Shikoh Naz  ( Department of Community Dentistry, Hamdard College of Medicine and Dentistry, Karachi, Pakistan )
Syed Muhammad Zulfiqar Hyder Naqvi  ( Department of Community Medicine, Baqai Medical University, Karachi )
Syed Imtiaz Ahmed Jafry  ( Department of Community Medicine, Baqai Medical University, Karachi, Pakistan )
Saima Asim  ( Department of Community Dentistry, Hamdard College of Medicine and Dentistry, Karachi, Pakistan )

A knowledge, attitude and practice cross-sectional survey was conducted among dental practitioners doing private practice in district central, Karachi after checking eligibility and taking their written informed consent. The practitioners were interviewed by the principal investigator with the help of a pre-tested structured questionnaire developed specifically for this study. The study results revealed that 175(88.8%) of the participants were aware that waste management guidelines are applicable to them, 184(93.4%) were aware that healthcare waste is a source of infection whereas 145(73.6%) were aware about the colour coding of healthcare waste bags/containers. Moreover, 165(84.1%) thought that health care waste disposal protocol lessens the chance of injuries and infections whereas 182(92.0%) were in favour of the need to continue medical education about health care waste management. It is recommended that healthcare waste should be segregated and disposed of in a safe manner to protect the people at risk and the environment.

Keywords: Knowledge, Attitude, Waste Management, Dentists.

DOI: https://doi.org/10.5455/JPMA.22368

 

Introduction

 

Healthcare waste is defined as the total waste produce from a healthcare activity; between 70-90% of the waste is nonhazardous, domestic or general waste, the remaining 10-25% health care waste is regarded as infectious/ hazardous/ healthcare risk waste; the nonhazardous waste or domestic waste contains paper, plastic packing and leftover food stuff, the hazardous waste or health care risk waste contains infectious agents, sharps, hazardous chemicals or pharmaceuticals, and is genotoxic and radioactive.¹ The institutions involved in generation of health care waste are hospitals, clinics, laboratories, blood banks, mortuaries, physician's offices, dental clinics and pharmacies; the individuals exposed to healthcare waste and thereby at risk of becoming injured or infected include doctors, nurses, sanitary staff, hospital maintenance personnel, in and out-patients, their visitors, workers in support services linked to healthcare facilities such as laundries, waste handling and transportation services and general public particularly the children.¹ In 2016, the average total, general and infectious hospital waste generation rates in Pakistan have been reported to be 0.667, 0.497 and 0.17kg / bed / day respectively; 73.85% of it consisted of general, 25.8% consisted of hazardous/infectious while 0.87% consisted of nonhazardous waste.² Effective management of healthcare waste essentially depends upon proper identification and segregation of the waste.³ The latest guidelines for segregation of biomedical waste recommend the following colour coding: highly infectious waste, pathological, anatomical and other infectious waste is to be held in a yellow container, marked "HIGHLY INFECTIOUS", with biohazard symbol; Sharps waste is to be held in a strong, leak-proof and puncture-proof yellow plastic bag or a container marked "SHARP" with biohazard symbol and capable of being autoclaved; chemical and pharmaceutical waste to be held in a brown plastic bag or rigid container labeled with appropriate hazard symbol; radioactive waste to be held in a lead box, labeled with radiation symbol and general health-care waste to be held in a black plastic bag.¹ Waste management and treatment options should first protect the healthcare workers and the population and then minimize the indirect impacts from environmental exposures to health care waste.¹ For this purpose it is essential that healthcare professionals and waste handlers have necessary awareness and are properly trained to manage healthcare waste. Although literature reports that there is a lack of knowledge regarding healthcare waste management among dental practitioners of Karachi,⁴ to the best of authors' knowledge, the attitude and practice of dental practitioners in this regard have not been evaluated yet. In order to expand the relevant local data base, this study was therefore conducted to determine knowledge, attitude and practice regarding dental waste management among dental practitioners of Karachi.

 

Methods and Results

 

A knowledge, attitude and practice survey was conducted in private dental clinics of district central, Karachi, from May 2018 to October, 2018. The study population consisted of conveniently sampled dental private practitioners from district central, Karachi. Graduate or post graduate registered dental practitioners doing private practice in district central, Karachi whereas dental internees were excluded from the study. Using the percentage frequency of the study outcome as 50% for maximum sample size, with 95% confidence interval, 7% precision, and factoring in a population size of 100000, the calculated sample size was 196 practitioners. A pretested structured questionnaire specifically designed for the study was given by the principal investigator to the dental practitioners after taking their written informed consent and taken back once they had filled it. The questionnaire was developed after a thorough literature review and was then pre-tested on 5% of sample size to check for face validity and reliability and was modified accordingly to yield a Cronbach's alpha value of 0.701. Data were analyzed by SPSS version 21 while descriptive analysis was performed by calculating means and standard deviations for continuous and frequencies and percentages for categorical variables. A response rate of 100% was recorded for the study. The mean age of the study participants was 34.16±7.37 years, 50.8% of them were females, 39.1% were graduates, 41.1% had <5 years' experience, 41.1% had less than 50000 rupees monthly incomes whereas 56.9% practiced in a rented clinic. In all 181(91.9%) of the dentists were aware of the term healthcare waste, 175(88.8%) knew that waste management guidelines are applicable to them, 184(93.4%) had the knowledge that healthcare waste is a source of infection, 157(79.7%) knew that different categories of healthcare waste generated in clinics whereas 145(73.6%) knew about the colour coding of healthcare waste bags/containers (Table-1).

Moreover, 165(84.1%) thought that health care waste disposal protocol lessens the chance of injuries and infections, 182(92.0%)were in favour of the need to continue medical education about health care waste management, 158(80.2%) of them recapped the used needles, 178(90.4%) discarded the used needles immediately, 154(78.2%) deformed the discarded needles in their clinic, 112(98.2%) disposed sharps in a colour coded bag whereas a similar percentage of them disposed extracted teeth and human tissues in a colour coded bag, 108(96.4%) disposed off used restorative material impression material plaster of Paris and expired materials in a colour coded bag, 105(92.1%) disposed fixer and developer in a colour coded bag whereas 106(93.0%) disposed general health waste in a colour coded bag (Table-2).

 

Conclusion

 

In line with the published literature,^5,6 majority of the study participants were aware about the term healthcare waste and that healthcare waste management guidelines are applicable to dentists. In all 93.4% of the participants were aware that health care waste is a source of infection; similar results were reported by Ahmed AAM et al., in 2014.⁷ Moreover 79.7% of study participant knew about the different categories of healthcare waste generated in clinics. Similarly Bansal M et al., in 2013 reported 86% of the respondents to have similar knowledge.⁸ More than 2/3rd of the participants knew that infective agents, sharps and chemicals are included in hazardous waste and were aware about colour coding of healthcare waste bags/ containers; similar results have been reported earlier as well.^6,9 Contrary findings were reported by Ismail IM et al., in 2013 though.¹⁰ As reported by Sanjeev R et al., in 2014,6 60.4% of study participants correctly knew that sharps were disposed in yellow puncture proof containers, Furthermore, 69.2% of the study participants responded that healthcare waste management is the responsibility of the government as well as teamwork of dental surgeon and auxiliaries. Similar results were reported by Sharma A et al., in 2013.¹¹ As reported previously,^12,13 a majority of the participants thought that it is important to have color coded bags/containers for healthcare waste disposal at their clinics and to inform sanitary staff to empty waste bags/container once it is completely filled. Furthermore, 92.2% of the study participants thought that there is a need of continued medical education on healthcare waste management, again a finding well in line with published literature.^6,10,14 In our study 80.2% of the participants recapped the used needles. Unlike our results NK Gupta et al., in 2017 reported that 20.0% of the respondents interviewed recapped the used needles.¹⁵ Moreover 90.4% of study participants discard the used needles immediately. NK Gupta et al., in 2017 reported similar findings.¹⁵ Furthermore, 61.4% of the participants used colour coded bags in the clinic for healthcare waste disposal. Abhishak KN et al., in 2016 reported likewise.¹⁴ Literature though reports contrary findings as well.¹⁰ Moreover, 98.2% of the study participants disposed sharps in colour coded bags. Though less frequently, Ismail IM et al., in 2013 reported similar results.¹⁰ Due to resource limitation, this survey could not be conducted with a larger sample size.

 

Disclaimer: This was the thesis of Masters in Public Health.

Conflict of Interest: None to declare.

Funding Disclosure: None to make.

 

References

 

1. Agarwal A, Bouvet F, Chartier Y, Drew C, Emmanuel J, Krisiunas E, et al. Safe management of wastes from health-care activities, 2nd ed. In: Chartier Y, Emmanuel J, Pieper U, Pruss-Ustun A, Rushbrook P, Stringer R, et al, eds. Geneva, Switzerland: WHO Press; 2014.

2. Ali M, Wang W, Chaudhry N, Geng Y. Hospital waste management in developing countries: A mini review. Waste Manag Res 2017; 35:581-592. doi: 10.1177/0734242X17691344.

3. Joseph K, Selvam A, Wong JWC. Healthcare Waste Management. In: Wong JWC, Surampalli RY, Zhang TC, Tyagi RD, Selvam A, eds. Sustainable Solid Waste Management. Reston, Virginia: American Society of Civil Engineers, 2016; pp 477-509.

4. Qadir M, Murad R, Faraz N. Hospital waste management; tertiary care hospitals. Professional Med J 2016; 23:802-6. DOI: 10.17957/TPMJ/16.3281

5. Chopra R, Mathur S, Dodwad V, Sharma N, Tevatia S. Awareness & attitude regarding biomedical waste disposal among postgraduate students, under-graduate students & auxiliary staff of a dental college - a questionnaire survey. Int J Dent Res 2017; 5:64- 7. doi: 10.14419/ijdr.v5i1.7515

6. Sanjeev R, Kuruvilla S, Subramaniam R, Prashant PS, Gopalakrishnan M. Knowledge, attitude, and practices about biomedical waste management among dental healthcare personnel in dental colleges in Kothamangalam: a cross-sectional study. Health Sci 2014; 1:1-12.

7. Ahmed AAM, Awooda EM, Elbeshir EI. Dentists knowledge, attitude and practice towards dental waste management in private clinics - khartoum locality. Int J Lat Res Sci Technol 2014; 3:93-96.

8. Bansal M, Vashisth S, Gupta N. Knowledge, awareness and practices of dental care waste management among private dental practitioners in Tricity (Chandigarh, Panchkula and Mohali). J Int Soc Prev Community Dent 2013; 3:72-6. doi: 10.4103/2231- 0762.122436.

9. GV U, Divyapriya GK, Basu M. Assessment of knowledge, attitude and practices of dental waste management among undergraduate dental students of Bapuji Dental College and Hospital in Davangere City- a cross sectional survey. Unique J Med Dent Sci 2016; 4:8-13.

10. Ismail IM, Kulkarni AG, Kamble SV, Borker SA, Rekha R, Amruth M. Knowledge, attitude and practice about bio-medical waste management among personnel of a tertiary health care institute in Dakshina Kannada, Karnataka. Al Ameen J Med Sci 2013; 6:376-80.

11. Sharma A, Sharma V, Sharma S, Singh P. Awareness of biomedical waste management among health care personnel in jaipur, India. Oral Health Dent Manag 2013; 12:32-40.

12. Khan MJ, Hamza MA, Zafar B, Mehmod R, Mushtaq S. Knowledge, attitude and practices of health care staff regarding hospital waste handling in tertiary care hospitals of Muzaffarabad, AJK, Pakistan. Int J Sci Rep 2017; 3:220-6.

13. Kumar PVS, Padmaja P. Knowledge, attitude, practices of biomedical waste management among nursing students and staff in a tertiary care hospital. Ann Int Med Den Res 2017; 3:CM01-4. DOI: 10.21276/aimdr.2017.3.4.CM1

14. Abhishek KN, Supreetha S, Varma Penumatsa N, Sam G, Khanapure SC, Sivarajan S. Awareness-knowledge and practices of dental waste management among private practitioners. Kathmandu Univ Med J 2016; 53:17-21.

15. Gupta NK, Shukla M, Tyagi S. Knowledge, attitude and practices of biomedical waste management among health care personnel in selected primary health care centres in Lucknow. Int J Community Med Public Health 2016; 3:309-13.