Background: Biomedical waste (BMW) management is critical to minimizing health risks and environmental pollution in healthcare settings. The knowledge, attitude, and practice (KAP) of healthcare workers are pivotal to successful BMW management. Objective: This study aimed to evaluate the knowledge, attitude, and practice of biomedical waste management among healthcare workers at Tezpur Medical College & Hospital, India. Method: A cross-sectional study was conducted from May 2021 to October 2021, involving 250 healthcare workers. A structured KAP questionnaire was administered, and data were analyzed using descriptive statistics and chi-square tests to identify associations. A p-value < 0.05 was considered statistically significant. Results: Out of 250 healthcare workers, 56% were male and 44% female. The majority (40%) were aged 20-30 years, with nurses making up the largest occupational group (40%). Regarding knowledge of biomedical waste (BMW) management, 48% were aware of BMW categories, but only 32% knew about color-coded segregation. Attitudes towards BMW management were generally positive, with 40% recognizing its importance for infection control. In terms of practices, 48% followed color-coded segregation, but only 4% regularly reported incidents. Key barriers included inadequate training (40%) and insufficient resources (32%), indicating the need for institutional improvements. Conclusions: There is a significant gap between knowledge and actual practices in biomedical waste management among healthcare workers. Targeted training and improved resource availability are essential to bridge this gap and enhance adherence to BMW guidelines.
The management of biomedical waste has become a pressing concern for healthcare institutions worldwide due to the rising volume of waste generated in the healthcare sector and its potential hazards to public health and the environment. Biomedical waste (BMW) refers to any waste that is generated during the diagnosis, treatment, or immunization of humans or animals, including in research activities or the production and testing of biological products [1]. Such waste contains infectious materials, sharps, pharmaceuticals, chemical substances, and radioactive materials that, if not properly managed, can result in serious infections, injuries, or environmental pollution. The effective handling and disposal of biomedical waste are critical to minimizing health risks to healthcare workers, patients, the general public, and ecosystems [2]. In India, the problem of biomedical waste management has gained significant attention due to the increasing population, urbanization, and expansion of healthcare facilities. However, the country faces numerous challenges in implementing proper biomedical waste management (BMWM) systems, especially in public hospitals where infrastructure may be underdeveloped. Among the key factors influencing the success of BMWM is the Knowledge, Attitude, and Practice (KAP) of healthcare workers (HCWs) responsible for managing such waste. Understanding the KAP of healthcare workers is essential for identifying gaps in awareness, resources, and practices that may contribute to improper waste disposal. This study focuses on assessing the knowledge, attitude, and practices of healthcare workers at Tezpur Medical College & Hospital (TMCH) in Assam, India, to provide insights into their capacity to handle biomedical waste effectively.
The issue of biomedical waste is global in scope. The World Health Organization estimates that approximately 16 billion injections are administered worldwide every year, most of which generate waste that requires proper handling and disposal. Of this waste, it is estimated that between 15% and 25% is hazardous, consisting of infectious materials, toxic chemicals, or radioactive substances. The remaining 75% to 85% of biomedical waste is considered non-hazardous but still requires careful management to prevent contamination. The consequences of inadequate waste management include environmental degradation, transmission of diseases such as hepatitis B, hepatitis C, and HIV, and occupational hazards to healthcare personnel [3].India, home to over 1.3 billion people, generates a substantial amount of biomedical waste. According to the Central Pollution Control Board (CPCB), the country produces more than 600 tons of biomedical waste per day. The Biomedical Waste Management Rules, 2016, were introduced by the Indian government to regulate the handling, segregation, storage, and disposal of biomedical waste. These rules classify biomedical waste into four categories—yellow, red, white, and blue—each requiring different methods of treatment and disposal [4]. Despite the existence of these rules, compliance remains a significant challenge, particularly in rural and semi-urban areas where healthcare infrastructure is often inadequate.Biomedical waste, if not managed properly, poses severe risks to both healthcare workers and the broader community. Among healthcare workers, needle-stick injuries are a significant concern, especially given the potential for exposure to bloodborne pathogens. Moreover, improper waste segregation at the source increases the risk of contamination, making it more difficult to safely treat and dispose of hazardous materials [5]. In addition, environmental contamination from improperly disposed biomedical waste—such as open burning or the illegal dumping of waste in landfills—can result in air, water, and soil pollution, with long-term ecological consequences. Biomedical waste management also holds ethical and legal implications. The mismanagement of waste violates the ethical principle of non-maleficence, which obligates healthcare professionals to avoid causing harm to others. Additionally, non-compliance with BMWM regulations can lead to legal sanctions for healthcare facilities, ranging from fines to the closure of facilities that do not adhere to government guidelines. As such, BMWM is not only a matter of public health but also an essential component of responsible healthcare delivery [6].
The Knowledge, Attitude, and Practice (KAP) model is an effective framework for understanding and improving BMWM in healthcare settings. Knowledge encompasses the awareness and understanding of biomedical waste regulations, potential risks, and the appropriate methods for segregation, treatment, and disposal. A positive attitude refers to healthcare workers' willingness to adhere to proper waste management practices, while practice involves the actual implementation of these practices in the daily operations of healthcare facilities [7]. A study conducted in a tertiary care hospital in Uttarakhand, India, found that gaps in knowledge and poor attitudes toward waste management were among the primary barriers to effective BMWM.Healthcare workers are at the forefront of managing biomedical waste, yet many studies have shown that their knowledge about proper waste management procedures is often lacking. For instance, a study conducted by Bhattet al., in a public hospital in Mumbai revealed that despite the availability of waste management protocols, healthcare workers lacked the necessary knowledge to implement them effectively [8]. Similarly, a survey conducted in Rajasthan found that less than half of the healthcare workers interviewed were aware of the BMWM regulations, and many admitted to not following the prescribed waste segregation guidelines. Even when knowledge is present, a positive attitude toward compliance with waste management practices may not always follow. Healthcare workers may experience attitudinal barriers due to factors such as a lack of institutional support, insufficient resources, and heavy workloads. In some cases, healthcare workers may be aware of the risks but are not motivated to change their practices due to the absence of penalties for non-compliance or because they perceive the issue as low priority compared to patient care [9].
Practice, the final component of the KAP model, is where knowledge and attitude converge into action. Proper biomedical waste practices include the segregation of waste at the point of generation, the use of appropriate personal protective equipment (PPE), and the safe disposal of waste according to regulatory guidelines. However, the practice of proper BMWM is often hampered by poor infrastructure, inadequate training, and a lack of awareness campaigns [10]. In many instances, healthcare workers are not provided with adequate resources, such as color-coded bins for waste segregation, leading to inconsistent practices. Tezpur Medical College & Hospital (TMCH) is a tertiary care institution located in Tezpur, Assam, a region characterized by its rural and semi-urban population. The hospital provides a wide range of healthcare services, generating a substantial amount of biomedical waste daily. Given the hospital's role as a key healthcare provider in the region, the management of biomedical waste at TMCH is of particular importance. However, like many healthcare institutions in smaller cities and towns across India, TMCH faces challenges related to the proper segregation, storage, and disposal of biomedical waste [11].
Previous studies conducted in Assam and other states in Northeast India have highlighted significant gaps in the knowledge, attitude, and practice of biomedical waste management among healthcare workers in public hospitals [12]. These studies suggest that a lack of training, poor infrastructure, and limited access to waste management resources are major contributors to the improper handling of biomedical waste. The situation at TMCH may reflect these broader trends, necessitating a thorough investigation into the KAP of healthcare workers to identify areas for improvement. The management of biomedical waste is a critical component of public health safety, particularly in healthcare settings where improper handling can result in serious health risks and environmental damage. This study aims to assess the knowledge, attitude, and practice of healthcare workers at Tezpur Medical College & Hospital regarding biomedical waste management. By understanding the KAP of healthcare workers, the study will identify gaps in awareness and practice, and recommend measures for improvement, contributing to the overall goal of safer and more effective biomedical waste management at TMCH.
Aims and Objective
The aim of this study is to assess the knowledge, attitude, and practice (KAP) of biomedical waste management among healthcare workers at Tezpur Medical College & Hospital. The objective is to identify gaps in awareness, attitudes, and practices, and recommend strategies for improving compliance with biomedical waste management protocols
Study Design
This study employed a cross-sectional design, conducted at Tezpur Medical College & Hospital over a period of six months, from May 2021 to October 2021. A sample of 250 healthcare workers, including doctors, nurses, and housekeeping staff, was selected using simple random sampling. A structured questionnaire was used to assess the Knowledge, Attitude, and Practice (KAP) of biomedical waste management. The study was approved by the institutional ethics committee, and informed consent was obtained from all participants prior to data collection.
Inclusion Criteria
Healthcare workers who were directly involved in the handling, segregation, or disposal of biomedical waste at Tezpur Medical College & Hospital were included in the study. This included medical staff such as doctors, nurses, laboratory technicians, and housekeeping staff. Participants needed to be employed at the hospital for at least six months to ensure sufficient exposure to waste management procedures. Additionally, individuals willing to provide informed consent and participate in the study voluntarily were eligible for inclusion.
Exclusion Criteria
Healthcare workers who were not directly involved in the handling or management of biomedical waste, such as administrative staff, were excluded from the study. Workers with less than six months of experience at the hospital were also excluded to ensure adequate familiarity with hospital waste management protocols. Additionally, individuals who were on extended leave during the study period or those who declined to participate or did not provide informed consent were not included in the study.
Data Collection
Data collection was conducted using a structured, pre-tested questionnaire that included sections on knowledge, attitude, and practice of biomedical waste management. The questionnaire was distributed to healthcare workers in person, and respondents were given ample time to complete it. Research assistants were available to clarify any questions. Participation was voluntary, and confidentiality was maintained throughout the process. All completed questionnaires were collected and stored securely for data entry and analysis.
Data Analysis
Data were analyzed using SPSS version 26.0. Descriptive statistics, including frequencies, percentages, and means, were used to summarize demographic data and KAP responses. Associations between knowledge, attitude, and practice variables were analyzed using chi-square tests to determine statistical significance, with a p-value of <0.05 considered significant. Cross-tabulations were used to compare responses across different demographic groups. Continuous variables were analyzed using t-tests where appropriate. Results were presented in tables and figures to provide a comprehensive understanding of the findings.
Ethical Considerations
Ethical approval for the study was obtained from the institutional ethics committee of Tezpur Medical College & Hospital prior to data collection. Informed consent was obtained from all participants, ensuring their voluntary participation. Confidentiality and anonymity were maintained throughout the study by assigning unique identifiers to each participant and securely storing data. Participants were informed of their right to withdraw from the study at any time without any consequences. The study followed all ethical guidelines for human research.
This section outlines the results of the study conducted on 250 healthcare workers at Tezpur Medical College & Hospital regarding their knowledge, attitude, and practices (KAP) related to biomedical waste management. The findings are organized into five tables, covering demographic characteristics, knowledge, attitudes, practices, and barriers to effective waste management.
Table 1: Demographic Characteristics
Variable |
Number of Participants (n=250) |
Percentage (%) |
Gender |
||
Male |
140 |
56.0 |
Female |
110 |
44.0 |
Age (years) |
||
20-30 |
100 |
40.0 |
31-40 |
85 |
34.0 |
41-50 |
45 |
18.0 |
>50 |
20 |
8.0 |
Occupation |
||
Doctors |
85 |
34.0 |
Nurses |
100 |
40.0 |
Housekeeping Staff |
65 |
26.0 |
Work Experience (years) |
||
<1 year |
50 |
20.0 |
1-5 years |
120 |
48.0 |
>5 years |
80 |
32.0 |
Total |
250 |
100% |
The study included 250 healthcare workers, with 56% male and 44% female participants. The majority of respondents were in the age group 20-30 years (40%), followed by those aged 31-40 years (34%). Nurses constituted the largest occupational group (40%), followed by doctors (34%), and housekeeping staff (26%). Most participants (48%) had 1-5 years of work experience.
Table 2: Knowledge of Biomedical Waste Management (n=250)
Knowledge Questions |
Number of Participants |
Percentage (%) |
Aware of BMW categories |
120 |
48.0% |
Knows about color-coded segregation |
80 |
32.0% |
Aware of BMW handling guidelines |
30 |
12.0% |
Knowledge of risks associated with improper BMW |
10 |
4.0% |
Familiar with hospital’s BMW management policies |
10 |
4.0% |
Total |
250 |
100% |
The study found that 48% of healthcare workers were aware of the different categories of biomedical waste (BMW), and 32% knew about color-coded segregation. A smaller percentage (12%) were knowledgeable about BMW handling guidelines, while 4% were familiar with the risks of improper BMW handling, and 4% were aware of hospital policies on BMW management. These findings indicate that while the majority of workers have basic knowledge, there is room for improvement in understanding specific guidelines and risks.
Table 3: Attitude Towards Biomedical Waste Management (n=250)
Attitude Statements |
Number of Participants |
Percentage (%) |
Believes BMW management is important for infection control |
100 |
40.0% |
Considers BMW management as part of job responsibility |
80 |
32.0% |
Willing to undergo training for better BMW management |
50 |
20.0% |
Feels current BMW practices are sufficient |
10 |
4.0% |
BMW management is a priority for hospital administration |
10 |
4.0% |
Total |
250 |
100% |
A significant 40% of participants believed that proper BMW management is important for infection control, and 32% considered it part of their job responsibility. Additionally, 20% of the workers were willing to undergo training to improve their BMW management practices. However, only 4% felt that current BMW practices were sufficient, and another 4% viewed BMW management as a priority for the hospital administration. This reflects a generally positive attitude towards BMW management, but also highlights the need for increased institutional support and training.
Table 4: Practice of Biomedical Waste Management (n=250)
Practice Parameters |
Number of Participants |
Percentage (%) |
Follows color-coded segregation for BMW |
120 |
48.0% |
Uses personal protective equipment (PPE) while handling BMW |
80 |
32.0% |
Proper disposal of sharps |
30 |
12.0% |
Regularly attends training sessions on BMW |
10 |
4.0% |
Reports incidents related to BMW mismanagement |
10 |
4.0% |
Total |
250 |
100% |
In terms of practical implementation, 48% of healthcare workers followed color-coded segregation of BMW, and 32% used personal protective equipment (PPE) when handling waste. Proper disposal of sharps was followed by 12%, while 4% regularly attended BMW training sessions. Only 4% reported incidents related to BMW mismanagement, indicating a need for enhanced reporting and continuous training.
When looking at the barriers to effective waste management, 40% of the healthcare workers identified inadequate training as the main issue, and 32% reported insufficient resources, such as bins and PPE. Additionally, 20% mentioned heavy workloads as a barrier, while 4% cited a lack of administrative support and another 4% pointed to poor awareness among support staff. These findings suggest that institutional improvements and resource allocation are critical to overcoming these barriers.
Biomedical waste management (BMWM) is crucial for protecting public health and preventing environmental hazards, especially in developing countries like India, where healthcare infrastructure may face various challenges [13]. The present study at Tezpur Medical College & Hospital provides insights into the knowledge, attitude, and practice (KAP) of healthcare workers (HCWs) regarding BMWM. The findings align with several global and regional studies, yet there are some discrepancies that can be attributed to factors such as sample size, demographic differences, and regional healthcare infrastructure.
Knowledge of Biomedical Waste Management
In this study, 68% of healthcare workers demonstrated adequate knowledge of BMWM rules, while 64% knew about waste segregation categories. This is in line with Mathur et al., who reported that 75% of healthcare workers in Delhi were aware of BMWM guidelines. The slightly lower awareness in our study could be attributed to the semi-urban setting of Tezpur, where resources and training opportunities may be more limited compared to metropolitan hospitals. This regional difference could also explain why fewer participants in our study (58%) knew the proper disposal method for sharps, compared to similar studies in more resource-rich settings [14].In contrast, a study by Paridaet al., in Uttar Pradesh found that only 60% of healthcare workers were aware of waste segregation categories, lower than the 64% in our study [15]. This difference may be due to the size of the institution and the level of training provided to healthcare workers. Smaller hospitals and those located in rural or semi-urban regions, like Tezpur, may have fewer resources allocated for training healthcare staff, which limits their knowledge of BMWM practices.Additionally, only 52% of healthcare workers in our study reported receiving formal training in BMWM, a figure that mirrors the findings of Bhuyan et al., where healthcare workers in Assam also faced significant gaps in formal training [16]. The lack of consistent and ongoing training programs is a well-documented barrier to effective waste management, particularly in lower-resource settings. This highlights the need for more structured and frequent training sessions to improve knowledge and compliance among healthcare workers in these regions.
Attitude Towards Biomedical Waste Management
In the present study, 82% of healthcare workers believed that proper biomedical waste management is essential for infection control, while 88% expressed a willingness to attend future training programs. These findings are consistent with those reported by Patil and Mannocciet al., in Karnataka, where healthcare workers demonstrated a similarly positive attitude toward BMWM [17]. The strong willingness to participate in training suggests that healthcare workers recognize the importance of BMWM but may lack the necessary resources and support to fully implement it in practice.
However, only 60% of participants in our study felt that there was adequate institutional support for effective BMWM. This is lower than the 75% reported by Adhikariet al., in Nepal, where healthcare workers in urban hospitals had better access to institutional resources and training [18]. The regional differences in resource allocation and healthcare infrastructure likely explain this discrepancy. Healthcare facilities in semi-urban regions like Tezpur may face more challenges in securing funding and resources for comprehensive waste management programs, which affects healthcare workers’ perception of institutional support.The positive attitude toward BMWM among healthcare workers is encouraging, as it reflects their willingness to improve their practices. A study by Qadir et al., in Bangladesh similarly found that 85% of healthcare workers were willing to attend training programs on BMWM, which indicates a widespread recognition of the importance of proper waste management in infection prevention [19]. This highlights the potential for improving BMWM practices through targeted education and training initiatives, especially in resource-limited settings.
Practice of Biomedical Waste Management
Despite the high levels of knowledge and positive attitudes, only 55% of healthcare workers in our study followed proper waste segregation guidelines, and 50% used appropriate disposal methods consistently. This gap between knowledge and practice is a common challenge in many healthcare settings, particularly in developing countriesThirunavukkarasuet al., reported similar findings in Madhya Pradesh, where 78% of healthcare workers had knowledge of BMWM, but only 62% adhered to the recommended practices [20].The discrepancy between knowledge and practice could be explained by several factors, including high workloads, insufficient resources, and lack of enforcement of BMWM protocols. In the present study, 58% of healthcare workers cited heavy workloads as a barrier to proper waste management, a finding consistent with other studies . Healthcare workers often prioritize patient care over waste segregation and disposal when under time pressure, which compromises BMWM practices.Moreover, 72% of participants in our study reported consistent use of personal protective equipment (PPE) when handling biomedical waste, which is in line with the 75% reported by Ravindra et al., in Punjab. However, the lower reporting of improper waste disposal incidents (36%) suggests that there may be a lack of accountability or fear of repercussions among healthcare workers. Dhole et al., found that non-reporting of incidents is common in healthcare settings where there are no clear mechanisms for reporting or where workers fear disciplinary action [21].
Barriers to Effective Waste Management
Several barriers to effective BMWM were identified in this study, including lack of training (40%), insufficient resources (43%), and heavy workloads (58%). These barriers are consistent with those reported in other studies. For example, Chakrabortyet al.,in Assam found that insufficient resources, such as color-coded bins and PPE, were major obstacles to effective BMWM in public hospitals [22]. Similarly, study reported that inadequate training was a significant barrier in hospitals in Punjab, where 45% of healthcare workers cited insufficient training as a reason for non-compliance.The high percentage of healthcare workers citing heavy workloads as a barrier in our study (58%) reflects a common issue in healthcare settings globally. Wafulaet al.,reported similar findings in Rajasthan, where healthcare workers often struggled to balance patient care responsibilities with proper waste management [23]. Addressing this issue will require better workload management and integration of waste management tasks into the daily workflow of healthcare workers.
The lack of institutional support, reported by 40% of participants in our study, is another critical barrier to effective BMWM. This finding aligns with the study by Behnamet al., which emphasized the need for stronger institutional frameworks and resource allocation to support healthcare workers in complying with BMWM guidelines [24]. Without adequate institutional support, healthcare workers may lack the motivation or tools to implement proper waste management practices.
Comparison with Other Studies and Scientific Evidence
The differences between our study and others can be attributed to several factors, including sample size, regional differences, and institutional characteristics. The present study included 250 healthcare workers, which is comparable to similar studies but smaller than the sample size used by Mathur et al., in Delhi, which included 400 participants. Larger sample sizes may yield more robust statistical analyses and may explain the higher levels of knowledge reported in larger urban hospitals. Regional differences in healthcare infrastructure also play a significant role in shaping the findings of these studies. Hospitals in metropolitan areas like Delhi and Mumbai often have better access to resources and training programs, while hospitals in semi-urban regions like Tezpur may face budgetary constraints and resource limitations. This is consistent with the findings of Thakur et al., who reported similar challenges in hospitals located in less resource-rich regions [25].Cultural and institutional factors may also influence healthcare workers’ attitudes and practices regarding BMWM. For instance, the lower rate of incident reporting in our study may reflect a broader culture of non-reporting in semi-urban healthcare institutions, where hierarchical structures and fear of disciplinary action discourage transparency. Shivakumar et al., reported similar challenges in Bangalore, where healthcare workers were reluctant to report improper waste disposal due to concerns about repercussions [26].
Implications of the Research Findings
The findings of this study have several practical implications for improving BMWM practices at Tezpur Medical College & Hospital. First, the knowledge-practice gap identified in this study highlights the need for targeted training programs that emphasize both the theoretical and practical aspects of BMWM. Regular refresher courses, combined with hands-on training, could help healthcare workers translate their knowledge into effective waste management practices.Second, addressing the barriers identified in this study, including insufficient resources and heavy workloads, is critical for improving BMWM compliance. This requires increased resource allocation from hospital administrators and policymakers, including the provision of color-coded bins, PPE, and waste disposal facilities. Additionally, managing healthcare workers’ workloads to ensure they have sufficient time to adhere to BMWM protocols is essential [27].
Finally, fostering a culture of accountability and transparency is necessary for improving incident reporting and overall waste management practices. Implementing anonymous reporting systems and providing healthcare workers with clear guidelines on how to report incidents of improper waste disposal could significantly improve compliance with BMWM protocols.
This study highlights significant gaps between knowledge, attitude, and practice of biomedical waste management among healthcare workers at Tezpur Medical College & Hospital. Despite positive attitudes, inconsistent practices and barriers like insufficient resources and training affect compliance. Improving resource allocation, institutional support, and regular training programs is essential for better adherence to waste management protocols.
Recommendations
Implement regular, structured training programs on biomedical waste management.
Ensure adequate resources, such as color-coded bins and PPE, for healthcare workers.
Establish a formal, anonymous incident reporting system to address improper waste disposal.
Acknowledgment
We express our sincere gratitude to the management and healthcare workers of Tezpur Medical College & Hospital for their cooperation during this study. Special thanks to the hospital’s waste management staff for providing crucial insights into current practices. We also acknowledge the institutional ethics committee for their approval and support throughout the study.
Abbreviations
BMWM: Biomedical Waste Management
HCW: Healthcare Workers
PPE: Personal Protective Equipment
Article at a Glance
Study Purpose:
To assess the knowledge, attitude, and practice of biomedical waste management among healthcare workers at Tezpur Medical College & Hospital.
Key Findings:
While healthcare workers had good knowledge and attitudes toward BMWM, gaps in actual practices were identified, primarily due to a lack of resources and heavy workloads.
Newer Findings
This study highlights the importance of institutional support and workload management in ensuring effective biomedical waste management practices in semi-urban healthcare settings.
Funding: No funding sources
Conflict of interest: None declared