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ASSESSMENT OF HEALTHCARE WASTE MANAGEMENT PRACTICES AMONG HEALTH WORKERS

CHAPTER ONE

INTRODUCTION

1.1     Background of 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 is 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.

1.2       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 have 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 healthcare 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.

1.3       Objectives of the Study

The main objective of this study is to assess the healthcare waste management practices among health workers. The specific objectives include;

i.  To identify different types of waste generated in Healthcare facilities in Abeokuta South Local Government (ASLG);

ii.  To determine the level of knowledge of health workers on Healthcare waste management and its segregation;

iii.  To assess the healthcare waste management as practiced by health workers and

iv.  To determine how healthcare wastes are finally disposed of, by the healthcare facilities in ASLG. 

1.4       Research Questions

i.  What are the types of Healthcare wastes generated at health facilities in ASLG?

ii.  What is the level of knowledge of health workers on healthcare waste management?

iii.  What is the practice of healthcare waste management by health workers?

iv.  What is the final disposal of healthcare waste practiced by healthcare workers in ASLG?

1.5       Research Hypotheses

Hypothesis I

H0: There is no significant relationship between knowledge of respondents on Healthcare waste management in ASLG.

Hi: There is a significant relationship between knowledge of respondents on Healthcare waste management in ASLG.

Hypothesis II

H0: There is no significant relationship between practice of respondents on Healthcare waste management in ASLG.

Hi: There is a significant relationship between practice of respondents on Healthcare waste management in ASLG.

1.6    Significance of 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 healthcare 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 leading 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. This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

1.7       Scope of the Study

This study is on the assessment of healthcare waste management practices among health workers. 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.

1.8       Limitations of the study

The demanding schedule of respondents at work made it very difficult getting the respondents to participate in the survey. As a result, retrieving copies of questionnaire in timely fashion was very challenging. Also, the researcher is a student and therefore has limited time as well as resources in covering extensive literature available in conducting this research. Finally, the researcher is restricted only to the evidence provided by the participants in the research and therefore cannot determine the reliability and accuracy of the information provided.

Financial constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

Time constraint: The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

1.9       Operational Definition of Terms

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, healthcare laboratory technologists, pharmacists, radiographers and waste handlers.

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