Google Scholar]
- 22.Habeeb TH, Ahmad S. Handling health care waste management and gender differences inthe Madinah Primary Healthcare Centers, Kingdom of Saudi Arabia. Geografia Malays J Soc Space. 2015;11:47–55. [Google Scholar]
- 23.Mitiku G, Admasie A, Birara A, Yalew W. 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. 2022;17:e0266037. doi: 10.1371/journal.pone.0266037. doi: 10.1371/journal.pone. 0266037. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Singh S, Dhillon BS, Nityanand, Shrivastava AK, Kumar B, Bhattacharya S. Effectiveness of a training program about bio-medical waste management on the knowledge and practices of health-care professionals at a tertiary care teaching institute of North India. J Educ Health Promot. 2020;9:127.. doi: 10.4103/jehp.jehp_704_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Shaheen T, Ghani M, Kausar S. Gauging the effectiveness of training sessions among nurses regarding biomedical waste management: A Quasi-experimental study from a developing country. Cureus. 2020;12:e12196. doi: 10.7759/cureus.12196. doi: 10.7759/cureus. 12196. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Shekoohiyan S, Parsaee F, Ghayour S. 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 Engg. 2022;6:100207.. doi: 10.1016/j.cscee.2022.100207. [DOI] [PMC free article] [PubMed] [Google Scholar]