ASSESSMENT OF KNOWLEDGE, ATTITUDES, AND PRACTICES OF HEALTHCARE WORKERS REGARDING BIOMEDICAL WASTE MANAGEMENT AT BIYEM-ASSI DISTRICT HOSPITAL, YAOUNDE

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Hospitals are the central hub for healing as well as the generation of infectious waste. Inadequate and improper management of healthcare waste can have serious health consequences and significant effects on public health and the environment. Biomedical waste refers to the waste that is produced during the diagnosis, treatment, or immunisation of humans or animals, as well as in research activities related to the production or testing of biological materials. This waste can be categorised as non-hazardous or biohazardous (Udofia et al., 2019). Hospital waste consists of several types of garbage, including general waste, biological waste, pathological waste, sharps, chemical waste, pharmaceutical waste, waste with high heavy metal contents, Nano-medicines/material waste, radioactive waste, genotoxic waste, and pressurised waste (Gulis, 2017; Udofia et al., 2019). 

Improper waste management typically results in detrimental impacts on the environment and public health (Mugabi et al., 2018). Improper management of biomedical waste can lead to the transmission of several diseases, with the most serious ones being Hepatitis B, Hepatitis C, and AIDS. Additionally, it can also contribute to contamination of water, air, and soil (Fobil, 2019). According to Chima (2019), biomedical waste has the potential to spread over 30 hazardous bloodborne diseases. According to the World Health Organisation (WHO), 85% of hospital wastes are classified as nonhazardous, whereas 10% are infectious and 5% are non-infectious but nevertheless considered hazardous. Approximately 15% to 35% of hospital garbage is classified and controlled as infectious waste. The range is contingent upon the overall quantity of waste produced (Hattingh, 2020). The United States is estimated to produce approximately 3.6 million tonnes of Health Care Waste annually. In contrast, South Africa created 42,000 tonnes of Health Care Waste in 2010, with the cost of safely disposing of it estimated to be around R. 71 million per year (Hirosawa, 2019). The magnitude of the infectious risk linked to garbage is significant in low-income nations (Nagaraju, 2018). 

Biomedical waste must be sorted at its origin into bags or containers with colour-coded labels. The collection and appropriate disposal of this trash should be a significant concern for both medical staff and the institution responsible for generating such waste (Sarker, 2019). Inadequate management of medical waste can result in accidents caused by sharp equipment, environmental contamination due to dangerous chemicals, and the spread of diseases through infectious organisms (Ahami, 2017). Currently, the disposal of biomedical waste in healthcare facilities has become a growing concern. Recent evidence indicates that the management of biomedical waste in African health institutions is still inadequate (Sarker, 2019). 

Shinee et al. (2018) state that the global issue of Health Care Waste production and disposal is still in its early stages of management (Babu, et al., 2019). According to the World Health Organisation (WHO), healthcare workers produce health care waste that is dangerous at a rate of 10 to 25 percent (Chartier, et al., 2018). Nevertheless, the proportions differed among countries, spanning from 20% to 75%, as reported by Hayleeyesus and Cherinete (2020) in Ethiopia. Health Care Waste has the potential to spread over 30 hazardous blood-borne diseases, as stated by Sawalem et al. (2017). Among these diseases, HIV, HBV, and HCV infections are particularly concerning due to strong evidence of transmission through needle stick or sharp injury resulting from inadequate waste management. In the majority of developing countries, there is a significant problem with the management of health care waste. According to various researchers, implementing effective health care waste management is challenging due to the scarcity of healthcare professionals who are trained in waste management systems and the lack of public awareness regarding this issue. Inadequate Health Care Waste Management standards, laws, and viable treatment and disposal choices can impede waste management efforts (Hossain et al, 2021). Research indicates that Health Care Waste Management is still in its nascent phase in Africa (Bendjoudi, 2018).

As per the World Health Organisation (WHO), the individual responsible for producing each waste item should categorise it according to its potential for causing harm, the necessary treatment procedures, and the appropriate method of disposal (WHO, 2018). It is recommended that each medical facility should have distinct colour-coded bins for different types of healthcare waste. Specifically, infectious waste should be disposed of in yellow bins, chemical and pharmaceutical waste in brown bins, and general rubbish in black bins. Waste bags and sharp containers should not be filled more than 75% of their capacity (WHO, 2019). The collection period should be determined and appropriate for the quantity of garbage, but should not exceed a duration of one day. Every healthcare waste management system necessitates access to land for the ultimate disposal of any remaining healthcare waste materials following reduction or treatment. Landfills should include certain desirable attributes, such as limited accessibility to deter scavenging, daily application of soil coverings to minimise unpleasant smells, frequent compaction of trash, and proper isolation of the garbage (Annette et al., 2020). Common technologies for waste management include combustion, landfilling, autoclaving, and chemical treatment. India has developed a novel solar treatment technique (Majid, 2019).

In 2018, Gupta performed a cross-sectional survey at a tertiary care hospital in India. The survey included 200 hospital personnel. Among the participants, 52% had worked in a hospital for 1 to 5 years, 29% had worked for 1 year, 12.5% had worked for 6-10 years, and 6.5% had worked for more than 10 years (Gupta et al., 2018). In a cross-sectional survey done in Nainital, India, Kumar et al. found that 87.3% of health care workers were aware of HIV transmission through HCW, whereas 86.4% and 85.5% were aware of Hepatitis B and Hepatitis C transmission, respectively (Kumar et al., 2017). In 2019, Amouei conducted a descriptive cross-sectional study in Iran. Out of the 130 study participants, 12% had low knowledge of hospital waste management, 72% had medium knowledge, and 16% had high knowledge. Additionally, 16% had a medium attitude towards hospital waste management, while 84% had a high attitude. The study conducted by Amouei et al. (2019) revealed that approximately 4% of the participants engaged in low practice, whereas 46% and 50% of the individuals were involved in medium and high practice, respectively.

In 2017, Sabageh et al. performed a cross-sectional survey in Nigeria, revealing that a mere 50.8% of participants were aware of colour-coding, 37.2% were knowledgeable about segregation, and 45.0% possessed a significant understanding of healthcare waste management. Around 45.5% of the respondents expressed a favourable outlook on hospital waste management, whilst 54.5% held a negative perspective. Approximately 40.3% of individuals engaged in waste segregation, while 47.6% were employed in establishments that had an established healthcare waste management policy. Furthermore, 31.4% had undergone training in healthcare waste management. In terms of trash disposal methods, 35.6% resorted to open dumping, followed by burning (23%) and burying (19.9%) (Sabageh et al., 2017). A study done by Azuike et al. in 2020 in Nigeria surveyed 331 healthcare professionals (HCPs). The findings revealed that 96.7% of the HCPs had received a tertiary degree, while only 0.9% had completed elementary education. Approximately 93% of healthcare personnel possessed awareness regarding the hazards associated with healthcare waste. The practice of disposing sharps into the safety box was prevalent (Azuike et al., 2020).

In Cameroon, the health and legislative development initiatives inadequately address the issue of biological waste disposal. The inadequate legislative framework hinders the effective management of this waste (Talla, 2017; Tebeu, 2019; Efuetnkeng et al., 2022). The role and obligations of those participating in biological waste management lack clear and specific definition. Healthcare institutions have two main concerns. Firstly, as health providers, they must prioritise good hygiene practices to safeguard the well-being of the population and the environment. This requires a thorough understanding of health standards and regulations, including BMW management. Secondly, as producers of waste, healthcare institutions bear the responsibility of proper disposal. Biyem-Assi District Hospital, situated in Yaoundé, the capital city of Cameroon, caters to a varied population and plays a crucial role in delivering healthcare services in the region. The hospital produces diverse forms of biomedical waste as a result of its wide array of medical operations and patient care activities. It is essential to prioritise efficient biological waste management in this context to safeguard the health and safety of both the community and the hospital personnel. The objective of this study is to evaluate the knowledge, attitudes, and practices (KAP) of healthcare professionals at Biyem-Assi District Hospital about the management of biomedical waste. The study aims to discover gaps and opportunities for improvement by assessing individuals' existing understanding, perceptions, and behaviours.

1.2 Statement of the problem

Efficient management of biomedical waste is a crucial aspect of healthcare operations, as it plays a vital role in reducing the transmission of infections, safeguarding environmental well-being, and guaranteeing adherence to legislation. The efficient handling of biomedical waste is crucial at Biyem-Assi District Hospital in Yaoundé, given the hospital's wide range of medical services and the substantial amount of trash produced.

Healthcare professionals may have a deficiency in their understanding of the various categories of biomedical waste, the potential dangers linked to wrong treatment, and the established protocols for efficient waste disposal. Lack of understanding can result in inappropriate techniques for segregating, handling, and disposing of garbage (Diaby, 2022). Research has indicated that inadequate handling of biological waste might result in the spread of contagious diseases among patients, personnel, and the community (Dia et al., 2023). Taofeek (2020) asserts that the attitudes of healthcare personnel towards the management of biomedical waste are of utmost importance. If workers consider waste management to be insignificant or regard it as a duty of low importance, it can lead to non-adherence to protocols and a general lack of respect for optimal methods. Furthermore, there has been seen a lack of consistency in the execution of waste management methods. Certain workers may fail to comply with appropriate segregation, handling, or disposal standards, maybe due to insufficient training, resources, or adherence to established procedures (Efuetnkeng et al., 2022).

Improper management of biomedical waste is a substantial risk to both public health and the environment (Lam, 2023). Healthcare facilities produce many categories of trash, such as infectious, hazardous, and ordinary garbage. Each form of waste necessitates distinct procedures for handling, treating, and disposing of it. Insufficient handling of biomedical waste can result in the transmission of illnesses, contamination of the environment, and detrimental effects on both healthcare personnel and the population (Pius & Nwankwo, 2023). The effectiveness of biomedical waste management at the Biyem-Assi District Hospital in Yaoundé is heavily influenced by the knowledge, attitudes, and practices (KAP) of healthcare professionals. Although there are established norms and processes, there may be discrepancies in comprehension and execution among personnel, which can undermine the safety and effectiveness of waste management procedures.

The issue is in the scarcity of empirical evidence concerning the present condition of knowledge, attitudes, and practices of biomedical waste management among healthcare personnel at Biyem-Assi District Hospital. Lacking this data, it becomes challenging to pinpoint precise areas for improvement or to devise focused initiatives for enhancing waste management procedures.This study aims to resolve this issue by evaluating the knowledge, attitudes, and practices (KAP) of healthcare staff at the hospital.

Objectives of the study

The primary objective of this study is to critically assess the knowledge, attitudes, and practices of healthcare workers regarding biomedical waste management at Biyem-assi district hospital, Yaoundé. Specific objectives of this study are to:

To assess the knowledge of Healthcare Workers regarding biomedical waste management at Biyem-assi district hospital, Yaoundé

To evaluate the Attitudes of Healthcare Workers regarding biomedical waste management at Biyem-assi district hospital, Yaoundé

To investigate the practices employed by healthcare workers regarding biomedical waste management at Biyem-assi district hospital, Yaoundé

To identify gaps in knowledge and areas where attitudes may be impacting practices negatively at Biyem-assi district hospital, Yaoundé.

To propose recommendations for improving knowledge, attitudes, and practices related to biomedical waste management at Biyem-assi district hospital, Yaoundé

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the level of Knowledge of Healthcare Workers regarding biomedical waste management at Biyem-assi district hospital, Yaoundé?

What are the Attitudes of Healthcare Workers regarding biomedical waste management at Biyem-assi district hospital, Yaoundé?

What are the actual Practices employed by healthcare workers regarding biomedical waste management at Biyem-assi district hospital, Yaoundé?

What are the gaps in knowledge and areas where attitudes may be impacting practices negatively at Biyem-assi district hospital, Yaoundé?

What recommendations can be made to enhance the knowledge, attitudes, and practices of healthcare workers regarding biomedical waste management?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The level of Knowledge of Healthcare Workers regarding biomedical waste management at Biyem-assi district hospital, Yaoundé is low.

Ha: The level of Knowledge of Healthcare Workers regarding biomedical waste management at Biyem-assi district hospital, Yaoundé is high.

1.6 Significance of the study

This study is important because it focusses on critical elements of biomedical waste management that have a direct impact on public health, environmental conservation, and the functioning of healthcare facilities. The study intends to increase overall waste management systems at Biyem-Assi District Hospital and potentially affect larger healthcare practices in similar contexts by enhancing knowledge, attitudes, and practices.

Efficient treatment of biomedical waste is essential for minimising the likelihood of infections and contamination. The study seeks to enhance waste management procedures by evaluating existing methods and identifying areas that need improvement. This will help reduce health hazards for patients, healthcare professionals, and the local community. By identifying gaps in knowledge and procedures, it becomes possible to design precise safety protocols that will result in a safer healthcare environment.

Furthermore, the appropriate disposal and management of biomedical waste serve to prevent environmental pollution. This study aims to guarantee that waste management practices are implemented to safeguard the quality of soil, water, and air, thereby promoting environmental sustainability. Implementing efficient waste management strategies would enable the hospital to adhere to environmental rules, so preventing potential legal complications and penalties.

Additionally, the study will illuminate deficiencies in knowledge and attitudes among healthcare staff. This information is crucial for developing and executing efficient training programs that target specific requirements and enhance general proficiency in waste management. The study aims to enhance awareness and underscore the significance of appropriate biological waste management by comprehending the attitudes and knowledge levels of healthcare personnel.

Furthermore, the outcomes will provide valuable insights for the enhancement and adjustment of hospital regulations and procedures pertaining to the handling and disposal of biomedical waste. This guarantees that policies are grounded in empirical knowledge and customised to address the unique requirements and obstacles of the facility. The study aims to synchronise hospital procedures with national and international legislation, thereby strengthening compliance and bolstering the hospital's reputation and operating standards.

Moreover, the project will provide significant data to the current corpus of research on the management of biological waste, specifically in healthcare facilities in Cameroon and comparable environments. The findings may emphasise certain areas that need additional examination, providing direction for future research endeavours in the field of biomedical waste management and healthcare waste practices.

1.7 Scope of the study

Broadly, this study focus is to critically assess the knowledge, attitudes, and practices of healthcare workers regarding biomedical waste management at hospitals in Cameroon. Specifically, this study seeks to assess the Knowledge of Healthcare Workers regarding biomedical waste management at hospitals in Cameroon, evaluate the Attitudes of Healthcare Workers regarding biomedical waste management at hospitals in Cameroon and investigate the Practices employed by healthcare workers regarding biomedical waste management at hospitals in Cameroon. 

Further, this study will focus on identifying gaps in knowledge and areas where attitudes may be impacting practices negatively at hospitals in Cameroon and it also seeks to offer recommendations for improving knowledge, attitudes, and practices related to biomedical waste management at hospitals in Cameroon.

 The study is carried out in Biyem-assi district hospital, Yaoundé, Cameroon. 

1.8 Limitations of the study

During the examination, the researchers observed numerous minor limitations, which are typical in any human attempt. The primary constraint was the paucity of comprehensive literature on the subject, stemming from the dearth of data on assessment of the knowledge, attitudes, and practices of healthcare workers regarding biomedical waste management at Biyem-assi district hospital, Yaoundé, Cameroon. Consequently, a substantial investment of time and effort was required to ascertain the suitable materials, books, or information and collect data. 

Moreover, this study is limited by its limited sample size and restricted geographic coverage, concentrating exclusively on Biyem-assi district hospital, Yaoundé, Cameroon. Hence, the ability to generalise the results of this study to a wider scope is limited, emphasising the necessity for more research. 

Furthermore, the researcher's shortcomings were predominantly attributed to financial restraints, as they are a student who lacks the necessary financial resources to support themselves. The excessively high transportation fees at the study site presented a difficulty in fulfilling the financial responsibilities associated with transportation costs.

In addition, the researcher encountered a time limitation as a result of the necessity to do this research while concurrently meeting the responsibilities of attending lectures and engaging in other educational endeavors.

1.9 Definition of terms

Biomedical waste: Biomedical waste is any waste containing infectious or potentially infectious materials. These wastes are generated during the diagnosis, treatment, and immunization of humans and animals. Biomedical wastes can be in both solid and liquid forms.

Biomedical waste management: Biomedical waste management plays a crucial role in safeguarding the safety and well-being of individuals and the environment. It encompasses the proper handling, treatment, and disposal of waste generated by healthcare facilities.