|Year : 2016 | Volume
| Issue : 3 | Page : 161-167
To assess the knowledge, level of awareness, and attitude on biomedical waste management among practicing dentists in Bengaluru city: A cross-sectional study
Ramesh Lakshmikantha1, Jyotsna Kanyadara2, Deepa Bullappa1, N Vanishree1, KS Keerthi Prasad1, N Naveen1, M Anushri1
1 Department of Public Health Dentistry, Bangalore Institute of Dental Sciences, Bengaluru, Karnataka, India
2 Bangalore Institute of Dental Sciences, Bengaluru, KarnatakaBangalore Institute of Dental Sciences, Bengaluru, Karnataka, India
|Date of Web Publication||9-Jun-2016|
Department of Public Health Dentistry, Bangalore Institute of Dental Sciences, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Dental waste is a subset of hazardous biomedical (BM) waste. It has been observed that most of the dental health facilities, the guidelines for proper management of dental waste are not adopted and not up to the prescribed standard. Aim: The aim of this study is to assess the knowledge, awareness, and attitude/behavior of BM waste generation, hazards, and legislation among the study subjects using self-structured questionnaire. Methodology: A cross-sectional study was conducted in 337 practicing dentists in Bengaluru city for the past 2 months. A self-structured questionnaire was used to obtain required data. The questionnaire was divided into three sections. The first section of the questionnaire contained questions regarding knowledge of BM waste generation, hazards, and legislation, whereas the second section contained questions regarding the level of awareness on BM waste management practice, and the third section contained questions regarding attitude/behavior toward BM waste. Results: Of 337 (100%) study participants, 176 (52.2%) were males and 161 (47.8%) were females. Among 337 (100%) study participants, more than three-fourth, i.e., 291 (88.4%) knew about BM waste generation and legislation, whereas 23 (6.8%) each did not know and were not aware of it. Conclusion: There is a good level of knowledge and awareness about BM waste generation hazards, legislation, and management among health care personnel in Bengaluru city. Regular monitoring and training are still required at all levels, and there is a need for continuing dental education on dental waste management practices to these dental practitioners.
Keywords: Attitude, awareness, biomedical waste management, knowledge, practicing dentists
|How to cite this article:|
Lakshmikantha R, Kanyadara J, Bullappa D, Vanishree N, Keerthi Prasad K S, Naveen N, Anushri M. To assess the knowledge, level of awareness, and attitude on biomedical waste management among practicing dentists in Bengaluru city: A cross-sectional study. CHRISMED J Health Res 2016;3:161-7
|How to cite this URL:|
Lakshmikantha R, Kanyadara J, Bullappa D, Vanishree N, Keerthi Prasad K S, Naveen N, Anushri M. To assess the knowledge, level of awareness, and attitude on biomedical waste management among practicing dentists in Bengaluru city: A cross-sectional study. CHRISMED J Health Res [serial online] 2016 [cited 2020 Feb 16];3:161-7. Available from: http://www.cjhr.org/text.asp?2016/3/3/161/183729
| Introduction|| |
The hospital is a place of almighty to serve the patient. Since beginning, the hospitals were known for the treatment of sick persons, but there was no awareness about the adverse effects of waste produced. On one hand, hospitals cure patients, and on the other hand, they have emerged as a source of several other diseases. 
The term biomedical (BM) waste has been defined as any waste that is generated during diagnosis, treatment or immunization of human beings, animals or in research activities pertaining to or in the production or testing of biologicals and includes categories mentioned in schedule I of the Government of India's BM waste management and handling rules 1998.  Dental waste is a subset of hazardous BM waste. Dental practices generate large amounts of cotton, plastic, latex, glass, sharps, dental tissues, and other materials much of which may be contaminated with body fluids. According to the World Health Organization (WHO), the 11 South-East Asian countries together produce approximately 350,000 tons of health care waste per year close to 1000 tons a day which is both hazardous and nonhazardous.  Hospital-acquired infections have been estimated at 10% of all fatal life-threatening diseases in South-East Asia region and have been identified as one of the indicators for the management of waste. 
It has been observed that most of the dental health facilities, the guidelines for proper management of dental waste are not adopted and not up to the prescribed standard. Some studies have discussed the waste management scenario in medical hospitals. Very few studies have been conducted in dental healthcare to see the awareness among practicing Dentists. Hence, this study aimed at assessing the knowledge, awareness, and attitude of dental waste management among practicing dentists in Bengaluru city.
| Methodology|| |
A cross-sectional survey was carried out among practicing dentists in Bengaluru for 4 months. Data were collected by conducting a survey of active dental practitioners in Bengaluru city. Random sample (n = 337) was drawn from a list of dental practitioners from the registry of dental care facilities (including multispecialty clinics, single specialty clinics, and corporate hospitals). The study sample was selected according to Karnataka Private Medical Establishment Act. The total number of active registered dental practitioners in Bengaluru city was 1100. Random sample size estimated was 337 (n). From the sample, we excluded subjects who were ill, deceased, or retired from practice and subjects who do not self-identify their primary professional activity as the practice of dentistry and themselves as a dental practitioner.
Ethical clearance was obtained from the Institutional Ethical Committee. Informed consent was obtained from the participants. Through the personal interview, the respondents were informed about the aim of this study as well as the fact that participation in the questionnaire survey was totally voluntary and anonymous.
The questionnaire was in English; its respective psychometric properties (validity and reliability) were assessed. Content validity was assessed by a panel of eight experts consisting of staff members of the Department of Public Health Dentistry. The purpose was to depict those items with a high degree of agreement among experts. Aiken's V was used to quantify concordance between experts for each item; values higher than 0.92 were always obtained.
Before commencing the study, a pilot study was performed to check the internal consistency of the questionnaire. The results thus obtained were subjected to statistical analysis. Cronbach's alpha value of 0.82 showed the good internal consistency of the questionnaire.
All the data were entered into a database on Microsoft Excel. Microsoft Word and Excel have been used to generate the tables and graphs. Statistical analysis was performed using SPSS software version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc).
Details of the dental practitioners were recorded: These included demographic details such as name, gender, age, educational qualification, and experience were recorded. A self-structured questionnaire was used to obtain required data. The questionnaire was divided into three sections. The first section of the questionnaire contained questions regarding knowledge of BM waste generation, hazards, and legislation. The second section contained questions regarding the level of awareness on BM waste management practice, and the third section contained questions regarding attitude/behavior toward BM waste. All the questionnaires were printed in English.
The data collected was entered into Excel spreadsheet and analyzed using the Statistical Package for Social Sciences (SPSS) version 21.0. Descriptive statistics with frequency, percentage were taken.
| Results|| |
Among 337 (100%) study participants, 176 (52.2%) were males and 161 (47.8%) were females, whereas more than half of the participants (183 [54.3%]) were in the age group of 20-35 years and the mean age was 36.46 ± 8.104. More than three-fourth had completed BDS - (77 [22.8%]), whereas 77 (22.8%) had completed MDS. Among the total of 337 (100%) in the study group, maximum, i.e., 135 (40.1%) had their period of practice for 4-8 years; 102 (30.3%) for <3 years; 56 (16.6%) for more than 15 years and above and 44 (13.1%) for 9-15 years. Of 337 (100%) study participants, 120 (35.6%) had the private solo type of practice; 115 (34.1%) were consultants and 102 (30.3%) had private group practice.
| Discussion|| |
Exposures to many risk factors are possible in workplaces. Occupational diseases can be caused by chemical, physical, biological and ergonomic risks and accidents can be caused by structural factors or incorrect procedures and maneuvers. Traditional risk factors, such as biological agents, still cause concern in workplaces, despite the advent of modern technologies, such as LASER systems and other electromagnetic sources.  Hospitals and other health care establishments have a "duty of care" for the environment and for public health, and have particular responsibilities in relation to the waste they produce. It is ironical that the very hospital that brings relief to the sick can create a health hazard for hospital staff, patients as well as the community at large. Safe management of healthcare waste becomes very important when it comes to environment conservation and health of the community. 
According to the WHO, "The human's element is more important than the technology." Almost any system of treatment and disposal that is operated by well-trained, and well-motivated staff can provide more protection for staff, patients and the community than an expensive or sophisticated system that is managed by staff who do not understand the risks, and the importance of their contribution.  According to WHO, South-East Asia Regional Office, the 11 South-East Asian countries together produce some 350,000 tons of health care waste per year, close to 1000 tons a day which is both hazardous and nonhazardous. 
A survey carried out in Bengaluru revealed that the quantity of solid wastes generated in hospitals and nursing homes generally varies from ½ to 4 kg/bed/day in government hospitals, ½-1 kg/bed/day in private hospitals, and ½-1 kg/bed/day in nursing homes. The total quantity of hospital wastes generated in Bengaluru is about 40 tonnes/day. Out of this nearly 45-50% is infectious. Segregation of infectious waste from noninfectious waste is done only in about 30% of hospitals. 
The success of a study based on a self-administered questionnaire essentially depends on the manner in which the questions are formatted, their content, the analysis, and the response rate. To avoid any recall bias, most of the questions were of a closed-end type. Such questions are easy to analyze and may achieve a quicker response from participants. In the present study, 183 (54.3%) were in the age group of 20-35 years followed by 112 (33.2%) in 36-50 year age group and the mean age was 36.46 ± 8.104 while in a study  conducted in and around New Delhi, the age ranged from 22 to 55 years.
In this study, 176 (52.2%) were males and 161 (47.8%) were females while in other studies, 63% were males and 37% were females;  nearly 52% were males and 48% were females.  In this study, more than three-fourth had completed BDS - (77 [22.8%]), whereas 77 (22.8%) had completed MDS in contrast to the studies where 47% were graduates and 53% were postgraduates,  and in another study,  68.6% had completed postgraduate education and the rest 31.4% were undergraduates.
Among the total of 337 (100%) in the study group, maximum, i.e., 135 (40.1%) had their period of practice for 4-8 years; 102 (30.3%) for <3 years; 56 (16.6%) for more than 15 years and above and 44 (13.1%) for 9-15 years. This is in line with the studies where 58% dentist's experience was of <5 years, 30% had 5-10 years of experience, 9% had 10-15 years of experience and 3% were having experience of more than 15 years  and in other study, 60% of the subjects had experience of <5 years; 28% had experience <5-10 years and 12% had experience for more than 10 years. 
In this study, 120 (35.6%) had the private solo type of practice; 115 (34.1%) were consultants, and 102 (30.3%) had private group practice, whereas 47% were teaching in a dental institute, 23% were dental students and 30% were private practitioners.  Approximately 34% of respondents are consultants. Therefore, one limitation of the study is that they may be following the guidelines of waste management protocol at one workplace and may not at the other. Hence, the actual practice in the management of waste may not have been obtained.
In this study, among 337 (100%) study participants, more than three-fourth i.e., 291 (88.4%) knew about BM waste generation and legislation whereas 23 (6.8%) each did not know and were not aware of it [Table 1] whereas in a study  conducted in New Delhi, India, among the 64 dentists who were teachers in government institutions reported that the majority of the respondents were not aware of the proper clinical waste management regulations. However, a study carried out to assess the dental BM waste management and awareness of waste management policy among private dental practitioners in Mangalore city, India, revealed that a large number of practitioners were aware of the legislation policy but had failed to contact and register their clinic with the certified waste management services of the city. 
|Table 1: Distribution of the study participants based on knowledge scores|
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In this study, more than three-fourth i.e. 276 (81.9%) disagreed for the statement "Safe management of healthcare waste is not an issue at all." whereas 49 (14.5%) agreed for the statement and 12 (3.6%) study participants could not comment [Table 2] which is comparable with a study where among 140 subjects, 41 (29%) subjects agreed that safe management of healthcare waste was not an issue at all whereas 57 (41%) subjects disagreed and 42 (30%) subjects did not comment. 
|Table 2: Distribution of the study participants based on attitude/behavior scores|
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In this study, more than 75% study participants agreed that for the statement- "Waste management is teamwork/no single class of people is responsible for safe management." whereas 34 (10.1%) disagreed and 6 (1.8%) could not comment [Table 2]. This is comparable with the study where 91 (65%) health care personnel agreed that waste management requires teamwork and no single team member is responsible. 
In the present study, more than 50% of the study participants disagreed for the statement-"Safe management of healthcare waste is an extra burden on work." whereas 91 (27%) agreed and 23 (6.8%) could not comment [Table 2]. This is comparable to a study  where 70 (50%) respondents agreed that it increased the financial burden on management.
In the present study, about 304 (90.2%) felt the college should organize separate classes or a continuing dental education program to upgrade existing knowledge about BM waste management whereas 17 (5%) felt no need and 16 (4.7%) could not comment [Table 2]. An important challenge to be overcome is the need to progress from the concept of "waste management" to one of sustainable decision making regarding resource use, including methods of waste minimization at source and recycling. It is therefore strongly recommended that waste management programs should be a part of academic curricula for all health care workers and in continuing dental education.
From the study conducted, it can be demonstrated that for proper disposal of BM waste, the introduction of laws is insufficient [Table 3]. The awareness of these laws among the public, as well as development of policies and enforcement that respect those laws, is essential. Appropriate measures should be taken to minimize hazardous waste where possible or action should be taken to ensure that all generated waste is disposed of in accordance with environmental legislation.
|Table 3: Distribution of the study participants based on practice scores|
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All measures should be adopted to inform the public about legislation regarding BM waste management, including the risks involved in scavenging discarded needles and other sharp items. This may not be easy as often it is illiterate and very poor people who are the scavengers. Information about the risks linked to BM waste can be displayed on posters in hospitals and primary health care clinics and at strategic points (such as near waste bins), giving instructions on waste segregation. Collated information on various methods of disposal and updated technology should be made available to all categories of health care personnel.
An important challenge to be overcome is the need to progress from the concept of "waste management" to one of sustainable decision making regarding resource use, including methods of waste minimization at source and recycling. It is therefore strongly recommended that waste management programs should be a part of academic curricula for all health care workers and in continuing dental education.
A chain is as strong as the weakest link in it, thus the entire staff involved in waste management at some point or the other should be trained properly. Before providing the training program, it is mandatory to understand the existing gaps and deficiencies in the study participants' knowledge, perceptions, behavior toward hospital waste management. Lack of these, even with good infrastructure and technology, is of little or no use in proper waste management. Knowing this, the training program can be aimed to make participants understand environment-friendly, healthy, and economically viable in-house management systems, to ensure that the waste is carried responsibly from cradle to grave. This study was conducted among a small group 337 subjects and in just one city in the country. Therefore, the authors recommend that similar studies should be performed, and more subjects should be included. The need for more research and accurate data to provide an evidence-base for future decision-making is highlighted.
| Conclusion|| |
There is a good level of knowledge and awareness about BM waste generation hazards, legislation, and management among health care personnel in Bengaluru city. A large number of practitioners were aware of different categories and color coding of different types of waste yet have failed to practice the same in their clinics. A subsequent literature review suggests that this is a common problem in many other health care institutions in both India and other countries. It is imperative that waste should be segregated and disposed of in a safe manner to protect the environment as well as human health. Regular monitoring and training are still required at all levels, and there is a need for continuing dental education on dental waste management practices to these dental practitioners.
We would like to thank ICMR(Indian Council of Medical Research) for giving scholarship (short term studentship) in conducting this study with reference ID-2014-03762.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]