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: 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: 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: METHODOLOGY
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
REFERENCES 67
APPENDICES 75
LIST OF TABLES
Table Page
2.1 Categories of healthcare waste 10
3.1 Numbers of healthcare facilities in the study area 44
3.2 Sample size of each healthcare facility in ASLG 47
4.1: Demographic Characteristics 51
4.2: Types of Healthcare waste generated in each healthcare facility 52
4.3: 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
4.7 Observation made by Researcher on Healthcare Waste Management in
Abeokuta South Local Government. 59
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 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
4.3 Dustbin and Improvised sharp boxes for Segregation on site
(Survey Data 2017) 78
4.4 Open vehicle for transportation of healthcare waste (HCW)
(Survey Data 2017) 79
4.5 Scavengers with waste at dump site (Survey Data 2017) 80
4.6 Healthcare waste (HCW) at dump site with municipal waste
(Survey Data 2017) 81
ABBREVIATIONS
AIDS Acquired immune-deficiency syndrome
ASLG Abeokuta south local government
FDA Food and Drug Administration
HBV Hepatitis B Virus
HCW Healthcare waste
HCWM Healthcare waste management
HCV Hepatitis C virus
HIV Human immune deficiency virus
ICO Infection control officer
LG Local government
U.S.A United State America
WHO 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.
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 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.
1.3 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.
1.4 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?
1.5 Hypothesis
Ho1: There is no significant relationship between knowledge and practice of respondents on
Healthcare waste management in ASLG.
1.6 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.
1.7 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.
1.8 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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