Surveillance of Biomedical Waste Practices in a Multi Speciality Hospital, its Evaluation and Audit

Aims: To assess the knowledge of Biomedical waste (BMW) categories, colour coding, transport, storage & disposal of Biomedical waste among the healthcare workers. Study Design: Cross sectional. Place and Duration of Study: Multi speciality Hospital, Pune, over the duration of 1 month. Methodology: A predesigned questionnaire containing closed-ended questions was used to conduct this cross sectional study on HCWs. The data related to awareness & knowledge about various aspects of Biomedical waste amongst the Healthcare workers was collected. Results: Out of total 100 Healthcare workers (HCWs), 40 doctors were correctly knowing all the categories of Biomedical waste. 45 doctors & 40 nursing staff (total 85 out of 100 HCWs) could answer correctly the questions on colour coding of BMW. Only 30 doctors & 21 nursing staff could answer correctly about BMW transport. 25 doctors &18 nurses could answer correctly the questions related to BMW storage & disposal. Conclusion: The vigorous & repeated training & evaluation is needed to bridge the observed knowledge gaps amongst the HCWs. Original Research Article Kulkarni and Pathak; JPRI, 33(49A): 133-140, 2021; Article no.JPRI.76402 134


INTRODUCTION
People of any age, sex, race and religion utilize healthcare services when they are medically unfit. Hospitals, in addition to patients, also consist of doctors and other healthcare workers [1]. Since the earlier times, the hospitals aid in treating unhealthy people but unknowingly without people being aware about the bad effects of the waste generated in the process on the environment & mankind. It is a well-known & entrenched that hospital waste is an inherent health hazard to the health care workers working in the facility as well as to the people in the vicinity & ecosystem present. HIV/AIDS, Hepatitis B and C are the blood borne pathogens which have a great transmission capacity through the waste generated by health care systems. The term "biomedical waste" has been defined as "any waste that is generated during diagnosis, treatment or immunisation of human beings or animals, or in the research activities pertaining to or in the production or testing of biologicals and includes categories mentioned in schedule I of the Government of India's Biomedical Waste (Management and Handling) Rules 1998" [2,3]. Hospital waste (Biomedical waste) is dangerous due to its hazardous and infectious nature in comparison to the other kind of wastes. Almost 75-90% of waste produced by hospitals, nursing homes etc. is non-risk in nature as it is generated from administrative and general housekeeping. Remaining 10-25% of waste is regarded as 'hazardous' and may create variety of health risks due to its infectious nature [4]. As per gross annual estimate, about 0.33 million tonnes of hospital waste is generated in India the pace of which ranges from 0.5 to 2.0 kg per bed per day approximately [5]. A valid & sound way of tacking biomedical waste is a mandate in healthcare facility . Efficient & sound management of biomedical waste is a legal,ethical & social liability of each & every individual working in healthcare. Ideal biomedical waste management (BMWM) process has pivotal steps (segregation, storage, transportation, treatment, and disposal) [6,7] which requires unique inquisitiveness [8][9][10].
Haphazard disposal of Biomedical waste and exposure to such an irresponsibly disposed waste carries a grave menace to the environment and to overall mankind. It is statutory that appropriate pre treatment is carried out on the biomedical waste prior to its final disposal. Furthermore the high prevalence of diseases such as human immunosuppressive virus (HIV) and hepatitis B and C also emphasize the need of proper handling of the BMW [11].
10% of all fatal/life-threatening diseases in the South-East Asia region is attributed to the Hospital-acquired infections which indirectly points out to the improper management of hospital waste [12].
Improper biomedical waste practices lead to change in the ecosystem and spread of antimicrobial drug resistance hence the most suitable method for disposal involves implementation of apt methods especially for the disposal of toxic substances from hospital to environment.
In the above context, the study was planned out with the main objective of assessing knowledge, attitude, and practices among the doctors & nurses in the field of health care waste management till final disposal including BMW categories, segregation, color coding, storage ,transport & disposal of BMW.

Distribution of Healthcare Workers
A total 100 questionnaires were analyzed. This questionnaire assessed different aspects of Biomedical waste knowledge amongst various categories of Healthcare workers. We included 50 doctors & 50 nursing staff in this study (Fig.  1).

Demographic profile of Health care workers
We included equal number of male & female HCWs in our study. Age distribution & professional experience amongst them was as shown in Table 1.

Assessment of Knowledge of BMW Categories among Healthcare Workers
Out of 50 doctors, 40 were correctly knowing all the categories of Biomedical waste. A gap in the knowledge of BMW categories, was observed in nursing staff as only 28 out of 50 nursing staff was having knowledge about BMW categories (Fig. 2 ).

Assessment of Knowledge of Colour Coding of BMW
Knowledge of healthcare workers was found pretty good in regards to color coding of biomedical waste.45 doctors & 40 nursing staff (total 85 out of 100 HCWs) could answer correctly the questions on colour coding of biomedical waste (Fig. 3).

Assessment of Knowledge of BMW Transport
From the answers obtained from the questionnaire regarding transportation aspect of biomedical waste, it was observed that there need to be a lot of education to be given to all healthcare workers including doctors regarding details of transport of biomedical waste within the hospital & transport outside the hospital as there was deficiency observed in the knowledge about it. Only 30 doctors &21 nursing staff could answer regarding the transport of BMW (Fig. 4).

Assessment of Knowledge of BMW Storage and Disposal
25 doctors &18 nursing staff could answer correctly the questions related to BMW storage & disposal. (Fig. 5).

Fig. 5. Distribution of HCWs having knowledge about BMW storage & disposal
The data obtained was compiled and entered in Excel spreadsheet and analyzed using SPSS software version 16.0. Proportions along with 95% Confidence Interval was used to express the results.

Discussion
This questionnaire assessed different aspects of Biomedical waste knowledge amongst various categories of Healthcare workers. A gap in the knowledge of BMW categories, was observed in nursing staff as only 56% (28 out of 50) nursing staff was having knowledge about BMW categories. This gap in the knowledge could be attributed to lack of professional experience of these nursing staff as many were freshly passed out nurses with 5-6 months of work experience. which also showed concordant results [15].
In a study by MC Yadavannavar et al ,in 2010, 97.4% teaching staff answered correctly questions on BMW management in comparison with the nonteaching staff who answered with 80% accuracy [16].
We found discordant results as compared with some previous studies conducted by Pandit et al. [17] & Saini et al. [18]. In their studies, they have found high knowledge level on BMW rules amongst doctors & nurses whereas we found this poor in our study [17,18].

CONCLUSION
The vigorous & repeated training & evaluation is needed to bridge the observed knowledge gaps amongst the HCWs. Hands on sessions on various aspects of BMW management under supervision need to be organized separately involving each category of HCWs as well as for the frontline staff (Pharmacists, billing ,reception) in every healthcare organization to improve the compliance amongst all stakeholders.

LIMITATIONS OF THE STUDY
Sample size was small in this study. Hence, studies involving large sample size will be needed to provide broader knowledge & deep insight of the current BMW handling & management situation in health care organizations. Also we could include only doctors & nursing staff in this study. Study involving broader category of HCWs like paramedics, class IV workers & Housekeeping staff would be more appropriate to draw a better conclusion.

CONSENT
Written informed consent was obtained from the study participants for publication of this study.

ETHICAL APPROVALS
we conducted our research after obtaining institutional ethical committee approval (UH/IEC/2021/115).