Description
The primary objective of this study is to assess health workers’ Knowledge, Attitudes, and Practice (KAP) about Health Care Waste Management (HCWM) in the Nifas Silk Lafto sub-city. A facility-based cross- sectional study of 254 healthcare workers was conducted. A stratified random sampling method and quantitative analysis were used. The overall KAP score of the study participants was 78.9% having adequate knowledge, 92.7% having a good attitude, and 63.4% having a good practice score. The highest adequate knowledge score was noted among laboratory personnel (99.7%), followed by health officers (98.4%), and the least was noted among nurses (60.5%). Cleaners had the lowest positive attitude, at 89.5%, while laboratory professionals had the highest, at 98.9%. The highest “good practice” score was among laboratory professionals (72.5%), followed by medical doctors (70.8%), while the least was among cleaners (44.2%). Information sources, the assigned infection prevention committee, educational level, work experience, working section, and healthcare workers’ profession were factors associated with the KAP of healthcare workers about HCWM. Generally, the overall KAP was unsatisfactory, and a great discrepancy was seen among healthcare workers regarding their knowledge, attitude, and practice level. The government shall work on the availability of guidelines, visual aids, policy manuals, basic training, sufficient PPE, color-coded waste bins, and infrastructure for waste storage, treatment, and disposal, and studies should be conducted to overcome the problems.
Keywords: healthcare waste; healthcare worker; knowledge; attitude; practice; waste management.
Interpretation and Discussions
Only 75.6% of healthcare workers, according to this study, have access to visual aids or guidelines at work, which is significantly better than the findings of studies done in Nigeria (54%; Sabageh et al., 2015); Debre Markos Town (54%; Deress et al., 2019); and Gondar Town (3.1%; Yenesew et al., 2012). This was most likely a result of the location and time of data management and collecting, of the work done by the infection prevention committee, of volunteerism, and of the HCWs’ internal motivational processes. Hospitals and other HCFs have a responsibility to safeguard the environment and advance public health (Uddin MN, et al., 2014). In comparison to research conducted in India (44.3%), Bangladesh (61.1%), Debremarkos (368.8%) (Deress et al., 2019), Gondar town (46.9%) (Azage and Kumie, 2010), and Adama town (31.9%), only 84.1% of respondents participated in HCWM or related training (Hayleeyesus and Cherinete , 2016).
HBV vaccination was advised to reduce threats to occupational health (Chartier et al., 2014). Only 82.5% of the study subjects received an HBV vaccination. This result was lower than the study conducted in India (95%) (Amouei et al., 2015) and in Iraq (85.5%) (Mane V et al., 2016), but higher than the result of the study in Debre Markos, 29.0% (Deress et al., 2019), and Addis Ababa city administration’s hospitals, 24.6% (Kedija, 2015). This could be caused by a lack of facility commitment, a tight budget, or a vaccination shortage. Waste handlers are required to receive HCWM training as a nationwide requirement (FMoH, 2008.). In comparison to studies conducted in Nigeria (31.4%) (Sabageh et al., 2015) and Gondar, Ethiopia (53.1%), 84.1% of health care personnel received training (Azage and Kumie, 2010). In the previous 12 months, 9.2% of healthcare professionals were exposed to needle stick injuries, which was nearly three times better than studies done at DebreMarkos (24.5%) and Gondar Town (30.8%) and five times better than Nigeria (51%) (Sabageh et al., 2015). (Azage and Kumie , 2010).
Knowledge of the Study Participant
The overall adequate knowledge of the study participant was 78.9%, which was better than the study done in Nigeria (45%; Sabageh et al., 2015) and in Ethiopia at Debre Markos Town (55% Deress et al., 2019), but lower than the study conducted in Kolkata, India (98.21%; Ray et al., 2014). About 93.5% knew their facilities generate healthcare wastes, which was more or less
comparable with the study conducted in India (89.5%; Mane V et al., 2016), but higher than the study conducted in Iran (47%; Amouei et al., 2015); and Debre Markos, Ethiopia (84.8%; Deress et al., 2019).
Nationally, three color-coded waste containers were recommended (black, yellow, and safety boxes for general, hazardous, and sharp waste, respectively). (FMoH, 2008.). 93.1% of the study participants had good knowledge of segregating wastes following the color-coding principle, which was almost similar to the study conducted in India, where 92.3% had good knowledge (Karmakar., 2016), but higher than the 77.2%, 37%, and 17.5% of the studies conducted in Ethiopia at Debre Markos, Adama, and Gondar towns, respectively (Hayleeyesus and Cherinete, 2016). This distinction was due to a sufficient supply of waste bins, safety boxes, personal protective equipment, adequate training, the active work of infection prevention committees, and strong support from facility leaders and the government.
In this study, 74.8%, 74.4%, and 93.1% of the study participants correctly identified the yellow bin, black bin, and safety box for disposal of infectious, general/noninfectious, and sharp material according to their categories, respectively, which was higher than the study conducted in Iran with 48.2% (Amouei et al., 2015). Infectious waste containers must be marked with an internationally recognized biohazard symbol (Chartier et al., 2014; FEPA, 2004). 92.7% of healthcare workers correctly identified waste containers labeled with the biohazard symbol, which was higher than 54.4% and 53.6% of the studies conducted in India (Radha, R., 2012) and Ethiopia at Debre Markos Town, respectively (Deress et al., 2019). Infectious wastes should only be kept for a maximum of 48 hours (two days) (Chartier et al., 2014; FEPA, 2004). 76.8% of the study participants have knowledge about how long the infectious wastes in HCFs were stored before being treated and disposed, which was higher than the study conducted in India (36.5%) (Radha, 2012) and Ethiopia at Debre Markos Town (10%) (Deress et al., 2019).
Attitude of the Study Participant
The overall positive attitude of study participants was 92.7%, which was twice as high as studies done in Nigeria (45.5%), Zambia (34%); DebreMarkos (62.1%) (Deress T, et al., 2019); and Gondar towns, Ethiopia (59.9%) (Yenesew et al., 2012), but lower than studies conducted in
Tripura, India (96.8%) (Leonard, 2022). This gap might be due to academic differences, training toward HCWs’ perceptions, accessibility of operational manuals at working sections, or national policy or regulation toward HCWM. This study result showed that about 94.3%, 99.9%, and 97.7% of the study participants agreed that HIV, HBV, and HCV were transmitted through contaminated healthcare wastes, respectively, which was higher than the study finding in Nainital, India, of 87.3%, 86.4%, and 85.5% (Kumar et al., 2015) and at DebreMarkos Town, Ethiopia, of 92%, 91.7%, and 76.9%. This study revealed 88.1% of the study respondents segregate waste at the point of generation before disposal, which is equal to the study conducted in India (88.7%) and higher than the 86.3% done at Debre Markos Town, Ethiopia (Deress et al., 2019).
Study Respondents Practical Score
The overall practice score of this study’s respondents was 63.4%, which was higher than the studies conducted at the same time and in different countries in Iran (50%) (Amouei et al., 2015), Nigeria (40.5%) (Sabageh et al., 2015), and Gondar, Ethiopia (33% Yenesew et al., 2012), but lower than the study conducted at DebreMarkos Town (78.9%) (Deress et al., 2019). This gap could be caused by a lack of supplies, a lack of motivation among HCPs, a lack of active committee functioning, a lack of incentives and job satisfaction, a lack of governmental support and mentorship, a lack of higher officials’ commitment and enforcement, work experience, academic differences, a lack of training, a lack of awareness, and the lack of updated guidelines and policies. Waste was separated at the source using different color-coded waste bins (Chartier, 2014). 92.2% of healthcare professionals segregate waste by following color-coded waste bins, which was better than the studies conducted in India (80.6%) (Karmakar, 2016) and Nigeria (21.7%) (Uchechukwu, et al., 2017). Specifically, 98.5% of healthcare professionals segregate sharp materials into safety boxes. This result was higher than the study conducted in Nigeria (71.9%) (Azuike et al., 2015) and in Debre Markos Town (83.4%) (Deress et al., 2019).
Gloves, heavy-duty gloves, boots, and aprons must always be worn while handling or working with HCW (Chartier, 2014). This study result showed 88.3% of HCPs use gloves, 75% of cleaners always wear heavy duty gloves, 47.5% wear aprons, and 70% wear boots while handling or working with healthcare waste, which was lower than the national guideline expectations. This may be due to a lack of knowledge, experience, work burden, training, or academic factors. During
24 to 48 hours of service delivery, waste was collected, transported in closed containers, and sorted (Chartier, 2014; FMoH, 2008). Yet, only 80%, 40%, and 42.5% of states collected and transported lidded garbage containers on schedule and in accordance with their segregation, respectively, falling short of the criteria of the national guidelines. This is probably brought on by a dearth of suitable waste transportation tools, a busy workload, or a lack of awareness of the value of trash segregation.
Waste Treatment and Disposal in HCFs
Hazardous HCWs should be stored in a separate central storage area prior to treatment and disposal, as should HCWs treated onsite using methods such as incineration, sterilization, and chemical disinfection; infectious HCWs should not be stored for more than 48 hours (FMoH, 2008). According to the study findings, all health care facilities (100%) had no central storage areas prior to treatment and disposal; two facilities stored infectious waste for more than two days; and all healthcare facilities used onsite treatment methods, but the incineration found in all facilities was not standardized; some lacked closing doors and separated pit ash; and were not fenced and restricted from unauthorized persons.
Associated Explanatory Variables with KAP of the Respondents
With a statistical significance value of 0.0344, those with a BSc or higher in education had better understanding about healthcare waste management than those with a diploma or certificate. This was presumably because they participated in higher education, learned material relevant to their career, and worked in departments, which increased their knowledge.
The occupations of the workers have a highly significant association (PV = 0.0001), which may be due to their closer relationship to daily HCW generation than others, their greater training and access to information, the fact that instruction, job aids, and guidelines are not equally available at the working site, and the fact that they have different perspectives on the benefits of using PPE to reduce infection risk and waste segregation based on their category.
Likewise, working divisions with healthcare waste management (PV = 0.0057) Also, there are considerable connections between the respondents’ knowledge and working hours (PV = 0.0290),
the availability of guidelines (PV = 0.0268), the assigned committee (PV = 0.0265), practice (PV
= 0.0010), and attitude (PV = 0.0000). The availability of guidelines, a positive outlook, actively participating in a designated infection prevention committee that promptly monitors and assesses the level of knowledge and practice of HCWs, the availability of PPE in sufficient numbers, and timely attendance at training are possible explanations.
On the other hand, the knowledge and educational level of the healthcare workers have a strong statistically significant (PV = 0.0000) association with their attitude. In parallel, sex (PV = 0.0179), working department (PV = 0.293), information sources (PV = 0.0246), guidelines availability (PV
= 0.0436), and HCW practice (PV = 0.0027) have a direct and significant association with attitude. This may be due to enrollment in higher education, timely training, and the accessibility of information sources, the availability of instruction or job aids on site, well-trained employees, and the support of an actively working infection prevention committee. Directly or indirectly, good knowledge and a positive attitude affect the practice of the HCW among healthcare workers have a statistically significant association with the practice of the HCWs’ knowledge (PV = 0.0010) and attitude (PV = 0.0027).
Conclusion and Recommendations
According to the study, healthcare workers had adequate knowledge (78.9%), a positive attitude (92.7%), and adequate practice (63.4%). Among the three, the practice score was low. Similarly, this low result was also scored among cleaners (44.2%), nurses (66.1%), and midwives (67%). Similarly, the lowest knowledge score was obtained among nurses (60.5%) and medical doctors (64.5%). In addition, the good attitude of the study participants was scored among cleaners (89.5%) and nurses (90.9%). Educational and informational sources, the assigned committee, and the profession of the respondents had statistically significant associations with the respondents’ knowledge; experience, working conditions, and educational level of the respondents also had a statistically significant effect on the attitude of the healthcare workers. In addition, both the attitude and sex of the study participants had a statistically significant effect on the practice level of the healthcare workers at a level of 95% confidence with a PV of 0.05 marginal error.
The government shall work on the knowledge, perception, and practice of the HCWs, upgrading their educational level, availing of guidelines, visual aids, policy manuals, and other necessary
reference materials at the working sites, actively functioning assigned infection prevention committees, providing basic training and creating self-awareness, sufficient PPE, color-coded waste bins, gloves, boots, and biohazard symbols, and a standardized waste storage, treatment, and disposal area regarding effective healthcare waste management. In addition, further, more comprehensive studies should be conducted to overcome the problems.
