Department of Community Medicine, Tezpur Medical College, Assam
Background: Biomedical waste (BMW) management is crucial in healthcare facilities to mitigate risks from hazardous materials. Nursing staff, as primary handlers, are essential for proper segregation and disposal. Deficiencies in knowledge, attitude and practice (KAP) can lead to health and environmental hazards.Objective: To assess KAP regarding BMW management among nursing staff in a tertiary care centre in Sonitpur District, Assam.Methods: A hospital-based cross-sectional study was conducted at Tezpur Medical College and Hospital (TMCH) from 1st to 30th September 2024. Purposive sampling selected 60 consenting nurses. Data were collected using a pre-designed, pre-tested interview schedule and analyzed in MS Excel, presented as tables, bar diagrams, and pie charts.Results: Participants were mostly aged 31-40 (40%). Awareness of BMW rules (1998) was 75%, knowledge of sources 81.66%, training received 86%, and segregation practice 90%. Hazard awareness was highest for infectious waste (85%). PPE use included gloves (96.66%) and masks (85%). Hepatitis B vaccination was 76.66%.Conclusion: While awareness and practices were generally good, gaps in training, PPE adherence, and vaccination necessitate reinforced education and compliance with BMW rules.
Biomedical waste includes waste generated during the diagnosis, treatment or immunization of humans or animals and also encompasses sharps, pathological remnants and chemical residues.(1) Effective management of BMW involves segregation, collection, transportation, treatment and disposal in an orderly sequence to minimize risks from exposure to harmful materials.(2) Healthcare waste is considered a significant health risk worldwide, with WHO estimating that 15–25% of this type of waste is infectious, providing a potential vehicle for spreading diseases such as hepatitis B, hepatitis C and HIV through needle-stick injuries or improper handling(3). In low- and middle-income countries, including India, inappropriate disposal of BMW enhances environmental pollution due to soil, water and air contamination by toxic substances resulting from the generation of dioxins and heavy metals.(4)The Bio-Medical Waste Management Rules notified for the first time in 1998 and later amended in 2016 in India require color-coded segregation and safe disposal in order to protect healthcare workers and the general public.(5) The rules categorize BMW according to treatment options, emphasizing that untreated waste cannot be stored beyond 48 hours.(5) Being at the frontline in patient care, nursing staff play a significant role in initial segregation, handling, and disposal of waste, and thus their knowledge, attitude, and practices become of utmost importance for good compliance with the regulations.(6) Poor KAP among the nursing fraternity can result in compromising biomedical waste management and may lead to occupational hazards, nosocomial infections and legal non-compliances.(7)Most of the earlier studies conducted in India have presented variable levels of KAP among health care workers. For instance, a cross-sectional study carried out in Uttar Pradesh indicated that only 35.5% of nurses possessed excellent knowledge, hence requiring focused training.(8) In West Bengal, although the overall knowledge among nurses in primary health care settings was satisfactory, their practices were poor.(9) In Assam, very few studies have been conducted in tertiary care centers where high patient loads increase BMW generation.(10) This study fills the gap by evaluating the KAP regarding BMW management among nursing staff at a tertiary care center in Sonitpur District, Assam, with the aim of informing interventions to improve compliance and safety.
Objective
To assess KAP about BMW management among nursing staff at a tertiary care center in Sonitpur District, Assam.
MATERIALS AND METHODS
This hospital-based cross-sectional study was conducted to evaluate the KAP regarding BMW management among nursing staff at a tertiary care center in Sonitpur District, Assam. Cross-sectional designs are very much common in KAP studies due to their efficiency in capturing point-in-time data from a defined population.(11)The present study was carried out at Tezpur Medical College and Hospital (TMCH), Sonitpur District, Assam, which is a tertiary care facility and represents a diverse population. The study period was from 1st September to 30th September, 2024, which enabled adequate data collection within routine shifts.The population was defined as all nurses working in TMCH. Inclusion criteria included nurses who gave written informed consent. The exclusion criteria were: (1) nurses unavailable at the time of the study and (2) those unwilling to participate.The sample size of 60 was selected through purposive sampling so that the departments like medicine, surgery, and ICU were adequately represented. Purposive sampling is deemed appropriate for targeting specific knowledgeable groups in healthcare settings.(12)Ethical Considerations The study was approved by the Institutional Ethics Committee of Tezpur Medical College, Assam.Data collection was done through a pre-designed and pre-tested interview schedule. Sections included sociodemographics, knowledge (like awareness of BMW rules, sources, hazards), attitude (perceived importance regarding segregation), and practice (use of PPE, vaccination status). The schedule was adapted from validated tools that have been used in similar studies and pre-tested for clarity and reliability on 10 nonstudy nurses.(8) Face-to-face interviews were conducted in private settings to minimize interviewer bias. Written informed consent was taken after explaining the purpose of the study to them.Microsoft Excel was used for data entry and analysis. Descriptive statistics were then computed, including frequencies and percentages. Where necessary, tabulation of results was done. No results were subjected to any form of inferential statistic, since the nature of the study was exploratory.
RESULT
60 nursing staff participated in the study. T
he majority were aged 31–40 years of age (40%), followed by 41–50 years (26.7%) and 51– 60 years (23.3%). Only 10% were aged 21–30 years of age (Table 1).Knowledge about BMW management rules within the hospital revealed that 75% were informed about BMW Management Rules, 1998, while 25% of the respondents had not heard of the rules. Awareness about sources of generation within the hospital revealed that 81.66% of the respondents were aware about it. Training imparted to participants regarding BMW management revealed that 86% had received training on BMW management whereas 14% had not received any formal training regarding this(Table 2). Knowledge about health hazards associated with different categories of BMW was found to be variable; infectious wastes and sharps revealed 85%, chemical and pharmaceutical waste 63.33%, genotoxic waste 48.33%, and radioactive waste 25% .In relation to attitudes, 40% of respondents felt that management of BMW plays a very important role in infection control.73.3% considered management of BMW an essential part of professional duties. Only 38.33% expressed that the current practices of BMW management were sufficient (Table 3).Regarding practices, 90% of the participants said that they segregated BMW in the workplace, following rules for BMW management. Application of PPE during handling BMW was also noted among the respondents; 96.66% used gloves and 85% used masks during handling (Table 4). Hepatitis B vaccination status was noted to be 76.66% among nursing staff, while 23.33% were not vaccinated.
Table 1: Age Group
|
age group |
no of respondents |
percentage |
|
21-30 |
6 |
10% |
|
31-40 |
24 |
40% |
|
41-50 |
16 |
26.7% |
|
51-60 |
14 |
23.3% |
Table 2: Knowledge of BMW Management
|
Knowledge Questions |
no of response |
percentage |
|
Aware about BMW rules, 1998 |
45 |
75% |
|
knowledge of source of BMW generation |
49 |
81.66% |
|
training on BMW management received |
51 |
86% |
Table 3: Attitude towards Biomedical Waste Management
|
Attitude statements |
no of respondents |
percentage |
|
Believed that BMW management is important role in infection control |
42 |
70% |
|
Consider BMW Management as integral part of job responsibility |
44 |
73.33% |
|
Feels existing BMW management practices were adequate |
23 |
38.33% |
Table 4: Practice of biomedical waste management
|
Practice parameters |
no of respondents |
percentage |
|
Follows color coded segregation for BMW at work place |
54 |
90% |
|
Gloves(PPE) |
58 |
96.66% |
|
Mask(PPE) |
51 |
85% |
DISCUSSION
The current study suggests a generally encouraging KAP profile among nursing staff at TMCH, with 75% aware of the 1998 BMW rules, which is higher than the 39.2% reported to have good knowledge in a Uttar Pradesh study but comparable to 89.7% awareness in Andhra Pradesh.(8)(13) This could be indicative of institutional efforts in Assam, although 25% remain unaware, indicating the need for wider dissemination of the 2016 amendments that have laid emphasis on stricter segregation and treatment protocols.(5) Knowledge of BMW sources was 81.66%, comparable to 85% in a Bangladesh tertiary hospital, and may suggest recognition of common generation points like wards and laboratories.(14)The training coverage stood at 86%, which is higher than the 76.1% reported by a recent survey on Indian nursing students, but 14% without formal training underlines the non-implementation of periodic programs advocated by the WHO.(3)(15) Knowledge of health hazards presented variations: high among infectious waste, at 85%, which is an important concern all over the world with regards to sharps injuries and infections, but much lower for radioactive and genotoxic wastes, at 25% and 48.33%, respectively, possibly because of low exposure in this environment.(3)(16) Similarly, in Iran, knowledge of hazards stood out for infectious categories.(17) Segregation practices were encouraging, standing at 90%, compared to poorer practices observed in primary care at West Bengal; these again reflect the effectiveness of rule-based training.(9)(5)PPE use was good for gloves at 96.66% and masks at 85%, consistent with improvements following interventions in Egyptian studies.(18) Hepatitis B vaccination is 76.66%, higher than some reports from India, but it falls short of universal coverage, leaving staff vulnerable to blood-borne pathogens.(19)(3)These findings indicate that although KAP is adequate, focused interventions-such as compulsory annual training and vaccination campaigns-can improve compliance further and reduce occupational risks as well as environmental impact.(2)(7) Limitations of the study include the small purposive sample size, which restricts generalization, and the self-reported nature of the data, prone to social desirability bias. These results need to be validated in larger samples through future multicentre studies, using observation methods wherever feasible.(11)
CONCLUSION
75% of the nurses were aware about BMW management rules. The importance of training regarding biomedical waste management needs emphasis and adherence to practices as per BMW management rules.Efforts should also be directed at the creation of awareness among all nursing staff regarding health hazards, the use of PPE by each member, and the facilitation of universal Hep B vaccination.
ACKNOWLEDGEMENTS
The authors thank the study participants and the staff of the Department of Community Medicine, Tezpur Medical College, for their cooperation and support during the conduct of this study.
REFERENCES
Dr. S.K. M.D. Wasim Ikbal*, Dr. Rupali Baruah, Dr. Shashanka Chakraborty, Knowledge, Attitude and Practice of Biomedical Waste Management Among Nursing Staff in a Tertiary Care Centre of Sonitpur District of Assam, Int. J. of Pharm. Sci., 2026, Vol 4, Issue 2, 1196-1201. https://doi.org/10.5281/zenodo.18533745
10.5281/zenodo.18533745
