|PAPERS PRESENTED AT THE XVII ANNUAL CONFERENCE OF HOSPITAL INFECTION
|Year : 2021 | Volume
| Issue : 3 | Page : 95-99
Knowledge, attitude and practices of medical students regarding biomedical waste management
Fatima Khan1, Jowairiya Tehreem Khan2, Manal Khursheed2, Asfia Sultan1, Haris M Khan1
1 Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
2 MBBS Students, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
|Date of Submission||16-Apr-2022|
|Date of Acceptance||07-Jun-2022|
|Date of Web Publication||22-Jul-2022|
Dr. Jowairiya Tehreem Khan
Jawaharlal Nehru Medical College, Faculty of Medicine, Aligarh Muslim University, Aligarh - 202 002, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Context: India generates around 3 million tonnes of medical wastes every year, an amount that is expected to grow at 8% annually. Improper handling of biomedical waste (BMW) can result in the spread of infections such as HIV-acquired immunodeficiency syndrome, hepatitis B virus and hepatitis C virus in addition to being a burden on the environment. Segregation being the most important step in BMW management (BMWM) necessitates that people working in the health-care system are aware of its rules and regulations. Therefore, it is important to understand and explore any lacunae in knowledge, attitudes and practices regarding BMWM.
Aim: The aim of this study is to develop an insight into the knowledge, attitude and practices of medical students regarding BMWM.
Settings and Design: An institutional-based cross-sectional study with a quantitative approach was conducted.
Subjects and Methods: A structured questionnaire prepared according to the knowledge, attitude and practices (KAP) model.
Statistical Analysis Used: Data were analysed by the IBM SPSS (Statistical Package for the Social Sciences), v20.0 software.
Results: The participants' knowledge on BMWM was scored on a scale of 0–50. Thirty-six per cent of them scored in the range of 20–30, while 30.9% scored between 30 and 40. Three-fourths of them believed that it was important to be aware of BMW generation, hazards and legislation. About 87.09% opined that soft skills regarding BMWM should be a part of the curriculum for health-care students. About 76% of the respondents claimed to follow colour coding while discarding BMW. About 41.3% of the participants responded that they would report anyone found breaking the rules of BMWM.
Conclusions: The study revealed that there is still a significant lack in the KAP of health-care students regarding BMWM.
Keywords: Awareness, biomedical waste management, knowledge, attitude and practices, medical students
|How to cite this article:|
Khan F, Khan JT, Khursheed M, Sultan A, Khan HM. Knowledge, attitude and practices of medical students regarding biomedical waste management. J Patient Saf Infect Control 2021;9:95-9
|How to cite this URL:|
Khan F, Khan JT, Khursheed M, Sultan A, Khan HM. Knowledge, attitude and practices of medical students regarding biomedical waste management. J Patient Saf Infect Control [serial online] 2021 [cited 2022 Aug 18];9:95-9. Available from: https://www.jpsiconline.com/text.asp?2021/9/3/95/351736
| Introduction|| |
Biomedical waste (BMW) refers to any solid and/or liquid waste, including its container and any intermediate product which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research pertaining thereto or in the production or testing thereof., The ever-increasing population and a corresponding increase in the number of health-care facilities have led to a multifold rise in the amount of BMW production, with India alone generating around 3 million tonnes of medical wastes every year, an amount that is expected to grow at 8% annually. Anatomical waste, cytotoxic wastes and sharps are a part of BMW; their improper disposal could lead to significant public health problems such as the transmission of HIV and hepatitis B and C infections; in addition to causing disruptions in the environment and adversely impacting ecological balance.,
Since segregation is the most crucial step in the proper management of BMW, it is imperative that every person working in a health-care setting is fully aware of the rules and regulations of BMW management (BMWM). Studies conducted across the country have reported significant lacunae in the knowledge, attitude and practices of health-care workers regarding BMWM, a subject which is a matter of grave concern.,
| Subjects and Methods|| |
Study setting, design and period
An institutional-based cross-sectional study with a quantitative approach was conducted from April 2021 to June 2021.
Health-care students studying at a Government Medical College in Aligarh, Uttar Pradesh, India were included in the study.
Description of the tool used
A structured questionnaire according to the knowledge, attitude and practices (KAP) model was developed for the study, which was reviewed by experts and validated through a pilot study. The questionnaire was then circulated amongst the study participants through Google Forms.
The questionnaire had three sections consisting of a total of 20 questions:
- Knowledge (10 questions)
- Attitude (5 questions)
- Practices (5 questions).
Data processing and analysis
The collected data were analysed by the IBM SPSS (Statistical Package for the Social Sciences), v20.0 software, Armonk, New York, USA. Graphs were drawn using Microsoft Excel.
| Results|| |
The study was conducted at a government medical college located in Aligarh, India. A total of 155 medical students were enrolled in the study. The gender-and year-wise distribution of the study population is shown in [Table 1].
|Table 1: Distribution of the study population according to gender and year of the study|
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The participants' knowledge regarding BMWM was scored on a scale of 0–50, with each question carrying a score of 5. Score bands were made in accordance with the Likert scale, where scores of 0–10, 10–20, 20–30, 30–40 and 40–50 imply no knowledge, minimal knowledge, basic knowledge, adequate knowledge and superior knowledge, respectively. Approximately 36% of the participants scored in the range of 20–30, while 30.9% of the participants scored between 30 and 40 [Figure 1].
|Figure 1: Knowledge score of participants regarding biomedical waste management|
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The percentage of participants who correctly answered individual questions in the knowledge section of the questionnaire is depicted in [Table 2].
|Table 2: Knowledge of medical students on questions pertaining to biomedical waste management|
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A majority (76.12%) of the participants believed that it is extremely important for medical students to be aware of BMW generation, hazards and legislation; however, 17.5% and 16.8% of the respondents, respectively, were unsure or believed that it is not important for medical students to know about the same.
About 41.3% of the respondents claimed that if they observed someone breaking the rules of BMWM, they would report them to the concerned authorities, while 48.4% of the participants answered that they would not report such incidents. Sixteen participants were of the opinion that reporting such incidents would be an unnecessary burden on them [Figure 2].
|Figure 2: Attitude towards reporting of non-followers of biomedical waste management rules|
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Majority of the participants (87.09%) believed that soft skills regarding BMWM should be a part of the curriculum for health-care students.
One hundred and twenty-six participants believed that it is extremely important to segregate BMWs properly, while 27 participants thought that this was moderately important to important.
More than half of the respondents (58.7%) were of the opinion that they had basic knowledge regarding BMWM; 26% of them believed they possessed adequate to superior knowledge on the subject.
Roughly 76% of the respondents claimed to follow colour coding on BMWM. The practices of participants pertaining to the colour-coded segregation and discarding of various BMWs are shown in [Figure 3]. Out of the four segregation-related questions, only 17.4% of the respondents were able to answer them all correctly, while 23.22%, 35.48%, 19.35% and 4.51% of them, respectively, answered three, two, one and none of the questions right.
|Figure 3: Practices of medical students regarding segregation of different biomedical wastes|
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A comparison of the participants' perception of the importance of BMWM rules, their perception of their own knowledge, and their actual knowledge as calculated from the knowledge section of the questionnaire is depicted in [Figure 4].
|Figure 4: Comparison of the participants' perception of the importance of BMWM rules, their perception of their own knowledge and their actual knowledge. BMWM: Biomedical waste management|
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| Discussion|| |
Medical students of today are the health-care providers of tomorrow. These students begin their journey of direct, supervised contact with patients while at clinical ward postings, where they inevitably come in contact with BMWs and should therefore be well equipped to deal with them. Any lacunae in their knowledge pertaining to BMWM can serve as a potential danger to the students themselves and in turn to the patients as well. The current study conducted on MBBS students studying at a government medical college in Aligarh aimed to assess their KAP regarding BMWM through a structured questionnaire.
The knowledge of participants was assessed through a wide variety of questions on BMWM. As shown in [Table 2], a large number of respondents (80.6%) were aware of what comprises BMW. This might be because the majority of the study population (65.78%) consisted of 2nd- and 3rd-year undergraduate students who are going through or have already been through with the theory of the subjects (microbiology), in which BMWM is taught.
Our study demonstrated that 75.5% of the respondents were quite aware that the segregation of BMW had to be done at the point of generation; this was found to be low when compared to the findings of Selvaraj et al. amongst medical practitioners, where 98% of the study population correctly knew about the same. Only a few (38.7%) of our study participants were aware of the maximum duration for which untreated BMW can be stored for, in contrast to a study conducted by Najotra et al., India, where 60% awareness regarding the same was reported.
The BMWM rules, 2016 specify that health-care workers and others involved in BMW handling should be vaccinated against hepatitis B and tetanus. About 70% of our study population was aware of this requirement which was similar to a study conducted by Vohra et al., where it was reported that 74% of the population was aware of the importance of hepatitis B vaccination.
On testing the knowledge on what should be done as the next step in case of a needlestick injury by presenting a case scenario, as mentioned in point 9 of [Table 1], only 37.4% of the respondents were able to answer it correctly. This might be the consequence of a lack of clinical exposure in the majority of our study population as a result of institutional shut down during the COVID-19 pandemic.
It is extremely essential that everyone associated with the health-care system is well trained in basic BMWM practices. About 49.3% of the respondents had attended a training, as compared to a study done in Jammu and Kashmir, India, in which only 10% of the MBBS students underwent training on BMWM. About 87.09% of the participants believed that soft skills regarding BMWM should be a part of the curriculum for health-care students, whereas in a study conducted by Singh et al. at a tertiary care hospital, all the MBBS students felt a need for the same.
From [Figure 2], it can be seen that the attitude towards reporting someone who does not follow BMWM rules was poor, as only 41.3% of respondents answered that they report such incidents to the concerned authorities, while 10% felt that doing so would be an unnecessary burden.
About 81.3% of the students believed that it was extremely important to segregate BMW properly. Although the significance of segregation is instilled in the participants, they showed a lack of correct practices when tested in the practice session of the questionnaire, where only 17.4% of the participants answered all questions correctly while approximately 23% correctly answered three questions.
From [Figure 3], it can be seen that metallic implants were correctly discarded in a blue colour bin by a majority of the respondents (53.5%), which is concurrence with the fact that around 67% of the respondents lie in the 20–40 score band according to the scoring system devised for knowledge. About 46.2% answered correctly that sharps should be discarded in a white colour bin/bag, whereas 22% answered the same question correctly in a study conducted in Kahn and Raviprabhu. Correct answer to the colour of the bag used to discard human anatomical waste was given by 78.6% of the respondents, whereas only 22.8% were able to answer the same in a similar study done at Tirupati.
A majority of the participants believed that it is extremely important to be aware of the rules and regulations regarding BMWM. [Figure 4], which depicts a comparison of the participants' perception of their own knowledge with their actual knowledge as deduced from the knowledge section of the questionnaire, revealed that while 82.6% of the participants believed that they had basic-to-adequate knowledge regarding BMWM, 59.4% of the total respondents actually had basic-to-adequate knowledge on the subject.
There still is a scope for gaining more knowledge and its effective application, as was concluded from the present study. The reason for this might be that more emphasis is laid on theoretical learning about BMWM while only 49.3% of the respondents had actually undergone training.
Extensive studies with larger sample sizes that include all medical, paramedical, nursing students and staff, technical and non-technical personnel associated with health-care need to be conducted to accurately assess the KAP regarding BMWM in health-care settings. To predict the changes of KAP over time, a prospective study could be conducted.
The authors are grateful to all participants for filling up the questionnaire.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]