key: cord-0799658-62wxe077 authors: Lemma, Hailu; Asefa, Lechisa; Gemeda, Tesfaye; Dangesu, Degefa title: Infectious medical waste management during the COVID-19 pandemic in public hospitals of West Guji zone, southern Ethiopia date: 2022-03-26 journal: Clin Epidemiol Glob Health DOI: 10.1016/j.cegh.2022.101037 sha: b9f31441019fa56a19716231360b3654d2fe6d24 doc_id: 799658 cord_uid: 62wxe077 INTRODUCTION: COVID-19 has swept through the world in a very short period; large volumes of medical waste are being generated in response to the pandemic. Hence, it is imperative to plan and develop evidence-based additional waste management systems. OBJECTIVE: To assess infectious medical waste management system during the COVID-19 pandemic in public hospitals of the West Guji zone, southern Ethiopia, 2020. METHODS: Institution-based cross-sectional study design was conducted from November 05-25/2020. To determine infectious medical waste generation rate different color plastic buckets and bags was distributed to each ward of the hospitals. Then, its quantity was measured by using a calibrated weighing balance for seven consecutive days. An interviewer-administered questionnaire and an observational checklist were used to collect data related to the existing waste management system, and the knowledge, attitude and practice of waste handlers. The data were analyzed by SPSS version 25 and presented in tables, figures and texts as appropriate. RESULT: The average infectious medical waste generation rate was determined to be 2.1 kg/bed/day and/or 0.57kg/patient/day. Besides, there was limited segregation of infectious medical waste at the point of generation. Mixed medical waste was collected and transported by using open plastic bin and burned in a brick incinerator or/and dumped in an open field. Moreover, about 42%, 44.6% and 64.8% of the waste handlers had adequate knowledge; a positive attitude and adequate practice respectively. CONCLUSION: The average infectious medical waste generation rate is above the threshold value (0.2kg/bed/day) set by the WHO. Besides, its management was limited. There was also a gap in the knowledge and attitude of waste handlers towards infectious medical waste management during the COVID-19 pandemic. COVID-19 has swept through the world in a very short period, causing widespread concern for 26 many countries 1 . Large volumes of medical wastes, such as personal protective equipment, are 27 being generated in response to the pandemic 2 . 28 The study conducted in Hubei Province, People's Republic of China, showed that the infectious 29 medical waste generation was increased by 600% from 4 tons per day to 240 tons per day during 30 the COVID-19 outbreak 3 . This quickly overwhelmed existing medical transport and disposal 31 infrastructure around hospitals 4 . Especially in least developed countries, where there is no or 32 very limited safe management of health care waste 5 ; the outbreak of COVID-19 further 33 exacerbates the already growing waste management challenges 6 . 34 In Ethiopia, as in many developing countries COVID-19 transmission and the number of 35 COVID-19 patients were rising sharply within the past few months; and thus increasing demand 36 for health services. These combined trends increase the amount of medical waste generated in the 37 country 7 . 38 However, waste management across health institutions is still inadequate and received less 39 attention 8, 9 . At the same time, there is very low attention is given to healthcare waste 40 management (HCW) by healthcare administrators. So that, the impact of improper medical waste 41 management on the health of healthcare waste collectors is assumed to be very high 10 . Hence, it 42 is imperative to plan and develop evidence-based additional waste management systems 11 , to 43 reduce the risk of COVID-19 transmission. 44 Therefore, this study will be aimed at filling this gap by providing important information on the 45 amount of infectious medical waste generated, identify the gap in existing infectious medical 46 management practices as well as knowledge, attitude and practice of healthcare waste handlers 47 Then, the quantity of infectious medical waste generated from each ward was measured using a 81 calibrated weight balance for seven consecutive days 12 . During data collection, data collectors 82 were used gloves, masks, gowns and antiseptics to prevent infection. 83 The existing infectious medical waste management system practiced in each hospital and the 84 knowledge, attitude and practice of healthcare waste handlers towards infectious medical waste 85 management during the COVID-19 pandemic was investigated by using a pretested interviewer-86 administered questionnaire and observational checklist adapted from the United Nations 87 Environmental Program (UNEP) 13 . 88 The questionnaire of knowledge, attitude and practice domains consisted of 14, 13 and 8 89 questions, respectively. Knowledge and practice responses were scored as either 1 or 0 points for 90 correct and incorrect responses, respectively. Whereas, attitude questions responses were 91 indicated with the three-point Likert type scale of measurement as "disagree", "neutral" and 92 "agree" and numerical values of 1, 2, and 3, respectively. Then, the mean scores were calculated 93 and used as a cut of a point to categorize the knowledge, attitude and practice of the study 94 participants as adequate knowledge, positive attitude, and adequate practice scores 14 Thematic analyses of the data were conducted manually, by sorting and organizing information 110 according to their thematic similarities and differences. Then, the information was categorized 111 and studied to understand their relationships in the overall context of the study. 112 Data Quality Assurance: To assure the data quality, training was given to data collectors on 113 how to use personal protective equipment and on data collection tools. The weighing scale was 114 calibrated before the actual measurements started. An interview-administered questionnaire was 115 pretested with a pilot survey of a similar study population at Yabello general hospital before the 116 actual data collection period. In addition, daily on-site supervision was made by the supervisors 117 during the actual waste measurements. 118 Basic infectious medical waste management service: -Waste is safely segregated into at least 120 three bins, and sharps and infectious waste are treated and disposed of safely. 121 Limited infectious medical waste management service: -There is limited separation and/ or 122 treatment and disposal of sharps and infectious waste, but not all requirements for basic service 123 are met. 124 No infectious medical waste management service: -There are no separate bins for sharps or 125 infectious waste, and sharps and/or infectious waste are not treated/disposed of safely. 126 Adequate knowledge: -participants who correctly answered the knowledge-based questions 127 greater than or equal to the mean knowledge score were considered as having adequate 128 knowledge. 129 Inadequate knowledge: -participants who answered the knowledge-related questions correctly 130 less the mean knowledge score were considered as having inadequate knowledge. 131 Positive attitude: -those participants who correctly responded to the attitude-related questions 132 greater than or equal to the mean score were considered as having a positive attitude. Adequate practice: -those participants who correctly answered greater than or equal to the 136 mean score of the practice-related questions were considered as having an adequate practice. 137 Inadequate practice: -those participants who correctly answered less than the mean score of 138 the questions were considered as having an inadequate practice. 139 Ethical permission to undertake the study was obtained from Bule Hora University Research and 141 Community Service Directorate. An official letter of cooperation was given to west Guji zone 142 hospitals. Informed consent to participate in the study was obtained before conducting the 143 interview. Infectious medical waste generation rate: The average infectious medical waste generation 153 rate in all public hospitals of the west Guji zone was determined to be 0.57 kg/patient/day and/or 154 2.1 kg/bed/day. It was identified that a high amount of infectious medical waste was generated 155 from Bule Hora general hospital (0.26 kg/patient/day), while the least amount was recorded at 156 Melka Soda primary hospital (0.15 kg/patient/day) ( Table 1) . Pearson's 163 correlation coefficient (r) was used to test the existence of any bivariate correlation between the 164 total number of patients and the amount of infectious medical waste generated from the public 165 hospitals. Accordingly, there was a strong positive correlation between the total amount of 166 infectious medical waste generated and total patient flow in the public hospitals (r = 0.91, p = 167 0.004). 168 the result of finding from the mentioned research showed that the inadequate level of knowledge 279 is due to a low level of training particularly for the cleaning staff. The infectious medical waste generation rate during the COVID-19 pandemic (2.1 kg/bed/day 282 and/or 0.57 kg/patient/day) is above the threshold value of hazardous health care waste 283 generation rate in low-income countries, as reported by the WHO, and its management was poor. 284 There is also a gap in the knowledge and attitude of healthcare waste handlers towards infectious 285 medical waste management systems. Thus, in order to prevent and control the transmission of 286 coronavirus; all public hospitals of West Guji zone needs for further planning and improvement 287 of the current infectious medical waste management system following the national and 288 international guidelines. 289 We would like to express our sincere thanks to Bule Hora University for giving us ethical 291 clearance. 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