Evaluation of knowledge, practices, and possible barriers among healthcare providers regarding medical waste management in Dhaka, Bangladesh

Knowledge, behaviours, practices, and expectations regarding climate change and environmental sustainability among health workers in France: a multicentre, cross-sectional study

BACKGROUND

Faced with climate change, hospitals are confronted with a dual challenge. On one hand, they need to embark on a far-reaching ecological transformation to reduce their contribution to greenhouse gas emissions and other environmental impacts; on the other hand, they need to limit the effects of climate change on their activities. We aimed to evaluate the knowledge, behaviours, practices, and expectations of health workers in French hospitals regarding climate change and environmental sustainability.

METHODS

This multicentre, cross-sectional study was carried out in six French hospitals from June 1, 2021 to Dec 31, 2022. All health workers at the hospitals were eligible to participate and were recruited through internal publicity. We designed a structured questionnaire consisting of five parts: participant characteristics, knowledge and perceptions of climate change, pro-environmental behaviours, practices concerning environmental sustainability actions, and expectations. A multilevel logistic regression model was used to evaluate associations between the knowledge, behaviours, and practices of health workers and the characteristics of the health workers and hospitals.

FINDINGS

Of 57 034 health workers across the six hospitals, 4552 (8·0%) participated in the study. Of those for whom gender data were available, 3518 (78·2%) participants were women and 979 (21·8%) were men. Participants considered energy consumption (71·0%) and waste and discharges related to medical activities (55·6%) and non-medical activities (50·2%) to be the three activities with the greatest environmental impact. On a scale of 1 (not a priority) to 10 (high priority), the median rating attributed by the participants to the commitment of their hospitals to ecological transformation was 5·0 (IQR 3·0-6·0). 1079 (23·7%) of 4552 participants had already initiated at least one environmental sustainability action in their hospital. Barriers reported by participants to the implementation of environmental sustainability-related projects were the lack of dedicated time (40·4%), hierarchical support (32·5%), methodological support (28·9%), and access to training (23·7%). The presence of a sustainable development steering committee, especially one with more than 5 years of activity, was positively associated with health workers feeling better informed about the ecological transformation of their hospital (adjusted odds ratio 1·78 [95% CI 1·29-2·45]), having better knowledge of the environmental impacts of their hospital (1·83 [1·32-2·53]), and initiating a larger number of environmental sustainability actions (1·74 [1·33-2·29]).

INTERPRETATION

We showed that health workers in French hospitals seem to be committed to the ecological transformation of their workplaces, and identified some drivers and barriers to further support these essential transformations. There is an urgent need to bolster training for all health workers, enhance structural frameworks within hospitals, and encourage future interdisciplinary research on the vulnerability of health-care facilities to climate change.

FUNDING

The University Hospital of Poitiers.

Knowledge, perceptions and practices on healthcare waste management and associated occupational health hazards among healthcare professionals in the Colombo District, Sri Lanka: a cross-sectional study

Background

Proper Healthcare Waste (HW) management is directly influenced by the knowledge and attitudes of Healthcare Professionals (HCP). However, studies that characterize the knowledge and practices of HCP on HW management are limited in Sri Lanka. This study was conducted to characterize the knowledge, perceptions and practices of HCP on the management of HW and to determine the risk factors influencing HW related occupational health hazards in the Colombo District of Sri Lanka.

Methods

A total of 407 HCP were recruited as the study population from selected hospitals in the Colombo District. Information on socio-demographic factors, knowledge, attitudes and practices on HW management were gathered using an interviewer-administrated questionnaire. The Binary Logistic Regression (BLR) was used to determine the socio-economic risk factors associated with the occurrence of HW related health issues among the respondents.

Results

The majority of respondents were characterized with a high knowledge level (76.9%) and positive attitudes (53.8%) on HW management. Incineration (82.6%) was recognized as the most widely used HW treatment method. Personal Protective Equipment (PPE) was used at a satisfactory level (85.5%), while liquid waste treatment was limited (57.5%). The occupational designation, level of training received in HW management, professional experience, vaccination status for tetanus, degree of knowledge and attitudes on HW management were recognized as significant risk factors (p < 0.05) associated with the occurrence of HW related occupational hazards.

Conclusion

Even though, the treatment of HW was satisfactory, strengthening the existing mechanisms for monitoring of HW management, provisioning more resources and organizing training and awareness programmes on HW management for HCP are recommended.

Knowledge, Attitude and Practice of Biomedical Waste Management Among Doctors and Nurses During the COVID-19 Pandemic in Puducherry: A Cross-Sectional Study

Background Biomedical waste (BMW) management is an important practice that has to be followed by all healthcare workers (HCW) in health centres. COVID-19 had become a global threat, and the spread of the infection had increased drastically. Healthcare workers were already involved in managing COVID-19 patients. It is essential to have adequate knowledge, attitude and good practices among healthcare workers during the COVID-19 period. Hence, the present study was conducted to assess the knowledge, attitude and practices of COVID-19 biomedical waste management among doctors and nurses working in a private tertiary care centre in Puducherry. Methods A cross-sectional study was conducted to assess the knowledge, attitude and practice of BMW management among doctors and nurses who were working during the COVID-19 period. A total of 384 samples were recruited, and the study was conducted for a period of four months. Data were collected from a pre-validated, pre-tested questionnaire that assessed the knowledge, attitude and practices of biomedical waste management. Further analysis was done using Microsoft (MS) Excel (Microsoft® Corp., Redmond, WA) and the Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). Results Among the 384 participants, 152 (39.6%) had excellent knowledge, 143 (37.2%) had good knowledge and 89 (23.2%) had poor knowledge. Among the 111 doctors, 55 (49.5%) had excellent knowledge, and 36 (32.4%) had good knowledge. Among the 273 nurses, 107 (39.2%) had good knowledge and 97 (35.5%) had excellent knowledge. Of the study participants, 98.2% had a favourable attitude, and 89.6% had favourable practices towards biomedical waste management. Occupation and training received on BMW management were found to be predictors of knowledge regarding biomedical waste management. Conclusion From the present study, it is found that the knowledge of biomedical waste management needs to be improved among doctors and nurses, especially in situations such as the COVID-19 pandemic. In this study, a positive correlation was found between knowledge score and practice score, which states that increasing knowledge regarding biomedical waste management will improve practice towards biomedical waste management. Also, doctors and nurses who had already received training in biomedical waste management were found to have better knowledge than those who had not. Hence, the college administration should do various health education activities and training sessions to enhance biomedical waste management among doctors and nurses working in the hospital.

Assessing and overcoming the barriers for healthcare waste management in India: an integrated AHP and Fuzzy TOPSIS approach

PURPOSE

Due to the coronavirus disease 2019 (COVID-19) pandemic, the world faces different issues, and proper healthcare waste (HCW) treatment is one of them. If appropriate disposal of HCW is not performed, it will have hazardous effects on humanity. This paper has identified the significant barriers hindering the proper treatment of healthcare waste management (HCWM) with the strategies to overcome these barriers.

DESIGN/METHODOLOGY/APPROACH

This paper has identified the significant barriers hindering the proper treatment of HCWM with the strategies to overcome these barriers, and different barriers are identified and categorized into organizational, waste handling, human resource and technical barriers. The analytical hierarchy process (AHP) process is used to rank the barriers and sub-barriers. Then, the Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method evaluates the strategies for proper implementation of HCWM.

FINDINGS

The results show that organizational barriers are the most significant barrier, with a lack of coordination of hospitals with other authorities and no priority given to waste management issues as highly ranked barriers. The results of the Fuzzy TOPSIS method indicate that "Increase govt support and policies" and "Enhance training and awareness of employees" are the most feasible strategies to overcome these barriers for the successful implementation of HCWM.

PRACTICAL IMPLICATIONS

This study will be helpful in policy formulations for the proper treatment of HCW in an efficient manner. This paper helps to complete the research gap by providing the different characteristics of barriers.

ORIGINALITY/VALUE

This paper fills the research gap by expanding the limited knowledge in this field and providing further evidence on this phenomenon. The study also enables the distinctive characteristics of barriers to be understood within a particular context.

Healthcare waste in Bangladesh: Current status, the impact of Covid-19 and sustainable management with life cycle and circular economy framework

COVID-19 has accelerated the generation of healthcare (medical) waste throughout the world. Developing countries are the most affected by this hazardous and toxic medical waste due to poor management systems. In recent years, Bangladesh has experienced increasing medical waste generation with estimated growth of 3 % per year. The existing healthcare waste management in Bangladesh is far behind the sustainable waste management concept. To achieve an effective waste management structure, Bangladesh has to implement life cycle assessment (LCA) and circular economy (CE) concepts in this area. However, inadequate data and insufficient research in this field are the primary barriers to the establishment of an efficient medical waste management systen in Bangladesh. This study is introduced as a guidebook containing a comprehensive overview of the medical waste generation scenario, management techniques, Covid-19 impact from treatment to testing and vaccination, and the circular economy concept for sustainable waste management in Bangladesh. The estimated generation of medical waste in Bangladesh without considering the surge due to Covid-19 and other unusual medical emergencies would be approximately 50,000 tons (1.25 kg/bed/day) in 2025, out of which 12,435 tons were predicted to be hazardous waste. However, our calculation estimated that a total of 82,553, 168.4, and 2300 tons of medical waste was generated only from handling of Covid patients, test kits, and vaccination from March 2021 to May 2022. Applicability of existing guidelines, and legislation to handle the current situation and feasibility of LCA on medical waste management system to minimize environmental impact were scrutinized. Incineration with energy recovery and microwave sterilization were found to be the best treatment techniques with minimal environmental impact. A circular economy model with the concept of waste minimizaton, and value recovery was proposed for sustainable medical waste management. This study suggests proper training on healthcare waste management, proposing strict regulations, structured research allocation, and implementation of public-private partnerships to reduce, and control medical waste generation for creating a sustainable medical waste management system in Bangladesh.

Hygiene knowledge and practices and determinants of occupational safety among waste and sanitation workers in Bangladesh during the COVID-19 pandemic

Waste and sanitation workers provide essential services to society. In most low-and middle-income countries, they are often mistreated and lack access to necessary personal protective equipment (PPE) and hygiene facilities that ensure occupational safety in workplaces. COVID-19 has also imposed serious health risks upon these worker groups. This study explores factors associated with poor occupational health and safety based on a conceptual framework. We conducted 499 surveys with five categories of waste and sanitation workers across ten cities in Bangladesh. We performed descriptive analysis and used Firth's logistic regression model following the conceptual framework. The analysis revealed consistent distinctions between workers considered to be in "safe" versus "unsafe" working conditions. The result showed that workers had not been adequately trained, not provided with proper equipment, and many had an informal status that prevented access to hygiene facilities. The workers who received occupational training, knew how to prevent COVID-19 by wearing a face mask, hand washing, and maintaining social distance, maintained protective measures, and practiced proper disposing of PPEs were more likely to be in safe condition. Initiatives to improve the situation of the waste workers who work in unsafe work conditions are still inadequate. Therefore, we recommend supplying proper protective equipment, ensuring a regular supply of gender-specific PPEs, and providing functional facilities necessary to practice personal hygiene and occupational safety, such as handwashing stations, changing rooms, and disposal facilities of used PPEs at the workplace. We also urge increased institutional management procedures, infrastructure that facilitates hygiene practices, and social policies to reduce occupational hazards for the waste workers in Bangladesh during and beyond the COVID-19 pandemic.

On prioritising global health's triple crisis of sepsis, COVID-19 and antimicrobial resistance: a mixed-methods study from Malawi

Sepsis causes 20% of global deaths, particularly among children and vulnerable populations living in developing countries. This study investigated how sepsis is prioritised in Malawi’s health system to inform health policy. In this mixed-methods study, twenty multisectoral stakeholders were qualitatively interviewed and asked to quantitatively rate the likelihood of sepsis-related medium-term policy outcomes being realised. Respondents indicated that sepsis is not prioritised in Malawi due to a lack of local sepsis-related evidence and policies. However, they highlighted strong linkages between sepsis and maternal health, antimicrobial resistance and COVID-19, which are already existing national priorities, and offers opportunities for sepsis researchers as policy entrepreneurs. To address the burden of sepsis, we recommend that funding should be channelled to the generation of local evidence, evidence uptake, procurement of resources and treatment of sepsis cases, development of appropriate indicators for sepsis, adherence to infection prevention and control measures, and antimicrobial stewardship.

Medical Waste Management: An Assessment of District-Level Public Health Facilities in Bangladesh

Background Due to the huge patient load and different types of services, public health facilities produce a bulk of medical waste (MW) in Bangladesh. Improper disposal of MW increases the risk of infection among healthcare service personnel, patients, and attendants. To ensure quality services, this study aimed to assess the practices of MW management and quantify those to find out the shortcomings in the specific steps of waste management. Methodology As part of a larger interventional study, a facility assessment was conducted from February to April 2016 at a District Hospital (DH) and a Mother and Child Welfare Centre (MCWC) in one district. Non-participatory observation of MW management was done using a checklist that was developed following the Guideline for Medical Waste Management of Bangladesh. Scoring was applied for various activities of MW management performed in the study facilities. Results The overall scores for bin management, segregation, and collection of waste were 64.5%, 58.1%, and 62.0% in DH and 53.1%, 41.5%, and 48.0% in MCWC, respectively. The performance of operation theater in MCWC was the lowest among different corners (16.7% to 36.0%). Reusable waste was segregated poorly (32% in DH and 0% in MCWC), and almost none was shredded (4% in DH and 0% in MCWC). Waste was transported from in-house to out-house temporary storage area in an open bin without any trolley or specific route. The storage area was accessible to unauthorized persons, for example, a waste picker in DH. While DH segregated 84% of its infectious waste at the source, it eventually got mixed up with other waste in the storage area and delivered to the municipality to be dumped. MCWC could segregate only 40% of its infectious waste at the source and disposed of them using the pit method. Both the facilities disposed of sharp MW by open-air burning and liquid waste through sewerage without any treatment. Conclusions The performance of MW management was poor in both study facilities. Advocacy to the healthcare personnel and refresher training along with supportive supervision and monitoring may improve the situation. Moreover, a larger study is needed to find out the reasons behind such poor MW management.

Evolutionary Game Analysis of Medical Waste Disposal in China under Different Reward and Penalty Models

Although local governments have issued relevant reward and penalty policies, there are still problems of medical waste disposal in China, particularly in light of the special situation of the COVID-19 pandemic. Furthermore, these problems are generated in the game between local governments and disposal enterprises. Accordingly, based on the evolutionary game theory, this paper establishes and analyzes the game system between local governments and disposal enterprises under four modes: static reward and static penalty, dynamic reward and static penalty, static reward and dynamic penalty, and dynamic reward and dynamic penalty. The theoretical analysis is verified through numerical simulation of a medical waste disposal case in China. The results showed that when local governments choose the static reward and static penalty mode, the game system hardly always has an evolutionary stable state, and the dynamic reward or dynamic penalty mode can make up for the shortcomings of the static reward and static penalty mode. The static reward and dynamic penalty mode is considerably better than the other two dynamic reward and penalty modes, which has the best effect on improving the quality of medical waste disposal. Additionally, if the reward or penalty increases dynamically, local governments tend to implement a “relaxed supervision” strategy, and disposal enterprises will still improve the disposal quality of medical waste. The suggestions proposed based on the research conclusions offer some enlightenment for policymakers to formulate reasonable reward and penalty measures.

Biomedical waste management practices and associated factors among health care workers in the era of the covid-19 pandemic at metropolitan city private hospitals, Amhara region, Ethiopia, 2020

BACKGROUND

Biomedical waste management is an important precondition to safeguard the healthcare workers and community members, as well as the environment, from being contaminated with infectious substances. However, biomedical waste management practices during the pandemic era of COVID-19 were unknown.

OBJECTIVE

This study was aimed to assess biomedical waste management practices and associated factors among health care workers during the COVID-19 pandemic era at metropolitan city private hospitals, Amhara Region, Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted at metropolitan city private hospitals in Amhara Region. Simple random sampling was used to select 431 study participants. Data were collected through a self-administered questionnaire and observational checklists. The data were cleaned, coded, and entered into the Epi-data version 4.6, and then exported to SPSS version 20. for analysis. Variables with a p-value less than 0.05 were considered as significant factors in multivariable logistic regression analysis and AOR with a 95% confidence level was used to measure the strength of association.

RESULTS

The proportion of health care workers who had good practices in biomedical waste management was 49.4%. Participants who had MSc education level, [AOR = 4.20, 95% CI (1.01, 17.40)], Bachelor degree [AOR = 3.52, 95% CI (2.13, 5.82)], got training on biomedical waste management [AOR = 4.33, 95% CI (2.71, 6.93)], access to color-coded three bins in their working department [AOR = 6.24.95% CI (3.84, 10.13)] and those who had good attitude (AOR = 2.64, 95% CI (1.65, 4.22), were significantly associated with biomedical waste management practices in private hospitals.

CONCLUSION

The practice of biomedical waste management in the study area was low. Level of education, taking training on biomedical waste management, availability of color-coded three bins, and attitude of health care workers were significantly associated with biomedical waste management practices. Hence, in-service training is recommended to improve biomedical waste management practices.

Effectiveness of a multimodal capacity building initiative for upgrading biomedical waste management practices at healthcare facilities in Bangladesh: a 21st century challenge for developing countries

INTRODUCTION

Bio-medical Waste Management (BMWM) has attracted critical attention across the world as its improper management can pose a serious threat for healthcare workers (HCWs), the general population and the environment as well. This study aims to analyse the effectiveness of a multimodal intervention (MMI) in upgrading BMWM practices at healthcare facilities across Bangladesh.

METHODS

This quasi-experimental study, with a pre- and post-test design, was carried out at nine healthcare facilities (five public, three private and one autonomous) over three phases and concluded in 2019. The MMI included various strategies including: i) system change; ii) education and training, iii) visual reminders, iv) monitoring and feedback; v) ensuring sustainability at the study hospitals. The data collected from 2726 HCWs and waste handlers through direct observation was statistically analysed using SPSS 24.

RESULT

Significant improvements were observed in waste segregation practices (rising from 1% to 79%) using colour-coded bins. Use of PPEs during transportation and final management/disposal was also enhanced from 3% to 55%. Compliance to use of standardized methods for collecting and transporting biomedical waste (BMW) increased substantially from 0% to 78% while compliance to standard final management/disposal of BMW practices improved by 39%.

CONCLUSION

Compliance to BMWM practices is very poor in Bangladesh due to a lack of knowledge, manpower and resources. Nevertheless, MMI can be used as a tool to significantly upgrade BMWM practices across healthcare facilities. Such initiatives will assist the government of Bangladesh to achieve sustainable development goal (SDG) 3.3 and universal health coverage by 2030.

Waste management in an Italian Hospital's operating theatres: An observational study

BACKGROUND

Each day operating theatres produce lots of waste. The wrong segregation represents both an environmental and economic problem, which is reflected in increased disposal cost and in a loss of resources.

AIM

To examine waste segregation by medical and nonmedical healthcare personnel in an Italian hospital's operating theatres.

METHODS

We used an observational tool, according to the local regulations and validated by a panel of experts.

RESULT

Fifty-seven percent of waste were disposed of incorrectly, of these 71% could have been recycled and 1% recovered. The preoperative phase had the greatest production of waste (48%) and the highest percentage of incorrect differentiation (72%). Sixty-six percent of waste handled as "undifferentiated" could have been recycled. Waste managed as hazardous that could have been recycled, reused or otherwise segregated stood at 54%. Hazardous waste was managed incorrectly in 5% of the disposals.

CONCLUSION

The lack of a variety of bins for waste segregation and improper classification by personnel appear to be the cause of the incorrect segregation, which should be error free.

Perceived risk and associated factors of healthcare waste in selected hospitals of Kathmandu, Nepal

BACKGROUND

Healthcare waste management is the subject of a neglected issue in many developing countries. Health care facilities are facing a major challenge in handling healthcare wastes and reducing their potential risks to human health and the environment. Insufficient understanding of the risk associated with healthcare waste by health workforce can contribute to poor waste management practices. The main aim of this study is to assess risk perception towards healthcare waste among hospital attendants and to identify associated factors.

METHODOLOGY

We carried out a cross-sectional hospital-based study among 120 attendants of a private and public hospital in Kathmandu, Nepal. We used two-stage random sampling for the selection of hospital and participants. We conducted a face-to-face interview with the participants using semi-structured questionnaires. Based on the mean score, we classified risk perception as good and poor. Bivariate and multivariate analysis was carried out to determine associates of risk perception towards healthcare waste.

RESULTS

Approximately 51.0% of hospital attendants had poor risk perception of healthcare waste. Nearly half of the participants (49.2%) had inadequate knowledge and 43.0% had a negative attitude. Factors such as healthcare waste management training (p = 0.028), housekeeping department (p = 0.036) and attitude (p = 0.001) were associated with risk perception of healthcare waste.

CONCLUSION

Hospital attendants had a poor understanding of risk perception of healthcare waste. Periodic training on healthcare waste management and edification on the risk associated with healthcare waste is essential to boost awareness among all healthcare workers. Communication on behavioral improvements for appropriate waste management must be prioritized to change the perception of health workers.

Assessing knowledge, attitude, and practice of healthcare personnel regarding biomedical waste management: a systematic review of available tools

Biomedical waste (BMW) management is an important commitment of hospitals both in terms of the possible infectious risk and from the financial point of view. Monitoring the knowledge, attitude, and practice (KAP) of healthcare professionals on this topic represents a source of information on BMW management. The aim of this study is to perform a systematic review to identify the reliable and valid tools able to assess the KAP of professionals in healthcare centers to manage BMW. Two databases (PubMed and Scopus) were searched on 10 May 2018 for cross-sectional studies with tools on BWM management, including original research studies from peer-reviewed journals, case studies, and review studies. Information on validation and reliability were collected. Methodological quality was assessed using the Newcastle-Ottawa scale for cross-sectional studies. Fifty-three articles were included, of which 19 presented a questionnaire on BMW for healthcare workers. Nine proposed a validated questionnaire: four reported Cronbach's alpha, which ranged from 0.62 to 0.86. Results further emphasize the prevalence of Asian studies facing the problem of assessing KAP about BMW management using specific tools. Overall, 14 questionnaires were designed in Asia, two in Africa, one in America, one in Australia, and one questionnaire was elaborated in Europe, in Spain. This systematic review highlighted the need of creation of validated and methodologically high-quality questionnaires. Therefore, there is the need of new cross-sectional studies to investigate these problems, improving generalization, and facilitating international comparison of research findings.

Assessment of Nurses' Practice and Potential Barriers Regarding the Medical Waste Management at Hamad Medical Corporation in Qatar: A Cross‑Sectional Study

Background

The improper management of wastes generated in healthcare facilities can severely affect the health of caregivers, patients, and members of the community. Medical waste management can be achieved with the cooperation of all workers and patients; however, nursing personnel plays a significant role in the whole process^. Therefore, nurses need to be well equipped with skills and practices in managing medical waste. This will result in the reduction of risks and hazards to their health. This study is done to assess the practice of nursing professionals regarding waste management across Hamad Medical Corporation (HMC) hospitals in Doha and to identify the potential barriers toward medical waste management

Methods

An analytical cross‑sectional study conducted at four governmental hospitals in Doha city; Hamad General Hospital (HGH), Women's Hospital (WH), Rumiallalh Hospital (RH), and Al-Amal hospital. A stratified proportionate random sampling method was employed to recruit 420 nurses.

Results

The response rate among nurses was 82.3%, with most of them being females and non-Qatari. Overall, the correct practice of color-coding of different waste categories among nurses was 92.8%. Unavoidable exposure was identified by 60.3% of nurses as a barrier to waste management, and nurses working at the intensive care unit reported it at the highest percentage (67.2%)

Conclusions

The majority of nurses showed correct practice and could correctly match the color-coding of different waste categories. Unavoidable exposure and excessive production of waste were the most reported barriers. Excessive production of waste and unavoidable exposure should be further evaluated by quantifying medical waste and addressing appropriate control strategies tackling the identified barriers.

Assessing Knowledge, Attitudes, and Practices of Healthcare Workers regarding Biomedical Waste Management at Biyem-Assi District Hospital, Yaounde: A Cross-Sectional Analytical Study

Background. Biomedical waste (BMW) is defined as unwanted materials generated during diagnosis, treatment, operation, immunization, or in research activities including production of biologicals. Healthcare workers are responsible for the proper management of this waste for human safety and for the protection of the environment. Methods. An analytical knowledge, attitude, and practice (KAP) study was carried out at Biyem-Assi District Hospital from June 1st to July 5th, 2018, including 100 health workers from different departments. Variables of interest were knowledge, attitudes, and practices of the respondents. A structured and pretested questionnaire was used for data collection. Data analysis was carried out using software Epi Info version 7.2.2.6. Logistic regression was used to establish the relationship between knowledge, attitudes, and practices. Results. Nurses constituted 32.0% of the participants, and more than half of the participants had 1–4 years of working experience (56.0%). Overall, the level of knowledge was satisfactory at 50.0%, that of attitudes was as unfavorable at 83.0%, and that of practices was as poor at 50.0%. Favorable attitudes were associated to satisfactory level of knowledge (ORa = 5.14 [3.10–8.51] and p=0.005). Good practices were associated to good level of knowledge (ORa = 5.26 [3.17–8.7] and p<0.001) and a favorable attitude (ORa = 7.30 [2.25–23, 71] and p<0.001). Conclusion. The level of knowledge was considered unsatisfactory for half of the staff interviewed. Attitudes were unfavourable at 83.0% and poor practices at 50.0%. Staff with a good level of knowledge were more likely to have favourable attitudes towards BWM. Also, good knowledge and attitude positively influenced the practice with regard to BMW management.

Health-Care Facility Water, Sanitation, and Health-Care Waste Management Basic Service Levels in Bangladesh: Results from a Nation-Wide Survey

We conducted a nationally representative cross-sectional study of 875 health-care facilities (HCFs) to determine water, sanitation, and health-care waste disposal service levels in Bangladesh for doctors, staff, and patients/caregivers in 2013. We calculated proportions and prevalence ratios to compare urban versus rural and government versus other HCFs. We report World Health Organization (WHO)-defined basic HCF service levels. The most common HCF was nongovernmental private (80%, 698/875), with an average of 25 beds and 12 admissions per day. There was an improved water source inside the HCF for doctors (79%, 95% confidence intervals [CI]: 75, 82), staff (59%, 95% CI: 55, 64), and patients/caregivers (59%, 95% CI: 55, 63). Improved toilets for doctors (81%, 95% CI: 78, 85) and other staff (73%, 95% CI: 70, 77) were more common than for patients/caregivers (54%, 95% CI: 50, 58). Forty-three percentage (434/875) of HCFs had no disposal method for health-care waste. More urban than rural and more government than other HCFs had an improved water source on the premises and improved toilets for staff. WHO-defined basic service levels were detected in > 90% of HCFs for drinking water, among 46-77% for sanitation, and 68% for handwashing at point of care but 26% near toilets. Forty-seven percentage of HCFs attained basic health-care waste management service levels. Patient/caregiver access to water, sanitation, and hygiene facilities is inadequate in many HCFs across Bangladesh. Improving facilities for this group should be an integral part of accreditation.

Healthcare waste management at primary health centres in Mon State, Myanmar: the comparisons between hospital and non-hospital type primary health centres

Improper healthcare waste management (HCWM) poses a serious public health problem worldwide. Primary health centres (PHCs) provide public health and medical care services as the basic structural and functional units of healthcare services in Myanmar. However, no study has been conducted in Myanmar about HCWM at PHCs. This study aims to assess the practice of HCWM at PHCs in Mon State, Myanmar. A cross-sectional study was conducted in all ten townships in Mon State, Myanmar. In total, 93 PHCs (71 non-hospitals and 22 hospitals) were selected using simple random sampling. The observational checklist which was developed based on the World Health Organization’s standard guideline procedure of HCWM was used to determine the practice of HCWM at PHCs. Binary logistic regression was used for final data analysis. The burning in pits method was used as the final disposal method of healthcare waste in 78.5% of PHCs. Non-hospital type PHC were more likely not to have colour coding system for HCWM (odds ratio [OR] 7.54; 95% confidence interval [CI] 2.15–26.52), did not have equipment for accidental spillage of healthcare waste (OR 3.92; 95% CI 1.3–11.77) and did not have separate staff for HCWM (OR 8.27; 95% CI 2.77–24.64), relative to hospitals. Non-hospital type PHCs practices poorly on the colour coding for waste segregation, assigning separate staff for HCWM, and possessing equipment for accidental spillage of healthcare waste than hospital type PHCs. The Ministry of Health and Sports should issue technical guidelines of safe HCWM as a compulsory policy for both hospitals and non-hospital type PHCs.

Knowledge, attitude, and practice of waste handlers about medical waste management in Debre Markos town healthcare facilities, northwest Ethiopia

Objective

Medical waste is a total waste stream which is generated from the healthcare facilities during the healthcare delivery process. It can contain potentially hazardous substances for the human being and the environment. Waste handlers play a significant role for its proper management and they need to have adequate knowledge, attitude, and practices. The study aimed to evaluate the knowledge, attitude, and practices of waste handlers regarding medical waste management in Debre Markos town healthcare facilities, northwest Ethiopia.

Results

A total of 55 medical waste handlers were studied from 12 healthcare facilities. Among this, 25 (45.4%) were diploma and certificate holders. The majority (69.1%) of the study participants were not provided with proper training. There was a lack of personal protective devices and waste management equipment supply. Regarding knowledge, attitude, and practices, 25 (45.5%), 43 (78.2%), and 44 (80%) of the study participants had adequate knowledge, favorable attitude, and adequate practice scores, respectively. There was high (30.9%) prevalence of needlestick and sharps injuries. Healthcare facilities should provide periodic training and adequate supplies for the waste handlers. Further study should be conducted on a large scale by including different levels of health facilities and regions of the country.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4174-7) contains supplementary material, which is available to authorized users.

Assessment of Knowledge, Attitude, and Practice about Biomedical Waste Management and Associated Factors among the Healthcare Professionals at Debre Markos Town Healthcare Facilities, Northwest Ethiopia

Background

Healthcare activities restore health and save lives at the same time; however, they can generate hazardous biomedical wastes to a human being or the environment. Generation and disposal of biomedical wastes have become an emerging problem worldwide.

Objective

To assess knowledge, attitude, and practice about biomedical waste management and associated factors among healthcare professionals in Debre Markos town healthcare facilities, northwest Ethiopia.

Methods

A cross-sectional study was employed, and data were collected through structured self-administered questionnaire and observational checklist. Data were entered into the Epi-data 3.1 software and exported into SPSS version 20 for analysis. Bivariate and multivariate logistic regression analyses were computed. Variables with a P value of <0.05 in the multivariate logistic regression analysis were considered to explain the presence of statistically significant associations.

Result

Among 296 healthcare professionals studied, 168 (56.8%), 196 (66.2%), and 229 (77.4%) had adequate knowledge, favorable attitude, and adequate practice score, respectively. Regarding associated factors, MSc and MD+ (AOR: 4, 95% CI: (1.37, 149.52)), BSc holders (AOR: 2.53, 95% CI: (1.47, 4.38)), and availability of color-coded bins (AOR: 7.68, 95% CI: (3.30, 17.89)) were identified more likely to contribute for adequate knowledge, favorable attitude, and adequate practice scores, respectively.

Conclusion

The level of knowledge, attitude, and practice scores were not satisfactory. Majority of the healthcare professionals did not access biomedical waste management training. Educational level, use of visual aid, and availability of color-coded bins in the department were identified as a factor for biomedical waste management. Regular training should be given to healthcare professionals.

Transferring knowledge into practice: a multi-modal, multi-centre intervention for enhancing nurses' infection control competency in Bangladesh

BACKGROUND

Nurses are considered as the key to infection prevention as they play a major role in treatment as well as taking care of patients.

AIM

To assess the role of a multi-modal intervention (MMI) in improving nurses' competency and adherence to standard infection control practices in Bangladesh.

METHODS

The study adopted a pretest-post-test intervention approach, in three different periods (from 2012 to 2017) in five hospitals (two public, two private, and one autonomous) in Bangladesh. Each study period was divided into three phases: pretest, MMI, and post-test. Data were collected on 642 nurses using direct observation method through a structured checklist.

FINDINGS

After implementing the MMI, overall hand hygiene compliance significantly increased before patient contact (from 1.3% to 50.2%; P < 0.000) and after patient contact (from 2.8% to 59.6%; P < 0.000). Remarkable improvements were also achieved in adherence to use of gloves (from 14.6% to 57.6%; P < 0.000), maintaining sterility of equipment during aseptic techniques (from 34.9% to 86%; P < 0.000), biomedical waste segregation (from 1.8% to 81.3%; P < 0.000) and labelling of procedural sites (from 0% to 85.7%; P < 0.000). Moreover, needlestick injury rate notably decreased (from 6.2% to 0.6%; P < 0.000).

CONCLUSION

MMI can play a vital role in improving nurses' compliance with the standard infection control practices. Such context-specific interventions, which are crucial for preventing healthcare-associated infections and for decreasing occupational hazards, should be replicated in resource-poor countries for achieving universal health coverage by 2030.

Waste management barriers in developing country hospitals: Case study and AHP analysis

Healthcare waste management is an essential field for both researchers and practitioners. Although there have been few studies using statistical methods for its evaluation, it has been the subject of several studies in different contexts. Furthermore, the known precarious practices for waste management in developing countries raise questions about its potential barriers. This study aims to investigate the barriers in healthcare waste management and their relevance. For this purpose, this paper analyses waste management practices in two Brazilian hospitals by using case study and the Analytic Hierarchy Process method. The barriers were organized into three categories - human factors, management, and infrastructure, and the main findings suggest that cost and employee awareness were the most significant barriers. These results highlight the main barriers to more sustainable waste management, and provide an empirical basis for multi-criteria evaluation of the literature.