Abstract
BACKGROUND: Biomedical waste (BMW) makes up 15% of the total waste generated in healthcare facilities. South Africa is also among the countries facing significant challenges in managing BMW. The poor segregation, collection and treatment of BMW affect what ends up in the environment, negatively impacting occupational and environmental health. The emergence of COVID-19 also led to the increased use of personal protective equipment (PPE) to prevent cross-infection among healthcare professionals (HCPs), potentially increasing the amount of BMW generated in hospitals. HCPs’ knowledge, attitudes and practices in the management of BMW have been linked to the outcome of BMW generation.
AIM: This study aimed to determine COVID-19’s effect on BMW generation in selected hospitals from three provinces in South Africa, and explore HCPs’ knowledge, attitudes, and practices in its management.
OBJECTIVES: To quantify the amount of BMW generated during 2017–2022 and determine the difference between pre-COVID-19 and post-COVID-19 amounts of BMW; to determine COVID-19’s effect on BMW generation and explore HCPs’ knowledge attitudes, and practices in managing this waste and to determine whether measures are in place to minimise BMW generation.
METHODOLOGY: A descriptive, quantitative, cross-sectional research design was used, in which a self-administered, closed-ended questionnaire was distributed to gain data from respondents about HCPs’ knowledge, attitudes, and practices in BMW management. In addition, secondary data were collected from records of BMW collected from the selected hospitals to quantify the volume of BMW generated during 2017–2022. A stratified random sampling method was applied, and a sample of doctors and nurses (N=202) who met the study’s inclusion criteria was selected.
RESULTS: Some HCPs (60.7%) indicated they had attended in-service training, though 39.3% said they had not. Of the respondents, 86.9% stated that Standard Working Procedure (SWP) is available to guide BMW management in their institution, and 13.1% said no. HCPs believed it was their responsibility to manage waste (50.5%). Moreover, 49.0% of HCPs strongly agreed that they did wear extra PPE during COVID-19 to protect themselves from infection. It was also determined that 91.0% of HCPs knew which colour-coded bin is used for BMW and which colour-coded container is used to discard sharps. Summer months saw the highest levels of waste production; January (10.91%) and February (11.46%) ranked among
vii
the top months for waste totals. Poor record-keeping led to the researcher’s inability to fully quantify the volume of BMW generated in the three selected hospitals. Those with 16-20 years’ experience had 2.02 times higher odds of always practising proper waste management than the <5-year reference group (95% CI 0.11-0.93, p=0.036). Those with a degree had 1.78 times higher odds of always practising proper waste management versus the diploma reference group (95% CI 1.43-2.01, p=0.023).
CONCLUSION: Improved record-keeping of BMW certificates/receipts is required in digital form to avoid a loss of data and to have evidence that a reputable company is collecting BMW from the sampled hospitals. HCPs’ knowledge, attitudes and practices in BMW management at the three hospitals were sufficient. Continued training to ensure consistency is recommended. The COVID-19 pandemic had an impact on respondents and made them more careful in discarding of BMW. HCPs’ practices of correctly discarding waste was not affected by the pressure they worked under during the pandemic.
KEYWORDS: Biomedical waste management, COVID-19, Healthcare professionals, Hospitals, Knowledge, Attitude, Practice