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Indian Journal of Medical Microbiology, (2015) 33(1): 129-131 1

Brief Communication

Biomedical waste management: Study on the awareness and practice among

healthcare workers in a tertiary teaching hospital
L Joseph, H Paul, J Premkumar, Rabindranath, R Paul, JS Michael*

Abstract
Bio-medical waste has a higher potential of infection and injury to the healthcare worker, patient and the surrounding
community. Awareness programmes on their proper handling and management to healthcare workers can prevent the
spread of infectious diseases and epidemics. This study was conducted in a tertiary care hospital to assess the impact
of training, audits and education/implementations from 2009 to 2012 on awareness and practice of biomedical waste
segregation. Our study reveals focused training, strict supervision, daily surveillance, audits inspections, involvement of
hospital administrators and regular appraisals are essential to optimise the segregation of biomedical waste.

Key words: Biomedical waste, health care worker, hospital safety, segregation

Introduction guidelines and aim to minimise cross infection, improve the

Biomedical waste is defined as any solid or liquid waste
generated during diagnosis, treatment or immunisation
of human beings and animals or during research that may
present a threat of infections to humans.[1] A total of 80% of
the waste generated in the hospitals is composed of general
waste while the remaining 20% comprises of infectious,
toxic or radioactive waste.[2]
Of this, 20% of the waste is highly infectious and
dangerous and could cause serious damage to the society
and the environment when it is not properly segregated and
disposed off.
In India uniform guidelines for practice in the country
have been laid down under the Bio-medical Management
and handling Rules 1998. The waste management
programme in hospitals are in accordance to these
*Corresponding author (email: <joymichael@cmcvellore.ac.in>)
Quality Manager, Quality Management Cell (LJ), Infection
Control Doctor, Hospital Infection Control Committee (HP),
Nursing Superintendent (JP), Hospital Infection Control
Committee Nurse (RB), Audit Facilitation Officer (R),
Hospital Infection Control Committee, Department of Clinical
Microbiology (JSM), Christian Medical College and Hospital,
Vellore, Tamil Nadu, India
Received: 29-07-2013
Accepted: 10-10-2013
Access this article online
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PMID:
***
DOI:
10.4103/0255-0857.148411
general hygiene in hospitals and minimise environmental
pollution through proper treatment and disposal of waste.[3]
The success of biomedical waste management programme
rests on the knowledge and practice of the Health Care
Worker (HCW). This study was done at a tertiary, teaching
hospital in south India with over 2500 beds with an average
occupancy of 80% and 6000 outpatients’ everyday on an
average. About 2 tonnes of biomedical waste is generated
everyday in the hospital and proper segregation of the waste
at source is a challenge. It has a multi-disciplinary biomedical
waste management committee to oversee the programme.
Material and Methods
A number of cross-sectional audits had been conducted from
2009 to 2012 on the biomedical waste segregation and the
awareness of the HCW on the biomedical waste segregation
in the hospital. The results of the audits are collated and
presented as a longitudinal study in this paper.
• Audit on staff awareness on biomedical waste
segregation was conducted in September 2009 and the
main focus of this audit was to assess the awareness
level among the healthcare workers, doctors and
nurses and allied staff with regard to biomedical waste
segregation. The audit was done by administering a
pre-tested questionnaire to 166 randomly selected
health care workers with a response rate of 54%
• Audit on segregation was conducted during the
month of October 2009 to assess the practice of
biomedical waste segregation in 145 areas, which
included all wards, Laboratories Operation theatres,
investigation areas and intensive care units jointly by
infection nurses and the interns Quality Management
team by observation of waste segregated at source
• Re-audit on segregation was conducted to assess
the change in practice after the training sessions and
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130 Indian Journal of Medical Microbiology
other implementations between September 2009
and January 2012. Same areas that were audited in
October 2009 were re-audited and the same checklist
and methodology was adopted
• Re-audit was conducted in June 2012 to assess
the awareness after the training programmes and
sessions conducted regularly between September
2009 and January 2012 with the help of a pre-tested
questionnaire to 190 randomly selected health care
workers with a response rate of 43%.
Results
Awareness among healthcare workers
It was found that the awareness on the segregation
of cytotoxic drugs had increased from 53% to 76%,
segregation and disposal of sharps from 90% to 98%,
infectious plastics from 72% to 83% and from 67% to 85%
on the different colour bags used for segregation, which are
statistically significant.
Actual practice of biomedical waste segregation
As shown in Figure 1 the actual practice of segregation
of infectious non-plastic waste has improved from 69% to
93%, infectious plastics and Personnel protective equipment
(PPEs) from 77% to 96%, non-infectious waste segregation
from 86% to 97% and sharps from 86% to 96%, which are
statistically significant. There is no significant improvement
in the segregation of cytotoxic waste.
Discussion
To assess the awareness on Biomedical waste
segregation among the healthcare workers, an audit was
conducted in September 2009. The results revealed, among
the samples audited, 53% were aware of the segregation of
cytotoxic drugs, 90% on segregation and disposal of sharps,
72% on infectious plastics. Only 67% were aware of the
Awareness on biomedical waste segregation
98%
100%
90%
80% 76%
60% 53%
40%
20%
0%
Segregation of Cytotoxic Segregation of Sharp
drugs
Figure 1: Practice of Biomedical waste at the hospital
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vol. 33, No. 1
different colour bags used for segregation. In comparison
to a study conducted at Mahatma Gandhi Dental College
Hospital Pondicherry, the knowledge about colour coding of
biomedical wastes was 74%.[4]
The subsequent audit to assess the practice revealed
similar results with the infectious non-plastics segregation
69%, infectious plastics and PPEs segregation 77%,
non-infectious waste segregation 86%, sharps segregation
86% and cytotoxic wastes 88%. These audits showed the
need to improve awareness among HCW’s and the necessity
to develop new strategies achieves good compliance to
waste segregation. The initiatives taken are listed below.
Setting up the biomedical waste management committee
A multi-disciplinary biomedical waste management
committee was set up in 2009, which includes the
administration and the infection control team. This
committee is responsible for making hospital specific action
plans for biomedical waste management its supervision,
monitoring and implementation.
Continuous training of staff
In a study done by waste management among doctors
showed the necessity of having a balance between effective
practical training and theoretical aptitude building among
the medical group.[5] Pandit et al., showed that training of
staff, both technical and non-technical, is critical for the
proper and appropriate management of biomedical waste.[6]
A session on biomedical waste management was
introduced as part of mandatory training for all HCWS in
the institution to improve the awareness. Focussed training
session in areas with poor compliance was also done.
Biomedical waste management posters
Biomedical waste segregation posters highlighting the
colour codes for different categories of waste was put in
83% 85%
72%
67%
Sep-09
Jun-12
Segregation of Infectious Colour bags used for bio-
plastic medical waste
segregation.
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January - March 2015 Joseph, et al.: Biomedical waste management in a tertiary care centre
all the areas in the hospital as a constant reminder of the
need for proper segregation of waste. The posters were
multi-lingual and predominantly pictorial.
Reducing the number of colour bags used for segregation
Five colour system of segregation existed in the
institution prior to 2009, which was changed to four colours,
as recommended by Tamil Nadu Pollution control board
simplified the process of segregation.
Accountability through labels
Practice of pasting labels on the bags, denoting the
location, date and time of disposal of waste generation,
prior to sending them to the temporary storage yard ensured
accountability, which was substantiated by frequent audits
and tracking improperly segregated wastes.
Repeated audits and inspections
Repeated audits both scheduled and unscheduled were
conducted by the Hospital infection control team and the
quality management team. These audits and inspections
focussed on interviewing staff to assess awareness,
scrutinising the training records and also the actual practice
of segregation. Reports of these inspections and audits
were sent to administration and respective areas. The
recommendations were implemented and followed up by the
biomedical waste management committee.
Re-audits on waste segregation practice and awareness
at were conducted in January 2012 and June 2012,
respectively, showed a significant improvement in the above
parameters.
Conclusion
The present study reveals that periodic focused training
and emphasis on implementation of the policies laid down
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131
for bio-medical waste segregation for all HCW is essential
to optimise the compliance to effective segregation
strict supervision, daily surveillance, frequent audits and
inspections are recommended to implement the bio-medical
waste management rules in the hospital. Involvement of the
hospital administrators and regular appraisal with the status
of bio-medical waste management in waste management
and quality steering committee play a pivotal role in
executing the policies effectively.
References
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4. Hospital Waste Management in the Union Territory of
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6. Pandit NB, Mehta HK, Kartha GP, Choudhary SK.
Management of bio-medical waste: Awareness and practices
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How to cite this article: Joseph L, Paul H, Premkumar J, Paul R,
Michael JS. Biomedical waste management: Study on the awareness
and practice among healthcare workers in a tertiary teaching hospital.
Indian J Med Microbiol 2015;33:129-31.
Source of Support: Nill. Conflict of Interest: None declared.