Available via license: CC BY-NC
Content may be subject to copyright.
International Journal of Community Medicine and Public Health | November 2019 | Vol 6 | Issue 11 Page 4907
International Journal of Community Medicine and Public Health
Agrawal S et al. Int J Community Med Public Health. 2019 Nov;6(11):4907-4911
http://www.ijcmph.com
pISSN 2394-6032 | eISSN 2394-6040
Original Research Article
Discernment, apropos on dispensation of hospital waste
among paramedics: a descriptive study
Swati Agrawal1*, Vrinda Saxena2, Swapnil Jain1, Vijayta Sharva1
INTRODUCTION
India is one of the most populated and rapidly growing
countries in the world and is the source of humongous
amounts of waste every year, including municipal solid
waste, hazardous waste, biomedical waste or e-waste. As
per the Central Pollution Control Board (CPCB), the
average solid waste generated in India ranges from 0.21
to 0.5 kg per capita per day. Healthcare is one of the
largest sector in India both in terms of revenue and
employment. With growing healthcare, there is a
requirement of management of bio-medical waste.1
The term “biomedical waste” has been defined as “any
waste that is generated during diagnosis, treatment or
immunisation of human beings or animals, or in the
research activities pertaining to or in the production or
testing of biologicals and includes categories” mentioned
in schedule I of the Government of India’s Biomedical
Waste Rules 1998.2,3 Bio-medical waste (BMW) although
comprises a small proportion of total waste generated
(around 1%) but needs special handling and treatment due
to its highly toxic contents, and it is highly infectious and
can pose a severe threat to human health.1
ABSTRACT
Background:
India is one of the most populated and rapidly growing countries in the world and is the source of
humongous amounts of waste every year, including municipal solid waste, hazardous waste, biomedical waste or e-
waste. Healthcare is one of the largest sectors in India both in terms of revenue and employment. With growing
healthcare, there is a requirement of management of bio-medical waste. This study is conducted to assess
discernment, apropos on dispensation of hospital waste by paramedics.
Methods:
A cross-sectional study was conducted to assess the discernment and apropos of paramedical staff in 3
private hospitals regarding disposal of waste in Bhopal city and convenience sampling was used. A total of 204
individuals were approached for the study. The collected data analysed by using SPSS 21.0 and Descriptive analysis
was done.
Results:
Total 204 paramedical staff participated in the study out of which 125 (61.2%) were males and 79 (38.7%)
were males. It showed that there was limited level of knowledge, attitude and practices among class 3 workers i.e.,
attenders as compared to nurses and technicians.
Conclusions:
Study concluded that there is lack of knowledge about waste management which leads to improper
waste disposal and pointed out that class 3 workers have less knowledge as compared to class 1 and class 2 workers.
The technicians and nurses comparatively were having better knowledge and attitude, and also practiced waste
management better than the attenders.
Keywords: Biomedical waste, Hospital waste management, Waste disposal
1Department of Public Health Dentistry, Peoples Dental Academy, Bhopal, Madhya Pradesh, India
2Department of Public Health Dentistry, Government Dental College, Indore, Madhya Pradesh, India
Received: 11 September 2019
Accepted: 15 October 2019
*Correspondence:
Dr. Swati Agrawal,
E-mail: drswatibansall@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20195078
Agrawal S et al. Int J Community Med Public Health. 2019 Nov;6(11):4907-4911
International Journal of Community Medicine and Public Health | November 2019 | Vol 6 | Issue 11 Page 4908
According to WHO, SEARO, the 11 South-East Asian
countries together produce some 350,000 tons of health
care waste per year, close to 1000 tons a day which is
both hazardous and nonhazardous. The total bio-medical
waste generated in India is approximately 519.7 (2016)
and 501 (2015) tons per day (TPD) or from over 187,486
healthcare facilities (HCF). An estimated 483.3 (2016)
and 486 (2015) tons per day of this biomedical waste is
treated in India daily. The average quantity of hospital
solid waste produced in India ranges from 1.5 to 2.2
kg/day/bed.1
The generators of biomedical waste i.e., doctors, nurses;
technicians, etc., (medical and paramedical personnel)
should come forward and take over the mantle of
segregation. The segregation should be done in
accordance to the Biomedical Waste (management and
handling) rule of 1998. Optimal waste management is at
best, a moving target. Waste-handling is left to lower-
level workers who operate without any training, guidance,
and supervision .Usually attenders are responsible for
spearheading the waste management initiatives. therefore,
this study is conducted to assess the discernment, apropos
on dispensation of hospital waste by paramedics.
Persistent user friendly approach and logistic support is
important in the implementation of rules and regulations
concerning the medical practice other than the core
mandate they are assigned to and Proper management of
waste should be addressed with 2Ds i.e., dignity and duty
and not by any means of pressure.4.
METHODS
A questionnaire based cross — sectional survey was
conducted to assess the discernment and apropos of
paramedical staff in 3 private hospitals regarding disposal
of waste in Bhopal City from Feb 1st 2019 to March 20th
2019. Convenience sampling method was applied in the
study. A total of 204 individuals were approached for the
study. The ethical clearance was obtained from
Institutional Ethical Clearence Committe prior to the start
of the study. Verbal consent was obtained from the head
of the concerned departments and the study participants.
The participants who were not present at the day of
administration of questionnaire and not willing to
participate were under exclusion criteria of the study.
The study is based on the information received from the
interview schedule. A predesigned, pretested and
prevalidated questionnaire was used and modified with
the help of experts according to the need of the study. The
questionnaires were framed to interrogate personnel
related to health care settings Such as technicinas/lab
technicians, nurses and attenders. Time acquired per
person for filling the entire questionnaire varied from 5 to
7 minutes. It was validated on 20 people, Cronbach’s
Alpha was 0.805, so the standard of questionnaire was
made according to paramedical staff.
The collected data from 204 paramedical staff were
entered and analysed by using SPSS 21.0. Frequency,
proportions were calculated and reported. The main
motive behind the study was to comprehend mundane
activities in hospital waste management, to recommend
training if required by any department of the hospital.
Also it emphasised on enlightening suggestions for
rectifying waste management techniques.
RESULTS
The study was conducted among paramedical staff of
three colleges in Bhopal City. Total 204 paramedical staff
participated in the study out of which 125 (61.2%) were
males and 79 (38.7%) were males. Regarding age 70
respondents were in age group between 31-40 years of
age. Health care personnel were divided into three classes
according to their designations. 75 workers are Class 1
workers including lab technicians/technicians, 64 workers
were class 2 includes nurses and 65 workers were class 3
include attenders working in medical and dental colleges.
Amongst them 82 were having work experience of 6-10
years (Table 1).
Table 1: Socio-demographic details of the study population (n=204).
Demographic details
Variable category
Study participant
N (%)
Gender
Male
125 (61.2)
Female
79 (38.7)
Age groups (years)
<30
15 (7.3)
31-40
70 (34.3)
41-50
61 (29.9)
>50
58 (28.4)
Health care personnel
Class 1-includes technicians / lab technicians
75 (36.7)
Class 2-includes sisters/nurses
64 (31.3)
Class 3-includes attenders
65 (31.8)
Work experience
1-5 years
101 (49.5)
6-10 years
82 (40.1)
>10 years
21 (10.2)
Agrawal S et al. Int J Community Med Public Health. 2019 Nov;6(11):4907-4911
International Journal of Community Medicine and Public Health | November 2019 | Vol 6 | Issue 11 Page 4909
Table 2: Positive response of class 1, 2 and 3 workers regarding bio-medical waste management.
Questions
Class 1
(n=75)
Class 2
(n=64)
Class3
(n=65)
P value
N (%)
N (%)
N (%)
Knowledge
Q1) Do you know hospital waste
causes health hazards?
73 (97.3)
62 (96.9)
57 (87.7)
0.028*
Q2) Do you have coloured dustbins
for waste disposal in your
hospital/college?
73 (97.3)
60 (93.8)
59 (90.8)
0.255
Q3) Do you know how to recycle
different types of waste?
61 (81.3)
56 (87.5)
51 (78.5)
0.387
Q4) Does your department have
biomedical waste chart?
68 (90.7)
64 (100)
59 (90.8)
0.042*
Attitude
Q5) Do you feel a need to use two
gloves for segregation of waste
68 (90.7)
56 (87.5)
41 (63.1)
0.001*
Q6) Do you feel a need to use detail
and floor cleaners for cleaning
departments/hospital
75 (100)
64 (100)
59 (90.8)
0.001*
Practice
Q7) Do you colour code the waste
for disposal?
75 (100)
56 (87.5)
59 (90.8)
0.010
Q8) Do you use gloves for
segregation of waste?
75 (100)
48 (75)
43 (66.2)
0.001*
Q9) Do you wash your hands after
segregation of waste?
61 (81.3)
56 (87.5)
51 (78.5)
0.387
Q10) Do you keep used and unused
instruments together?
29 (38.7)
6 (9.41)
11 (16.9)
0.001*
Q11) Is the infection waste labeled
with the biohazard symbol?
75 (100)
64 (100)
56 (86.2)
0.001*
Q12) Do you segregate the waste
chair side?
68 (90.7)
40 (62.5)
46 (70.8)
0.001*
*statistically significant.
Figure 1: Knowledge, attitude and practices of paramedical staff.
The first part of questionnaire for this study was to assess
the knowledge of workers regarding the disposal of
biomedical waste. Out of 204 participants, 97.3% of class
1 workers know that hospital waste causes health hazards.
97.3% agreed that they use coloured dustbins for disposal
of waste. 87.5% class 3 workers know how to recycle
hospital waste and 100% class 2 workers have knowledge
about biomedical waste chart they have in their
0
50
100
150
200
250
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12
Percentage
Questions
CLASS 1 CLASS 2 CLASS 3
Agrawal S et al. Int J Community Med Public Health. 2019 Nov;6(11):4907-4911
International Journal of Community Medicine and Public Health | November 2019 | Vol 6 | Issue 11 Page 4910
departments. The attitude of workers towards the use of
two gloves for segregation of waste and need to use
Dettol/floor cleaners for cleaning departments and
hospitals found to be positive and when compared
between 3 groups, the values are found statistically
significant. The lab technicians/technicians (90.7%) have
a better attitude towards a need to use two gloves for
separation of waste. Out of 204 workers majority (198)
feel that Dettol/floor cleaners should be used for cleaning.
In the questions related to practice, 100% class 1 workers
use colour codes for disposal of waste and use gloves for
segregation of waste. Among all only 87.5% class 2
workers wash their hands after segregation of waste and
only 38.7% class1 , 9.41% class 2 and 16.9% class 3
workers keep used and unused instrument. Separately
100% class 1 and class 2 workers labelled waste disposal
with biohazard symbol and only 90.7% class 1 workers
segregate the waste chair side. (Table 2, Figure 1).
DISCUSSION
Biomedical waste management and handling is an
important adjunct to the successful medical and
healthcare. It is our social, moral and legal obligation that
we pay attention to each and every aspect of medical
waste right from minimisation to final disposal.5
The present study was conducted in private dental and
medical colleges of Bhopal City. It showed that there was
limited level of knowledge, attitude and practices among
class 3 workers i.e., attenders as compared to nurses and
technicians.
The results of the study are in accordance with previous
study. In a study conducted in medical college hospital,
Bangalore rural Knowledge about biomedical waste
management rules among the technically qualified
personnel like the doctors, nurses, and laboratory staff
was satisfactory but was limited among the attenders and
housekeeping staff6.This was similar to the findings from
other studies.7-9 In Gujarat, it was found that technicians
and nurses were aware of risk of health hazards whereas
attenders had very limited knowledge about it.8
Knowledge about colour coding of containers, and waste
segregation was also found to be better among
technician’s and nurses as compared to that of the other
staff.8 In Bangalore, Majority (96.1%) were aware of the
colour coding for waste segregation but they did not have
any clear idea of what should be disposed in which bin.6
In the present study they were not very clear as to what
should go in each coloured bin.
In present study nurses and technicians practice
segregation of infectious and non-infectious waste at
chair side as compared to attenders as in a study
conducted in a Palestinian hospital in the West Bank
showed that there was insufficient separation between
hazardous and non-hazardous wastes and there was an
absence of necessary rules and regulations for the
collection of waste materials from the hospital wards.10
Assessment of medical waste management practice in the
northern part of Jordan showed that there are no defined
methods for the handling and disposal of these wastes.
Moreover, there were no specific regulations or
guidelines for segregation or classification of these
wastes.11
Lack of awareness, appropriate policy and laws, and
willingness have been responsible for the improper
management of medical waste in Dhaka City.12 Study by
Gurubacharya revealed that 46% of the nurses and Lab
Technicians had correct knowledge regarding universal
precautions.13
CONCLUSION
The study concluded that there is lack of knowledge
about waste management which leads to improper waste
disposal. This study pointed out that class 3 workers have
less knowledge as compared to class 1 and class 2
workers. The technicians and nurses comparatively were
having better knowledge and attitude, and also practiced
waste management better than the attenders. Regular
training of all class 1, 2 and 3 workers should be done and
system of monitoring should be evolved.
Following recommendations are proposed (i) monthly
training sessions should be conducted for health care
workers in institutions for strict implementation of
biomedical waste management rules (ii) every alternate
year , certificate programmes should be organised and it
should be made compulsory for healthcare facilities to get
their healthcare workers trained (iii) in every 5 year,
exam should be conducted for health care workers and
salary increment should be done according to their
performances (iv) they should trained about health related
hazard due to improper waste disposal (v) rules should be
made for on rotation supervision for collecting and
disposing waste from the site.
If we will introduce incentive based training for health
care workers, participation will increased and more
workers will enrol for training.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
REFERENCES
1. The Associated Chambers Of Commerce And
Industry Of India. Unearthing The Growth Curve
And Necessities Of Bio Medical Waste
Management In India, March 2018. Available at
www.assocham.org. Accessed on 4th September
2019.
2. Government of India, Ministry of Environment and
Forests. Bio-Medical Waste (Management and
Handling) Rules. Gazette of India. 1998 (27 Jul).
Agrawal S et al. Int J Community Med Public Health. 2019 Nov;6(11):4907-4911
International Journal of Community Medicine and Public Health | November 2019 | Vol 6 | Issue 11 Page 4911
Available at http://envfor.nic.in/legis/hsm/biomed.
html. Accessed on 4th September 2019.
3. Government of India, Ministry of Health and Family
Welfare (MoHFW). National Guidelines on Hospital
Waste Management Based upon the Bio-Medical
Waste (Management and Handling) Rules, 1998.
New Delhi: MoHFW; 2002.
4. National Health System Resource Centre, Technical
Support Institution with National Health Mission,
Ministry of Health & Family Welfare, Government
of India. Implementation Guidelines for
Management of Healthcare Waste in Health Care
Facilities as per Bio Medical Waste Management
Rules, 2016. Available at http://cpcb.nic.in.
Accessed on 4th September 2019.
5. Lahiri KK, Jena, Kapila K. Issues in Management of
Biomedical Waste in Laboratory Medicine. Journal
of ISHWM. 2006;5(1).
6. 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(1).
7. 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.
8. Pandit NB, Mehta HK, Kartha GP, Choudhary SK.
Management of bio-medical waste: Awareness and
practices in a district of Gujarat. Indian J Public
Health. 2005;49:245-7.
9. Saini S, Nagarajan SS, Sarma RK. Knowledge;
Attitude and Practices of Bio-Medical Waste
Management Amongst Staff of a Tertiary Level
Hospital in India. J Acad Hosp Adm. 2005;17:2.
10. Al-Khatib IA, Khatib RA. Assessment of medical
waste management in a Palestinian hospital. Eastern
Mediterranean Health J. 2006;12:359-71.
11. Bdour A, Altrabsheh B, Hadadin N, Al-Shareif M.
Assessment of medical wastes management
practice: a case study of the northern part of Jordan.
Waste Management. 2007;27:746-59.
12. Hassan MM, Ahmed SA, Rahman KA, Biswas TK.
Pattern of medical waste management: existing
scenario in Dhaka City, Bangladesh. BMC Public
Health. 2008;8:36.
13. Gurubacharya DL, Mathura KC, Karki DB.
Knowledge, attitude and practices among health
care workers on needle stick injuries in Health Care
Settings. Kathmandu Univ Med J. 2003;1(2)91-4.
Cite this article as: Agrawal S, Saxena V, Jain S,
Sharva V. Discernment, apropos on dispensation of
hospital waste among paramedics: a descriptive study.
Int J Community Med Public Health 2019;6:4907-11.
