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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 13  |  Issue : 4  |  Page : 199-201

System Analysis of Biomedical Waste Management Across Health Care Clinics of Udupi Taluk


1 Faculty of Hospital Administration, Trainee, Master of Hospital Administration (MHA), Prasanna School of Public Health, Manipal, Karnataka, India
2 Department of Hospital Administration, Kasturba Medical College, Manipal, Karnataka, India
3 Faculty of Hospital Administration, PSPH, Manipal, Karnataka, India
4 Faculty of Hospital Administration, SOM, Manipal, MAHE, Manipal, Karnataka, India

Date of Web Publication16-Apr-2019

Correspondence Address:
Ms. Brayal Dsouza
PSPH, Manipal University, Manipal, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_94_17

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  Abstract 


Background: Improper Biomedical Waste (BMW) management by healthcare facilities can pose severe hazardous effects on the larger population, the environment, and its resources. Due to resurgence in number of clinics in urban areas, there is need to understand the practices and compliance to BMW management. It can be understood by studying and observing their practices and processes of BMW management and understanding the knowledge, attitude, and practice among the staff in the clinics. Aim: The objective of the study was to analyze the BMW management process across the healthcare clinics in Udupi taluk. Methods: A cross-sectional, observational study was conducted using self-administered questionnaires and checklists across 15 clinics in Udupi taluk. The sample size is 130 out of which Doctors, Nurses, housekeeping staff and descriptive Statistics were reported. Results: Of the 15 clinics only eight of them had basic requirements of BMW management; lack of trained workforce, non-compliance to segregation of waste, and non-compliance to collection and storage of waste are seen among majority of the clinics. Other findings during our study are 73.3% had inadequate transportation facility, while only 13.3% had adequate storage space. Doctors and nurses had 100% knowledge and positive attitude, environmental health workforce (housekeeping staff) had poor knowledge and attitude.

Keywords: Biomedical waste, healthcare waste, medical waste


How to cite this article:
Tony G, Kumar N, Dsouza B, Kamath R, Kamath S. System Analysis of Biomedical Waste Management Across Health Care Clinics of Udupi Taluk. J Datta Meghe Inst Med Sci Univ 2018;13:199-201

How to cite this URL:
Tony G, Kumar N, Dsouza B, Kamath R, Kamath S. System Analysis of Biomedical Waste Management Across Health Care Clinics of Udupi Taluk. J Datta Meghe Inst Med Sci Univ [serial online] 2018 [cited 2019 Jul 20];13:199-201. Available from: http://www.journaldmims.com/text.asp?2018/13/4/199/256217




  Introduction Top


Biomedical waste (BMW) is defined as the waste generated during the activities of diagnosis, treatment or immunization of human beings or animals in research activities or in the production or testing of biological substances including categories mentioned in Schedule I of the BMW (Handling and Management) Act 2016.[1],[2] It is estimated that annually about 0.33 million tons of hospital waste is generated in India: the waste generation rate ranges from 0.5 to 2.0 kg per bed per day.[3] BMW mis-management at health care facility poses various environmental, biological, and radiological hazards to the population.[4] “Healthcare facility” means a place where diagnosis, treatment, or immunization of human beings or animals is provided irrespective of the type and size of health treatment system and research activity.[2] The BMW generated from healthcare units depends on a number of factors such as waste management methods, type of healthcare units, occupancy of healthcare units, specialization of healthcare units, ratio of reusable items in use and availability of infrastructure and resources.[5] The hazards of poor management of BMW have aroused concern the world over, especially in the light of its far-reaching effects on human health and the environment.[6] The problem of waste disposal in hospitals and other healthcare institutions has become an issue of increasing concern.[7] The expansion of healthcare facilities as well as the recent trend of using disposables has led to an unprecedented burden of healthcare-related waste. In the last three decades, the unregulated handling of BMW has emerged as a serious threat to human health and safety and many researchers have documented this as a priority area. The concern over human immunodeficiency virus/acquired immune deficiency syndrome (HIV)/AIDS and other blood-borne infections has led to increased professional and environmental activism on this issue.[8],[9] A major issue related to the current BMW management in many hospitals is that the implementation of bio-waste regulation is unsatisfactory as some hospitals are disposing waste in a haphazard, improper, and indiscriminate manner. Lack of segregation practices results in the mixing of hospital wastes with general waste, making the whole waste stream hazardous. Inappropriate segregation ultimately results in an incorrect method of waste disposal.[10] Inadequate BMW management will thus cause environmental pollution, unpleasant smell and the growth and multiplication of vectors such as insects, rodents and worms. This may lead to the transmission of diseases such as typhoid, cholera, hepatitis and AIDS through injuries from contaminated syringes and needles.[11]


  Methodology Top


A cross-sectional observational study was conducted using self-administered questionnaires and checklists across 15 healthcare clinics in Udupi taluk. The checklist was used to observe the processes and practices of BMW management. A structured self-administered questionnaire was used to assess the knowledge, attitude, and practices of the staff at the clinics toward BMW management. The questionnaire was distributed to 130 people in the sample – 30 Doctors, 14 nurses, 51 Clerical staff, 30 housekeeping staff and 5 laboratory technicians. The checklist and questionnaire were prepared based on the new BMW management rules 2016. The checklist contains eight domains and parameters based on BMW rules 2016: (1) Basic requirements of BMW management (includes 12 parameters), (2) Workforce for BMW management (includes 3 parameters), (3) Training for BMW management (includes 1 parameter), (4) Process that includes segregation (6 parameters), collection and storage (6 parameters), transportation (5 parameters), treatment and disposal (7 parameters), and (5) Management of different waste streams (26 parameters). Segregation was taken as compliant and noncompliant if all the waste was segregated as per the rules; improper segregation of even any one category was considered as noncompliant.


  Results Top


Waste management of different waste streams was observed. The availability and use of personal protective equipment, mercury spillage, availability of segregation signage above the disposal area, proper segregation, hand washing, vaccination of staff members, visiting of outsourced site, detachment of needle from syringe before disposal, shredding, and mutilation of waste. [Figure 1] 33.3% i.e. five clinics, had adequate management of different waste streams. 66.7% i.e. 10 clinics, had inadequate management of different waste streams. Non vailability of basic requirements e.g. adequate bin, puncture-proof container, waste record register, personal protective equipment and weighing scale was considered inadequate and of the 15 clinics, eight clinics had adequate basic requirements for BMW management and the remaining seven clinics had inadequate basic requirements. In case of workforce for BMW management, only one clinic had a trained workforce. Of the15 clinics, none of the clinics had adequate training for BMW management. Segregation was taken as compliant and noncompliant if all the waste was segregated as per the rules; improper segregation of even any one category was considered as noncompliant. Of the 15 clinics, eight clinics were compliant to segregation of BMW as per the BMW management rules 2016 and seven clinics were noncompliant. Majority of the clinics, i.e. 73.3%, were noncompliant to the proper collection, segregation and storage of BMW. Waste disposal was not outsourced and no records of outsourcing were maintained. Waste was stored beyond 48 hours, bins were filled more than 3/4th level, and mixing of waste on collection was seen. None of the clinics followed Disinfection of Waste as per the 2016 BMW guidelines. A total of 105 participants participated in the study. Doctors, nurses, and laboratory technicians had 100% knowledge regarding BMW management. Out of 29 clerical staff, 7 (24.13%) had adequate knowledge regarding BMW management; 22 (75.86%) did not have adequate knowledge. None of the environmental health workers (housekeeping) employees had complete knowledge regarding BMW and its management. All doctors had a positive attitude towards the BMW management process. Ten out of 14 nurses (71.4%) had a positive attitude towards BMW management. Five laboratory technicians (38.6%) and six clerical staff (20.6%) had a positive attitude towards BMW management. None of the Class 4 employees had a positive attitude towards BMW management. In the present study, all the 30 doctors (100%), 10 out of 14 nurses (71.4%), 5 out of 13 laboratory technicians (38.46%) and 6 out of 29 clerical staffs (20.6%) practiced BMW management properly. However, 4 nurses (28.57%),8 laboratory technicians (61.56%),23 clerical staff and all Class 4 employees (100%) were not aware of the practices with respect to waste management.
Figure 1: Biomedical waste management process across the health care clinics

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  Discussion Top


Appropriate knowledge, positive attitude and proper practices among healthcare workers are essential for the adequate management of BMW in healthcare facilities. In the present study, the checklist and questionnaire used for assessing the processes in the healthcare clinics and the knowledge, attitude, and practices of BMW management among the staff are prepared as per the BMW management rules 2016. From the present study it is clear that the processes of BMW management across the healthcare clinics in Udupi taluk are not complying with BMW management rules 2016. Continuous evaluation and monitoring are necessary to ensure that policies and procedures related to BMW handling are followed. Even a small proportion of badly managed waste can become potentially dangerous. The WHO acknowledges this as a problem and observes that the human element is as important as technology in waste management. Waseem et al. evaluated the awareness of BMW management among the staff of the Government SMHS Hospital, Srinagar. The results of the study revealed that there is adequate knowledge among doctors regarding awareness of the hazards of BMW and the risk of infections such as Hepatitis and AIDS. Definite positive response regarding the subject was 86% (P = 0.005). Significant awareness was found among nursing staffs as well, who were found to be adequately aware of the possible health hazards of BMW. Positive response regarding the subject was 58% (P = 0.05). However, among paramedical personnel, positive responses regarding the subject was 11% (P = 0.05). The findings suggest that there is inadequate knowledge about the subject and poor concept of BMW among the paramedical personnel.[12] Pandit et al. conducted a cross-sectional study on the management of BMW: awareness and practice in a district of Gujarat. Thirty hospitals with a minimum of 30 beds were randomly selected from Sabarkanth district, Gujarat. The doctors and auxiliary staff of those 30 hospitals were the study population. While all the doctors knew about the existence of the laws related to BMW, they did not know the laws in detail. Doctors were aware of the risks of HIV and Hepatitis B and C, whereas auxiliary staff had very poor knowledge about it. There was no effective waste segregation, collection, transportation and disposal system at any hospitals in the district. The findings suggest that there is an immediate and urgent need to train and educate all doctors and staffs to adopt effective waste management practices.[13] Gadicherla et al. evaluated current practices of BMW among the health care facilities (HCF) that had participated in the selected districts level training program in karnataka as well supported the need for improvement at all levels.[14]


  Conclusion Top


It is of paramount importance that significant gaps in the waste management knowledge and practices among clinical establishments in the community need to be addressed. There should be efficient segregation, use of coded and colored bags, better handling and transfer of wastes. There is a need for adequate training and awareness programs for medical and paramedical personnel. There should be a focus on segregation, providing secure collection and transportation, reduction of non-degradable disposable wastes, a sharps management system, and an infrastructure for the safe disposal and recycling of hazardous material.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Biomedical Waste (Management and Handling) Act 2016. Haryana State Pollution Control Board; 2016. Available from: http://www.hspcb. gov.in/BMW%20Rules.pdf. [last accessed on 2017 Aug 01].  Back to cited text no. 1
    
2.
Government of India, Ministry of Environment Forest and Climate Change, Notification. Subsection (i), Part 2., Sec. 3. New Delhi: Gazette of India, Extraordinary; 2016. p. 6-21.  Back to cited text no. 2
    
3.
Pant D. Waste management in small hospitals: Trouble for environment. Environ Monit Assess 2012;184:4449-53.  Back to cited text no. 3
    
4.
Chethana T, Thapsey H, Gautham MS, Sreekantaiah P, Suryanarayana SP. Situation analysis and issues in management of biomedical waste in select small health care facilities in a Ward Under BBMP, Bangalore, Indian J Community Health 2014;3:310-5.  Back to cited text no. 4
    
5.
Mandal SK, Dutta J. Integrated bio-medical waste management plan for Patna city, Institute of Town Planners. India J 2009;6:1-25.  Back to cited text no. 5
    
6.
Barar M, Kulkhestha A. Biomedical waste management – Need of today-A review. Int J Sci Res 2015;4:2417-21.  Back to cited text no. 6
    
7.
Chandra H. Hospital waste: An environmental hazard and its management. Int Soc Environ Botanists 1999;5.  Back to cited text no. 7
    
8.
Mostafa GM, Shazly MM, Sherief WI. Development of a waste management protocol based on assessment of knowledge and practice of healthcare personnel in surgical departments. Waste Manag 2009;29:430-9.  Back to cited text no. 8
    
9.
Rutala W, Mayhall G. Medical waste. SHEA position paper (Society of Hospital Epidemiology of America). Infect Control Hosp Epidemiol 1992;13:38-48.  Back to cited text no. 9
    
10.
Mathur P, Patan S, Shobhawat A. Need of biomedical waste management system in hospitals – An emerging issue – A review. Curr World Environ 2012;7:117-24.  Back to cited text no. 10
    
11.
Aggarwal H, Kumar P. Need for biomedical waste management. J Med Soc 2015;29:58-9.  Back to cited text no. 11
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12.
Waseem Q, Hassan G, Wani NA, Baba A, Kadri SM, Khan Nazir MS. Awareness of bio medical waste management amongst staffs of government SHMS Hospital Srinagar. J K Practitioner 2007;14:60-1.  Back to cited text no. 12
    
13.
Pandit NB, Mehta HK, Kartha GP, Choudhary SK. Management of bio-medical waste: Awareness and practices in a district of Gujarat. Indian J Public Health 2005;4:245-7.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Gadicherla S, Thapsey H, Krishnappa L, Somanna SN. Evaluation of bio medical waste management practices in select health care facilities of Karnataka, India. Int J Community Med Public Health 2016;3:2722-78.  Back to cited text no. 14
    


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