Knowledge, Perceptions and Practices Regarding Household Biomedical Waste in an Urban Area of Metropolitan City

Introduction

Bio-medical waste (BMW) means any waste generated during the laboratory tests, injections, vaccinations, dressings, intravenous fluids or antibiotics given for treatment among animals and humans. This waste can be generated at hospitals irrespective of bed strength, at dispensaries, dental clinics, polyclinics, veterinary clinics and hospitals, and in research and training establishments. Biotechnology institutions and slaughterhouses also generate animal or human wastes.¹ Biomedical waste is considered a major issue with the emergence of HIV and Hepatitis B infections considering the hazards they cause to human health. Biomedical waste has ramified to general population and can cause water and soil pollution. Thus, handling, segregation, disinfection, storage, transportation, and final disposal are vital steps for the safe and scientific management of bio-medical waste in any establishment. The occupier of the establishment must adhere to the biomedical waste management (BMWM) and handling rules, 2016.²

Biomedical waste management rules have been implemented in 2008 but household biomedical waste was neglected and continues to be so. Biomedical waste generated at home is slowly rising due to communicable diseases, eg. COVID 19, non-communicable diseases such as diabetes, shortened stays in hospitals to prevent hospital-acquired infections, and a continuum of care at home after discharge from the hospital. Household biomedical waste is a result of the extended treatment at home. It could include syringes and needles, insulin pens, blood-stained or pus-stained cotton and gauze bandages, expired or unused medicines, adult/baby diapers, soiled sanitary napkins, used X-ray films, band-aids, blood sugar, pregnancy strips and used condoms, mercury from the broken thermometer and sphygmomanometer.³ Some of these wastes are considered hazardous household biomedical waste as per the latest biomedical waste management rules of 2016. However, used condoms, sanitary pads, and other absorbent materials used during menstruation have not been considered as biomedical waste. These wastes when mixed with the general solid waste could make it all as infectious waste. When handed over to the scavengers or pourakarmiks, we are exposing them to numerous health hazards. They can be prone to needle stick injuries if heavy-duty gloves are not used.⁴

Domestic hazardous healthcare wastes contribute to approximately 0.5% of the entire biomedical waste. In a study conducted on the disposal of household medical waste in Ghana, unused medications (23.2%) and sharps waste (35%) were discarded loosely in household bins.⁵

In Saudi Arabia, less than 5% of the public return unwanted medications to the pharmacy or to their physicians, while most of the Saudi Arabian public throw unwanted medications into the household trash, regardless of medication type.⁶ In India, household biomedical waste has not been addressed in the BMWM rules, 2016.

Hence segregation of medical waste from general waste at the household level will not occur while the health hazards keep increasing. Very few studies have been conducted on the quantum and types of household waste that is generated. The present study aimed to assess the knowledge, perceptions, and practices regarding household biomedical waste.

Materials and Methods

A community-based cross-sectional study in the urban field practice area was done. The urban city limits are divided into various wards and each ward has five census enumeration blocks. From two census enumeration blocks, 450 households were chosen by simple random sampling. The residents who were not available at the time of the study were excluded. Institutional scientific and ethical clearance was obtained before the start of the study. A pretested, semi-structured questionnaire was used which included questions regarding socio-demographic details, knowledge of health hazards of household waste, household biomedical waste, and their types, availability at home, attitude towards their segregation and disposal, and the practices.

Results

Out of 450 households included in the study, the maximum were nuclear (n=373, 82.8%) families. A total population of 1632 was found residing in the 450 households included. Out of this, 817 (50.1%) were females and majority of the individuals belonged to the age group of 40-60 years (n=368, 7.8%) (Table 1). 

Regarding the respondents who visited a healthcare facility for any ailment, 367 (81.7%) individuals were found to have visited a hospital at least once or twice in the past year. About 257 (15.7%) respondents without any co-morbidities were found to have self-medicated at home at least once or twice in the past year (Table 2).

About 75 (16.6%) respondents knew about biomedical waste through public media and 38 (50.6%) expressed cotton as an example of BMW. Though 75 (16.6%) respondents were aware of bio-medical waste, only 15 (20%) segregated the BMW but finally disposed it in the municipality bin/van (Table 3).

Discussion

Biomedical waste generated in the hospitals has gained importance due to mushrooming of clinics, laboratories, and other health facilities, but household medical waste is now a growing issue with increasing number of noncommunicable diseases coming to the forefront. A increase in life expectancy, increase in buying power, and access to hom e care services have increased household biomedical waste. Household biomedical waste gets mixed with other household waste posing numerous health hazards. Ignoring household biomedical waste in the new BMW rules of 2016 has left a gap in the paradigm shift in the increasing health issues.⁷

The present study assessed the knowledge, perceptions, and practices of BMW and its management. Our study also described health-seeking behaviour and healthcare practices. In a comparative study on the knowledge, attitude, and perception toward hazardous medical waste produced at home in a coastal city of Karnataka, India, it was observed that 50 (66.7%) households knew about the hazards of BMW. However, in this study, only 75 (17.6%) were aware of the hazards considering it was conducted in a metropolitan city.

In a study conducted involving 30 waste handlers at Central Referral Hospital, Sikkim, 63.3% showed average practice and 36.6% showed a poor practice in terms of biomedical waste disposal.⁸ In hospitals with training and observation, the situation will be worrisome if the scavengers handle the biomedical waste. In a tertiary care hospital in North India, among all the 400 cadres of healthcare workers, overall awareness was observed to be not satisfactory, especially in the grass root level workers.⁹

In another cross-sectional study conducted among 1093 respondents in Guinea regarding waste-related disease causation, it was found that 96.2% of the respondents were aware that improper handling of waste is harmful to human health. But, 63.7% were unaware of contamination of water as a result of poor waste management.¹⁰

In another survey conducted among 600 households in Ghana, a questionnaire was used to evaluate the household disposal practices. Around 80% of the households mentioned disposing unwanted medicines in the household bins. 80% have discarded unwanted medicines and 89% have discarded sharps in household refuse bins. Also these items were discarded without a container among 23% and 35% respectively. Blood-soaked items (n=592) including sanitary pads were discarded in the dustbin.⁵

A few states in USA ask the households generating medical waste to contain them separately and the generators are charged an additional amount for collecting the same. In the United Kingdom, the Department of Health published a guide to the best practices for the management of healthcare waste. The guidelines state that healthcare waste produced in a household should never be disposed of in the domestic waste stream. If patients are treated in their homes by a community nurse or a member of the National Health System (NHS), any waste produced as a result is the healthcare professional's waste. If patients treat themselves in their own homes, any waste produced as a result should be their own responsibility.¹¹ But it has been reported that more than 85% of the public accumulates medications and later throws them into the garbage or flushes them down the toilet or sink, endangering public health and the environment.¹²

In a survey conducted among 324 households in Yogyakarta, majority of participants (85%) reported stocking unused medications in their homes and only 3% reported returning medications to a pharmacy. Antibiotics were common medicines kept at home (37%). The predominant reason for non-use of medications was disease or improvement in symptoms (97%). Less than half of respondents (41%) reported checking expiry date of their medications before use. Most respondents (80%) did not receive any advice from health professionals. More than two-thirds of all respondents (85%) reported storing unused medications in their homes, and more than half (71%) reported throwing medications in household waste. About 23% of the respondents gave their unused medicines to their friends or neighbors.¹³

In a survey involving 338 households in Malaysia, 95.9% of the respondents accepted that diarrhoea and malaria can be caused if waste is not managed correctly.¹⁴

It is also noted that tonnes of extremely hazardous biomedical waste generated from households go directly to landfills in Bangalore. There are no clear rules mandating the segregation of BMW from either wet or dry wastes. The expired drugs are taken back by certain pharmacies but the rest are dumped into municipal waste.¹⁴

Conclusion

Household biomedical waste such as sanitary pads, adult diapers, dressing bandages, plaster casts, materials contaminated with blood, catheters, and urine bags are all used at homes and disposed in to water bodies, rivers, and drains without treating them first. Sometimes such waste is burnt/ dumped in pits/ mixed with solid waste. Even if it is collected separately, there is no proper protocol for disposal. With increasing chronic health conditions and availability of home health care, it is the need of the hour to find practical solutions through regulatory authorities.

Conflicts of Interest

Nil