Hospital housekeepers: Victims of ineffective hospital waste management

Forgotten frontline workers: Environmental health service employees' perspectives on working during the COVID-19 pandemic

BACKGROUND

Environmental Health Service employees (EVS) sanitize healthcare facilities and are critical to preventing infection, but are under-resourced during the COVID-19 pandemic and at risk of burnout.

OBJECTIVE

Understand demands on EVS' work and strain on resources during COVID-19.

DESIGN

Qualitative descriptive study conducted in winter 2020-2021.

SETTING

One quaternary care academic medical center in Colorado.

PARTICIPANTS

A convenience sample of 16 EVS out of 305 eligible at the medical center. Fifty percent identified as Black, 31% as Hispanic, 6% as Asian, and 6% as White (another 6% identified as mixed race). Sixty-nine percent were female, and half were born in a country outside the United States.

MEASURES

Semistructured telephone interviews. Interviews were audio-recorded and transcribed, and thematic analysis was used to identify key themes.

RESULTS

Four themes illustrate EVS experiences with job strain and support during COVID-19: (1) Needs for ongoing training/education, (2) Emotional challenges of patient care, (3) Resource/staffing barriers, and (4) Lack of recognition as frontline responders. Despite feeling unrecognized during the pandemic, EVS identified structural supports with potential to mitigate job strain, including opportunities for increased communication with interdisciplinary colleagues, intentional acknowledgment, and education for those who speak languages other than English. Strategies that can increase physical and emotional resources and reduce job demands have potential to combat EVS burnout.

CONCLUSIONS

As the surge of COVID-19 cases continues to overwhelm healthcare facilities, healthcare systems and interdisciplinary colleagues can adopt policies and practices that ensure lower-wage healthcare workers have access to resources, education, and emotional support.

Hepatitis B virus infection and associated risk factors among medical students in eastern Ethiopia

BACKGROUND

Hepatitis B virus (HBV) is a highly contagious pathogen that has become a severe public health problem and a major cause of morbidity and mortality, particularly in developing countries. Medical students are at high occupational risk during their training. However, no facility-based studies were found among medical students in eastern Ethiopia. Thus, this study aimed to investigate the seroprevalence of Hepatitis B Virus and associated factors among medical students in eastern Ethiopia.

METHODS

A facility-based cross-sectional study was conducted among 407 randomly selected medical students from March to June 2018. A pretested and structured questionnaire was used to collect data on socio-demographic characteristics and other risk factors. A 5ml blood was collected, and the serum was analyzed for Hepatitis B surface antigen (HBsAg) using the Instant Hepatitis B surface antigen kit. Data were entered using Epidata version 3.1 and analyzed using SPSS statistical packages version 22. Outcome and explanatory variables were described using descriptive summary measures. Binary and multivariable logistic regression was conducted at 95% CI and an association at P-value < 0.05 was declared statistically significant.

RESULTS

The seroprevalence of hepatitis B virus surface antigen was 11.5% (95%CI = 8.6, 14.7). Poor knowledge of universal precaution guideline (AOR = 2.58; 95% CI = [1.35-4.93]), history of needle stick injury (AOR = 2.11; 95% CI = [1.07-4.18]) and never been vaccinated for HBV (AOR = 2.34; 95% CI = [1.17-4.69]) were found statistically significantly associated with HBsAg positivity after multivariate analysis.

CONCLUSION

Hepatitis B virus infection rate is high among health care trainees in eastern Ethiopia. Improvement at health care practice centers safety through training on universal precaution guidelines, and scaling up HBV vaccination is mandatory.

Post-vaccination anti-HBs testing among healthcare workers: More economical than post-exposure management for Hepatitis B

OBJECTIVE

to compare the direct cost, from the perspective of the Unified Health System, of assessing the post-vaccination serological status with post-exposure management for hepatitis B among health care workers exposed to biological material.

METHOD

cross-sectional study and cost-related, based on accident data recorded in the System of Information on Disease Notification between 2006 and 2016, where three post-exposure and one pre-exposure management scenarios were evaluated: A) accidents among vaccinated workers with positive and negative serological status tests for hepatitis B, exposed to known and unknown source-person; B) handling unvaccinated workers exposed to a known and unknown source-person; C) managing vaccinated workers and unknown serological status for hepatitis B and D) cost of the pre-exposure post-vaccination test. Accidents were assessed and the direct cost was calculated using the decision tree model.

RESULTS

scenarios where workers did not have protective titles after vaccination or were unaware of the serological status and were exposed to a positive or unknown source-person for hepatitis B.

CONCLUSION

the direct cost of hepatitis B prophylaxis, including confirmation of serological status after vaccination would be more economical for the health system.

A Review of Medical Waste Management in South Africa

Background:

Poor medical waste management has been implicated in an increase in the number of epidemics and waste-related diseases in the past years. South Africa is resource-constrained in the management of medical waste.

Objectives:

A review of studies regarding medical waste management in South Africa in the past decade was undertaken to explore the practices of medical waste management and the challenges being faced by stakeholders.

Method:

Published articles, South African government documents, reports of hospital surveys, unpublished theses and dissertations were consulted, analysed and synthesised. The studies employed quantitative, qualitative and mixed research methods and documented comparable results from all provinces.

Results:

The absence of a national policy to guide the medical waste management practice in the provinces was identified as the principal problem. Poor practices were reported across the country from the point of medical waste generation to disposal, as well as non-enforcement of guidelines in the provinces where they exit. The authorized disposal sites nationally are currently unable to cope with the enormous amount of the medical waste being generated and illegal dumping of the waste in unapproved sites have been reported. The challenges range from lack of adequate facilities for temporary storage of waste to final disposal.

Conclusion:

These challenges must be addressed and the practices corrected to forestall the adverse effects of poorly managed medical waste on the country. There is a need to develop a medical waste policy to assist in the management of such waste.

Risk of Potential Exposure Incident in Non-healthcare Workers in Contact with Infectious and Municipal Waste

Introduction

The proper classification of sharp and infectious waste in situ by the healthcare workers is an important measure of prevention of sharps and other exposure incidents in non-healthcare workers, who handle such waste. The aim was to examine the practice of classifying sharp and infectious waste in family and dental practices.

Methods

An analysis of 50 bags of infectious and 50 bags of municipal waste from five family and five dental practices for five days in October 2016 at the Health centre Osijek.

Results

Healthcare workers in 70% of the practices deposited sharps in infectious waste. In 56% of infectious waste bags, sharp object were found. More risky bags of infectious waste were produced by family practices (64%), but with no significant differences in relation to dental practices (48%), (P=0.143). Disposing of infectious into municipal waste was the case in 90% of the practitioners, where in 60% of municipal waste bags, infectious waste was disposed. Dental practices produced more risky bags of municipal waste (76%) in relation to family practices (44%), but with no significant difference (P=0.714).

Conclusions

The results of this research point to importance of performing audits of proper disposal of sharps and infectious waste to reduce the risks of injury to non-healthcare workers who come into contact with the said waste. Given results could be used for framing written protocols of proper disposal of sharps and infectious waste that should be visibly available in family and dental practices and for education of healthcare workers.