Knowledge, Risk and Challenges of Waste Handlers in Selected Tertiary Health Institutions in Ekiti State
CHAPTER ONE
Objective of the Study
The main objective of this study is to assess the knowledge, risk and challenges of waste handlers in selected tertiary health institutions in Ekiti state in Abuad Multi-System Hospital and Ekiti State University Teaching Hospital of Ekiti State. The specific objectives are to:
- identify different types of waste generated in Healthcare facilities in Ekiti State;
- determine the level of knowledge of health workers on Healthcare waste management and its segregation;
- assess the healthcare waste management as practiced by waste handlers and
- determine how healthcare wastes are finally disposed off, by the healthcare facilities in Abuad Multi-System Hospital and Ekiti State University Teaching Hospital.
- examine the risksand challenges of waste handlers towards healthcare waste in Abuad Multi-System Hospital and Ekiti State University Teaching Hospital
CHAPTER TWO
REVIEW OF LITERATURE
Introduction
The aim of this section is to review literature on healthcare facility waste management. Specifically, the appraisal focused on the nature of healthcare waste generated in the healthcare facilities, segregation of healthcare waste at the point of generation, method of waste collection, storage of waste, transportation, treatment, disposal of waste and the training of healthcare workers and waste handlers. Theoretically, explanation of the environmental theory for explanation of the healthcare waste management and the development of conceptual framework for the study.
Nature of Healthcare Waste
Crick (2020) described biohazard waste generally as liquid or solid that is used in human diagnosis, treatment or immunization or in animal research, or in the production or testing of biological matter. It also includes waste substances such as discarded needles and lancets, blood soaked gauze, cotton wool, culture dishes and bandages, and other discarded surgical gloves and instruments, cultures and stock and removable body organs (Jang, 2021). Biohazard waste is a type of waste which is commonly produced in healthcare facilities. Agumuth, (2020) also defines healthcare waste as waste generating from medical, nursing, veterinary, pharmaceutical, dental, or treatment or research practice. Holmes (2019) assume that medical waste is clinical waste that may prove hazardous to whoever that comes in contact with it. Healthcare waste can be used in exchange with biohazard waste, medical waste, hospital waste, biohazard waste or medical waste around the world (Jang, 2021). In Nigeria, biohazard waste is commonly known as healthcare waste; World Health Organization (WHO) as well as other international bodies refer to it as healthcare waste, emphasizing that not all waste produced from healthcare facilities is clinical waste (Mbongweet al., 2018). Lee et al. (2016) recognized all types of waste produced by healthcare facilities as medical waste.
Agumuth (2020) reported that healthcare waste is a small part of general waste and recommends there should be a better agreement on how much of the waste produced is dangerous to human health. Injurious medical waste in turn presents only a small fraction of total Healthcare waste which cannot be neglected. Rappe and Nyregen (2019), postulated that large quantities of healthcare wastes are generated daily from different sources. Dangerous and toxic biohazard waste is mostly found in healthcare facilities.
CHAPTER THREE
METHODOLOGY
Introduction
This chapter outlines in detail how the study was conducted. It describes the research design, brief profile of the setting, description of the population and sampling procedure.
Research Design
This research was descriptive cross-sectional in design.
Population
The study participants were selected healthcare facilities in Ekiti state, focusing on Abuad Multi-System Hospital and Ekiti State University Teaching Hospital. This includes nurses, doctors, pharmacists, medical laboratory scientists, radiographers and waste handlers. The overall populations of health workers that were sampled in Ekiti State are One thousand one hundred and fifty-four (1,154) health workers
CHAPTER FOUR
DATA ANALYSIS, RESULTS AND DISCUSSION OF FINDINGS
Introduction
This chapter presents data gathered from the field, followed by reports on the study’s analysis and interpretation of findings how the data were analyzed with appropriate statistical tools and highlights the findings of the research. The results of the research hypotheses tested were also discussed in this chapter. Three hundred and three (303) copies of the questionnaire were retrieved, which amounted to 78.9% response rate. Below are the tables showing the frequency distribution of variables and responses of respondents to administered questions.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATION
Summary
This study investigated the knowledge, risk and challenges of waste handlers in selected tertiary health institutions in Ekiti state. In this study, most of the respondents were females which disagree with the study conducted in Anambra which reported that below average of the respondents were females. Findings revealed that 41.2% respondents had been in their jobs for less than 5 years it is however in accordance with the study conducted in Anambra which reported that 38.1% of the respondents have worked in the hospital for 2-4 years. Findings reveal that 48.8% nurses participated in the study and medical doctors 31.0% however it is not in consonance with the study conducted in Anambra which reported that medical doctors responded more than the nurses in a similar study.
Hence, the study shows that majority has the knowledge of what Healthcare Waste Management is all about but there are some factors that associate with Healthcare Waste Management. The factors included: lack of supply of colour coded bag, inadequate training for all the health workers, lack of weighing scale and lack of incinerator.
According to WHO, (2020), Healthcare Waste must be segregated at the point of generation by using colour coded bags. The findings revealed that 88.8% segregated healthcare waste generated inside colour coded bags but it was observed that only tertiary and secondary healthcare facilities do partial segregation by separating sharps from other waste inside black bags and dustbin but the two primary health centres use nylon bag (poly bag). Although, 53.8% of respondents rated segregation of healthcare waste as good while 25.1% rated it poor but it was observed that segregation is very poor in all the four healthcare facilities surveyed. Waste Handlers and Contractors responsible for collection and disposal of healthcare waste also reported that segregation is poor in tertiary and secondary healthcare facilities that were surveyed because they find sharps inside hazardous/ general waste even together with tissue waste that is pathological waste. Findings of this study related to the study conducted in Jordan, which reported that the main problem facing Healthcare Waste Management is improper segregation. A survey done by Hassan et al, (2018) in Bangladesh revealed that no proper and systemic segregation of medical waste is done.
It was observed that sharps container always fill the boxes most of the time especially where they are practicing partial segregation before they replace it, which is contrary to WHO, (2017) recommendation which stated that bags or sharp containers should be replaced when it is ¾ full. Majority of the respondents had adequate knowledge of healthcare waste management which is similar to the study conducted at Anambra by Azuike, et al., (2015) reported that the knowledge of the respondents on healthcare waste was high and it further agrees with the findings of a study done in India by Saini, et al., (2017) which reported that 91.7% of health workers had high knowledge. Tejas, et al., (2019) with the findings of Saini, et al., (2017) in India reported high knowledge of healthcare waste management among the health workers 86%, however on the contrary, a study done in Egypt by Mostafa, et al., (2019) reported a poor knowledge of the healthcare workers regarding healthcare waste management. The findings could be as a result of a good number of them having received training on healthcare waste management (HCWM) at an earlier time before the commencement of the study.
The type of HCW generated by selected healthcare facilities were mostly sharps, followed by general, pathological, chemical and radioactive wastes. Hazardous wastes was not properly segregated, collected and disposed. In fact, open dumping was commonly used for final disposal of healthcare waste by all the examined health facilities which is similar to Anozie, (2017). Findings reveal that health workers and the public are exposed to hazardous wastes. Moreover based on these findings, it is stated according to WHO, 2016 that improper disposal of hazardous healthcare waste (HCW) can pose health risk to health workers, patient and the public through environmental pollution by contaminating soil. (Abah and Ohimain, 2021) Even this observation is consistent with several studies (Allsopp, 2015; Echegaray, 2016; Ndidi, 2019; Ogbonna, 2021). There are no health facilities that practice incineration of healthcare waste and this is contrary to the study conducted by Njoroge, (2021) which reported that incineration is recognized as best standard and effective means of biomedical waste disposal.
Conclusion
The level of knowledge of the health workers of healthcare waste management was high; the practice of discarding sharps into the safety box by waste handlers was high. The current management practices for healthcare wastes generated at the health facility studied is unsustainable and cannot be relied upon to protect human health and environmental integrity. There is no existing policy or plan and no systems in place for sustainable management of healthcare waste management (HCW). There is urgent need to take practical steps aimed at ensuring the ‘duty of care’ and safeguarding the environment for current and future generations.
It was observed that healthcare waste was not quantified in all the four healthcare facilities that were surveyed due to lack of weighing scale. ‘You cannot manage what you don’t measure, is a classical management adage that has been proven by Ananth et al (2020)’. Partial segregation were done by tertiary and secondary healthcare facilities by separating sharps from other waste while primary healthcare centres did not segregate their waste. Black bags and dustbin were used for hazardous waste. Healthcare facilities transport healthcare waste with open vehicle to dispose openly in dumpsites. The choice of waste treatment technology according to Abah and Ohimain (2021) should be tailored to urban or rural health facility. Waste segregation therefore, should be employed as a critical step to achieve waste minimization, cost reduction and sustainable waste management practice. The knowledge of health workers on healthcare waste management was high, their practice was moderate but inadequate and that exposes health workers and the public to health hazards.
Recommendations
Based on the findings from the study, the following recommendations were made:
- The management of each hospital should provide colour coded bag for segregation of healthcare waste in their healthcare facilities.
- Training and retraining of all health workers on healthcare waste management must be done from time to time.
- The necessary equipments like healthcare waste weighing scale, incinerator must be provided for proper healthcare waste management.
- Formulation of appropriate institutional and national policies on Healthcare waste (HCW) and enforce the policies nationwide.
Limitation of the study
- The researcher was limited by the instrument that was used to carry out assessment like weighing scale.
- Healthcare waste is not accessible.
- Lack of funds.
Suggestion for further Studies
Findings from this research revealed the need for further studies on quantity of healthcare waste generated by each healthcare facility, collection, storage and treatment of healthcare waste.
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