Knowledge, Attitude, and Practices about Biomedical Waste Management among Healthcare Personnel: A Cross-sectional Study

Background:

The waste produced in the course of healthcare activities carries a higher potential for infection and injury than any other type of waste. Inadequate and inappropriate knowledge of handling of healthcare waste may have serious health consequences and a significant impact on the environment as well.

Objective:

The objective was to assess knowledge, attitude, and practices of doctors, nurses, laboratory technicians, and sanitary staff regarding biomedical waste management.

Materials and Methods:

This was a cross-sectional study.

Setting:

The study was conducted among hospitals (bed capacity >100) of Allahabad city.

Participants:

Medical personnel included were doctors (75), nurses (60), laboratory technicians (78), and sanitary staff (70).

Results:

Doctors, nurses, and laboratory technicians have better knowledge than sanitary staff regarding biomedical waste management. Knowledge regarding the color coding and waste segregation at source was found to be better among nurses and laboratory staff as compared to doctors. Regarding practices related to biomedical waste management, sanitary staff were ignorant on all the counts. However, injury reporting was low across all the groups of health professionals.

Conclusion:

The importance of training regarding biomedical waste management needs emphasis; lack of proper and complete knowledge about biomedical waste management impacts practices of appropriate waste disposal.     

Hospital waste management and it's probable health effect: a lesson learned from Bangladesh

A study was conducted to evaluate the current status of hospital waste management (HWM) in Bangladesh. The aim is to recognize the health effect of the existing practice, to determine the awareness level of doctors and nurses about hospital waste, to identify the weaknesses, and to provide suggestions for improvement. Hospital staff, waste pickers, and local residents were interviewed while in depth field observation, which included sample collection and laboratory analysis was also conducted. Through this investigation, it has been quite evident that a satisfactory hospital waste management system in government hospitals and several private clinics is severely lacking. At present, Bangladesh has no rigorous laws or regulation, which are enforced in this area. The waste is generally dumped together in a public place such as the hospital surroundings, the roadside or City Corporation dustbin. Many doctors and nurses are not fully aware about what constitutes as medical waste. Health care workers have only a basic understanding of health care and do not perceive handling or disposal of medial waste as a hazardous work. Laboratory analysis shows existing contamination of infectious agents in the environment. Some staff members interviewed were suffering from various kinds of infectious diseases such as viral hepatitis B/C, typhoid, skin disease/allergy, diarrhea, dysentery, tuberculosis, and malaria. During field observation it was discovered that improved HWM systems have only recently been introduced in a small number of private hospitals and clinics, some of which could be used as references to formulate guidelines for reaching the optimal at the national level. The study indicates that there is a need to improve the handling and disposal methods of hospital waste in almost all the available medical facilities. There are a few NGOs that have started awareness building and training on waste management for selected hospital staff and NGO officials. Based on the analysis of the situation, several suggestions and recommendations have been made to aid in the development of a waste management system.     

北京农村慢性病防治能力调查

目的 评价北京郊区农村开展慢性病防治的能力。方法 对昌平、顺义、房山、大兴卫生局疾病控制科及健康教育负责人员进行个人访谈，对4个区76名区医院内科医生、l93名镇(乡)医院医生、37个镇(乡)医院领导进行问卷调查。结果 4个区前5位死因顺位依次是脑血管疾病、心脏病、呼吸系统疾病、恶性肿瘤、损伤和中毒；区卫生局和疾病控制中心设立了疾病控制科或慢性病防治职能科室；慢性病防治费用最多为16万元，最低10万元。平均每个镇医院有医生25人，护士5人；医生中36％具有专科以上学历；平均拥有病床27张；100％镇医院拥有血压计、心电图、X线、B超、救护车．84％镇医院具有生化分析设备。除血脂异常诊断标准镇(乡)卫生院医生回答正确率高于区医院医生外．高血压、糖尿病，冠心病、血脂异常其它相关知识正确回答率区医院医生和镇(乡)医院医生没有显著差别。高血压危险因素、高血压药物治疗原则、2型糖尿病主要危险因素、冠心病危险因素等知识正确回答率偏低。结论在机构、人力资源、医疗设施等方面农村具有开展慢性病防治的能力，但卫生投入不足．医疗保健制度不完善，人力资源培训还需加强。     

Management of medical waste in Tanzanian hospitals

A survey was conducted to study the existing medical waste management (MWM) systems in Tanzanian hospitals during a nationwide health-care waste management-training programme conducted from 2003 to 2005. The aim of the programme was to enable health workers to establish MWM systems in their health facilities aimed at improving infection prevention and control and occupational health aspects. During the training sessions, a questionnaire was prepared and circulated to collect information on the MWM practices existing in hospitals in eight regions of the Tanzania. The analysis showed that increased population and poor MWM systems as well as expanded use of disposables were the main reasons for increased medical wastes in hospitals. The main disposal methods comprised of open pit burning (50%) and burying (30%) of the waste. A large proportion (71%) of the hospitals used dust bins for transporting waste from generation points to incinerator without plastic bags. Most hospitals had low incineration capacity, with few of them having fire brick incinerators. Most of the respondents preferred on-site versus off-site waste incineration. Some hospitals were using untrained casual labourers in medical waste management and general cleanliness. The knowledge level in MWM issues was low among the health workers. It is concluded that hospital waste management in Tanzania is poor. There is need for proper training and management regarding awareness and practices of medical waste management to cover all carders of health workers in the country.     

Knowledge,attitude and practice of health workers in Keffi local government hospitals regarding Baby-Friendly Hospital Initiative (BFHI) practices

OBJECTIVE: To assess the knowledge, attitude and practice of health workers towards Baby Friendly Hospital Initiative (BFHI) practices and thereafter plan an advocacy on BFHI training of the workers. DESIGN: A randomised cross-sectional study. SETING: Ten out of 16 health facilities reflecting all the levels of healthcare provision in Keffi Local Government Area in Nassarawa State, Nigeria, were selected. Staff of these health facilities had not received BFHI training, although breastfeeding is the norm in this population, exclusive breastfeeding is almost zero. SUBJECTS: A total of 250 health workers (six doctors, 160 nurses and 84 auxiliary staff) met in the health facilities at the time of interview. INTERVENTION: A structured questionnaire based on 10 steps to successful breastfeeding was administered by one of the authors and a Lactad nurse between July and October 1995. RESULTS: Fifty-two (20.8%) were aware of the need for initiating breastfeeding within 30 min of birth and 92 (36.8%) were aware of breastfeeding support groups. However, there were significant differences in the level of awareness among the doctors compared to the other categories of health staff (P<0.05). Also, 48 (19.2%) of the health workers believed that babies less than 6 months of age should not be given water (statistical difference (P<0.05) between doctors' attitude and that of the other health workers). Thirteen (5.22%) health workers could demonstrate correct positioning and attachment. CONCLUSION: There was general lack of awareness of some major recommended practices in the hospitals that will promote and sustain breastfeeding. There is therefore the need for policy changes and BFHI training for the staff of these health facilities to respond to the concern and growing need for proper infant/young child feeding.     

新疆包虫病外科救治定点医院人力资源现状研究

目的 了解新疆包虫病外科救治定点医院的人力资源现状.方法 采用自行设计的调查表,对定点医院等级、现有从事包虫病外科救治执业(助理)医师和注册护士数、床位数,以及执业(助理)医师和注册护士年龄、学历和职称等现状进行分析.结果 各级定点医院拥有救治包虫病床位数687张,执业(助理)医师333人、注册护士435人,医护比1:...     

Disposal of waste glass in sanitary departments: a sample survey in the Lazio region

As a result of Italian law, DPR 15/7/2003 n. 254, about hospital waste, and given that little has been written about recycling waste glass in hospitals, a survey of 28 health departments in Lazio was performed. The objectives were: to estimate the mean quantity of clear vitreous waste in one year, to estimate how vitreous waste is administered, to estimate the extent of the use of plastic instead of glass, to analyse the costs and benefits of glass use and/or plastic use and to evaluate staff training about hospital waste disposal. The average production of clear vitreous waste was 0.28 kilogram per day per hospital bed occupied. (This would be the theoretical maximum quantity of glass to be recycled). Among the 28 departments studied, 82% separated waste products but only 36% disposed of glass in accordance with the law. The estimated possible savings on glass phleboclysis in 2002 year were 35,000 euro. Staff training could avoid this conspicuous waste of money. Fifteen departments also used plastic phleboclysis; of these, in 2 departments plastic waste is separated in the wards, but unfortunately this material is later disposed of in the bins for general solid urban waste. The other thirteen hospitals dispose of waste plastic as infectious material. Using glass phleboclysis instead of plastic phleboclysis would save about 680,000 euros per year. The disposal of glass waste material in practice was not found to follow the principles taught in the training courses. Theoretic data about glass production, estimated in this survey, refers only to clear glass and it is an underestimate of that of all glass used in departments. The quantity of glass actually recycled has been about 0.14 kilogram per day per hospital bed occupied and thus only 50% of the theoretical quantity (0.28 kilogram per day per hospital bed occupied). This percentage could be improved by effective training. Ideally, the disposal of waste glass would follow the legal requirements and be monitored locally.     

某医院医疗废物处置状况调查

[目的]了解某医院医疗废物处置状况,探讨医疗费物处置措施。[方法]采用查阅医院医疗废物回收处理记录和问卷方法,调查1所二级甲等医院2008年1～6月医疗废物从产生到最终处置的状况、管理过程及相关工作人员对医疗废物处置的认知情况。[结果]2008年1～6月共产生一般性废弃物210000kg,医疗废物115058kg,医疗废物占医院废物的35．40％。在医疗废物中,感染性废弃物占11．24％,病理性废弃物占0．26％,回收的一次性塑料占4．46％,输液玻璃瓶占84．04％。医疗废物中88．50％被厂家回收。相关人员对处置方式知识的了解情况、焚烧等毁灭性彻底处理方式知晓率为10％左右,高压消毒等回收再利用性处置知晓率较高,为77．78％。[结论]医疗废物中部分废弃物暂无有效的处理方法,人们对彻底处置医疗废物的知晓率不高,对环境构成潜在的污染,危害人们的健康。     

Hospital Workers' Awareness of Health and Environmental Impacts of Poor Clinical Waste Disposal in the Northwest Region of Cameroon

Abstract

Due to the infectious nature of some clinical waste, poor disposal practices have sparked concern regarding the impact on public health and the environment. Lack of sufficient knowledge of the associated risks may be a strong factor contributing to inadequate disposal practices. We conducted a survey to evaluate hospital workers' awareness of health and environmental impacts of poor clinical waste disposal in Cameroon. We randomly distributed 500 questionnaires to hospital workers in three hospitals in the Northwest Region of Cameroon in April 2008. In addition, we observed collection, segregation, transportation, and disposal of clinical waste at the three hospitals. Of 475 total respondents, most lacked sufficient awareness of any environmental or public health impacts of poor clinical waste disposal and had never heard of any policy—national or international—on safe clinical waste management. Methods of collecting, segregating, transporting and disposing clinical waste at the three hospitals was poor. The development of a comprehensive policy on efficient clinical waste management in Cameroon is imperative.     

The disposal of used sharps by diabetic patients living at home

The disposal of sharps generated in the community has been identified as an area of public health and environmental health concern. While there is a large amount of literature on sharps disposal practices in healthcare settings, the sharps disposal practices of diabetic patients living at home has been poorly documented. This study describes the sharps disposal practices of diabetic patients in South Staffordshire, an English health district. A randomly selected sample of 1,348 adult (aged >or= 16 years) diabetic patients were obtained from the district population-based diabetes register. A self-administered questionnaire was posted to the sample. Non-responders received up to two reminders. A response rate of 91% was achieved. Household containers were used by: 34.1% of respondents for syringes; 35.1% for lancets; and 27.6% for needles. Sharps boxes were the least used method of sharps disposal. Many respondents indicated that they had received only verbal information on how to dispose of their sharps. Those who recalled receiving information were more likely to dispose of their sharps safely. The results of this study suggest that sharps are disposed of in the most convenient manner, into the household waste. This contributes to environmental pollution and places people at risk of physical and psychological trauma.     

辽宁省精神卫生专科医院服务人员现状调查

[目的]了解辽宁省精神卫生专科医院人力资源现状。[方法]采用自制调查表对全省44所精神卫生专科医院的人力资源现状进行调查。[结果]全省精神卫生专科医院服务人员(含非在编人员)6425人,其中管理者165人,医生1483人,护士2541人。研究生学历48人(0.74%),本科学历1131人(17.6%)。[结论]辽宁省高学历人员欠缺,精神卫生专业人才欠缺,人员素质和服务质量有待提高。     

Medical waste management practices in a Southern African hospital

PURPOSE: The purpose of this paper is to examine the medical waste management practices of a hospital in Southern Africa. DESIGN/METHODOLOGY/APPROACH: A case study methodology was utilised. FINDINGS: The results revealed that the hospital does not quantify medical waste. Segregation of medical waste into infectious waste and non-infectious waste is not conducted according to definite rules and standards. Separation of medical waste and municipal waste is however practiced to a satisfactory extent. Wheeled trolleys are used for on-site transportation of waste. Off-site transportation of waste is outsourced to a private firm. Incineration is used in the final disposal of infectious waste. Non-infectious waste is disposed using land disposal method. There is no policy and plan in place for managing medical waste. A number of problems were identified with respect to medical waste management. ORIGINALITY/VALUE: The paper gives recommendations with the aim of improving medical waste management in hospitals.     

Measuring the hospital experiences of junior doctors

The development of an appraisal questionnaire which measures junior doctors' opinions about their hospital experiences is described. The first section of the questionnaire consists of seven reliable subscales which measure opinions about teaching and learning, registrar teaching, consultant teaching, staff support, workload, administration and overall experiences during a period of attachment or term. The second part of the survey contains 11 reliable questions about the hours spent on service and education during the term. The responses to this measure of 257 randomly selected Australian junior doctors are described. The questionnaire may be used to contrast the experiences of junior doctors in different types of terms, different hospitals or varying levels of training. The data generated from the instrument can provide useful information about hospitals, such as the work practices of junior staff and the effectiveness of educational programs.     

Biomedical waste management in the Regional Hospital Center of Ziguinchor

To make the hospital environment healthier for those it serves, the management of biomedical waste (BMW) was studied in the Ziguinchor Regional Hospital Center (RHC) in Senegal from 1 March through 15 March, 2000. The RHC incinerator had stopped operating in 1993. Problems in BMW management were observed at all levels. Neither identification nor sorting took place during collection. Waste bins were exposed everywhere. Workers, rather than carrying waste bins on their back or head, used rolling tables. BMW ended up in a shallow open pit where they were periodically burned. Workers collected, stored, and transported BMW without any type of protection (gloves, boots, masks, aprons, etc.). The principal determinants of this poor management appear to be inadequate funding and training for the cleaning staff, the staff's failure to realize the dangers, and their use of non-standardized practices, due to the absence of BMW policies. BMW management at Ziguinchor RHC must be corrected. Protective equipment must be used systematically. Similarly, standardized practices must be applied to the decontamination of used objects, the identification and sorting at the source, the recovery and recycling of all objects with any remaining value, and the correct storage of BMW. This waste must be transported under high security from its place of storage to its final disposal site. Deep burial has been selected as the most feasible method of disposal under current conditions. A year-long program has been proposed towards this end. Strategies include training, information, motivation, equipment, supervision and evaluation. The budget to implement this program is CFA 5,423,454 francs, distributed between training (22%), equipment (40%), construction of the pit, and follow-up (38%). The tasks are distributed between a public health doctor, department supervisors, and cleaning staff. The follow-up will include three quarterly inspections, at 3, 6, and 9 months and an evaluation at the end of the program. The effect of the program will be judged by the disappearance of unlawful dumping due to the disposal of all BMW in the RHS's deep burial pit.     

深圳市某区医疗机构卫生监督结果分析

目的了解深圳市某区医疗机构的运作现状及存在的主要问题。方法通过现场监督和询问的方式,调查全区已注册的268家医疗机构的医护人员的执业资格,执业注册的情况、诊疗范围、机构标牌和广告设置、医疗废物处理等执行情况。结果医护人员的执业资格、执业注册情况的合格率为77.24%;诊疗范围的合格率为76.87%,而医疗废物处理的合格率较低,仅为58.21%。且发现营利性医疗机构的上述指标合格率都低于非营利性医疗机构。结论要加强医疗卫生机构医疗废弃物的处理,同时要加强对营利性医疗机构的卫生监督与管理。     

深圳市某区医疗机构卫生监督结果分析

目的 了解深圳市某区医疗机构的运作现状及存在的主要问题.方法 通过现场监督和询问的方式,调查全区已注册的268家医疗机构的医护人员的执业资格,执业注册的情况、诊疗范围、机构标牌和广告设置、医疗废物处理等执行情况.结果 医护人员的执业资格、执业注册情况的合格率为77.24%;诊疗范围的合格率为76.87%,而医疗废物处理的合格率较低,仅为58.21%.且发现营利性医疗机构的上述指标合格率都低于非营利性医疗机构.结论 要加强医疗卫生机构医疗废弃物的处理,同时要加强对营利性医疗机构的卫生监督与管理.     

Getting a Taste for Food Waste: A Mixed Methods Ethnographic Study into Hospital Food Waste before Patient Consumption Conducted at Three New Zealand Foodservice Facilities

Foodservice organizations, particularly those in hospitals, are large producers of food waste. To date, research on waste in hospitals has focused primarily on plate waste and the affect of food waste on patient nutrition outcomes. Less focus has been placed on waste generation at the kitchen end of the hospital food system. We used a novel approach to understand reasons for hospital food waste before consumption and offer recommendations on waste minimization within foodservices. A mixed methods ethnographic research approach was adopted. Three New Zealand hospital foodservices were selected as research sites, all of which were contracted to an external foodservice provider. Data collection techniques included document analyses, observations, focus groups with kitchen staff, and one-on-one interviews with managers. Thematic analysis was conducted to generate common themes. Most food waste occurred during service and as a result of overproduction. Attitudes and habits of foodservice personnel were considered influential factors of waste generation. Implications of food waste were perceived differently by different levels of staff. Whereas managers raised discussion from a financial perspective, kitchen staff drew upon social implications. Organizational plans, controls, and use of pre-prepared ingredients assisted in waste minimization. An array of factors influenced waste generation in hospital foodservices. Exploring attitudes and practices of foodservice personnel allowed an understanding of reasons behind hospital food waste and ways in which it could be minimized. This study provides a foundation for further research on sustainable behavior within the wider foodservice sector and dietetics practice.     

某市三甲综合医院医师多点执业现状研究

目的:研究影响医师多点执业政策有效实施的因素,提出促进政策执行的建议。方法:以连云港市两家三甲综合医院的医师为研究对象,采用问卷调查法研究政策目标群体对政策的认知,对调查结果进行统计分析。结果:医师多点执业政策的实施,卫生行政主管部门认为增加了其监管难度,第一执业机构认为容易导致人才与技术流失,医生认为多点执业面临医疗风险,患者就医更倾向于大型公立医院。结论:应淡化公立医院编制管理,实施合同聘用管理;完善医师多点执业的相关政策配套;鼓励医师以合作形式参与多点执业;卫生行政主管部门应加强对医师及医疗机构的监管与考核。     

Practices and knowledge regarding prevention of tetanus among doctors in Delhi

A cross-sectional study was conducted in Delhi to study immunisation practices regarding prevention of tetanus among doctors and their knowledge regarding its prevention. Delhi was divided into five zones, and from each zone two hospitals and five dispensaries were selected, giving due representation agency-wise. All the doctors posted for casualty duty in the selected hospitals, all doctors posted in the selected dispensaries and two private practitioners selected randomly from the nearby area of the selected dispensaries were included in the study. Only 7% of doctors had received their last dose of tetanus toxoid to complete the immunisation schedule and majority had received it following injury. As much as 38.3% of doctors favoured TT after every injury. Out of the remaining who opposed it only 59.5% could provide the correct reason for this. Less than half of the doctors knew the indications of anti-tetanus serum. There is a need for the doctors to take TT immunisation more seriously and adopt recommended immunisation practices, because if they themselves are not following the guidelines, it is likely to be reflected in their advice and motivation to patients.     

Considering risks to healthcare workers from glutaraldehyde alternatives in high-level disinfection

Due to concerns over glutaraldehyde's toxicity, two substitutes have recently been introduced; ortho-phthalaldehyde (OPA), and a mixture of hydrogen peroxide and peracetic acid. There is limited information about the health effects for employees from these products. This study assesses the current practices regarding the use of high-level disinfectants in British Columbian hospitals and predicts the relative toxicities of each product. Industry practices were compiled using a comprehensive survey of current practices and decision processes in all hospitals in British Columbia. Of 95 hospitals, 64 returned surveys; 80% of these used high-level disinfection. Among user hospitals, 49% used glutaraldehyde alone and 51% had introduced alternatives. Concern about staff health was the most common reason for substituting, but this was frequently not considered when choosing specific alternatives. Hospitals that involved occupational health, infection control or regional staff in high-level disinfectant decisions used glutaraldehyde alternatives less often. In most hospitals, it was difficult to find individuals who were knowledgeable about the use of disinfectants. Potential health effects associated with each type of high-level disinfectant were assessed by review of the published literature and available manufacturers' data along with qualitative structure-activity relationship analysis. Results indicated that although all products irritate the skin and respiratory tract, OPA is a potential dermal and respiratory sensitizer but hydrogen peroxide and peracetic acid do not cause allergic reactions. Despite little being known about the risks to employees from glutaraldehyde alternatives, their use is widespread. The potential risks of all high-level disinfectants are serious; thus regulators and users are faced with important risk management decisions before and after they have been introduced into the workplace.