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BRIEF COMMUNICATION
Year : 2015  |  Volume : 33  |  Issue : 4  |  Page : 580-582
 

Awareness and practices regarding bio-medical waste management among health care workers in a tertiary care hospital in Delhi


Department of Microbiology, Employees State Insurance Corporation Post Graduate Institute of Medical Science and Research, Basaidarapur - 110 015, Delhi, India

Date of Submission28-May-2014
Date of Acceptance07-Apr-2015
Date of Web Publication16-Oct-2015

Correspondence Address:
G Bhagawati
Department of Microbiology, Employees State Insurance Corporation Post Graduate Institute of Medical Science and Research, Basaidarapur - 110 015, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.167323

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 ~ Abstract 

Health care institutions are generating large amount of Bio-Medical Waste (BMW), which needs to be properly segregated and treated. With this concern, a questionnaire based cross-sectional study was done to determine the current status of awareness and practices regarding BMW Management (BMWM) and areas of deficit amongst the HCWs in a tertiary care teaching hospital in New Delhi, India. The correct responses were graded as satisfactory (more than 80%), intermediate (50–80%) and unsatisfactory (less than 50%). Some major areas of deficit found were about knowledge regarding number of BMW categories (17%), mercury waste disposal (37.56%) and definition of BMW (47%).


Keywords: Awareness, Bio medical waste management, Bio-medical waste mangement practices, Bio-medical waste awareness, health care worker, hospital, practice, tertiary care teaching hospital


How to cite this article:
Bhagawati G, Nandwani S, Singhal S. Awareness and practices regarding bio-medical waste management among health care workers in a tertiary care hospital in Delhi. Indian J Med Microbiol 2015;33:580-2

How to cite this URL:
Bhagawati G, Nandwani S, Singhal S. Awareness and practices regarding bio-medical waste management among health care workers in a tertiary care hospital in Delhi. Indian J Med Microbiol [serial online] 2015 [cited 2017 Sep 22];33:580-2. Available from: http://www.ijmm.org/text.asp?2015/33/4/580/167323



 ~ Introduction Top


Health care waste is defined as the total waste stream from a health care facility.[1] Bio-medical waste (BMW) means any waste generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals, including categories mentioned in Schedule I of BMW Management (BMWM) and Handling Rules 1998.[2] In 2011, it was estimated that gross generation of BMW in India was 4,05,702 kg/day of which only 2,91,983 kg/day was disposed, which means that almost 28% of the wastes was left untreated.[3]

In 2013, the hospitals and nursing homes in Delhi were found to generate 70 tonnes/day of BMW, out of which only 10.7 tonnes/day were being treated properly.[4]

A joint team of the Central Pollution Control Board (CPCB) and the Delhi Pollution Control Committee (DPCC), directed by the National Green tribunal (NGT) found that some hospitals of the capital were violating the BMW Rules.[5]

With this concern a study was conducted in a tertiary care teaching hospital in Delhi. with the aim to determine the current status of awareness and practices regarding BMWM among the healthcare workers (HCWs) in the hospital, to identify the areas of deficit and to forward the results to BMWM Committee (BMWMC) of the hospital to take requisite corrective action.


 ~ Materials and Methods Top


A cross-sectional indirect interview type of study was conducted in a 600 bedded tertiary care teaching hospital in Delhi over a period of one month, from 15th August to 14th September, 2013 through self-distributed pre-tested semi-structured questionnaires randomly distributed among four categories of HCWs: Doctors, nurses, technicians and other paramedical staff of the hospital. Each questionnaire was composed of two sections. Section A comprised of demographic profile of the subjects while Section B comprised of questions to test the awareness (Section BI) and practices (Section B II) regarding BMWM. The overall response of the participants was graded based on correct responses as: Satisfactory (more than 80%), intermediate (50–80%) and unsatisfactory (less than 50%).


 ~ Results Top


A total 120 questionnaires were distributed, out of which 110 (91.66%) were received back. The 110 respondents comprised of: 26 Doctors (23.64%), 29 Nurses (26.36%), 20 technicians (18.18%) and 35 other paramedical staff (31.82%). Doctors included in the study were senior residents (34%), interns (27%), post-graduate students (23%) and few senior doctors including teaching faculty members (4%), specialists (8%) and medical officers (4%). The paramedical staff comprised of laboratory assistants (54%), nursing orderlies (NO, 26%), Operation Theatre (OT) assistants (3%) and radiographers (17%). Period of work experience varied from less than 5 years (41.82%), 5–10 years (16.36%) and more than 10 years (41.82%) among the HCWs.

Grading of individual and overall responses is shown in [Table 1] and [Figure 1]. The results of the study were forwarded to BMWMC to stress on the areas of deficit and to strengthen them by adequate training programmes.
Table 1: Awareness and practices regarding BMWM amongst various HCWs

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Figure 1: Percentage of correct response regarding BMWM Note: A/R: Awareness regarding, HH: Health hazards, CD: Chemical disinfectants, NSW: Non-sharp waste, BHS: Bio-hazard symbol, HBV: Hepatitis B vaccination

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 ~ Discussion Top


An active BMWMC exists in the hospital which has formulated action plans and guidelines for the BMWM and the same has been circulated to all the departments and displayed at major waste generating areas. This study was planned to check the awareness regarding BMW among the hospital staff.

Overall only 17% of the HCWs were aware of the number of categories of BMW [Figure 1]. Most of them categorized the wastes that had usually been generated in day care setting. This is similar to the finding of Madhukumar et al.,[6] (only 3.13% awareness). In our analysis, awareness about this was very poor amongst the technicians (0%) and nurses (0%) in contrast to the study by Madhukumar et al.,[6] and Mathew et al.,[7] where awareness about the same was quite high 62.5% and 100% amongst the technicians and paramedical staff respectively.

There was a lack of awareness regarding mercury waste disposal (62.44% unaware) [Figure 1] in our study which is in contrast to the findings of Charania et al.,[8] (only 35.2% improper disposal). This might be because his study was focused on dentists who commonly use mercury products whereas in our hospital use of mercury products has been phased out.

Among the HCWs 47% had knowledge regarding the definition of BMW [Figure 1] which is similar to the finding of Desmukh et al.,[9] (36.9% aware) but was higher than findings of Kahn et al.,[10] (only 4.7% aware).

Overall response regarding the guidelines laid down by Government of India for BMWM was satisfactory (85%) [Figure 1]. However the awareness was least among the doctors (73%) as compared to the nurses (96.55%), technicians (90%) and other paramedical staff (88.57%) [Table 1]. This may be because majority of the doctors (86.61%) had work experience less than 5 years; moreover, 27% of the doctors were interns who had graduated outside India which could have been the reason for their lack of awareness regarding the Indian guidelines. This is in contrast with the findings of Narang et al.,[11] (awareness: 85.4% doctors, 73.7% nurses and 71.4% paramedical staff) regarding the same.

Awareness regarding biohazard symbol was satisfactory (91%) [Figure 1], which is similar to the findings of Madhukumar et al.,[6] (13.8% unaware). In our study, it was least among doctors (80.77%) [Table 1] which is similar to the finding of Mathew et al.,[7] (79.2%).

Awareness regarding health hazards due to improper BMWM was found to be 60.10% [Figure 1]. In our study, only 63.46% of the doctors [Table 1] were aware of the same which is in contrast to the finding of Narang et al.,[11] (100% aware).

Overall response regarding the practice of disposal of non-sharp waste was 68.27% and that of sharps was 86% [Figure 1]. In this regard, doctors' response was 79.8% and 96.15% respectively followed by nurses (71.55% and 89.65% respectively) [Table 1]. This is similar to the study of Narang et al.,[11] (85% dentists and 55% auxiliaries awareness-non-sharp waste disposal).

Awareness regarding segregation was 53.76% among the HCWs [Figure 1]. This was in contrast to the finding of Nandwani et al.,[12] in her previous study which was done at a private hospital (82% awareness). In our study, doctors had a very casual approach towards segregation of waste (57.7%) [Table 1], which is in contrast to the study of Selvaraj et al.,[13] (98%). A reason for the same could be because of overloading of the patients in casualty and out-patient departments (OPD) in this government set-up with doctors prioritizing patient-care more than waste segregation.


 ~ Conclusion Top


Managing hospital waste requires effective knowledge among the people who produce the waste, not just those who handle it. Our study revealed some lacunae in knowledge regarding BMWM especially amongst doctors with experience less than five years. Moreover the interns who participated in our study and who had graduated outside India were not aware of Indian BMW rules. There is an urgent need for raising awareness on BMWM among the hospital staff in all health-care setups.

 
 ~ References Top

1.
Healthcare Waste Management Types of HCW. Proportions and Hazards. Available from: http://www.healthcarewaste.org/basics/definitions [Last accessed on 2014 Jan 20].  Back to cited text no. 1
    
2.
Bio-Medical Waste (Handling and Management) Rules 1998. Available from: http://www.moef.nic.in/legis/hsm/biomed.html[Last accessed on 2014 Jan 20].  Back to cited text no. 2
    
3.
Centre for Science and Environment. Bio Medical Waste Rules made stringent. Available from: http:/www.cseindia.org/node/3702[Last accessed on 2014 Jan 20].  Back to cited text no. 3
    
4.
Delhi Green Blog. Biomedical Waste Management in Delhi: Need of the Hour. Available from: http://delhigreens.com/2013/08/15/biomedical-waste-management-in-delhi-need-of-the-hour[Last accessed on 2014 Jan 20].  Back to cited text no. 4
    
5.
Before The National Green Tribunal, Principal Bench, New Delhi Appeal No. 63 of 2012. Available from: http://www.greentribunal.gov.in/orderinpdf/63-2012(Ap)_23Aug2013.pdf [Last accessed on 2014 Jan 20].  Back to cited text no. 5
    
6.
Madhukumar S, Ramesh G. Study about awareness and practices about health care waste management among hospital staff in a medical college hospital, Banglore. Int J Basic Med Sci 2012;3:1.  Back to cited text no. 6
    
7.
Mathew SS, Benjamin AI, Sengupta P. Assessment of biomedical waste management practices in a tertiary care teaching hospital in Ludhiana. Healthline 2011;2:28.  Back to cited text no. 7
    
8.
Charania ZK, Ingle NA. Awareness and practices of dental care waste management among dental practitioners in Chennai City. J Contemp Dent 2011;1:1.  Back to cited text no. 8
    
9.
Deshmukh JS, Deshmukh NN, Shewte MK. Biomedical waste management and nosocomial infections: Knowledge, attitudes and practices in a tertiary care hospital. J Acad Ind Res 2013;2:7.  Back to cited text no. 9
    
10.
Kahn PS, Raviprabhu G. Knowledge about biomedical waste management among medical students of a tertiary care hospital, Tirupati. Int J Res Health Sci 2013;1:2.  Back to cited text no. 10
    
11.
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. 11
    
12.
Nandwani S. Study of biomedical waste management practices in a private hospital and evaluation of the benefits after implementing remedial measures for the same. J Commun Dis 2010;42:39-44.  Back to cited text no. 12
    
13.
Selvaraj K, Sivaprakasam P, Nelson SB, Kumar GH, Norman P, Pandiyan KR. Knowledge and practice of Biomedical Waste (BMW) Management among the medical practitioners of Kanchipuram Town, India. Int J Curr Microbiol Appl Sci 2013;2:262-7.  Back to cited text no. 13
    


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