ABSTRACT
The study uses FMC and AKTH as a case study in order to assess the
knowledge, practices and attitudes of waste handlers on biomedical waste
management. The study investigates the major problems associated with
management and handling practices and the possible solutions to tackle those
problems. Based on the findings from this study, recommendations will be proposed
to the hospitals on ways to improve the system of biomedical waste management and
handling.
A total of 12 individuals from a private company named Gaby-cord limited
were involved in the survey at FMC, sample size was chosen based on the idea of
saturation. Questionnaires, semi-structured interviews and direct observation were
used to gather all the data required for the study at FMC. On the other hand, semistructured
interviews, direct observation and hospital records were used to acquire
vii
information at Aminu Kano teaching hospital (AKTH), Kano. A total of three
individuals were involved in the survey including the head of department, data
collection was carried out at AKTH.
FMC waste handlers have limited knowledge on biomedical waste
management legislations and guidelines. Waste handlers have positive attitudes
towards biomedical waste management and are aware of common practices of
biomedical waste management. Generally biomedical waste management is poor at
FMC. On the other hand, AKTH has the potential to meet the standard biomedical
waste management system proposed by the World Health Organization. However, it
is recommended for both hospitals to aim for positive goals based on fixed standards
and set a time frame at which the goals are expected to be achieved.
Key words: Biomedical Waste, Biomedical Waste Management, Waste Handlers,
Knowledge, Attitude and practices.
viii
TABLE OF CONTENTS
Title page …………………………………………………………………………………….. i
Certification ……………………………………………………………………………….. ii
Readers’ approval ………………………………………………………………………. iii
Dedication ………………………………………………………………………………… iv
Acknowledgement ……………………………………………………………………….. v
Abstract ……………………………………………………………………………………. vi
Table of contents……………………………………………………………………….. vii
List of table …………………………………………………………………………….. ix-x
List of abbreviations ……………………………………………………………………. x
1.0 Introduction ………………………………………………………………………….. 1
1.1 Statement of problem …………………………………………………….. 2
1.2 Aim/Objectives …. ………………………………………………………… 2
1.3 Hypothesis …………………………………………………………………… 3
1.4 Study Area …………………………………………………………………… 3
2.0 Literature Review …………………………………………………………………… 5
2.1 What is biomedical waste? ……………………………………………… 5
2.2 Classification of Biomedical waste …………………………………… 5
2.3 Categories of Biomedical waste ………………………………………. 8
2.4 Sources of Biomedical waste in Yola/Nigeria …………………… 10
2.5 Biomedical waste management ……………………………………… 11
2.6 Standard for biomedical waste management system ………….. 11
2.7 Need for biomedical waste management …………………………. 14
2.8 Impacts of poorly managed biomedical waste ………………….. 14
2.9 Problems faced by healthcare centers in Nigeria ……………….. 17
ix
3.0 Materials and Methods …………………………………………………………… 21
3.1 Federal Medical center …………………………………………………. 21
3.1.1 Research strategy ……………………………………….. 21
3.1.2 Questionnaire administration ……………………….. 21
3.1.3 Semi structured interviews …………………………… 22
3.1.4 Direct observation ………………………………………. 22
3.2 Aminu Kano Teaching Hospital …………………………………….. 22
3.2.1 Research strategy ……………………………………….. 22
3.2.2 Semi structured interviews …………………………… 23
3.2.3 Direct observation ……………………………………… 23
4.0 Analysis and Results ……………………………………………………………. 24
4.1 Federal Medical center (FMC) ………………………………………. 24
4.1.1 Observation outside wards (FMC) …………………. 25
4.1.2 Qualitative data from interview ……. ……………… 34
4.2 Aminu Kano Teaching Hospital (AKTH) ………………………… 36
4.2.1 Data from interview/ hospital records …………………….. 37
5.0 Discussion ……………………………………………………………………………. 44
5.1 Problems encountered during survey ………………………………. 44
5.2 Findings from FMC, Yola …………………………………………….. 45
5.3 Findings from AKTH, Kano ………………………………………….. 48
5.4 Comparison of BMWM practice at AKTH and FMC ………… 51
6.0 Conclusion and recommendations ………………………………………….. 52
References ……………………………………………………………………… 54
Appendix ……………………………………………………………………….. 57
x
LIST OF TABLES/FIGURES
Table: 1 Classification of BMW (FMC) …………………………………………………… 9
Table 2: Diseases associated with BMW (FMC) ………………………………………. 16
Table 3: Observation within wards (FMC) ………………………………………………. 24
Table 4: Knowledge of BMWM hazard/legislations (FMC)….. ………………….. 29
Table 5: Awareness of BMWM practices (FMC) ……………………………………… 31
Table 6: Attitude towards BMWM (FMC) ………………………………………………. 33
Table 7 Observation within wards (AKTH) ……………………………………………… 36
Fig 1 FMC, Yola …………………………………………………………………………………… 4
Fig 2 Biohazard symbol …………………………………………………………………………. 7
Fig 3 Landfill Disposal ………………………………………………………………………… 13
Fig 4 Color-coding segregation of waste …………………………………………………. 13
Fig 5Yearly progression of waste collection ……………………………………………. 20
Fig 6 Waste bins at the emergency ward …………………………………………………. 27
Fig 7 Waste bins at the laboratory ward ………………………………………………….. 28
Fig 8 Graphical representation of Knowledge assessment …………………………… 30
Fig 9 Graphical representation of awareness assessment ……………………………. 32
Fig 10 Attitude assessment towards BMWM …………………………………………… 34
Fig 11 Temporary dumpsite …………………………………………………………………. 36
Fig 12 AKTH segregation of waste ………………………………………………………… 37
Fig 13 Ballet incinerator ……….. …………………………………………………………….. 38
Fig 14 Mechanical incinerator ………………………………………………………………. 38
Fig 15 Needle pit …………………………………………………………………………………. 39
Fig 16 Face Mask ……………………………………………………………………………….. 40
Fig 17 Googles …………………………………………………………………………………… 40
Fig 18 Protective clothing for waste handlers …………………………………………… 41
Fig 19 Staff involved in BMWM ……………………………………………………………. 42
Fig 20 Training sessions for healthcare workers ……………………………………….. 43
xi
List of abbreviations
BMW- Biomedical Waste
BMWM- Biomedical Waste Management
WHO- World health Organization
AKTH- Aminu Kano Teaching Hospital
FMC- Federal Medical Center
USAID- United States Agency for International Development
NHMCR- National Health and Medical Research Council
LAWMA- Lagos State Waste Management Agency
1
1.0 INTRODUCTION
Healthcare Waste, also referred to as Biomedical Waste (BMW) is rated to
be the second most hazardous form of waste after radioactive waste. People with
diverse form of infections visit the hospital for treatment; this involves the use of
medical equipment which is regarded as BMW after use. A reasonable number of
hospitals especially in underdeveloped countries fail to manage BMW properly
therefore putting lives at risk. Considering the fact that this category of waste is
generated in medical facilities, its threats can go beyond the facility premises and
affect other people and organisms. It has been noted that an estimated sixteen million
injections are administered globally in a year, but not all of the needles and syringes
are properly disposed of afterwards (WHO, 2011). Improper management of BMW
further promotes higher occurrence and prevalence of diseases both within and
outside the medical facility.
Poor management of BMW has become more prominent especially in the
northern part of Nigeria due to the insufficient attention given to the issue. In most
Nigerian hospitals, waste handlers are employed without considering their level of
knowledge and certification (Longe, 2006). Within healthcare centers waste
segregation can be said to be a major drawback, infectious wastes are usually mixed
up in the same containers with non-infectious waste; thereby increasing the quantity
of infectious waste (Sanusi, 2014). Other factors that promote improper healthcare
waste handling and management in Nigeria include: handling by poorly trained
workers, insufficient resources to carry out the necessary practices and ignorance of
responsibility to handle the waste produced (Khopar, 2009).
2
1.1
Statement of problem
Considering the fact that BMW has been rated as one of the most
hazardous categories of waste in the world, insufficient attention is given to the topic.
To be more precise, BMWM has become a major problem over the years in Nigerian
hospitals. Regarding the health of individuals, proper management of waste has to be
considered as a top priority in both government and owners of private hospitals.
Ignorance of responsibilities to safeguard the health of individuals from the
hazards associated with BMW is a primary issue as well. It is usually assumed that
waste handlers are in charge of waste management but ironically, the 1998 rule on
biomedical waste handling and management clearly states that the responsibility lies
among all those that generate, treat, transport and dispose biomedical waste in
healthcare centers disposal (Ministry of Environment & Forests , 1998).
The question is, despite the fact that BMW is highly and potentially
infectious, why is its proper disposal still a major issue in Nigerian hospitals today?
Results from several studies have investigated several reasons behind this major
drawback. The study in progress uses FMC and AKTH to know the stance of
biomedical waste management in both hospitals.
1.2
Aim/Objectives
This study aims at assessing knowledge, awareness and practices of
biomedical waste management among waste handlers at FMC and AKTH.
– To promote awareness of biomedical waste management among waste
handlers at the hospitals.
3
– To provide feedback and recommendations based on the research to the
hospitals.
– To understand the major drawbacks that result in improper biomedical waste
management in the country.
1.3
Hypothesis
– Practices of BMWM will be poor at FMC and AKTH because they are
tertiary healthcare centers and therefore will not be easy to maintain.
– Knowledge and awareness of BMWM will not be common among waste
handlers due to their level of education.
1.4
Study area
Adamawa state which was formally part of Gongola State was established
in 1991 and is located in the northeastern Nigeria. The state occupies almost 40,000
square kilometers and is populated with about 3,106,585 people (Federal republic of
Nigeria, 2006). It has twenty one local governments with Yola as the State capital.
Compared to other states in Nigeria, Yola is yet to develop to meet with the
development level in Nigeria.
FMC is located on Lamido Zubairu way; Yola bye-pass and is a tertiary
health care center in north eastern Nigeria. The vision of the facility is to be the best
healthcare center in north eastern Nigeria and to be the one of the top ten best
hospitals in the country (Taking It Global, 2014). The hospital has several
departments including casualty wards/ emergency, major operating theatre, minor
operating theatre, laboratory and maternal ward.
Tertiary hospitals are known to have units or organizations in charge of
their waste management. In the case of FMC, Gaby-Cord Company is responsible for
4
its waste disposal. The branch of the company is located near the hospital at Lamido
Zubairu Way; Yola bye-pass, it provides laundry services, office and home cleaning,
industrial waste management and disposal and environmental beautification.
Fig 1: FMC, Yola
Source: FMC official website
On the other hand, Kano State which is located the north western part of
Nigeria is a well-developed and populated city. AKTH is a well-known federal
hospital in northern part of Nigeria and it is located along Zaria Road, Kano. It was
established in 1988 and it is well known for its constant records of effectiveness and
professionalism. The hospital’s goal is to ensure that patients are satisfied with their
services and to provide job opportunities for less privileged people in the society.
The hospital has several departments including dental and maxillofacial, hematology
5
and blood transfusion, histopathology, microbiology and parasitology, pediatric,
pharmacy, and physiotherapy.
The environment and horticulture department is responsible for managing and
handling biomedical waste and other aspects of maintaining a fit and healthy hospital
environment. Some of these include the following:
-Ensuring general sanitation of the hospitals
-Undertaking pest and /vector control
-Undertaking fumigation in operating theatres
-Disposing corpses and displacement of from histopathology department
-Collecting and disposing of safety boxes and expired unit of blood
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