|Year : 2015 | Volume
| Issue : 3 | Page : 166-169
Knowledge, attitude, and practices about biomedical waste management among dental healthcare personnel in dental colleges in Himachal Pradesh: A cross-sectional study
Kavita Manchanda1, Shailee Fotedar1, Parveen Dahiya2, Ankur Vats3, Avishek De Sarkar4, Anjali Shrivastava Vats3
1 Department of Public Health Dentistry, Government Dental College and Hospital, Shimla, Himachal Pradesh, India
2 Department of Periodontics, Himachal Institute of Dental Sciences, Ponta Sahib, Sirmour, Himachal Pradesh, India
3 Department Conservative and Endodontic, Bhojia Dental College, Baddi, Himachal Pradesh, India
4 Department of Oral and Maxillofacial Surgery, Gurunanak Institute of Dental Science Research, Sodepur, Kolkata, India
|Date of Web Publication||4-Aug-2015|
Manchanda Medical Store, 65 The Mall, Shimla - 171 001, Himachal Pradesh
Introduction: The waste created by the healthcare services while providing services which may be either curative, promotive, or preventive may be hazardous to health and environment if there is indiscriminate disposal of hospital waste. Objective: The objective was to assess knowledge, attitude, and practices of students (3 rd years, 4 th years), interns and teaching staff. Materials and Methods: A cross-sectional study was conducted using a close-ended questionnaire among the students, interns and teaching staff of three dental colleges in Himachal Pradesh. A total of 578 subjects were included in the study with their prior consent. Statistical Analysis: The data were tabulated, and interpretation was done in percentages by using SPSS version 13.0 (SPSS Inc., Chicago, IL, USA). Results: Many dentists have the knowledge about the waste management, but they lack in the attitude and practice. Conclusion: There is a need for education regarding hazards associated with improper waste disposal at all levels of dental personnel.
Keywords: Health care waste management, health hazards, hospital, medical professionals, survey
|How to cite this article:|
Manchanda K, Fotedar S, Dahiya P, Vats A, Sarkar AD, Vats AS. Knowledge, attitude, and practices about biomedical waste management among dental healthcare personnel in dental colleges in Himachal Pradesh: A cross-sectional study. SRM J Res Dent Sci 2015;6:166-9
|How to cite this URL:|
Manchanda K, Fotedar S, Dahiya P, Vats A, Sarkar AD, Vats AS. Knowledge, attitude, and practices about biomedical waste management among dental healthcare personnel in dental colleges in Himachal Pradesh: A cross-sectional study. SRM J Res Dent Sci [serial online] 2015 [cited 2020 Jul 13];6:166-9. Available from: http://www.srmjrds.in/text.asp?2015/6/3/166/156215
| Introduction|| |
Let the wastes of "the sick" not contaminate the lives of "the healthy."
In spite of the remarkable innovations over the years in the health care system, it is strange that the health care settings, which reinstates and maintain the health of the community, are also threatening their well-being. A huge risk to the health of the public, patients, professionals, and environment arise due to poor waste management practices. 
The hospital hygiene and safety of health care workers and communities are ensured by the process of health care waste management (HCWM). One of the effective contributors of HCWM can be our health workers. Although their efforts may seem to be small, but their each step builds a base of sound morals and rational that are necessary for the success of the whole community. 
With the notification of the biomedical waste (BMW) rules, 1998, hospital waste management has been brought into focus in India. According to the rules, it is mandatory for the health care establishments to segregate, disinfect, and dispose their waste in an eco-friendly manner. 
Even though there is increased global awareness among health care professionals about threats and also suitable management techniques, in India, the level of awareness has been found to be unsatisfactory.  As there is no available information which describes the actual practice followed in handling these types of waste products in Himachal Pradesh at present, so this study aims to assess the knowledge, attitude, and practices among the dental health personnel's regarding BMW handling in the dental institutions.
| Materials and Methods|| |
For this cross-sectional closed-ended questionnaire study, ethical approval was obtained from the Institutional Review Board of H.P. Government Dental College and Hospital, Shimla. The study was carried out for a period of 3 months from May 2014 to July 2014. Of five dental colleges, three dental institutes were randomly selected.
The survey had questions in four major categories. Section 1 consisted of demographic questions, including the gender, college year, work experience, qualification. Section 2 had 10 close - ended questions concerning the practitioner's knowledge about BMW management. The knowledge questions were answered using the options "correct" and "incorrect." Each question answered correctly received 1 point, for a maximum score of 10. The scores were transformed into percentage of correct answers. Hence, a student's score could range from 0 (no correct answer) to 100% (all 10 answers correct). Student with <25% was considered to have a poor knowledge, between 25% and 50% to have moderate knowledge, between 50% and 75% to have good knowledge and more than 75% to have excellent knowledge. The third section consisted of 10 questions were included to assess the attitude regarding the management of waste generated in the health sector. The answers to these questions were given on a five-point Likert scales (strongly agree, agree, don't know, disagree, and strongly disagree). Further strongly agreed, agreed, strongly disagreed and disagreed were combined. Then the correct attitude for each year was calculated in percentages. The fourth section consisted of ten closed-ended questions on practice items with the answer options as "Yes" and "No."
A pilot study was undertaken on 10% of the study population to ensure that the subjects understood the questions and were able to answer them without any help. Cronbach's alpha value of 0.75 showed acceptable internal consistency of the questionnaire.
The data were tabulated, and interpretation was done in percentages using SPSS version 13.0 (SPSS Inc., Chicago, IL, USA).
| Results|| |
Of total 600 questionnaires that were distributed only 578 were received back, which means the response rate of the study was 96.3%. There were 31.8% males and 68.2% females. The demographic details regarding the distribution of gender, work experience, and qualification are given in [Table 1].
When the knowledge regarding the BMW management was considered, 246 (42.5%) respondents had excellent knowledge regarding the proper management of BMW. [Table 2] represents the distribution according to qualification of the respondents.
|Table 2: Level of knowledge of respondents regarding biomedical waste management|
Click here to view
Totally, 513 (88.8%) of the subjects agreed that decontamination/disinfection reduces chances of infection and 189 (32.7%) disagreed that segregation of waste at the source increases the risk of injury to waste holders. [Table 3] describes the profession wise distribution concerning the correct attitude toward hospital waste management.
|Table 3: Respondent's correct attitude towards hospital waste management|
Click here to view
Regarding practices related to BMW management 53.8% subjects used segregate waste into different categories at the point of origin. 41.7% of them collected waste sharps in heavy duty (puncture proof) plastic container. Response toward practices of BMW management has been illustrated in [Table 4].
| Discussion|| |
Proper handling, treatment, and disposal of BMWs are important steps in infection control program. Properly designed and applied waste management can be a relatively efficient compliance-related practice.  The inappropriate management of BMW can lead to various health hazards affecting the healthcare workers, communities, and surroundings. 
Dentists have an ethical responsibility to the environment, so, it is the responsibility of the dental schools to ensure the formation of an association with solid technical, scientific, and ethical knowledge, aimed at promoting health, emphasizing the philosophy of prevention of health care risk due to improper disposal of waste. Hence, the study was conducted to assess the knowledge, attitude, and practices about BMW management among dental institutes of Himachal Pradesh.
The study population consisted of 31.8% males and 68.2% females, which is consistent with the fact that, in India, the profession of dentistry is largely practiced by females.
42.5% of the total respondents had excellent knowledge which was higher than the results reported by Sharma et al. where 30% had excellent knowledge.  On comparing the average, knowledge percentage was highest among teaching staff followed by 4 th years, interns and 3 rd years. The reason that 4 th years may be having good knowledge compared to the other 2 years could be due to the fact that BMW management is included in the theory circular apart from the practical.
In the present study, 90% of the participants agreed that use of color code for segregation is a must. This is in lower than what was reported by Sanjeev et al. (96.6%), Chudasama et al. (96.5%) and but was more than study conducted by Mathur et al. (81.3%) where different colored bags were used for disposing the waste. ,,
One hundred and ninety-seven (34.1%) used to treat sharp waste prior to disposal while 241 (41.7%) collected the waste sharps in heavy duty (puncture proof) plastic container. This was much less than the results observed by Mathur et al., Bansal et al., and Chudasama et al. where around 65.3%, 58%, and 63.1% used to dispose sharps in puncture proof containers. ,, But it was >19.5% and 26.4%, as reported by Osamong et al. along with Charania and Ingle. , Maximum care and precaution are required to handle sharps as improper handling can lead to various health hazards. The needles, which comprised of the bulk of "sharps," should be destroyed by needle destroyers and should be placed in puncture-proof container containing 1% NaOCl for disinfection. Once the container is three-fourth filled it should be sent for shredding, encapsulation, and disposal in landfills. 
Thirty-three (5.7%) subjects used to follow the system of recording and reporting injuries/accidents. Low reporting of injuries may be attributed to the fact that most of the doctors are not aware about a formal system of injury reporting which should be established within all the health facilities. 
The limitation of the study is that it is based on self-administered questionnaire which may lead to over and under reporting plus recall bias can also occur where the respondent's past experience influences his present action. But according to Gilbert et al. and Charania and Ingle, this method is sufficiently valid for most important research questions and is a good method of collecting data from a larger population in a quick and inexpensive manner. ,
| Conclusion|| |
The findings of the study suggest that the BMW management program cannot successfully be implemented without the willingness and cooperation of the health professionals. If we want to protect our environment and health of the community, we must sense ourselves to this important issue not only in the interest of health managers but also in the interest of the community. As it was seen that the attitude and practice of regarding hospital waste management were less satisfactory there should be a continuing training program along with the monitoring those of practices, so that it leads to a safe protected biohazard free environment.
| References|| |
Umar A, Yaro A. Hospital waste management in Katsina State. Bayero J Pure Appl Sci 2009;2:22-6.
Sharma S. Awareness about bio-medical waste management among health care personnel of some important medical centers in Agra. Int J Environ Sci Dev 2010;1:251-5.
Sharma A, Sharma V, Sharma S, Singh P. Awareness of biomedical waste management among health care personnel in Jaipur, India. Oral Health Dent Manag 2013;12:32-40.
Naik R, Sureshchandra B, Hegde S, Damda A, Malik M. Best management practices for hazardous dental waste disposal. Endodontology:108-13.
Mohamed Soliman S, Ibrahim Ahmed A. Overview of biomedical waste management in selected Governorates in Egypt: A pilot study. Waste Manag 2007;27:1920-3.
Sanjeev R, Kuruvilla S, Subramaniam R, Prashant PS, Gopalakrishnan M. Knowledge, attitude, and practices about biomedical waste management among dental healthcare personnel in dental colleges in Kothamangalam: A cross-sectional study. Health Sci 2014;13:1-12.
Chudasama RK, Rangoonwala M, Sheth A, Misra SK, Kadri AM, Patel UV. Biomedical waste management: A study of knowledge, attitude and practice among health care personnel at tertiary care hospital in Rajkot. J Res Med Dent Sci 2013;1:17-22.
Mathur V, Dwivedi S, Hassan MA, Misra RP. Knowledge, attitude, and practices about biomedical waste management among healthcare personnel: A cross-sectional study. Indian J Community Med 2011;36:143-5.
Bansal M, Vashisth S, Gupta N. Knowledge, awareness and practices of dental care waste management among private dental practitioners in Tricity (Chandigarh, Panchkula and Mohali). J Int Soc Prev Community Dent 2013;3:72-6.
Osamong LA, Gathece LW, Kisumbi BK, Mutave RJ. Management of dental waste by Practitioners in Nairobi, Kenya. Afr J Oral Health 2005;2:24-9.
Charania ZK, Ingle NA. Awareness and practice of dental care management among dental practitioners in Chennai city. J Contemp Dent 2011;1:15-21.
Madhukumar S, Ramesh G. Study about awareness and practices about health care wastes management among hospital staff in a medical college hospital, Bangalore. Int J Basic Med Sci 2012;3:7-11.
Gilbert GH, Rose JS, Shelton BJ. A prospective study of the validity of data on self-reported dental visits. Community Dent Oral Epidemiol 2002;30:352-62.
[Table 1], [Table 2], [Table 3], [Table 4]