ABSTRACT
The outcome of healthcare services is aimed at preventing potential human health risks and environmental hazards as well as improving wellbeing. In the process, however, wastes that are potentially harmful are generated and poor management of these healthcare wastes (HCW) exposes the health workers, patients, patient’s visitors, waste handlers and the general public to health risks. The objective of this study is to assess the waste management practices of health workers in Abeokuta South Local Government Area, Ogun state.
A descriptive cross-sectional design was employed to collect data from four selected healthcare facilities. A total of 303 health workers randomly selected served as respondents. A structured questionnaire was administered to health workers to determine their knowledge and practice on healthcare waste management. Whereas non-participatory observation checklist was used to collect data on their current practices as regards to Healthcare waste management. Data were analysed, and presented as descriptive statistics using Statistical Package for Social Sciences (SPSS) version 20.0 and hypothesis was tested using Pearson product-moment correlation coefficient.
Findings revealed that 228 (75.2%) of the respondents are working in tertiary health care facility, 60 (19.8%) working in secondary health care facility and 15(5.0%) are working in primary health care facility. Majority 183 (60.4%) of respondents were females and others 120 (39.6%) were males. The highest occurring age group were 31-40 years 127 (41.9%) while the least occurring age group was 60 years 12 (4.0%). 148 (48.8%) were nurses, 94 (31.0%) were Doctors, 32 (10.5%). Findings revealed that there was a significant relationship (p<0.05) between their knowledge and practice. Majority of the respondents (78.2%) had high knowledge on healthcare waste management, 20.5% had moderate knowledge, while few (1.3%) had low knowledge about healthcare waste management. The practice of healthcare waste management is moderate but not adequate.
In conclusion, management of healthcare wastes (HCW) has become one of the critical concerns in developing countries especially Nigeria. Healthcare waste is dangerous, if handled, treated or disposed off incorrectly can spread diseases, and poison people, livestock, wild animals, plants and ecosystems. Healthcare institutions must utilize the most practical options to achieve acceptable standards and practices for Healthcare waste management using available technologies. Measures to improve the Healthcare waste management practices in healthcare facilities in Abeokuta South Local Government and the country at large is to enhance training of all health workers on healthcare waste management. It is recommended that colour coded bag should be made available for segregation of clinical waste in all the healthcare facilities.
Keywords:Â Assessment, Disposal of healthcare waste, Healthcare waste, Knowledge,
Management, Practices, Segregation of healthcare waste.
Word Count: 427
                                                                                   TABLE OF CONTENTS
Content                                                                                                                                                                                                                                             Page
Title Page                                                                                                                                                                                                                                          i
Certification                                                                                                                                                                                                                                      ii
Dedication                                                                                                                                                                                                                                        iii
Acknowledgements                                                                                                                                                                                                                    iv
Abstract                                                                                                                                                                                                                                            vi
Table of Contents                                                                                                                                                                                                                       vii
List of Tables                                                                                                                                                                                                                             xi
List of Figures                                                                                                                                                                                                                           xii
Abbreviations                                                                                                                                                                                                                            xiii
CHAPTER ONE:Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â INTRODUCTION
1.1                                                                        Background to the Study                                                                                                                                                1
1.2                                                                        Statement of the Problem                                                                                                                                                3
1.3.     Objective of the Study                                                                                                         4
1.4                                                                        Research Questions                                                                                                                                                                     4
1.5                                                                        Hypothesis                                                                                                                                                                                 4
1.6                                                                        Scope of the Study                                                                                                                                                                      4
1.7                                                                        Justification for the Study                                                                                                                                              4
1.8                                                                        Operational definition of terms                                                                                                                                       5       CHAPTER TWO: REVIEW OF LITERATURE
2.0                                                                        Introduction                                                                                                                                                                               7
2.1                                                                        Nature of healthcare waste                                                                                                                                                          7
2.1.1                                                                     Sharps waste                                                                                                                                                                                11
2.1.2                                                                     Infectious waste                                                                                                                                                             11
2.1.3                                                                     Pathological waste                                                                                                                                                           11
2.1.4                                                                     Pharmaceutical waste                                                                                                                                                                  11
2.1.5                                                                     Chemical waste                                                                                                                                                               12
2.1.6                                                                     Radioactive waste                                                                                                                                                           12
2.2                                                                        Healthcare waste management                                                                                                                                        14
Content                                                                                                                                                                                                                                             Page
2.3                                                                        Healthcare waste generation                                                                                                                                                       15
2.3.1                                                                     Healthcare waste generation in developing countries                                                                                                                 17
2.3.2                                                                     Healthcare waste generation in developed countries                                                                                                                  18
2.4                                                                        Healthcare waste management practices                                                                                                                         19
2.4.1                                                                     Segregation                                                                                                                                                                                  19
2.4.2                                                                     Handling and collection                                                                                                                                                  21
2.4.3                                                                     Storage                                                                                                                                                                            21
2.4.4                                                                     Transportation                                                                                                                                                                           22
2.4.5                                                                     Treatment and disposal                                                                                                                                                   23
2.4.6                                                                     Training and education                                                                                                                                                    25
2.5                                                                        Health waste management practices in developed countries                                                                                                          26
2.6                                                                        Healthcare waste management practices in developing countries                                                                                 27
2.7      Potential impacts associated with healthcare waste                                                34
2.8                                                                        Acts and legislation on healthcare waste management                                                                                                   37
2.9                                                                        Theoretical Framework                                                                                                                                                    40
2.10                                                                      Concept adopted for the study                                                                                                                                       42
2.10.1                                                                   Concept of cleanliness                                                                                                                                                     42
CHAPTER THREE: METHODOLOGYÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
3.0                                                                        Introduction                                                                                                                                                                              43
3.1                                                                        Research Design                                                                                                                                                            43                             3.2        Population                                                                                                                                                                           43
3.3      Sample size and sampling Technique                                                            45
3.4      Research Instruments                                                                                                                       47
3.5.1   Questionnaire                                                                                                                                                                                                      48
3.5.2                                                                     Field Observation                                                                                                                                                            48
3.5.3                                                                     Validity and Reliability of Instrument                                                                                                                           48
3.6                                                                        Method of Data Collection                                                                                                                                                        48
3.6.1                                                                     Method of Data Analysis                                                                                                                                              49
3.7.1                                                                     Inclusion criteria                                                                                                                                                            49
Content                                                                                                                                                                                                                                            Page
3.7.2                                                                     Exclusion criteria                                                                                                                                                           49
3.8                                                                        Ethical Consideration                                                                                                                                                                49
3.8.1                                                                     Permission for the study                                                                                                                                                  49
3.8.2                                                                     Post research benefits                                                                                                                                                                49
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND
DISCUSSION OF FINDINGS
4.1                                                                        Results                                                                                                                                                                                        50
4.2                                                                        Discussion                                                                                                                                                                       60
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1                                                                        Summary                                                                                                                                                                        63
5.2                                                                        Conclusion                                                                                                                                                                       64
5.3                                                                        Recommendations                                                                                                                                                                      65
5.4       Limitation of the Study                                                                                                        65
5.5      Suggestion for further Studies                                                                                  66
REFERENCESÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 67
APPENDICESÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 75
LIST OF TABLES
Table                                                                                                                                                                                                                                                               Page
2.1                                                                        Categories of healthcare waste                                                                                                                                       10
3.1                                                                        Numbers of healthcare facilities in the study area                                                                                                          44
3.2Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Sample size of each healthcare facility in ASLGÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 47
 4.1:    Demographic Characteristics                                                                                                  51
4.2:    Types of Healthcare waste generated in each healthcare facility                                52
4.3:Â Â Â Knowledge of respondents regarding Healthcare waste management and
its Segregation                                                                                                                                                                                                                  53
4.4:    Practice of healthcare waste management by health workers                                     54
4.5:    Practices of healthcare facility on final disposal of waste                                          55
4.6    Relationship between the knowledge and practices of the respondents                     58
4.7Â Â Observation made by Researcher on Healthcare Waste Management in
Abeokuta South Local Government.                                                                           59
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LIST OF FIGURES
Figure                                                                                                                                    Page
2.1      Healthcare waste compositions                                                                      8
2.2     Categories of waste from healthcare facilities                                                          13
2.3      Differentiation of Waste Management                                                        16
2.4     Healthcare wastes with municipal waste in open dump                                            30
2.5 Â Â Â Â Â Burning of Healthcare waste with municipal waste in dumping
site at Abeokuta                                                                                                                     34
2.7     Conceptual Model                                                                                                      42
4.1     Level of practice of Healthcare Waste Management                                                  56
4.2     Knowledge of respondents on Healthcare Waste Management                                 57
4.3Â Â Â Â Â Dustbin and Improvised sharp boxes for Segregation on site
(Survey Data 2017) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 78
4.4Â Â Â Â Â Open vehicle for transportation of healthcare waste (HCW)
(Survey Data 2017) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 79
4.5Â Â Â Â Â Scavengers with waste at dump site (Survey Data 2017) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 80
4.6Â Â Â Â Â Healthcare waste (HCW) at dump site with municipal waste
(Survey Data 2017)Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 81
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                                                                               ABBREVIATIONS
AIDSÂ Â Â Â Â Â Â Â Acquired immune-deficiency syndrome
ASLGÂ Â Â Â Â Â Â Abeokuta south local government
FDAÂ Â Â Â Â Â Â Â Â Â Food and Drug Administration
HBVÂ Â Â Â Â Â Â Â Â Â Hepatitis B Virus
HCWÂ Â Â Â Â Â Â Â Healthcare waste
HCWMÂ Â Â Â Â Â Healthcare waste management
HCVÂ Â Â Â Â Â Â Â Â Â Hepatitis C virus
HIVÂ Â Â Â Â Â Â Â Â Â Human immune deficiency virus
ICOÂ Â Â Â Â Â Â Â Â Â Â Infection control officer
LGÂ Â Â Â Â Â Â Â Â Â Â Â Â Local government
U.S.AÂ Â Â Â Â Â Â Â United State America
WHOÂ Â Â Â Â Â Â Â Â World Health Organization
                                            CHAPTER ONE
                                           INTRODUCTION
1.0 Background to the Study
Healthcare waste threatens the public health due to its contagious nature. Most healthcare facilities are located in the heart of the cities and therefore, healthcare waste that are not correctly managed can cause dangerous infection and pose potential threat to the nearby environment, health workers, patients and to the public (WHO, 2014). Dehghani, Azam, Changani and Fard (2008) noted that Healthcare Waste (HCW) if not appropriately managed can be a serious threat to human health due to their infectious attributes. Nigeria, one of developing countries, has health issues that are competing for limited resources; it is not amazing that healthcare waste management receives less attention and precedence than it merits (Stephen, & Elijah, 2011). Therefore, there is a serious challenge in developing countries, where there are no Institutional provisions for healthcare waste management. Clinical wastes are disposed openly in the dumpsite along with municipal waste and the practice make the members of the community gain access to it which may lead to outbreak of infectious diseases (Alagoz, Kocasay, Abah, & Ohimain, 2010) . Cheng, Sung, Yang, Lo, Chung and Li (2009) noted that as small as healthcare waste is in proportion to the total community waste, its management is considered an important issue worldwide. World Health Organization (2014) reported that 15% of total waste generated in the healthcare facility is hazardous and must be properly segregated at the point of generation to prevent the whole healthcare waste becoming 100% hazardous. The World Health Organization estimates that each year there are about 8 to 16 million new cases of Hepatitis B virus (HBV), 2.3 to 4.7 million cases of Hepatitis C virus (HCV) and 80,000 to 160,000 cases of human immune deficiency virus (HIV) due to unsafe injections disposal and mostly due to very poor waste management systems.
Across the globe, the risk associated with Healthcare Waste (HCW) and its management has gained tremendous attention from health practitioners and non practitioners. If healthcare facilities know the types and quantities of clinical waste generated, it will help them in planning, budgeting adequate revenue for the management of hazardous waste (Bongayi, 2013). A study conducted by Olubukola (2009) in two General hospitals at Lagos reported that due to lack of quantification of healthcare waste, there was no waste reduction plan in the hospitals.
This lack of plan for healthcare waste management eventually leads to inadequate waste segregation at point of use, collection, storage and final disposal. This poor healthcare waste management practice creates health hazards for health workers, patients and the environment. Identified gaps like lack of colour code bags for segregation of healthcare waste at point of use, lack of guidelines on segregation and disposal for health workers lead to poor healthcare waste management in hospitals. The mismanagement of healthcare waste by healthcare facilities does not pose health hazard to health workers and patients alone but also to patients’ visitors and the community where they are improperly disposed by contaminating the soil, air and water. Healthcare facilities are supposed to protect the health of people in their environment, not to be a creator of potential health hazard for them.
Furthermore, increase in patient turned-out has increase the generation of healthcare waste. Mboguwe, Mimereki and Magashula(2008) also reported that increase in population results to increase in healthcare facilities that lead to increased healthcare waste generation. It is expected that because of this increase, more attention should be paid to and priority given to proper healthcare waste management in Abeokuta South Local Government (ASLG). Management of healthcare waste continues to present an array of challenges especially as economic situation of the country deepen daily therefore, healthcare waste management has become a concern.
So many studies have been conducted on healthcare waste management but little or no work has been done concerning segregation of clinical waste which is a vital aspect in healthcare waste management (Coker, Sangodoyin, Sridhar, Booth, Olomolaiye, 2009). Segregation of waste is crucial in healthcare waste management because it is the first step in clinical waste management. Segregation of healthcare waste helps in reduction of the quantity of waste that is hazardous. Once healthcare waste are segregated, collection will be easy, proper storage will be done and disposal of infectious waste carried out in the way that it will not pose any harm to health workers, patients and the environment (WHO, 2014). Proper management of healthcare waste depends on good organization, sufficient funding and active participation of trained personnel. It was observed that healthcare facilities were not spending resources on clinical waste management Healthcare facility must allocate resources for colour coded bags and training of generator of healthcare waste for proper segregation and disposal for its sustainability. The intention of this study is to assess healthcare waste management practices at health facilities in Abeokuta South Local Government.
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1.2Â Â Â Â Statement of the Problem
Indiscriminate dumping of untreated hospital waste in Municipal bins increases the chances of survival and mutation of pathogenic microorganism population in the municipal waste, which can lead to disease epidemics and increased incidence of communicable disease in the community. The prevalence of infectious disease like Hepatitis B, C, Measles, Acquired immunodeficiency syndrome, Tuberculosis, Chickenpox, Cholera and others has also been traced to the inappropriate segregation and disposal of hospital waste (Sreejith, 2008).In Ogun State, the researcher observed that the healthcare facilities neglected healthcare waste management in the area of segregation and disposal. Materials required for segregation and disposal of these hospital wastes are not provided by the constituted authority, thus these pose a serious threat to the health workers, patients, environments and the community at large. There has been recent cases of hospital acquired infectious diseases among health workers which has been traced to contamination from healthcare waste, leading to untimely death of some of these health workers.
The indiscriminate dumping of hospital waste among domestic waste make the community members easily access it. A tour of these health facilities shows the absence of waste management facilities such as incinerators, autoclave, and microwave. Therefore, it is most likely that medical wastes are dumped at municipal site; this practice may lead to outbreak of communicable diseases. It is in the light of these problems identified above that the researcher developed interest in assessing healthcare waste management practices among health workers in Abeokuta South Local Government of Ogun State. The result of this study will be used to improve the healthcare waste management in health facilities in Abeokuta South Local Government. It will also provide empirical data to policy makers, researchers and other concern bodies to develop effective healthcare waste management policy in Abeokuta South Local Government and the country as a whole.
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1.3Â Â Â Â Â Objective of the Study
The main objective of this study is to assess the waste management practices of health workers in four healthcare facilities in Abeokuta South Local Government Area of Ogun State. The specific objectives are to:
- identify different types of waste generated in Healthcare facilities in Abeokuta South Local Government (ASLG);
- determine the level of knowledge of health workers on Healthcare waste management and its segregation;
- assess the healthcare waste management as practiced by health workers and
- determine how healthcare wastes are finally disposed off, by the healthcare facilities in
ASLG.
1.4Â Â Â Â Â Â Research Questions
- What are the types of Healthcare wastes generated at health facilities in ASLG?
- What is the level of knowledge of health workers on healthcare waste management?
- What is the practice of healthcare waste management by health workers?
- What is the final disposal of healthcare waste practiced by healthcare workers in ASLG?
1.5Â Â Â Â Â Â Hypothesis
Ho1:Â Â There is no significant relationship between knowledge and practice of respondents on
Healthcare waste management in ASLG.
1.6Â Â Â Â Â Â Scope of the Study
The study focused on generation, segregation and final disposal of healthcare waste in healthcare facilities in Abeokuta South Local Government. One tertiary Healthcare facility, one secondary Healthcare facility and two primary Healthcare facilities were used.
1.7Â Â Â Â Â Â Justification for the Study
Hospital waste management is part of hospital hygiene and infection control activities.While the healthcare facilities work towards the goals of reducing health problems and eliminating potential human health risks, they also create waste that may pose health hazards to patients, health workers and the community (Bongayi, 2013). Mohee (2005) noted that healthcare wastes worldwide have sharply increased in recent times due to increased population, numbers and sizes of healthcare facilities as well as the use of disposable medical products. Poor management of clinical waste has direct effect on individuals working in healthcare facilities, patients, the community and natural environment (Goddu, Duvvuri, & Bakki, 2007).
Therefore, when hazardous waste is not segregated at the source of generation and mixed with nonhazardous waste, they all become hazardous. Risks associated with HCW and its management have gained attention across the world in various summits, locally and internationally. So there is need for proper management of healthcare waste for the following reasons: injuries may occur from sharps objects sleading to infection to all categories of hospital personnel and waste handler. Nosocomial infections in patients from poor infection control practices and poor waste management, risk of infection may happen outside hospital for waste handlers, animals that feed on waste and at time general public living in the vicinity of hospitals, risk associated with hazardous chemicals, drugs to persons handling wastes at all levels, “disposable” being repacked and sold by unscrupulous elements without even being washed, drugs which have been disposed repacked and sold to unsuspecting buyers and risk of air, water and soil pollution due to waste or defective incineration emissions and ash. It is hoped that this study will provide information concerning healthcare waste management in healthcare facilities and will generate interest in the systematic control effort for effective clinical waste management. It is also hoped that the study will help the government, and local authorities to improve their present waste management methods.
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1.8Â Â Â Â Â Â Â Operational Definition of Terms
Abeokuta South Local Government: it is one of twenty local governments in Ogun State which is situated in the state capital, Abeokuta.
Assessment: it is the evaluation of healthcare waste management in healthcare facilities, ASLG.
Healthcare waste (HCW) is a by-product of healthcare facility that includes sharps, non-sharps, blood, body parts or tissues, chemicals, pharmaceuticals and radioactive materials generated during diagnosis, treatment or immunization or research.
Healthcare waste management (HCWM) is the generation, segregation, and disposal of healthcare waste.
Health facilities: are places that offer health care which consist of hospitals, clinics and primary health centres.
Practice: is the routine or accepted procedure or way of handling waste.
Health Care Workers: are group of people who works in the healthcare facility for example doctors, nurses, medical laboratory technologists, pharmacists, radiographers and waste handlers
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