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National Journal of Community Medicine Vol 2 Issue 3 Oct-Dec 2011 Page 452

ORIGINAL ARTICLE .

BIOMEDICAL WASTE MANAGEMENT: AWARENESS

AND PRACTICES IN A DISTRICT OF MADHYA PRADESH

Manoj Bansal1,Ashok Mishra2,Praveen Gautam3,Richa Changulani3,Dhiraj Srivastava4,NeerajSingh Gour5

1Assistant Professor, Department of Community Medicine, Bundelkhand Medical College, Sagar(MP) 2Professor 3Assistant Professor, Department of Community Medicine, G.R Medical College,Gwalior (MP) 4Lecturer, Department of Community Medicine, UP RIMS&R, Saifai, Etawah (UP)5Assistant Professor, College of Medicine, JNM Hospital, Kalyani, (AP)

Correspondence:Dr. Manoj BansalAssistant Professor, Department of Community MedicineBundelkhand Medical College, Sagar (M.P.)

E-mail: [email protected], Phone no. 09907542382

ABSTRACT

Background:A hospital is an establishment that provides medical care facilities. Since the majority ofthe persons receiving treatment in the hospital are suffering with infectious diseases therefore, thewaste generated in hospital has potential to transmit infections and other hazards to hospital staff andnearby community, if not managed adequately. Adequate awareness in the hospital staff andpractices regarding the biomedical waste management is crucial to prevent these hazards.Objective: To assess the awareness and existing practices regarding biomedical waste and itsmanagement in a district of Madhya Pradesh.

Material And Methods:The present study was a cross sectional study carried out in both urban andrural health facilities of Gwalior district from Jan to Jun 2008. Only those hospitals having indoor carefacility were included randomly. Medical, para-medical and non-medical personnel working at theircurrent position for at least 6 months were included as study participants to assess awareness.Statistical Analysis: Percentage and Proportion were applied to interpret the result.Results: Awareness regarding biomedical waste management was highest among doctors followedby para-medical staff and least among non-medical staff. Practices of waste management in hospitalswere grossly inadequate, particularly in rural area.Conclusion: The present study concludes that regular orientation and re-orientation trainingprograms should be organized for hospital staff and strict implementation of guidelines of biomedicalwaste management, to protect themselves and hospital visitors.

Key Words:Biomedical Waste, Hazards, Health care personnel

INTRODUCTION

A hospital is an establishment that providesmedical care facilities to persons suffering orsuspected to be suffering from any disease orinjury. The medical facilities available in ahospital may be diagnostic, therapeutic orrehabilitative. Hospital wastes have always beenconsidered as potentially hazardous. The major

identified hazard is infection, because most ofthe persons receiving medical care in the

hospital are suffering from communicablediseases.1 Other hazards associated with poorwaste management includes injuries fromsharps, risks associated with hazardouschemicals or drugs and disposables beingrepacked and sold without being washed. Wastepiles also attract variety of disease vectors,including mosquitoes and flies. 2 It is importantto note that not all hospital waste has thepotential to transmit infection. It is estimatedthat 8085% is non-infectious general waste, 10%

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In this study, the overall awareness was foundmaximum among doctors followed by para-medical workers and least among non-medicalworkers. Majority of the medical workers werefound aware about the biomedical wastemanagement. Awareness regarding colour

coding and segregation was little bid greateramong para-medical workers than doctors.Regarding composition of hospital waste, only32.75% medical, 25% para-medical and 3.44%non-medical workers gave correct answer.(Table 2)

Table 2: Showing awareness regarding biomedical waste and its management among health carepersonnel.

Question regarding Correct Response

Medical

(n=116)(%)Paramedical

(n=72)(%)Nonmedico(n=58) (%)

Hazards associated with BMWManagement &Handling

116 (100) 69 (95.83) 25 (43.10)

Prevention of hazards associated with BMW

Management & Handling116 (100) 67 (93.05) 22 (37.93)

Colour coding 64 (55.17) 44 (61.11) 06 (10.34)Segregation of BMW 52 (44.82) 37 (51.38) 04 (6.89)Segregation of sharp waste such as contaminatedneedle

83 (71.55) 43 (59.72) 06 (10.34)

Transportation of BMWfor terminal disposal 112 (96.55) 54 (75.00) 27 (46.55)Open unused sharps are not considered as BMW. 78 (67.24) 30 (41.67) 05 (8.62)Any item which has had contact with bloodor any other fluid is considered as BMW

115 (99.13) 63 (87.50) 30 (51.72)

Untreated BMW* can be stored maximum for 48 hrs. 70 (60.34) 31 (43.05) 07 (12.06)About 10-25% of total waste generated in a hospital ishazardous

38 (32.75) 18 (25.00) 02 (3.44)

Biomedical Waste

As far as practices of biomedical waste isconcerned, in our study only one hospital ofurban area adequately segregating the hospitalwaste while pre-treatment was done in only 33%hospitals under study. Transportation ofbiomedical waste out side the hospital wasadequate in almost all the urban health facilitiesbut none of the rural health facility showsadequate transportation. In urban area, all thehospitals were using Common BiomedicalWaste Treatment Facility (CBWTF) for terminaldisposal of waste. In rural area, the healthfacilities were using deep burial, burning andopen dumping, either single method or incombination for terminal disposal. (Table 3)

DISCUSSION:

The present study was conducted ingovernment and private hospitals of both urbanand rural area to find out the awareness andexisting practices regarding biomedical wastemanagement in the district. Awareness amonghealth care workers is essential for the adequate

management of biomedical waste. The overallawareness about biomedical waste management

was found highest among medical professionals.Almost all the doctors and majority of the para-medical workers were quite aware abouthazards and method of prevention of hazards ofbiomedical waste management and handlingwhile it was least among non-medical workers.Similar observations were noted by Deo et al 8and Pandit NB et al 9

The knowledge regarding segregation isimportant to prevent the mixing of hazardous

and non-hazardous or domestic waste whichhas to be disposed off with municipal waste. Inthis study, knowledge about colour coding andsegregation was more among para-medical thanmedical staff. These findings were supported bystudies done by various researchers. 8, 10

Our study reveals that knowledge abouttransportation of waste for terminal disposalwas highest among doctors than para-medicalstaff and least among non-medical staff. In ourstudy, only 32.75% doctors, 25% para-medicaland 3.44% non-medical staff were agree with thefact that about 10-25% of total waste generatedin a hospital is hazardous. This may be because

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of there low level of education. Saini et al foundthat person with higher education level weremore aware regarding the issue.11

Segregation is the most important step in theentire process of biomedical waste management.

Segregation not only reduces the risksassociated with the biomedical waste but alsothe cost of handling, treatment and disposal. Asper the findings of this study, majority of thehospitals using two or three colour coded bagsto segregate the waste and the practices of wastesegregating were not adequate and mixing ofwaste was found. Pandit NA et al in his study inSrinagar and Gupta et al in Lucknow alsoreported that there was no mechanism for wastesegregation of infectious and non-infectiouswaste.12,13

Storage and transportation of waste were foundadequate in hospitals of urban area, while not in

rural health facilities. This may occur because inurban area, all the hospitals under study have acontract with Common Biomedical WasteTreatment Facility for transportation andterminal disposal. Persons working withCBWTF collect waste from these hospitals dailyby separate vehicle used only for transportationof biomedical waste.

The health facilities of rural area were usingdeep burial, burning and open dumping near tohospital premises for terminal disposal. PanditNB et al in his study carried out in a district ofGujarat and Rijal et al in Kathmandu valley alsonoted that there were no effective wastesegregation, collection, and transportation anddisposal system in most of the health careinstitutions.9, 14

Table 3: Showing existing practices of biomedical waste management in urban and rural hospitals.

Step of BMWManagement Urban Hospitals(n=04) (%)

Rural Hospitals(n=08) (%)

Total (n=12) (%)

SegregationAdequate 01 (25) 00 (00) 01 (8.33)Notadequate 03 (75) 08 (100) 11 (91.67)Pre-treatmentYes 02 (50) 02 (25) 04 (33.33)No 02 (50) 06 (75) 08 (66.67)Storage at site of production1day 00 (00) 05 (62.50) 05 (41.67)Frequency of removal1day 00 (00) 05 (62.50) 05 (41.67)TransportationAdequate 04 (100) 00 (00) 04 (33.33)Notadequate 00 (00) 08 (100) 08 (66.67)Method used for terminal disposalCBWTF# 04 (100) 00 (00) 04 (33.33)Others 00 (00) 08 (100) 08 (66.67)

# Common Biomedical Waste Treatment Facility

CONCLUSION:

The present study concluded that the awarenessregarding biomedical waste management wassatisfactory in medical personnel while poor inpara and non-medical workers. As theseworkers are regularly engaged in the process ofbiomedical waste management and handling,therefore there is an urgent need for orientationtraining regarding the issue, to entire health carepersonnel especially para and non-medical

workers to protect themselves and peoplevisiting to hospital and nearby community.Also, there is a need of strict implementation ofguidelines of biomedical waste managementand regular supervision and monitoring by aseparate committee, exclusively formed for theimplementation of rules related to the safemanagement and handling of hospital waste in

entire district.

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