Awareness on Medical Waste Management and Occupational Health Safety among the Employees Related to Medical Services at Upazila Level in Bangladesh

Journal of Environmental Treatment Techniques

2019, Volume 7, Issue 3, Pages: 282-288

J. Environ. Treat. Tech.

ISSN: 2309-1185

Journal web link: http://www.jett.dormaj.com

Awareness on Medical Waste Management and

Occupational Health Safety among the

Employees Related to Medical Services at

Upazila Level in Bangladesh

Kazi Shamima Akter *, Shaikh Mohammad Shamim Reza

- Military Institute of Science and Technology, Bangladesh University of Professionals, Dhaka, Bangladesh

- University of Asia Pacific, Dhaka Bangladesh

Received: 25/02/2019

Accepted: 10/06/2019

Published: 30/09/2019

Abstract

The proper knowledge in waste management is a vital requirement the proper waste management. Whereas the number of

Healthcare Establishments (HCEs) is increasing day by day at upazila level, it is necessary to evaluate the level of knowledge on

medical waste management of the employee related to medical services. It is also necessary to find the occupational health safety

practices among the employees. In this study, Singra Upazila of Natore district in Rajshahi division has been selected to achieve

the objectives of the study. A total 40 numbers of HCEs was selected in the study area. To find the level of knowledge in Medical

Waste Management (MWM) practices, a questionnaire survey was conducted among the employees of the selected HCEs. The

questionnaire also helped to find the occupational health safety practice and the difficulties faced by the employees. After getting

all the data from field observation and questionnaire survey, the results are accumulated by using SPSS software. After that,

results were presented by tables and bar charts. It was found that, hands on training played an important role in both knowledge

level of employees and occupational health safety practices. It was also found that all the non-government employees are non-

trained. On the other hand, most of government employees are trained and only a few were non-trained. So, the comparison

between government and non-government can consider as the comparison between trained and non-trained employee. The

knowledge level of government HCE‟s employees found higher than the private HCE‟s employees. The government HCE‟s

employees were also more aware about occupational health safety practices. So, they had less injuries the private HCE‟s

employees. Workers were facing different types of difficulties as well as occupational health hazard in both types of HCEs.

Finally it was recommended that, to run a proper waste management system, the employees will need hands on training on it.

Keywords: Medical Waste, Hazardous waste, Rural Health Care, Awareness, Knowledge, Occupational health safety

[

4]. Therefore, it is necessary to focus on the medical waste

Introduction

management system in rural level.

Medical waste management is an important issue at

It was found from a study that the non-government

hospitals managed medical wastes better than the

government ones [5]. Another study showed that

government HCEs are slightly better than the private HCEs

in upazila level [2]. A few NGO‟s are working on MWM

present days. The number of HCE is increasing day by day

at upazila level to give health care service for the people of

remote area [1]. Although the MW generation was in a

considerable amount but the waste management system was

found very poor. There was a vast lacking to follow the

waste management rules in this level [2]. Improper disposal

of medical wastes poses to transmitting hepatitis B and C,

HIV and other blood-borne diseases [3]. A study showed

that, about 5.2 million people including 4 million children

die each year from waste-related diseases all over the world

[6]. Although there is a future action plan of Ministry of

Health and Family Welfare (MoHFW) of Bangladesh, but

the overall present scenario of MWM in rural areas is not

satisfactory [7].

The proper waste management is not possible without

having the proper awareness and knowledge in waste

management. It is also very important to follow the

occupational health safety issues when it deals with

hazardous waste. The objectives of the study were knowing

the awareness, perception and knowledge about MWM of

Corresponding author: Kazi Shamima Akter, University

Asia

Pacific,

Dhaka

Bangladesh.

E-mail:

engr.shamim.ce@gmail.com.

Journal of Environmental Treatment Techniques

2019, Volume 7, Issue 3, Pages: 282-288

the employees related to medical services and to assess the

occupational health hazard and difficulties faced by the

employees in current medical waste management system

and their suggestions to improve the system.

Table 1: List of Healthcare Establishment (HCEs) selected

for the study

Sl. HCE Name

Type of HCE

Singra Upazila Health Complex

U.H.C.

Chowgram U.S.C.

Dangapara U.S.C.

Hulhulia U.S.C.

Kaliganj U.S.C.

Sukash U.H.F.W.C.

Dahia U.H.F.W.C.

Kalam U.H.F.W.C.

Chamari U.H.F.W.C.

Hatiandaha U.H.F.W.C.

Sherkole U.H.F.W.C.

Ramananda Khajura U.H.F.W.C.

Boalia C.C.

Materials and Method

Chowgram

Union Sub

Center

.1 Background information and Study Area

Singra Upazila was selected for the study area. The

upazila is situated at Natore district in Rajshahi division. It

The total area of the upazila is 528.46 square kilometer.

There are 12 unions and only one pourashava in this

upazila [2].

Union Health

and Family

Welfare

Centers

Joykuri C.C.

Dahia C.C.

Baragram C.C.

Kheerpota C.C.

Pakuria C.C.

Bonkury C.C.

Satpukuria C.C.

Mahismari C.C.

Gunaikhara C.C.

Baro baroihati C.C.

Chakpur C.C.

Community

Clinic

Shedhakhale C.C.

Puthimary C.C.

Tajpur C.C.

Figure 1: Map of Study Area (Source: Reza et. al., 2018)

Naogaon C.C.

Sthapondighi C.C.

Choto Chowgram C.C.

Singra upazila has an upazila health complex (UHC), 4

Union Sub Centres (USC), 8 Union Health and Family

Welfare Centres (UHFWC), 42 community clinics (CC)

and 3 registered diagnostic centres [8]. But the number of

private clinic and diagnostic centre were increasing. For

this study, the upazila health complex, 4 Union Sub

Centres, 7 Union Health and Family Welfare Centres, 22

community clinics and 6 private clinics and diagnostic

centres were selected which are shown in Table 1.

31 Bhulbaria C.C.

Pakisha C.C.

Panch pakhia C.C.

34 Bingram C.C.

Janani Diagnostic Center

Singra Diagnostic Center

Private clinic

and

.2 Methods

37 Al Hera Clinic and Diagnostic Center

This study was carried out from February 2015 to

December 2016. The methodology of the study was

focused on questionnaire survey. The questionnaire survey

helped to understand the level of knowledge and awareness

of the people related to medical services. It also gave a

view of occupational health hazard.

Diagnostic

Center

Desh Clinic and Diagnostic Center

Mahanogor Clinic

40 Dip Medical Services

2.3 Population and Sample

The population which has been selected for the study

was the medical employees like doctors, administrator,

nurse, paramedic, pathologist, chemists and workers of

Journal of Environmental Treatment Techniques

2019, Volume 7, Issue 3, Pages: 282-288

both sex in the HCEs. Total number of population was 273.

Inclusion criteria was, all co-operative employee who were

willing to participate in the study. And exclusion criteria

was, employees who were not willing to participate in the

study. The sample size was 85 due to time constraint.

Simple random sampling technique was followed.

The questionnaire was distributed among the HCEs 85

staffs. Then a small brief was given about the questionnaire

and the project. Survey was conducted when most of the

employees were less busy.

their professional position, gender, age, education level, job

experience, nature of job and training in health care sector

are shown in table 2.

Table 2: Demographic Data of Employees

Number

of People

Characteristics Category

Percentage

Doctor

17.65%

11.76%

29.41%

17.65%

23.53%

51.76%

48.24%

37.65%

41.18%

7.06%

Administrator

Professional

Position

Nurse/Paramedic

Pathologist/Pharmacist

Worker

.4 Questionnaire survey

A structured questionnaire was designed to collect

information regarding personnel knowledge about MWM.

The questionnaire was developed to collect data about all

level of personnel working in HCEs. It aimed at gathering

information about the demographic data like age, gender,

professional background etc.; training and interest towards

training; perception about MWM; knowledge about MWM

system; occupational health hazard and safety; difficulties

and problems; suggestions and opinions.

Male

Gender

Age

Female

8-30 years

31-40 years

41-50 years

1-60 years

7.06%

Designing or formulating the questionnaire is a very

important step.

61+ years

Post-Graduate

Graduate

Diploma

7.06%

5.88%

The first few questions were general which aimed

to address the age group, gender, the professional

background of the person to understand his/her

interest towards waste management.

28.24%

29.41%

9.41%

Education

Level

H.S.C.

ii.

There were also questions was focusing on

whether he/she knows the difference between

normal municipal waste and medical waste,

constituents and knowledge of the hazard

category of infectious waste. It also examined

people„s awareness about the risk associated with

the medical waste.

S.S.C.

5.88%

Primary

14.12%

7.06%

Below Primary

1-5 years

42.35%

25.88%

20.00%

4.71%

-10 years

Job Experience

in Health Care

Sector

iii.

iv.

There were also questions regarding current

waste segregation practice.

Following questions examined on the awareness

about the occupational health hazards.

The purpose of next questions was to find out

participant„s attitude towards training or to take

part in a public meeting on waste management.

The following question was aimed to interpret

which technology does him/she considered as the

best way to treat medical waste.

11-15 years

16-20 years

1+ years

7.06%

Government

55%

Nature of job

Training

Non-

Government/Private

45%

vi.

Trained

50.60%

49.40%

Not-Trained

vii.

An open question was also asked about the other

obstacles they faced, coordination problems

within the various departments and suggestions to

improve the medical waste management at the

hospital.

Analysing all the data from table 1 it was found that, the

awareness, perception and knowledge of the employees

were not much affected by their professional position,

gender, age, education level and job experience.

Employees‟ nature of job and training on MWM mostly

influenced the results.

.5 Data processing and analysis

The results were tabulated in SPSS and were presented

through graphs, tables and charts. There will be several

comparisons to be presented graphically.

.2 Training on MWM

Training on MWM was a most important factor to

comparison of the awareness, perception and knowledge of

the employees. It was found that employees‟ awareness,

perception and knowledge depended on training. The

percentage of trained and non-trained employee according

to their job nature is given in figure 4.1.

. Result and Discussion

.1 Demographic Data of Employees

Total 85 employees of different categories were

surveyed. Demographic data about the employees included

Journal of Environmental Treatment Techniques

2019, Volume 7, Issue 3, Pages: 282-288

.4 Evaluation of Employee’s Perception about MWM

From figure 3 it was found that, all the government

employees thought that proper medical waste management

is an important issue. Because they were previously

familiar to MWM issue and got training on it. On the other

hands, 24% of non-government employees thought proper

medical waste management is not an important factor as

they were not familiar with the issues.

Figure 2: Training on MWM of the Employee

From figure 2, it is found that all the non-government

employees are non-trained. On the other hand, 91% of

government employees are trained and only 9% are non-

trained. So, the comparison between government and non-

government can consider as the comparison between

trained and non-trained employee.

Figure 3: Perception on proper medical waste management

.3 Evaluation of Employee’s Perception towards

Training

It was very necessary to understand the employee‟s

perception towards training. To operate and maintain a

MWM system needs trained employees. The system would

be introduced by training to them. So, it was needed to

know their interest on training as well as their thoughts

about importance of training.

Table 3: Employees perception towards training

Government

Employee

91%

Private

Employee

Trained Employees

Interested in Training

Acknowledges

100%

Figure 4: Perception on Municipal waste and Medical Waste

the

Importance of Training

Non-trained Employees

Not-interested

Thinking no importance

of Training

100%

From figure 4 it was found that, government employees

also performed better than the non-government employees

because of their previous knowledge about MWM which

was gathered by training. 87 percent of government

employee said that medical waste is different than the

municipal waste which was correct answer. 10 percent of

them said that both wastes were similar which was wrong

answer and 3 percent had no idea. On the other hand, 66

percent non-government employees gave the correct

answer, 13 percent gave wrong answer and 21 percent had

no idea.

From table 3 it is found that 100% of trained and un-

trained government employees were interested in further

training and they also realized the importance of training.

Due to having previous experience of training, they might

understand the importance of training and they were also

interested for further training.

Among private employees, 92% were interested in

training and realized the importance of training. Though,

those employees had no training but hearing these issues on

MWM they realized the importance of the issue and shown

interest on training. On the other hands, 28% of private

employees were not interested and 25% found no

importance of training. Those fewer employees had no

previous training and their education level was primary to

below primary level. Therefore, they did not understand the

importance of training and was found not interested in

training.

.5 Evaluation of Employee’s Knowledge on Identifying

Medical Waste

From figure 5 it was found that, regarding the

identification of kitchen waste as non-hazardous, both

government and non-government employees answered very

close. In case of paper, cartons and boxes they also

answered very close and identified those as non-hazardous

waste. It was easier to understand that, kitchen waste as

well as paper, cartons and boxes were non-hazardous

medical waste. Without training, it could be answered by

Journal of Environmental Treatment Techniques

2019, Volume 7, Issue 3, Pages: 282-288

using common senses.

Figure 7: Knowledge about the Elements of MWM (Non-Govt.

Employee)

Half of them gave wrong answer about MW disposal.

Behind all of these, it might be due to the lack of training

on MW management and practice. From figure 5 and 6 it

was found that, government employees were performed

better than non-government employees. The reason may be

the training facility and practice of MWM.

Figure 5: Identifying Hazardous MW and Non-Hazardous MW

In case of unused/expired medicine, large percentage of

government employees considered it as hazardous waste.

On the other hands, 66% of non-government employees

considered it as non-hazardous waste. To identify body

fluids, dressing cotton and plasters as hazardous waste,

government employees were more correct than non-

government employees. It may be due to the previous

training on MWM by the government employees.

.7 Occupational Health Hazard

The history of accidental injuries during management of

MW of the workers is given in figure 4.7.

.6 Evaluation of Employee’s Knowledge on the Elements

of Medical Waste Management System

From figure 6 it was found that, government employees

familiar with coloured bin. It might be the result of training.

But they had trouble to answer to segregation and storage

related questions. It was clear from that; they had a great

weakness in segregation practice as well as storage

practice. For these two elements they gave more wrong

answers and had no idea. Most of them did not answer

properly about the storage time. It may be happened due to

irregular practice of MWM system.

Figure 8: Injuries of workers during work

From figure 8, non-government employees were found

suffering from more injuries compared to the government

employees. The reason behind the less injury of

government workers was that they got training and had

some safety measures. Non-government workers

experienced almost double injury due to hand cut compared

to the government employees during handling of MW.

There was no burn injury for the government workers but

8% of non-government workers got burn during handling

of MW.

Figure 6: Knowledge about the Elements of MWM (Govt.

Employee)

.8 Workers using safety measures

Whereas workers were directly to involved with

handling, storing, disposing the medical waste, so it was

very important to measure safety precautions. Out of 20

workers, 12 of them were govt. employee and 8 were non

govt employee. Out of 20 workers, 14 of them were using

gloves, 12 workers were using safety dress, only 4 of them

were using boots. Gas musk and goggles were used by 6

From figure 7 it was found that, most of the non-

government employee had no idea about coloured bin,

segregation and storage. Above the fifty percent of them

had no idea about MW treatment.

Journal of Environmental Treatment Techniques

2019, Volume 7, Issue 3, Pages: 282-288

and 5 workers respectively. But sanitizer was used by 19

workers. The safety measures used by the employees are

shown in table 4.

Only 2% of government employees and 13% of non-

government employees were satisfied with their current

MW management practice. A large number of non-

government employees were not satisfied on their current

MWM. Because they did not have proper facilities for the

MW management in their HCEs.

Table 4: Safety measures used by HCEs‟ workers

Govt. Workers

Private Workers

Safety

Employees were also facing a lot of difficulties in the

current MW management practice. Improper disposal and

lack of treatment facility both were the major problems

identified by the highest percentage of both the government

and private HCEs employees. Regarding storage, collection

and safety issues, non-government employees were found

to face significantly more difficulties compared to

government employees. It was due to the lacking of these

facilities in the non-government HCEs. Employees of both

types of HCEs faced MW transportation problem. These all

were shown in figure 11.

Equipment

Frequency Percentage Frequency Percentage

Gloves

Dress

Boots

Gas musk

Goggles

Sanitizer

83%

75%

25%

33%

100%

50%

38%

13%

25%

13%

88%

From table 4, we can also illustrate the data in a

histogram below:

Figure 9: Workers using safety measures

From figure 9, it is very much accessible that, trained

workers were more aware about occupational health safety

practice then the un-trained workers.

Figure 11: Difficulties faced by employees

.9 Difficulties Faced by Employees in Current MWM

System and their Suggestion to Improve the System

From figure 10 it was found that, most of the

4 Conclusions and Recommendations

4.1 Conclusions

This study showed a scenario of different types HCEs in

upazila level. The knowledge level of government HCE‟s

employees found higher than the private HCE‟s employees.

The government HCE‟s employees were also more aware

about occupational health safety practices. So, they had less

injuries the private HCE‟s employess. Workers were facing

different types of difficulties as well as occupational health

hazard in both types of HCEs.

government employees were not much satisfied with their

current MWM system. Whereas there were some facilities

of MWM system in the government HCE, therefore a very

few of them said “not satisfied”.

To run

a proper waste management system, the

employees will need hand on training on it. Most of the

employees both government and private HCEs were

interested for training because they were realized the

importance of the issue. Many of them were trained before

but they were also interested for further training as well.

.2 Recommendations

The following recommendations for the future development

of MWM

Need to increase perception and knowledge level of

employee through hands on training.

Figure 10: Employees satisfaction on current MWM system

Journal of Environmental Treatment Techniques

2019, Volume 7, Issue 3, Pages: 282-288

Important to give emphasis on occupational health

safety of workers and staffs.

Government needs to focus on private HCEs also.

www.ncbi.nlm.nih.gov/pmc/articlesPMC2254398/pdf/1

471-2458-8-36.pdf.

7. MoHFW. Environmental Assessment and Action Plan

for Health, Population and Nutrition Sector

Development Program. Ministry of Health and Family

Welfare, Dhaka, Bangladesh; 2011. Available from:

http://www.mohfw.gov.bd/index.php?option=com_doc

man&task=doc_download&gid=359&lang=en.

Acknowledgment

Authors are very grateful to all the employees of the

Upazila Health Complex, Singra and all other health care

establishments for helping to the survey. Authors are also

thankful to the authorities of the HCEs for giving the

permission to undertake the interviews, without which, it

would be very difficult to fulfil the study.

DGHS. Health Bulletin 2014 - Singra Upazila Heath

Complex. Ministry of Health and Family Welfare,

Dhaka, Bangladesh; 2014. Available from: http://

www.app.dghs.gov.bd/localhealthbulletin2014/publish/

publish.php?org=10001438&year=2014.

Ethical issue

Authors are aware of, and comply with, best practice in

publication ethics specifically with regard to authorship

Authors Profile

(

avoidance of guest authorship), dual submission,

Major Dr. Kazi Shamima Akter

received her PhD. in Urban

Engineering from The University of

Tokyo, Japan in 2013. Also received

M.Sc. and B.Sc. in Civil Engineering,

from Bangladesh University of

manipulation of figures, competing interests and

compliance with policies on research ethics. Authors

adhere to publication requirements that submitted work is

original and has not been published elsewhere in any

language.

Engineering Technology

and

(

BUET), Dhaka, Bangladesh in 2010

Competing interests

The authors declare that there is no conflict of interest

that would prejudice the impartiality of this scientific work.

and 2007 respectively. Currenly she

is working as Assistant Professor at

Department of Environmental, Water

Resources and Coastal Engineering

(

EWCE), Military Institute of Science

Authors’ contribution

All authors of this study have a complete contribution

for data collection, data analyses and manuscript writing.

and Technology (MIST), Dhaka. Her

research interests are in Air

polutuion,

Carbon

emmision

footprint, climate change, waste

water treatment, water pollution,

water policies, water securities,

References

DGHS. Health Bulletin 2014 (Second Edition).

Ministry of Health and Family Welfare, Dhaka,

Bangladesh; 2014. Available from: http://www.

dghs.gov.bd/images/docs/Publicaations/HB_2014_2nd_

Edition_060115.pdf.

hazardous/medical

waste

management,

municipal

management etc.

Shaikh Mohammad Shamim Reza

received MBA from Army Isntitute

of Business Administration, Savar

under Bangladesh University of

Professionals, Dhaka; in 2019. He

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for medical waste management at upazila & rural level

in Bangladesh. Journal of Environmental Treatment

Techniques; 2018 6(1), p. 1-7

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Waste Management and Its Probable Health Effect: A

Lesson Learned from Bangladesh. Indian Journal of

Environmental Health; 2002. 44(2), p. 124-137.

received

M.Engg.

Civil

Engineering from University of Asia

Pacific, Dhaka; in 2018 and B.Sc. in

Civil Engineering from Stamford

University Bangladesh , Dhaka; in

012. Currenly he is working as a

Akter, N. 2000. Medical Waste Management:

Network Modeller at Dhaka Water

Supply and Sewerage Authority. He

Review. Asian Institute of Technology, Thailand; 2000.

Available from: http://www. eng-consult.com/ben/

papers/paper-anasima.pdf

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Hassan MM, Ahmed SA, Rahman, KA, Biswas TK.

Pattern of medical waste management: existing

scenario in Dhaka City, Bangladesh. Biomed Central

Research article: 2008. Available from: http://

has more then

7 years working

experience on Water Supply,

Sanitation and Waste Management

sectors. His research interests are in

hazardous/medical

management, municipal

waste

management, recycling of waste for

sustainable development etc.