Perceived risk and associated factors of healthcare waste in selected hospitals of Kathmandu, Nepal

PLOS ONE RESEARCH ARTICLE Perceived risk and associated factors of healthcare waste in selected hospitals of Kathmandu, Nepal Sulata Karki ID1*, Surya Raj Niraula2, Sabita Karki3 1 Department of Public Health and Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal, 2 School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, 3 National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 * Abstract Background OPEN ACCESS Citation: Karki S, Niraula SR, Karki S (2020) Perceived risk and associated factors of healthcare waste in selected hospitals of Kathmandu, Nepal. PLoS ONE 15(7): e0235982. https://doi.org/ 10.1371/journal.pone.0235982 Editor: Mentore Vaccari, University of Brescia, ITALY Received: April 24, 2020 Accepted: June 25, 2020 Published: July 13, 2020 Copyright: © 2020 Karki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Abbreviations: AOR, Adjusted Odds Ratio; CI, Confidence Interval; HCWM, Healthcare Waste Management; SPSS, Statistical Package for Social Sciences. Healthcare waste management is the subject of a neglected issue in many developing countries. Health care facilities are facing a major challenge in handling healthcare wastes and reducing their potential risks to human health and the environment. Insufficient understanding of the risk associated with healthcare waste by health workforce can contribute to poor waste management practices. The main aim of this study is to assess risk perception towards healthcare waste among hospital attendants and to identify associated factors. Methodology We carried out a cross-sectional hospital-based study among 120 attendants of a private and public hospital in Kathmandu, Nepal. We used two-stage random sampling for the selection of hospital and participants. We conducted a face-to-face interview with the participants using semi-structured questionnaires. Based on the mean score, we classified risk perception as good and poor. Bivariate and multivariate analysis was carried out to determine associates of risk perception towards healthcare waste. Results Approximately 51.0% of hospital attendants had poor risk perception of healthcare waste. Nearly half of the participants (49.2%) had inadequate knowledge and 43.0% had a negative attitude. Factors such as healthcare waste management training (p = 0.028), housekeeping department (p = 0.036) and attitude (p = 0.001) were associated with risk perception of healthcare waste. Conclusion Hospital attendants had a poor understanding of risk perception of healthcare waste. Periodic training on healthcare waste management and edification on the risk associated with healthcare waste is essential to boost awareness among all healthcare workers. PLOS ONE | https://doi.org/10.1371/journal.pone.0235982 July 13, 2020 1 / 10 PLOS ONE Perception of hospital attendants on healthcare waste Communication on behavioral improvements for appropriate waste management must be prioritized to change the perception of health workers. Introduction Healthcare wastes are generated from different health care facilities which comprised of 85% general wastes i.e. non-hazardous, and rest 15% hazardous waste that may be infectious, toxic or radioactive.[1] Infectious waste have been accountable for public health risk and environmental challenges around the world.[2] Healthcare waste is second most dangerous waste after radiation waste.[3] With the increase in global population and expansion of medical facilities, the amount of waste generation is continuously rising.[4] In a study of epidemiological literature on the health effects of residence near hazardous waste disposal sites in the United Kingdom, it was found that increases in the risk of adverse health effects such as low birth weight, birth defects, certain forms of cancer have been identified near individual landfill sites and in some multi-site studies.[5] Self-reported disease symptoms like fever, headache, dizziness, itching, burning sensation in eyes, skin rash, cough, and accidental injuries from sharps were identified on human scavengers.[6] Complaints of difficulty breathing due to burning healthcare wastes, foul smell from the hospital, children’s exposure to dumping sites with contaminated syringes have been reported to health professional by the people residing around the hospital.[7] Every year, it is anticipated that over two million healthcare workers are exposed to percutaneous injuries with infected sharps.[8] There is a high perceived risk of HIV infection caused by healthcare waste in the United States of America.[9] The actual risk of contracting Hepatitis B from the handling of healthcare waste is higher than the risk of infection from other routes. [9] Health care workers and waste handlers are with the maximum risk of injury or infection due to close contact with infected healthcare wastes.[10] It is noted that the release of highly toxic fumes as a result of open burning and incineration of medical waste can cause adverse health effects and also contribute to global warming.[11] Despite small volume of healthcare waste generated within the hospitals, its disposal and proper management is a complex task and requires additional resources as it can pose a risk of infection to waste handlers.[12] The task of waste management is often assigned to less experienced and unskilled healthcare workers, who perform most activities without proper guidance and insufficient protection in resource constraint settings.[13] Healthcare workers, patients, clients, attendants and waste handlers have been responsible for most of the health problems particularly due to infectious wastes such as bloodborne pathogens, if unmanaged properly.[13] An increasing number of health facilities in South Asia has led to major challenges in managing healthcare wastes. For instance, uncontrolled burning, reuse of disposable items, unintended accidents from improperly discarded sharps are frequent and lead to health risks.[14] One of the biggest challenges in managing waste can be poor practices as well as substandard information on healthcare waste.[15] According to the Government of Nepal, a total of 274 hospitals produce 10,520 tons of nonhazardous and 3,094 tons of hazardous medical waste per year. These wastes disposed of with normal municipal garbage was a major concern for waste collectors.[16] A study conducted in some health institut (...truncated)