INTRODUCTION:

Hospitals are the center of cure and also the important centers of infectious or hazardous waste generation. Effective management of Biomedical Waste (BMW) is not only a legal necessity but also a social responsibility.¹

The World Health Organization (WHO) defines health care waste as all wastes generated by healthcare establishments, research facilities and laboratories. According to the World Health Organization (2011), the inappropriate health care waste management globally causes 21 million hepatitis B virus (HBV) infection (32% of all new cases); 2 million hepatitis C virus (HCV) infection (40% of all new cases) and 2,60,000 HIV infection.²

Hospital and medical wastes are a special classification of the urban waste- having various features and necessity of treatments for its disposal. It is an emerging problem and if things are not brought under control and quickly, hospitals instead of curing people of diseases; disabilities would become the source of many more problems, some of which would cost the heaviest price of them all life.³

Biomedical waste is defined as any waste material generated during diagnosis, treatment and immunization of human beings or animals with potential health and environment risks. Medical waste management is vital issue in regards to its infectious and hazardous nature that results in undesirable effects on humans and the environment. Management of healthcare waste in hospitals is important as they are responsible for many infections as well as chemical and radioactive injuries. The management of bio-medical waste is still in its infancy all over the world. As mentioned in the first survey on Health Care Waste Management (HCWM) conducted in 11 hospitals in the Kathmandu Valley (1997) found 0.54 kg/patient/day of HCW whereas health care risk waste (HCRW) was 0.16 kg/patient/day.⁴

Biomedical waste is defined as “any solid, fluid, or liquid waste, including its container and any intermediate product, which is generated during diagnosis, treatment, or immunization of human beings or animals, in research pertaining there to or in the production or testing of biological and animal waste from slaughter houses or any other like establishments”.⁵

Hospital waste management means the management of waste produced in hospitals by using different techniques that will prevent the spread of diseases.⁶

Biomedical Waste Management (BWM) also known as health care waste is a waste that has its potential effects on environment and health. It may contain highly toxic or infectious substance and can play a significant role in disease transmission.⁷

A study on biomedical waste management: incineration vs. Environmental safety. The public concerns about incinerator emissions, as well as the creation of federal regulations for medical waste incinerators, are causing many health care facilities to rethink their choices in medical waste treatment. As stated by health care without harm, non-incineration treatment technologies are a growing and developing field. The burning of solid and regulated medical waste generated by health care creates many problems. Medical waste incinerators emit toxic air pollutants and toxic ash residues that are the major source of dioxins in the environment. The international agency for research on cancer, an arm of who, acknowledged dioxins cancer-causing potential and classified it as a human carcinogen. Development of waste management policies, careful waste segregation, and training programs, as well as attention to materials purchased, are essential in minimizing the environmental and health impacts of any technology.^.8

Bio Medical Waste Management works for effective reduction of waste volume, proper collection, segregation, transport and economical disposal of waste to prevent harm resulting from it. As nursing staff is the backbone of BMW management, it is very important to create awareness and enough cognizant regarding bio medical waste management to nursing students and staffs.⁹

METHODS AND MATERIALS:

A descriptive cross-sectional study undertaken to evaluate the knowledge of biomedical waste management among nurses at a National Medical College and Teaching Hospital, Birgunj, Nepal. The hospital selection was based on the researchers' convenience and familiarity with its management and physical proximity. The study focused on nurses within the indoor department, and a sample size of 169 was determined using a calculated formula. Nonprobability purposive sampling technique was used to collect data. Data collection involved the use of semi-structured and self-administered questionnaires, covering socio-demographic information and knowledge on biomedical waste management. The latter included 32 semi-structured questions with multiple-choice options, each question carrying a score of 1. Scores were categorized into inadequate, moderate, and adequate knowledge levels based on the total sum. Instrument validity was ensured through literature review and expert consultation, with pretesting conducted on 10% of the total sample.

Approval from the Research Management Committee of National Medical College preceded data collection, during which informed consent was obtained from each respondent, emphasizing confidentiality and voluntary participation. Data collection occurred between August 23 and October 19, 2023, with respondents allocated 30-35 minutes to complete the questionnaires. Subsequently, data entry and analysis were performed using the Statistical Package for the Social Sciences (SPSS) version 23. Descriptive analysis, employing mean and standard deviation, was utilized to gauge the level of knowledge on biomedical waste management among nurses. Inferential analysis involved chi-square tests to explore associations between biomedical waste management knowledge and socio-demographic variables, considering a significance level of P < 0.05.

RESULTS:

The findings revealed that out of 169 participants, 49.1% fell within the 18-21 age group, 24.9% were in the 22-25 years range, and 26% were above 25 years old. In terms of education, P.C.L. nursing emerged as the predominant background, with 100 participants constituting 59.2% of the total. Regarding the working department, the majority of participants were associated with general departments, with 125 participants, accounting for 74%. A significant proportion of respondents reported having less than one year of work experience, comprising 111 participants. Similarly, the majority, 169 participants (95.9%), reported not having received any training on biomedical waste management.

Likely wise table 1 shows that Hospital biomedical waste management reveals critical insights, including a substantial majority (97.04%) identifying biomedical waste as hospital-produced. High awareness (75.73%) exists regarding hazardous waste capable of causing infections and injuries. The leading classification of medical waste is acknowledged by 76.92%, with 82.84% recognizing HIV and Hepatitis as major infectious hazards. Sharps needles are deemed the most hazardous (84.61%). Approximately 80.47% believe hospitals generate 1-3 kg of waste per bed daily. Obstetric and maternity departments are seen as major waste sources (84.61%). Notably, 85.20% recognize sharp containers as carrying biological hazards, and nursing professionals perceive the highest risk (85.79%). Concerningly, 73.37% believe segregating biomedical waste with bare hands is the most hazardous activity. These findings underscore the need for targeted interventions to enhance biomedical waste management, emphasizing safety measures during handling activities in healthcare settings.

Table 1: Knowledge on Biomedical Waste

n = 169

Variables	Correct response
Variables	Frequency	%
Biomedical waste is
*Waste produced in hospital	164	97.04
Hazardous waste is
*Waste causing infection and injuries	128	75.73
The major classification of medical waste is
*Infectious, non-infectious	130	76.92
The leading hazards from infectious waste is
*HIV and Hepatitis	140	82.84
The most hazardous waste to health care personnel is
*Sharps needles	143	84.61
The amount of waste generated from hospital per day is
*Approximately 1-3 kg/bed	136	80.47
The major source of the biomedical waste in the hospital is
*Obstetric and maternity department	143	84.61
Sharp container carries
*Biological hazard	144	85.2
The highest risk of biomedical hazard is
*Nurse	145	85.79
The most hazardous activity while handling Bio medical
waste is
*Segregating the waste with bare hand	124	73.37

*Multiple response-correct answer

Table 2 results shows that waste segregation practices reveals key insights. A majority of respondents (69.82%) use plastic containers for waste storage, and 74.55% recognize the importance of segregation to prevent mixing. The color-coded system for biomedical waste (yellow, red, blue/white translucent, and black bins) is acknowledged by the same percentage. Specifically, 75.73% identify the red bin for infected plastics, 76.92% associate the yellow bin with anatomical and pathological waste, and 75.14% recognize the blue bin for glass items. Notably, 75.55% use the green bin for kitchen waste. Respondents generally agree that waste can be stored for 48 hours (72.78%), and 79.28% believe in tying the container cover when it is filled to ¾ capacity. These findings suggest a shared understanding among respondents, forming a basis for effective waste management practices in healthcare settings.

Table 2: Knowledge on Segregation and Storage n= 169

Variables	Correct response
Variables	Frequency	%
Segregation of waste is
*Waste stored in plastic container	118	69.82
Segregation of waste is important
*To avoid mixing and non-mixing of waste	126	74.55
Color coding comprised for disposal of biomedical
waste management are
*Yellow, red, blue/ white translucent and black	126	74.55
The waste that is collected in red container with
biohazard symbol is
*Infected plastics	128	75.73
The color-coded bin with biohazard symbol is used
for anatomical and pathological waste is
*Yellow	130	76.92
The color-coded bin with biohazard symbol that is
used for disposal of glass item is
*Blue	127	75.14
The waste that is discarded in green container with
biohazard symbol is
*Kitchen waste	126	75.55
The waste can be stored in hospital
*For 48 hours	123	72.78
The cover in the waste container has to be tied
*When it is filled ¾	134	79.28

*Multiple response-correct answer

Table 3 shows the result that healthcare waste management highlights key preferences and beliefs among respondents. A significant majority (78.1%) advocates for chemically disinfecting and disposing of gloves, emphasizing hygiene and safety. Sterilization is widely recognized for its efficacy in removing all microorganisms, with 83.43% of participants endorsing it. Chlorine is the favored chemical (72.18%) for disinfecting materials contaminated with blood and body fluids. Hepatitis B vaccination is identified as the most common immunization for healthcare professionals in biomedical waste, endorsed by 74.78%. Placenta disposal through incineration is supported by 63.90%, and resulting ash is commonly stored in closed containers (66.27%). Incineration at 1000º centigrade is deemed necessary (68.04%) and recognized as non-recyclable (68.04%). The temperature range of 49-91º centigrade for destroying microorganisms is acknowledged by 76.33%. Mechanical treatment is the preferred process for treating medical waste (71%). In rural healthcare settings, a soakage pit is deemed practical for liquid waste disposal by 72.78%. Composting is seen as the cheapest and effective means for clinical waste when incineration is unavailable, endorsed by 72.18%. Importantly, 66.86% reject the misconception that any container, including food containers, can be used for hazardous waste, emphasizing the need for specialized containers. These findings collectively reflect a consensus on best practices for healthcare waste management, emphasizing safety, efficacy, and environmentally responsible approaches.

Table 3: Knowledge on Treatment and Disposal of Biomedical Waste n=169

Variables	Correct response
Variables	Frequency	%
After using gloves, it should be
*Chemically disinfected and disposed	132	78.1
All the microorganism including spores from an
object is removed by
*Sterilization	141	83.43
The chemical that is mostly used for disinfecting
materials contaminated with blood and body fluids is
*Chlorine	122 72.18
The most common immunization that should be taken
by health care professional who are involved in
biomedical waste is
*Hepatitis B	123	74.78
The placenta is disposed by
*Incineration	108	63.9
The incinerated ash is stored in
*Closed storage container	122	66.27
Incineration of waste should be done at
*1000º centigrade	115	68.05
The process that cannot be recycled, reused or disposed is
*Incineration	115	68.05
The temperature that is required to destroy the
microorganism in thermal process is
*49-91º centigrade	129	76.33
The process used for the treatment of medical waste is
*Mechanical	120	71
The useful method for final disposal of liquid waste in
rural and small health care institutions is
*Soakage pit	123	72.78
The cheapest and effective means of disposing clinical waste
when incineration facility is not available is
*Composting	122	72.18
Hazardous waste container does not mean
*Any type of container, including food container can be used
for hazardous waste	113	66.86

Table 4: Level of Knowledge on Biomedical Waste Management

Level of Knowledge	Frequency	%
Inadequate knowledge (≤16 score) Moderate adequate knowledge (17-23 score)	9 46	5.32 27.23
Adequate knowledge (≥24 score)	114	67.45
Total	169	100.0

Table 5: Association between level of knowledge and selected demographic variables n=169

Variables	Level of Knowledge		χ2	df	P- value
	Adequate Knowledge No (%)	Inadequate Moderate Knowledge Knowledge No (%) No (%)
Age (in years) 18-21	57 (33.72)	6 (3.55) 20 (11.83)	2.216	4	0.696
22-25	29 (17.15)	1 (0.59) 12 (7.1)
>25	28 (16.56)	2(1.18) 14 (8.28)
Education PCL Nursing B.N.S	71 (42.01) 5 (2.95)	3 (1.77) 26 (15.38) 1 (0.59) 5 (2.95)	4.763	4	0.313
BSC Nursing	38 (22.48)	5 (2.95) 15 (8.87)
Working Department Critical departments	31 (18.34)	1 (0.59) 12 (7.1)	1.316	2	0.518
General departments	83 (49.11)	8(4.73) 34 (20.11)
Work Experience <1 year	80 (47.33)	5 (2.95) 20 (11.83)	3.224	4	0.521
1-2 year	17 (10.05)	2 (1.18) 9 (5.32)
>2 years	17 (10.05)	2 (1.18) 11 (6.5)
In-service training Yes	2 (1.18)	8 (4.73) 3 (1.77)	5.928	4	0.205
No	112(66.27)	51 (30.17) 42 (24.85)

*Significance level at 0.05

χ2 Chi-square test, df degree of freedom

Table 5 analysis indicates no significant associations between various variables and the level of knowledge in the surveyed population. Age, education (PCL Nursing, B.N.S, BSC Nursing), working departments (Critical and General), work experience (<1 year, 1-2 years, >2 years), and in-service training show non-significant relationships with knowledge level, as evidenced by chi-square tests. Specifically, the results reveal no substantial evidence of a significant correlation between age and knowledge level (χ2 = 2.216, df = 4, p = 0.696), education categories (χ2 = 4.763, df = 4, p = 0.313), working departments (χ2 = 1.316, df = 2, p = 0.518), work experience (χ2 = 3.224, df = 4, p = 0.521), and in-service training (χ2 = 5.928, df = 4, p = 0.205). In summary, the examined variables do not exhibit significant correlations with the level of knowledge in the surveyed population.

DISCUSSION:

In contrast to a previous study conducted in Tamil Nadu with a sample size of 200, where only 40.44% of nurses were found to be aware of the concept of biomedical waste, this present study reveals that an overwhelming majority of respondents (96%) correctly understood the meaning of biomedical waste.¹⁰The findings showed that 74.55% answered correctly about question related to necessary of segregate infectious from noninfectious waste. Similarly, 68 % of the respondents knew necessary of segregate infectious from noninfectious waste, supported by the study conducted in New Delhi, India.¹¹

Similarly the findings showed 72.78% of respondents were known untreated biomedical waste should not be stored beyond 48 hours for proper waste management which is similar to the study done in Nagara with a sample size of 441 which showed 36.5% of respondents were known that waste should not be stored beyond 48 hours.¹²

In this study, most of the respondents (74.55%) had answered correctly about the recognition of colour coding systems for biomedical waste supported by the study conducted in Manglore, India where the majority of nurses (72.72%) answered correctly about the color-coding system of biomedical waste management.¹³ Similarly, another study showed 92% of respondent have good knowledge of color-coding coding for medical waste in Jodhpur.¹⁴ Likely wise, a study showed that knowledge of biomedical waste management among nurses 88.87% greater than among doctors 85.82%.¹⁵

The finding showed that that there is no association between level of knowledge with educational qualification, years of experience which is coherence with the findings of the study conducted in Biratnagar, Nepal in which level of knowledge is not significant with educational qualification and work experience.¹⁶

In a similar vein, the results indicated that age and training do not hold significant influence over the level of knowledge. This aligns with a study carried out in Udaipur, where it was observed that age and training did not exert any impact on knowledge.¹⁷

CONCLUSION:

It can be concluded from the present study that nurses in National Medical College and Teaching Hospital in Birgunj, possess a adequate level of knowledge regarding biomedical waste management. Additionally, no significant association was found between the level of knowledge and selected demographic variables. The findings emphasize the importance of considering demographic variables when designing interventions to improve biomedical waste management practices. While the nursing staff generally present a strong baseline knowledge, there are specific areas where targeted training and education can enhance competencies and ensure a consistently high standard of biomedical waste management across all departments. Continuous efforts in professional development and training will contribute to the sustainability of effective biomedical waste management practices within the healthcare sector.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

ACKNOWLEDGEMENTS:

The authors wish to extend heartfelt thanks to National for providing the opportunity to conduct this study. The researchers express gratitude to National Medical College and Teaching Hospital, as well as all the respondents, for their valuable time, support, and cooperation.

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Received on 22.01.2024 Modified on 21.02.2024

Int. J. of Advances in Nur. Management. 2024; 12(1):1-6.

DOI: 10.52711/2454-2652.2024.00001