Awareness about bio-medical waste (bmw) management among the private dental clinics in Gulbarga city - A survey

INTRODUCTION

The health care sector includes a diverse range of establishments, from large hospital to small dispensaries, dental clinics and diagnostic laboratories with an endeavor to diagnose and eliminate the health related problems of common man.

The recent developments in healthcare facilities are more involved precisely for the prevention and protection of community health.During this process, they generate a large amount of BMW which has become a matter of concern due to its multidimensional ramification as the risk factors to the people handling it and also the public at large. The waste generated during the health care are composed of variety of wastes including hypodermic needles, blades, scalpels, cotton and gauze, gloves, bandages, discarded medicines, clothes, body fluids, human tissues and organs, etc.¹

According to the All India Association of syringes and needles manufacturers, at least 20% of syringes sold are from recycled sources, which may harbor viruses causing hepatitis B, C, etc.²

Although very little disease transmission from BMW has been documented it is important to note that around 80-85% of BMW is non-hazardous, 10% is infections and 5% is potentially toxic. If this toxic waste gets mixed with general waste, the entire bulk of hospital waste becomes potentially infections.

In this regard, Govt. of India under the ratification of environmental protection act 1986 has brought BMW (handling and management) rules 1998, a very important legislation. This rule of the act classifies BMW in the schedule-I, Rule-5) and also the disposal of the BMW in 3 schedule-I Rule-6 (Class-I) .

Dental and oral health sectors have no excuse from the legislation of Govt. of India. The BMW produced in Dental clinics are also classified into four groups as hazardous, infections, sharps and non-hazardous (Class-II).

Aim of the study:

This present study is an attempt to find the real state of affairs (activities) of the awareness, knowledge, attitude and practices of the dental clinic personnel of Gulbarga city region regarding the BMW and its management.

MATERIALS AND METHOD:

The study included the survey of the dental clinics in Gulbarga city. Random sampling of the clinics was done for the study. A pretested, self-administered, questionnaire was prepared together the information regarding the knowledge, attitude and practice followed in these clinics with the BMW.

Questionnaire:

Each question was to be ticked by the dental clinic personnel for assessment in grades which were awarded. The results were derived from the available data received from the practitioners in the questionnaire. 

Knowledge Questionnaires:

1. Are you aware of any legislation application to the health care waste management

Yes / No

If Yes name a few ______________

2. Segregation of waste is best achieved at the time of

a) Final disposal

b) Point of generation

c) Intermediate storage

d) Final storage.

3. Predominant source of infection of health care personnel is through

a) Infected linen

b) Waste sharps

c) Contaminated dressing

d) Specimens

4. Indicate the colour of the bag for segregation

a) Microbiological and biotechnological . _____

b) Human and animal anatomical waste. _____

c) Waste Sharps. _____

d) Incinerated ash and discarded medicines. _____

e) Discarded medicine and cytotoxic drugs. _____

5. Which of the following should not be incinerated

a) Contaminated cotton, gauze

b) Anatomical waste

c) Chlorinated plastic

d) Paper waste.

RESULTS

This study which involved surveying the attitudes, knowledge and practice of BMW management of the dental clinic personnel includes the filling of the form which includes certain questionnaire showed the following results.

In an attempt to gather the knowledge regarding the management of BMW, it was observed that 100% i.e. everyone is aware about the legislation of application. 95% of the sample showed the segregation to be best achieved at the time of generation. A slight variation was noticed in the knowledge regarding the predominant source of infection. 75% said that infected liner and remaining considered waste Sharpe as the predominant source of infection. 75% of the sample had the knowledge about the colored bags for segregation. Regarding treatment and disposal of BMW 100% agreed in the incineration as the best method for disposal of BMW except few such as Chlorinated plastic. (Table 1)

The attitude of the personnel regarding the BMW showed very little difference. 100% disagree for the responsibility of only the doctors in safe management of BMW. 90% agree for the help of legal provision to improve the safe management of BMW.100% agree for not storing the contaminated waste for more than a working day. 100% agree for the potential spread of disease like hepatitis & HIV by the mismanagement of BMW(table 2, graph 1)

Regarding the practice in the BMW management, 100% has the same opinion about excised hard and soft tissue. 90% personnel practiced the correct method of disposable syringes and needles. 100% had the same attitude in the disposal of cotton and plastic materials; whereas 75% practiced the correct method of disposal of paper. (Table3a) (Graph 2)

The attempt to gather the practice method followed in the dental clinic showed that, 91.67% provided uniform, around 9% used aprons, boots were not found to be used in any of the clinic. 91.67% used masks, 0% used goggles,91.67% used gloves, and 100% used soap for washing and waste clothing was provided in all dental establishment participated in the survey which accounted for 100% (Table 3b) (Graph 3).

DISCUSSION

Biomedical waste in its precise way of definition is the waste generated in the diagnosis, treatment and immunization of human beings or animals, in research or in the production and testing of biological products.

Safe and effective management of BMW has essentially become a matter of concern due to its potential implication on the health of the patients, staff, waste handler and public at large.

The BMW has been classified broadly into 2 groups. One non-hazardous accounting for 80% and the other biohazards accounts for 20%. It becomes the responsibility of the health care personnel to handle this 20% hazardous BMW in effective manner.⁴

The Government of India in this regard has taken serious steps and has passed the BMW (management and handling) Rules (1998). It makes mandatory for all the health care establishments in accordance with regulations. This not only makes the health care personnel responsible, but also creates a legal binding on them.

The BMW management process consists of handling, segregation, storage and disposal.This study focused on the BMW management of the dental clinics in Gulbarga city. The BMW produced in the dental clinics are classified under different headings, as they include the waste as dental materials, different chemicals along with those of the medical wastes.

The actual BMW management situation in the developing country like India is grim. The reports given in the leading newspaper by Laxmi (2003) shows that even though there are rules stipulating the method of safe disposal of BMW, hospital waste generated by GHS is still largely dumped in open, wastage to be collected along with general waste.⁵

The literature shows that very few studies are done regarding the management of BMW particularly in dental clinics. The study done on the safety measures towards the use of dental amalgam in Riyadh Private Clinics show that the dental surgeons are reasonably aware about the toxicity and most of them use amalgamators in their clinics.⁶

The analysis results of one of the surveys showed that the colour coding was followed in most of the clinics and the storage of BMW was in isolated area and proper hygiene was maintained and further personal protective equipment and accessories were provided used in several clinic and general awareness among the hospital staff regarding BMW was satisfactory.

The results of the analysis done in this study showed that fairly good number of dental clinics follow the BMW management protocols. Most of the dentists are aware about the BMW and their effect.This can be attributed to the available facilities of collecting Bio-Medical Waste by the concerned people, Govt. policies and awareness of the dental personals regarding the importance of biomedical waste.

CONCLUSION

Proper handling, treatment and disposal of BMW are important elements of health care office infection control programs. Correct procedures will help protect health care workers, patients and the local community.

This study concludes that the BMW management should be supported through appropriate education through prescribed syllabus at University level, training, regular workshop and seminar and the commitment of the health care staff, management and health care managers within an effective policy and legislative framework.

Elaborate and still proper survey of waste management procedures in dental practices is needed.The need for strict enforcement of legal provisions and a better environmental management system for the disposal of BMW in dental clinics can be clearly demonstrated. A policy needs to be formulated based on reduce, recover, reuse and dispose concept.