Knowledge, Attitude And Practice Of Healthcare Workers Towards Management Of Healthcare Waste In FMC

Knowledge, Attitude And Practice Of Healthcare Workers Towards Management Of Healthcare Waste In FMC

Abstract

Knowledge and practice of health care workers have a greater impact on proper waste Management globally. Therefore, in this study it was essential to explore the knowledge and practice of HCWs on waste Management in Owo Ondo state. The aim of the study was to explore the knowledge, practice and attitude of health care workers on waste Management at Federal Medical center Owo and to propose interventions for improving waste Management. The objectives of the study were to examine health care workers’ knowledge on waste Management in Federal Medical center Owo, to explore and describe health care workers’ attitude towards correct waste Management and to assess health care workers’ practice on compliance with the waste Management. Participants of the study were doctors including interns, nurses, ward assistants and cleaners. Their knowledge and attitudes were assessed. Sample for each professional category of participants were as follow: Doctors n=20, nurses n=53, ward assistants n=7 and cleaners n=20. In total they were n=100. Furthermore, the wards were assessed by use of checklist and this underpinned how HCWs practiced waste Management. Samples in this case were 7 wards out of 14.

Data analysis involved checking and editing the collected data, cleaning and analysing them. Frequency distribution tables, descriptive statistics like measure of central tendency and measures of variability were employed.
The research findings were reported according to the main aspects of the study. Research findings indicated that respondents were health care workers aged between 23 and 64 years old. The mean ages of all respondents were 37.4 (SD 13.0) years, Median 36.5 and Mode 28. 89 (89.9%) of health care workers reported that health care wastes were hazardous, while only 8(8%) health care workers who did not know. The results indicated that 17(85.0%) doctors, 39(73. 6%) nurses, 7(100.0%) ward assistants and 16 (80.0%) cleaners knew where to put papers and papers plates. 11(55. 0%) doctors, 47(88.7%) nurses, 6(85.7%) ward assistants and 13(65.0%) cleaners knew where to put soiled linens. Meanwhile, 19(95.0%) doctors, 51(96.2%) nurses, 6(85.7%) ward assistants and 20(100.0%) cleaners knew where to put infectious and biohazardous wastes. The study further revealed that 4(20.0%) doctors, 41(77.4%) nurses, 5(71.4%) ward assistants and 15(75.0%) cleaners knew where to put left over food. Incorrect disposal was observed in 2 (28. 6%) wards, while such observation was not seen in 5 (71. 4%) wards.

Table of Content

• Title Page
• Certification
• Dedication
• Acknowledgement
• Table of Content
• List of Tables
• Abstract

Chapter One:

Introduction

• 1.1 Background to the study
• 1.2 Statement of the Problem
• 1.3 Objective of the study
• 1.4 Research Question
• 1.5 Significance of the study
• 1.6 Scope of the Study
• 1.7 Limitations Of The Study
• 1.8 Definition of Key Terms
• 1.9 Organizations of the study

Chapter Two:

Review of Literature

Chapter Three:

Research Methodology

• 3.1 Introduction
• 3.2 Research Designs
• 3.3 Population Of The Study
• 3.4 Sample And Sampling Method
• 3.4.1 Inclusion Criteria
• 3.4.2 Exclusion Criteria
• 3.5 Data Collection
• 3.5.1 Research instrument
• 3.5.2 Procedure for data collection
• 3.5.3 Validity of the data collection instrument
• 3.5.4 Reliability of the data collection instrument
• 3.6 Data Analysis
• 3.7 Ethical Consideration

Chapter Four:

Presentation and Data Analysis of the Result

Chapter Five:

Discussion, Conclusion and Recommendations

• 5.1 Introduction
• 5.2 Discussion Of Findings
• 5.3 Conclusion
• 5.4 Recommendations
• References
• APPENDIX: QUESTIONNAIRE

Chapter One

Introduction

1.1 Background to the Study

Medical waste is waste that is generated by health care workers when carrying out health care activities in health institutions. Health care workers produce various types of waste in the course of rendering health care services. Hospital waste is classified into medical waste, chemical waste, radioactive waste, cytotoxic waste, pharmaceutical waste and general waste. Medical waste includes sharps, laboratory and associated waste, human tissue and carcasses used for research purposes. Each classification must be disposed according to the prescribed guidelines (Health Professions Council, 2008).

Methods of disposal of waste are incineration, sterilization, chemical disinfection and secured landfill. Segregation of medical waste must be done at the point of generation. This should be done by discarding the medical waste in colour coded containers. Incineration, chemical disinfection and microwaving are methods of disposing sharps. Radioactive waste must be handled, stored and disposed in accordance with the prescribed legislature. Laboratory and associated waste directly involved in specimen processing can be disposed either through incineration or chemical disinfection. Human tissue must be disposed through incineration. Disposal of pharmaceutical waste depends on the composition of the materials. It must be stored in non-reactive containers and disposed through incineration (Chartier et al, 2014).

In order to prevent injuries to other employees, patients and to protect the environment from medical waste, health care workers must have adequate knowledge on disposal of medical waste. Hospitals have the responsibility to capacitate their employees with regard to medical waste disposal. The training should include occupational hazards, management of exposure to blood and body fluids, procedures to follow when disposing medical waste and prevention of injury and diseases, management of needle stick and blood and body substance exposure (South Africa, 2008). A study conducted in Karachi indicates that knowledge, attitude and practice of personnel involved in health care facilities waste management are extremely poor and proper facilities for management of hospital waste are almost non-existent (Habibullah & Afsar, 2007). Another study which was conducted among health care workers in Agra on medical waste management indicates deficiency in information and awareness among hospital employees regarding legislation associated with medical waste management (Lakshmi & Kumar, 2012).

There has been an increase in the number of needle stick injuries among general assistants at the hospital which occurred during their daily activities according to the occupational health statistics of the institution. The general assistants in various wards are not working with health care instruments, like sharps, and it is not acceptable for them to have needle pricks. This study was therefore done to determine the knowledge and practices of health care workers on medical waste disposal.

1.2 Statement of the Problem

Waste management inspections conducted at the Federal Medical center in the Owo, Ondo state in the year 2013 by the hospital waste management team indicated that there was non-compliance with waste management policies and guidelines. The remarks centred on improper segregation of waste which posed health risks to health care workers in the institution. The number of needle stick injuries among health workers and general assistants was also increasing according to the occupational health statistics of the institution.

Despite the magnitude of problems emanating from poor healthcare waste management there is yet to be an implemented legal provision guiding the management of healthcare waste in Nigeria. The poor state of solid waste management in our healthcare setting is caused by inadequate facilities, poor funding, and poor implementation of policies as well as lack of knowledge and poor waste management practices. In USA, 1994, 39 cases of HIV infection were recognized by the center for disease control and prevention as occupational infections mainly from poor healthcare waste management of sharps. A total of 347 injuries occurred, mainly due to improper disposal of needles (Almuneef and Memish, 2003). According to the world health organization, in 2000 alone it was estimated that injections with contaminated syringes caused 21million hepatitis B virus (HBV) infection (32% of all new infections), 2million hepatitis C virus (HCV) infection (40% of all new infection) and at least 260,000 HIV infections (5% of all new infection) in the world (http://www.who.int/mediacentre/factsheets, April 2014). Moreover incineration of waste produces toxic chemicals in the emissions leaving the stack (Geradu, 1995). According to the Environmental Protection Agency (EPA) USA, medical waste is the third leading source of dioxin emissions in the US and the fourth leading source of mercury emissions (http://www.epa.gov/dioxin, 2008). Heavy metals and dioxin may be dispersed over a wide area, settling on the food we eat and the water we drink. According to the EPA, up to 15% of women of childbearing age are exposed to mercury levels high enough to put their newborns at risk of irreversible neurological and developmental damage. Fetal exposure to mercury can cause mental retardation, learning disabilities, attention deficit, gait disturbances and impairments of language and memory (http:// www. epa. gov/ dioxin, 2008). The problem of effective solid waste management has to do with poor social services delivery efforts which cause unnecessary delays in solid waste clearance. It is either broken down machinery, non- maintenance of dumpsters, poor waste segregation using colour coded receptacles and irregularities in the designation of sanitary landfill sites (Stephen and Elijah, 2011).

Despite this laudable attention, the attitude of Nigerians as regards to collection, disposal, processing, treatment, and recycling wastes have defied solution. It is believed that the waste disposal habit of the people, corruption, work attitude, inadequate plants and equipment among others are the major factors militating against effective solid waste management in hospitals. Despite the menace emanating from improper healthcare waste disposal, only few studies have been done to find a probable solution. Improvement on healthcare waste management can be recorded if more studies are done to ascertain the knowledge, attitude, practice and implementation of policies regarding proper waste management.

The objectives of this study include ascertaining the knowledge and attitude of healthcare workers towards solid waste management problems in their environment and determining the practice of proper waste management methods in Federal Medical Center, Owo.

1.3 Objective of the Study

The main objective of this study is to examine the Knowledge and practices of health care waste management among Healthcare workers at FMC, Owo, Ondo state. Specifically the objective of this study is to:

1. Examine health care workers’ knowledge on waste management in Federal Medical Center, Owo.
2. Explore and describe health care workers’ attitude towards correct waste management
3. Assess health care workers’ practice on compliance with the waste segregation..

1.4 Significance of the Study

Hospital waste management is part of hospital hygiene and infection control activities. While the healthcare facilities work towards the goals of reducing health problems and eliminating potential human health risks, they also create waste that may pose health hazards to patients, health workers and the community (Bongayi, 2013). Mohee (2005) noted that healthcare wastes worldwide have sharply increased in recent times due to increased population, numbers and sizes of healthcare facilities as well as the use of disposable medical products. Poor management of clinical waste has direct effect on individuals working in healthcare facilities, patients, the community and natural environment (Goddu, Duvvuri, &Bakki, 2007).

Therefore, when hazardous waste is not segregated at the source of generation and mixed with nonhazardous waste, they all become hazardous. Risks associated with HCW and its management have gained attention across the world in various summits, locally and internationally. So there is need for proper management of healthcare waste for the following reasons: injuries may occur from sharps objects leading to infection to all categories of hospital personnel and waste handler. Nosocomial infections in patients from poor infection control practices and poor waste management, risk of infection may happen outside hospital for waste handlers, animals that feed on waste and at time general public living in the vicinity of hospitals, risk associated with hazardous chemicals, drugs to persons handling wastes at all levels, “disposable” being repacked and sold by unscrupulous elements without even being washed, drugs which have been disposed repacked and sold to unsuspecting buyers and risk of air, water and soil pollution due to waste or defective incineration emissions and ash. It is hoped that this study will provide information concerning healthcare waste management in healthcare facilities and will generate interest in the systematic control effort for effective clinical waste management. It is also hoped that the study will help the government, and local authorities to improve their present waste management methods.

1.5 Research Question

The following research questions will guide the study towards achieving the objectives of the study

1. What is the level of health care workers’ knowledge on waste management in Federal Medical Center, Owo ?.
2. What is health care workers’ attitude towards correct waste management ?
3. What is the level of health care workers’ practice on compliance with the waste segregation ?

1.6 Scope of the Study

The study focused on generation, segregation and final disposal of healthcare waste in healthcare facilities in Owo Local Government. One tertiary Healthcare facility, one secondary Healthcare facility and two primary Healthcare facilities were used.

1.7 Limitations of the Study

The study focused on the Health Care Workers at the Federal Medical Center, Owo and it was context-specific to the departments of those selected hospitals. These might affect the generalization of the findings to other sites. There were also insufficient funds since the study was self-financed by the researcher and she had no control over undertaking some activities such as procurement of stationery for the study.

1.8 Definition of Key Terms

Knowledge

Knowledge has been conventionally defined as beliefs that are true and are justified. It is reasonable to think of a true belief as one that is in accord with the way in which objects, people, processes and events exist and behave in the real world. Knowledge, itself, cannot be directly observed, it must be inferred from observing performance on a test, for example questions designed to determine the beliefs of a person about something (Hunt, 2003). In this study, health care workers were examined whether they possess knowledge on waste segregation.

Attitude

According to the Oxford Advanced Learners’ Dictionary (Hornby, 2010), an attitude is the way that someone think and feel about something or the way that somebody behave towards something that shows how you think and feel. In this study, health care workers’ attitude on waste segregation was explored so that they can express their feelings on waste segregation. The respondents were asked to rank themselves the way they segregate wastes by circling a number that best describe them.

Practice

According to the Oxford Advanced Learners’ Dictionary (Hornby, 2010), practice is the actual application rather than just ideas. It is the way of doing something that is usual or expected way in a particular organization or situation. It further stated that it is a custom or habit that is done regularly. Health care workers generate wastes on a daily basis when practicing. In this study, practices of health care workers were assessed using a checklist to analyze the existing situation of waste segregation. Availability and unavailability of colour coded plastic bags in the wards underpinned the way health care workers segregated the wastes.

Health Care Workers

Health care workers are all the people that are engaged in the promotion, protection and enhancement of the heath of the population. Health care workers are divided into three categories. Firstly, clinical staffs are those in primary care, who have regular, clinical contact with patients such as doctors, dentists and nurses, pharmacists/pharmacy assistants and radiographers/radiographer assistants. Secondly, laboratory and mortuary staffs are those who have direct contact with potentially infectious clinical specimens. Thirdly, non-clinical ancillary staffs are those who may have social contact with patients, but not usually of a prolonged or close nature. This group includes receptionists, ward clerks, gardeners and cleaners (ANHOPS, 2004). In this study the health care workers that were assessed are nurses, doctors, ward assistants and cleaners.

Waste Management

Waste Management is a proper manner of disposing of wastes according to its type; for example biological waste and is separated according to the colour coded plastic bags, to protect oneself and those who are around from infections, diseases and injuries.

1.9 Organizations of the Study

The chapter one consist of the introductory part of the study which includes the study background, the statement of the research problem, the study objective and scope of the study.

The second chapter is a critical review of other literatures relevant to the study and its objectives including the theoretical framework for the study. While the third chapter is methods of data collection, sampling and data analysis used in conducting the study. The fourth chapter centres around the research findings including an analysis of how it relates to previous findings. The fifth chapter consists of the summary of findings, conclusion and recommendations base on the study objectives.

Chapter Five

Discussion, Conclusion and Recommendations

5.1 Introduction

This is the final chapter of this research study and focuses on discussing the research findings and the results presented in Chapter 4. It also contains an evaluation of the overall purpose of the study, together with its three objectives. Subsequently, conclusions are drawn and recommendations are made. The overall purpose of this study was to explore the knowledge, practice and attitude of health care workers on waste Management in Federal Medical Center (FMC) Owo, Ondo state.

Accordingly, it is concluded that the research aim was achieved to a large extent by the findings of this study. To justify this conclusion, the findings were appraised against the research intention and the three research objectives for the study. These objectives were: 1) To examine health care workers’ knowledge on waste Management in Federal Medical center, Owo; 2) To explore and describe health care workers’ attitude towards correct waste Management; and 3) To assess health care workers’ practice on compliance with the waste Management. The researcher administered questionnaire to 100 health care workers at Federal Medical center, Owo.

5.2 Discussion of Findings

This chapter presents the discussion obtained from the analysis conducted on the data that were collected using self-administered questionnaire, checklist as well as in view of the objectives that assessed the knowledge, attitude and practice of health care workers on waste Management. Since, we have not found any study in Namibia addressing the same objectives, key strength of this study was that this assessment of KAP related to waste Management gave us a unique opportunity to provide information about a topic which is lacking in our country.
It also helps to identify the gaps between the current KAP among the health-care workers involved in waste Management and the future desired state that should be reached.

5.2.1 Section A: Demographic data of health care workers on waste Management

Respondents were (n=100) that includes 53 nurses, 20 doctors, 20 cleaners, and 7 ward assistants that have participated in the study. The demographic data that was discussed are gender, age, profession, duration of current work experience, hospital and the ward where the health care workers were working. Genders for all participants were 25% for male and 75% for female. Among nurses who respondents, 10 (18. 9%) were male, while 43 (81. 1%) were female; 11 (55. 0%) doctors were male, while 9 (45. 0%) were female. Meanwhile, both 7 (100%) ward assistants were female and lastly, cleaners 4 (20. 0%) were male and 16 (80. 0%) were female.

The oldest respondent in the sample was 64 years old, while the youngest was 23 years old. Meanwhile 4 (4. 0%) respondents did not state their ages. A large proportion of (34.4%) of the respondents were aged between 20 and 30 years, followed by (26%) in the age categories of 41-50. Furthermore, (25%) respondents were in the age categories of 31 to 40 age groups and (14.6%) fell into the age categories of 50 and above. The mean ages of all participants were 37.4 (SD 13.0) years, Median 36.5 and Mode 28. However, the mean ages per profession were as follows: Doctors 35. 7(SD 9.0), Nurses were 38. 3 (SD 13. 2), Ward assistants were 35.7 (SD 16. 5) and Cleaners were 37 (SD 15. 3) years.

Professional categories chosen were selected on the ground that they are the most health care workers that handle wastes in the selected wards. Other demographic data questions were applicable to all selected professions. 39% of respondents’ duration of work experience was ≤1 year-5years, while 26% and 34% respondents’ duration of work experience were ≤5 years- 10 years and ≤10 years respectively. From the point of nurses respondents (53%) who are the largest proportion of respondents, 23 (43.4%) had work experience duration of ≤1 year-5years and they were never trained on waste Management. Then, 11 (20.8%) and 19 (35.8%) had work experience duration of ≤5 years-10years and ≤10 years respectively. From the results of this study, a large proportion of younger age (32%) who had duration of work experience of ≤1 year-5years which was at 39% (of which the majority of HCWs’ duration of work experience were less than 2 years) can be attributed to poor knowledge on waste Management among this age group as majority of them were not trained. The 49% of respondents were from medical wards, 28% were from surgery wards and 11% of respondents were from gynaecology and postnatal wards each.

5.2.2 Section B: (Objective 1) Knowledge of health care workers on waste Management

Knowledge about waste Management is important for all health care workers as lack of knowledge about waste Management may jeopardise infection control in the health facilities. The study revealed that 95. 0% of doctors, 86. 8% of nurses, 85.7% ward assistants and 90.0% of cleaners who participated in the study knew that health care wastes are hazardous and could pose health risks if not properly segregated. That means doctors’ score were higher than the other 3 occupational categories on this item. This might also be explained by the fact that they have more in-depth understanding due to their higher education and professional levels. Doctors scored higher on red plastic bags 95%, ward assistants 86%; while nurses and cleaners scored exceptionally well with 96% and 100% respectively. Meanwhile, nurses and ward assistants scored high on green plastic bags knowledge, 89% and 86% respectively, while doctors scored 55% and cleaners 65% and this can be attributed to the fact that the two formers are dealing with soiled linen on a daily basis.

A study done in Egypt found that housekeeping staff including cleaners were less knowledgeable about waste Management and disposal. While in India, knowledge about color coding containers and waste Management was found to be better among doctors and nurses as compared to that of other staff (Madhukumar & Ramesh, 2012). On the other hand, doctors in our study were less knowledgeable about yellow plastic bags 20% and this could be attributed to the fact that they are not involved much with these plastic bags on a daily basis. Meanwhile, underscores of knowledge on yellow plastic bags were also noticed in other professionals, whereby nurses scored 77%, cleaners scored 75% and ward assistants scored 71%. This poor performance may be due to the fact that yellow plastic bags were not found in 4 out of 7 wards assessed with a checklist and food items were wrongly placed in black plastic bags. These study findings are in agreement with findings of other study conducted in government and private hospitals in Sana’a, Yemen that showed poor awareness among health care workers regarding medical waste handling, and a lack of differentiation between domestic and medical waste disposal (Al Emad, 2011).

Only doctors and nurses were assessed on handling used syringes and needles and both of them scored 100.0%. They were also assessed on safety box handling, whereby 19(95.0%) doctors possessed knowledge on handling of safety box and it was only 1(5.0%) who did not had knowledge on the same item. Meanwhile, nurses who were assessed, 45(84.9%) had knowledge on safety box handling, while 8(15.1%) did not have knowledge.

On the training item, doctors who were trained were only 4(20.0%), and the untrained were 16(80.0%). Nurses who were trained were 17(32.1%), while those who were not trained were 36(67.9%). On the other hand, ward assistants who were trained were 4(57.1%), while those who did not receive training were 3(42.9%). Lastly, cleaners who were trained were 18(90.0%), and those who were not trained were only 2(10.0%). The high overall knowledge score on waste Management into plastic bags among cleaners which was (80%) than the doctors which was (63. 8%) might be attributed to the fact that 90% of cleaners were trained on waste Management, whereas doctors trained were only 20%.

Based on the study findings, the following conclusions may be drawn: This is a clear indication that training was only directed towards HCWs with low educational level such as cleaners and ward assistants, while high educational level professionals such as doctors and nurses were denied training. It might also suggest that an increase with cleaners’ knowledge might be due to training they have acquired. In case of the doctors, this might also be attributed to the fact that doctors sometimes find it difficult to attend trainings given by nurses, since infection control officers in the hospitals that train HCWs on infection control including waste Management are nurses. However, training of these health care workers was not done regularly. Almost all HCWs trained, had their training done more than a year of which the highest trained HCWs in waste Management was cleaners with 90% and out of these percentages, 75. 0% respondents were trained more than a year ago. This irregularity might be attributed to shortage of staff in the hospitals that may hinder staff to attend trainings.

5.2.3 Section C: (Objective 2) attitude of health care workers on waste Management

Regarding the attitude of health care workers towards waste Management and disposal at the two training hospitals, the respondents were asked to rank themselves the way they segregate wastes by circling a number to best indicate their rating. On average, HCWs that strongly agreed that they always put wastes in the correct plastic bags were 57(57%). The percentage of HCWs that strongly agreed that safe disposal is of utmost importance for preventing infection transmission 83(83.0%). For this study, the main outcome of interest was that higher percentage of HCWs (83.3%) strongly agreed on this statement and that was a good indication that they know how to prevent infections. This was followed by 80(80.0%) of HCWs who strongly agreed that wearing personal protective equipment reduces the risk of contracting infection. While those who strongly agreed that waste disposal is a team work and not a hospital management responsibility were 64(64.0%). Furthermore, HCWs that strongly agreed that efforts in safe waste disposal are a financial burden on the administrative department of the hospital were only 37(37.0%). These study findings are in agreement with findings of another study conducted in Egypt that researched on some of the above statements such as; safe waste disposal should be a priority, waste disposal is teamwork not a hospital responsibility, and that disposal of waste is a financial burden on the hospital. In their study, the proportion of housekeeping staffs had showed a higher significant approval of these statements than other HCWs categories.
These statements were also assessed per professional category. It was found that the percentages of cleaners who strongly agreed that they always put wastes in the correct plastic bags were (80. 0%), ward assistants (71. 4%), nurses (52. 8%) and doctors (40.0%). Meanwhile, the percentage of HCWs that strongly agreed that safe disposal is of utmost importance for preventing infection transmission was as follows; ward assistants (85. 7%), doctors (85.0%), nurses (84.9%) and cleaners (75.0%). On the other hand, the percentages of nurses (84.9%), cleaners (85, 0%), ward assistants (71.4%) and doctors (65.0%) strongly agreed that using personal protective equipment decreases the risk of contracting infection. The proportion of cleaners strongly agreed that waste disposal is a team responsibility were 80.0%, nurses were 62.3%, doctors were 60.0% and ward assistants were 42.9%. Furthermore, HCWs that strongly agreed that safe waste disposal might be a financial burden on the administrative department were as follows; cleaners (50. 0%), doctors (45. 0%), ward assistants (42. 9%) and nurses (28.3%). It is interesting to note that cleaners are scoring higher than other categories and this could be attributed to the training they have received. Based on the study findings, the following conclusion may be drawn: Training on waste Management was only directed to low level categories of health care workers such as cleaners. A study done in Pakistan suggest that training could be an effective intervention for improving knowledge, attitudes and practices regarding infectious waste management if it is directed to all categories of health care workers.

5.2.4 Section D: (Objective 3) practice of health care workers on waste Management

On the practice of health care workers on waste Management, wards were assessed using a checklist to analyze the existing situation of waste Management practice of health care workers. Practices among HCWs were not found up to standard in some of these wards. On observation of the wards; black, red, green and clear plastic bags were found in all the wards (100%), while yellow plastic bags were not in 4 (57%) of the hospital wards assessed. According to the ward supervisors, this problem had been going on for months. This unavailability of yellow plastic bags had already underpinned the circumstances in which HCWs were working. That means, wastes that were supposed to be put in yellow plastic bags ended up in wrong plastic bags and eventually wrongly disposed of.

The World Health Organization suggested that a biohazardous symbol should be attached to the plastic bag used to indicate to others the types of wastes segregated in the specific plastic bag. Meanwhile, incorrect disposal of blood-contaminated fomites was observed in 2(28. 6%) wards, while such observation was not seen in 5 (71. 4%) of the wards. Practices could only be improved by regular and proper trainings and by allocating the proper budget for colour coded plastic bags. This was concurred by the study that was done in Pakistan which concluded that poor resources and lack of healthcare worker’s training in infectious waste resulted in poor waste management at hospitals.

5.3 Conclusion

It was concluded that training of personnel was not adequate and did not cater for all different level of health care workers. Some of the waste handlers did not segregate wastes properly, but mixed them up and a large amount was incinerated including the wastes that would otherwise have been non-infectious. The study concluded that regular orientation and re- orientation training programs should be organized for all hospital staff and strict
implementation of guidelines of biomedical waste management that includes waste Management, to protect themselves and hospital visitors (Othigo, 2014). Moreover, for effective implementation of waste Management practices in the hospitals, it requires mandatory periodical sensitization to improve the biomedical waste knowledge and practices among health care workers.

5.4 Recommendations

The results of this study show that not all of these HCWs possessed good knowledge and attitude towards waste Management. Doctors and nurses who were least trained are knowledgeable with colour coded plastic bags surrounding their area of work ,whereas cleaners and ward assistants who scored high on waste Management training possessed good knowledge almost with all colour coded plastic bags. However, the unavailability of yellow plastic bags in one hospital wards jeopardise efforts in safe waste disposal and can lead to financial burden of the hospital and the Ministry at large. Meanwhile, lack of yellow plastic bags in the wards underpinned the poor practice of health care workers as it was observed in the wards kitchen, where black plastic bags were used instead.
At times, HCWs might also ended up putting wastes in wrong plastic bags such as red plastic bags making the quantity more and overloaded, but is not really infectious waste. Moreover, wastes that was put in wrong plastic bags and has to go for incineration would overload the incinerators unnecessarily. Wastes that were taken to state landfills were weighted and they charged some amount of money from the FMC. Improper waste Management might add up unnecessary kilograms on such plastic bags and the Ministry of Health and Social Services ended up paying a huge amount of money. Furthermore, in some wards areas where plastic bags were loaded from the wards, bags were accumulated there and it became smelly and unhygienic.

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Frequently Asked Questions

Do healthcare workers know enough about medical waste management?

Medical waste management (MWM) is of concern to the medical and general community. Adequate knowledge regarding management of healthcare waste is an important precursor to the synthesis of appropriate attitudes and practices of proper handling and disposal of medical waste by healthcare workers (HCWs).

Do healthcare workers have good knowledge and positive attitude about PPE?

While being a non-physician, having lower education, working in private hospitals, and using office transport were associated with good practice regarding PPE. Conclusion The findings demonstrated that the healthcare workers had an overall good knowledge and a positive attitude but a poor practice regarding PPE.

Why is there a need for health-care workers involved in its management?

There is need for health-care workers involved in its management to understand the integral link between human health and environmental health. This study was done to identify gaps in knowledge, attitude and practice among the healthcare workers involved in its management hence endangering public health and polluting the environment.

Is health and safety in health-care waste management included in curricula?

It was found that health and safety in health-care waste management, was not included in most of the curricula for training the three healthcare professionals. Most of them acquired this through on-job training from seminars and informally through organized talks at work-places.