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.
TABLE OF
CONTENTS
Title
Page
Abstract
Table
of Contents
List of Tables
List of Figures
Abbreviations
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study
1.2 Statement of the Problem
1.3. Objective of the Study
1.4 Research Questions
1.5 Hypothesis
1.6 Scope of the Study
1.7 Justification for the Study
1.8 Operational definition of terms
CHAPTER TWO: REVIEW OF LITERATURE
2.0 Introduction
2.1 Nature of healthcare waste
2.1.1 Sharps waste
2.1.2 Infectious waste
2.1.3 Pathological waste
2.1.4 Pharmaceutical waste
2.1.5 Chemical waste
2.1.6 Radioactive waste
2.2 Healthcare waste management
2.3 Healthcare waste generation
2.3.1 Healthcare waste generation in developing
countries
2.3.2 Healthcare waste generation in developed
countries
2.4 Healthcare waste management practices
2.4.1 Segregation
2.4.2 Handling and collection
2.4.3 Storage
2.4.4 Transportation
2.4.5 Treatment and disposal
2.4.6 Training and education
2.5 Health waste management practices in
developed countries
2.6 Healthcare waste management practices in developing
countries
2.7 Potential impacts associated with
healthcare waste
2.8 Acts and legislation on healthcare waste
management
2.9 Theoretical Framework
2.10 Concept adopted for the study
2.10.1 Concept of cleanliness
CHAPTER THREE: METHODOLOGY
3.0 Introduction
3.1
Research Design
3.2 Population
3.3 Sample size and sampling Technique
3.4 Research Instruments
3.5.1 Questionnaire
3.5.2 Field Observation
3.5.3 Validity and Reliability of Instrument
3.6 Method of Data Collection
3.6.1 Method of Data Analysis
3.7.1 Inclusion criteria
3.7.2 Exclusion criteria
3.8 Ethical Consideration
3.8.1 Permission for the study
3.8.2 Post research benefits
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND
DISCUSSION OF FINDINGS
4.1 Results
4.2 Discussion
CHAPTER FIVE:
SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary
5.2 Conclusion
5.3 Recommendations
5.4
Limitation of the Study
5.5 Suggestion for further Studies
REFERENCES
APPENDICES
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 provisionsfor 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:
1. identify
different types of waste generated in Healthcare facilities in Abeokuta South
Local Government (ASLG);
2. determine the
level of knowledge of health workers on Healthcare waste management and its
segregation;
3. assess the
healthcare waste management as practiced by health workers and
4. determine how healthcare wastes are
finally disposed off, by the healthcare facilities in
ASLG.
1.4 Research Questions
1. What are the types of Healthcare wastes generated at
health facilities in ASLG?
2. What is the level of knowledge of health workers on
healthcare waste management?
3. What is the practice of healthcare waste management by
health workers?
4. 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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