Biomedical Waste Management in Hospitals

CHAPTER II

REVIEW OF LITERATURE

Biomedical waste:

Biomedical Waste Management and Handling Rules, India (1998) defines the biomedical waste as “Any waste which is produced by identification of problem, immunization of human beings or animals or treatment or in research activities pertaining or in the production or testing of biological¹¹.

According to WHO around 85% of the biomedical waste generated in the hospital were non-infectious/ non-hazardous waste similar to domestic waste. Only 15% of the waste were infectious or hazardous waste which were a risk for environment and health (10%- infectious and 5%- radioactive or chemical waste). The hospital waste was classified as sharp waste, infectious waste, pathological waste, pharmacological or cytotoxic waste, chemical waste, radioactive waste, non-hazardous general waste.

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Management of Safe waste from health care activities reported the biomedical waste were hazardous in nature as it contain one or more following property: 1) Infectious 2) Contain cytotoxic chemical composition 3) presence of toxic or hazardous chemicals 4) Radioactivity 5) Contain used sharped materials. Everyone coming close to hospital waste were at risk. The main group of individuals at risk was doctors, staff nurses, para medical and supportive staffs, patients, and their attenders. If hospital waste were disposed of improperly, it also risks for general public¹².

Rational for Biomedical Waste Management in Hospital:

Biomedical waste management is a part of hospital hygiene and maintenance activities. Only 15% of the waste generated in the hospital were infectious. If improper segregation of waste at source leads to 100% of biomedical waste to be infectious. Even though biomedical waste management require lot of resources like manpower, money, material and machinery support, it is important for the following reasons¹³:

1. Sharps waste like needles, hypodermic needles, scalpels and other blades, knives, infusion sets can cause cut injuries or puncture wounds. If these items were infected, it can infect all health care provider in hospital and waste handlers.
2. Infection control practices and poor waste management can lead to the spread of hospital acquired infection among patients.
3. Improper treatment and disposal of biomedical waste can be a potential risk to the general public especially to scavengers.
4. Genotoxic and cytotoxic waste in hospital waste is hazardous and have mutagenic, teratogenic, carcinogenic properties. Improper disposal of genotoxic waste raises serious safety problems, both inside hospitals and after disposal, and should be given special attention. The Risk associated with chemical hazardous, at all levels the drugs to persons can handle wastes.
5. Radioactive wastes were produced as a result of procedures such as analysis of body tissue and fluid, organ imaging and tumor localization and various investigative and therapeutic practices. These radioactive waste were a hazard to health and surrounding environment.
6. There is a risk of air, water and soil pollution can occur directly due to improper disposal of waste or due to defective incineration emissions and ash.

Biomedical waste management in India:

In 1998, the Ministry of Environment and Forests, Government of India, introduced the Biomedical Waste (Management and Handling) Rules which mandate to notify for the management and handling of bio-medical waste in the hospital. This rule was amended in 2003 and 2011. Even though strong legislation in India most of the hospitals were yet to achieve the recommended standards for biomedical waste management practices. An evaluation study was carried out by INCLEN (International Clinical Epidemiology Network) Program Evaluation Network (IPEN) in 2009. The study was carried out in Model Injection Centers (MICs) at 25 Partner Medical Colleges (PMC) in India. The study result showed that the biomedical waste management was poor in 82 % of primary care health centers, 60 % secondary care centers and 54 % tertiary care health centers. This showed that there was need for urgent interventions for improving systems capacity and resource in both public and private sectors^14.

Knowledge regarding Biomedical Waste Management

Chudasama et al. (2013) conducted an observational hospital based cross sectional study on knowledge, attitude and practice of bio medical waste handling and its management in a tertiary hospital in Rajkot city, India. The study included all health care provider like resident doctors, intern doctors, nursing staff, laboratory technicians, ward boys, and sweeper’s worker. Among the total study participants282, 92(32.6%) where are staff nurse. The result shows that 95% of participants know about BMW, and 44% of the participant had BMW training. Around 87% of participant known the biomedical waste symbol, 85% of participant know about color codes and 89% of the participant are aware that biomedical waste can transfer disease like HIV and Hepatitis¹⁵.

Vanesh Mathur et al. (2011) conducted an observational hospital based cross-sectional study on KAP (Knowledge, Attitude, and Practices) about BMW (Biomedical Waste Management) among Healthcare Personnel, 100 bedded hospital Allahabad city India. The study included all doctors, nurses, and laboratory technicians have better knowledge than sanitary staff regarding biomedical waste management among the total study participants 283,60(21%) where are staff nurse. The result shows that color-coding waste containers 56 (93.3), 55(91.6) of the participant are aware that biomedical waste can transfer disease like HIV and Hepatitis¹⁶.

Rekha Sachan et al. (2012), conducted a cross-sectional study on KAP regarding BMW among the Paramedical Staff and Medical in Tertiary hopital in the Department of Obstetrics and Gynaecology of CSM Medical University, Luck now, India. The Sample was 10 doctors and 20 nurses. Group A- Nursing female staff (20 nurses), Group B – Doctors (10 Junior Doctors, 8 from Obstetrics and Gynaecology, 2 from Paediatrics) two groups were made. 30% of the doctors and 20% nursing staff have more than 70% knowledge about BMW. 100% doctors and 60% nurses have a definitive attitude towards biomedical waste management¹⁷.

Sarika P Patil et al.(2011), conducted the cross-sectional study was conducted during1st August 2011 to 30th September 2011. Healthcare Workers Awareness regarding Biomedical Waste Management (BMW) at Tertiary Hospital Government in Dhule (India). The sample was 302 health care workers in which 156 are nurses; 45 are technicians and 101 are sanitation workers. The Sanitation workers include 18 attendants laboratory and 83 sweepers performing job of transportation and waste collection Undergone Training of BMW management 49 (60.5%) nurses were training about biomedical waste management, Knowledge regarding the Number of correct Colour Bags to be provided for BMW collection68 (84%), Out of 153 participants, 41.8% (64) and 81.7%(125) were immunized for tetanus and hepatitis B. It was derived that no vaccination of Hepatitis B among 49.4% (40) nurses and 45.7% (16) laboratory technicians during 89.2 %( 33) sanitary workers.¹⁸

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Sanjay Kini B et al. (2014) conducted a observational hospital based cross sectional study on knowledge, attitude and practice of bio medical waste management among staff of a tertiary healthcare Centre in coastal Karnataka Kasturba Medical College, Udupi district of coastal ,India. The study included all health care provider among consultants, junior residents, staff nurses, laboratory technicians and house-keeping staff in Kasturba Hospital in manipal, Among the total study participants 337, 189(56%),where are staff nurses, the result shows that nurses (62.4%) of participants know about BMW and 44% of participant had BMW training, and 46 (24.3%) Knowledge among the participants about biomedical waste management among the total staff 71 (37.6%) shows that less knowledge about biomedical waste management¹⁹.

S.B. Salve, et al. (2012) conducted an observational hospital based cross sectional study on knowledge, attitude and practice of biomedical waste handling and its management in tertiary hospital Mahatma Gandhi Mission’s Medical College and Hospital, Aurangabad [MS] India. Resident Doctors, Nursing Staff and class Employees were selected by the Stratified random sampling method. Among the total study participants110, 47 (42.7%) where are staff nurse. The result shows that 31 (66%) were having average score and 8 (17%) were having poor score, good knowledge 8 (17%), the result shows that 89.3% of participants had BMW training, remaining 10.7% participants untrained about the biomedical waste management²⁰.

Bathma Vishal et al. (2013) conducted an observational knowledge assessment of hospital staff regarding biomedical waste management in a tertiary care hospital. Bhanpur road, Bhopal, India. The study included all health all health care personals, doctors, nurses, and Lab technicians and 7 waste handlers/supporting staff. Among total participants110, 44(40%) where the nursing staff. The result shows that about the knowledge of Categories of waste in nurses 59.0%, and identify the bio hazard symbol 81.8% knows the symbol, Waste segregation in colour containers 70.5%nurses have knowledge, how to disposal method 75.0% have knowledge about the biomedical waste management, which type of disease spread in improper hospital waste management knows about 84.0%, Correct method of treatment & disposal knows about 77.3% of HIV and Hepatitis²¹.

Savan Sara Mathew et al. (2011) conducted an observational hospital based cross sectional study on Assessment of BMW practices in a tertiary care teaching hospital in Ludhiana city, India. The study included all health care provider like resident doctor’s nurses and paramedical staff, among the total study participants 100, 48(48%) were staff nurses. The results show that better knowledge of the nurses more in practical aspects of BMW management. categories of BMW was 97.4% , 92.1% was color coding system, 94.7% knew the methods of segregation, 92.1% knew that waste should not be stored for more than 48 hours, and 100% of aware about the methods of waste disposal. Nurses were equal to or better than the doctors in the aspects of practice. Their knowledge was less in theoretical aspects. 73.7% were aware of BMW Management Rules 1998; 86.8% were identified the biohazard symbol while 92.1% knew the diseases spread by improper waste management²².

Md. Asadullah, et al. (2013) conducted A descriptive cross-sectional study on knowledge, attitude and practices among nursing staff in private hospitals in Udupi City. India. The study included randomly 17 hospitals (as clusters) and 4 hospitals. A pre-structured questionnaire was used. Data were collected from 166 nursing staff, HIV may transmit through BMW 130(78.3), and Hepatitis-B may transmit through BMW 137(82.5), was answered Hepatitis-C may transmit through BMW 119(71.7), Training on biomedical waste management 122(73.5%) and vaccinated about hepatitis-B 153(92.2%) was immunized²³

Biomedical waste management Practice:

Chudasama et al.(2013) conducted an observational hospital based cross sectional study on knowledge, attitude and practice of bio medical waste handling and its management in a tertiary hospital in Rajkot city, India. The study included all health care provider like resident doctors, intern doctors, nursing staff, laboratory technicians, ward boys, and sweeper’s worker. Among the total study participants282, 92(32.6%) where are staff nurse. Study result shows 74.5% of participants reported that there is good maintenance of BMW records in wards and 87% reported having hub cutter in wards. Around 84% of participants are using personal protective measures like a mask, gloves, etc. while handling BMW. The correct practice of handling disposal plastic waste, soiled dressings/plaster casts/linen waste, sharps and needles waste and human anatomical waste are 80%, 66.8%, 63% and 63.1% respectively.

Vanesh Mathur et al. (2011) conducted an observational hospital based cross-sectional study on Knowledge, Practices, and Attitude about Biomedical Management Waste among Healthcare Personnel, 100 bedded hospital Allahabad city India. The study included all doctors, nurses, and laboratory technicians have better knowledge than sanitary staff regarding biomedical waste management among the total study participants 283, 60(21%) where are staff nurse Study result show 44(73.3%) were correct color coding containers are used, The correct practice of handling disposal plastic waste, soiled dressings/plaster casts/linen waste, sharps and needles waste and human anatomical waste are 42(71.0), The report of injury’s 18(30%), about the biomedical waste management

Rekha Sachan et al (2012) conducted cross-sectional study on knowledge, attitude and practices regarding BMW amongst the Paramedical Staff and Medical in Tertiary Health Care Centre in the Department of Obstetrics and Gynaecology of CSM Medical University, Luck now, India. 70% and 65% of the doctors and nurses were practicing higher than 70% of the right practices as according to the university norms. The comparison of Knowledge, with practice and Attitude of groups, shows that the people with high education qualification have better knowledge. This result can attributed to their commitment and accountability in patient and ward management.

Sarika P Patil et al.(2011), conducted the cross-sectional study was conducted during 1st August 2011 to 30th September 2011. Awareness of Healthcare Workers regarding BMW at government tertiary care Hospital in Dhule India. The study included of total 302 health care workers in which 156 are nurses, 45are technicians and 101 are sanitation workers. The result shows that Color coding correct disposal in block cover general waste 37 (45.7%),disposal of boy fluids 30 (37%),sharp and other type of container 65 (80.2%),72 (88.9%) of participants are using personal protective measures like mask, gloves, etc. while handling BMW. The correct practice of handling disposal plastic waste, soiled dressings/plaster casts/linen waste,

Sanjay Kini B et al (2014) conducted a observational hospital based cross sectional study on knowledge, attitude and practice of bio medical waste management among staff of a tertiary healthcare centre in coastal Karnataka Kasturba Medical College, Udupi district of coastal ,India. The study included all health care provider among consultants, junior residents, staff nurses, laboratory technicians and housekeeping staff in Kasturba Hospital in Manipal, Among the total study participants 337, 189 (56%), where are staff nurses, Study result show 45 (23.8) % of participants reported that there is good maintenance of biomedical waste management, all nurses are immunized against hepatitis B, disinfecting sharps at the point of generation and undergone any formal training biomedical waste management, Less practice of 44 (23.3%)

S.B. Salve, et al. (2012) conducted an observational hospital based cross sectional study on knowledge, attitude and practice of biomedical waste handling and its management in tertiary hospital Mahatma Gandhi Mission’s Medical College and Hospital, Aurangabad [MS] India. Resident Doctors, Nursing Staff and class Employees were selected by the Stratified random sampling method. Among the total study participants110, 47(42.7%) where are staff nurse. Practice about biomedical waste management among staff nurses 87.2% was good practice .comparative assessment of practice among trained and untrained individuals was made, which revealed 41 (59.42%) of trained individuals had “Good” practices as compared to 6 (19.5%) untrained individuals.

Bathma Vishal et al. (2013) conducted an observational knowledge assessment of hospital staff regarding biomedical waste management in a tertiary care hospital. Bhanpur road, Bhopal, India. The study included all health all health care personals, doctors, nurses, and Lab technicians and 7 waste handlers/supporting staff. Among total participants110, 44(40%) where the nursing staff. All nurses are according biomedical waste management rules are followed by 54.5%.