Evaluation of Healthcare Professionals' Ability to Manage Biomedical Waste in Saudi

Health care institutions, both public and private, as well as human safety, environmental, and law enforcement organizations, have lately begun to express significant concern about the proper disposal of biomedical waste. The term biomedical waste (BMW) means "any waste generated during diagnosis, treatment, or immunization of human beings or animals or in research activity pertaining to or in the production or testing of biological or in health camps" [1]. Every healthcare institution must have a system in place for handling biomedical waste if patient health and environmental sustainability are to be prioritized. As per government requirements, any health institution, major medical institute, or small clinic must guarantee adequate biological waste management. In this context, "health care facility" (HCF) refers to any establishment, big or little, dedicated to the diagnosis, treatment, or immunization of human beings. Private facilities range from huge corporate hospitals to minor clinics, while public facilities span from district hospitals to sub-district hospitals to community health centers to primary health centers to sub- centers [2]. Nosocomial infections, illnesses, and harmful effects on the environment may all originate in HCFs [3, 4]. Regulatory framework for BWM is often lacking at the national level. When it comes to biomedical waste management (BMWM) regulations, India was an early adopter . The "Bio-medical Waste Management and Handling Rules" were first announced in July 1998 by the Ministry of Environment and Forest under the Environment Protection Act, 1986 [5]. India's hospitals still have not reached the targeted BMWM criteria after a decade of implementation [6]. On March 28, 2016, the Ministry of Environment, Forest, and Climate Change announced the updated guidelines, which

biomedical waste - BMW classifications and available therapies are laid out in color-coded detail in Schedule 1. Biomedical waste management regulations are outlined in Schedule 2. Labels for biomedical waste bags or containers are described in Schedule 4, and a list of specified authorities and their responsibilities are described in Schedule 3.

Hospitals, health clinics, and dispensaries in Riyadh urban were the sites of the research. Government, non-governmental organizations, and a rising number of Health Centres, commercial clinics, and pharmacies all contribute to the city of Riyadh's health care infrastructure. To combat rising rates of maternal and infant mortality and HIV/AIDS transmission, the city operates mobile clinics, which are often active during local and national immunization programs.

A cross-sectional design with a quantitative approach was adopted for this investigation. Research started in August of 2022.

A population is the whole collection of cases from which a sample is drawn for in-depth research.

The sampling process for this investigation consisted of many stages. The first step is the selection of 12 health care institutions using a simple random sample method that does not include any replacements. Stage 2: Selection of 146 healthcare professionals using a straightforward random sample method, with no replacements made.

Primary data was gathered from the study's participants using questionnaires. Primary data were collected by interviewing staff members at the participating institutions.

Before beginning data collecting in the field, permission to perform the research was requested from OUS. Authorization was also secured from DMO and the facility administrators prior to the start of the research. Request for permission to participate in the research was also obtained from the possible

The questionnaire was pilot tested on health care professionals drawn from the research population prior to data collection to gauge how well the questions were comprehended by the study's intended respondents. Through piloting, we were able to hone the survey's questions.

All of the information gathered for this research was classified, categorized, and ranked according to the replies' emerging categories. Data was entered into SPSS version 20 (IBM Corp., Armonk, NY) for statistical analysis. Descriptive statistics, such as frequency and percentage distributions, and inferential statistics, such as the Chi-square test for significance, were used to draw conclusions about the data.

Rate of Reaction: Only 140 (94.7%) of the originally planned 150 health care professionals (50 from hospitals, 50 from health centers, and 50 from dispensaries) were really available to participate in the study. Eighty from clinics and health centers, forty from hospitals, and forty from dispensaries. Personal Information Provided by Respondents: Table 1 shows that out of the total number of healthcare institutions, data was obtained from 60 (42.8%) health centers, 40 (28.2%) hospitals, and 40 (28.2%) dispensaries. Of the respondents, 45 (30.3%) had less than one year of work experience, 43 (30.3%) between six and ten years, 25 (17.6%) between eleven and twenty years, and 17 (12.0%) or more than twenty years. The gender analysis of the responses revealed that female workers were the majority, that is 88 (62.0%) and men were 52 (37.01%). One person (0.7%) was found to be 19 or younger, 75 (53.5%) were found to be 20-29 years old, 32 (22.5%) were found to be 30-39 years old, 17 (12.0%) were found to be 40-49 years old, and 15 (10.6%) were found to be 50 or older. There were a total of 150 responders; 50 (35.7%) were nurses, 40 (28.1%) were pharmaceutical

graduate degree (0.7%); 69 with a diploma (48.6%); 32 with an undergraduate degree (22.5%); 28 with an undergraduate certificate (19.7%); 6 with a secondary degree (4.2%); and 4 with a basic degree (2.8%).

• Evaluation of the Respondents' Expertise:

The findings in Table 2 below reveal that, 135 (95.5%) of health care personnel were aware that incorrect waste management produces different health dangers,‖ 3 (2.1%) replied No and 2 (1.4%) did not know improper waste management causes health hazards or not. waste; nine respondents (6.7% of the total) responded no; and thirty respondents (21.1%) did not know. Of the respondents, 55 (38.7%) said that biomedical wastes were disposed of by dumping them directly into garbage cans, 49 (34.5%) said that the waste was incinerated, 22 (15.9%) said that they were given to garbage collectors, and 14 (9.9%) said that the waste was given to a biomedical waste management (BMWM) company. ―Sixty-four percent (64%) of respondents noted that it was required to keep records of biomedical waste (BMW) at their health care institutions, whereas twenty-five percent (14%) reported that no such records were maintained. Only three people out of 137 (2.1%), however, were uninformed that poor waste management may harm the environment.

• Evaluation of Health Care Workers' Attitudes:

Data from 129 respondents (90.8%) shows support for safe handling of biological waste, whereas 11 respondents (8.2%) express opposition. A total of 116 (81.7%) of the respondents indicated safe

votes (78.6%) and 29 no votes (20.4%) on whether or not trash management is a team sport. On the topic of whether or not safe management efforts by hospitals add to the financial burden on management, 86 respondents (61.0%) replied no, while 54 (38.0%) said yes. ―Safely disposing of medical waste was seen as an additional hardship by 121 (85.2%) respondents but not by 21 (14.8%).

Table 4 below displays the findings, showing that 131 respondents (92.7%) agreed that different colored bags were used to dispose of various wastes, whereas 5 respondents (3.5%) disagreed and 4 (2.8%) were unsure.‖ A total of 43 (30.3%) respondents reported used disposable plastic goods were disposed of in Yellow bags, 50 (35.2%) in Red bags, 13 (9.6%) in Black bags and 34 (23.9%) claimed they did not know. Among the respondents, 15.0% claimed blue/white bags were used to dispose of used dressings and impression materials, 43.4% said red bags were used, 21.1% indicated black, and 34.9% were unsure.Among those polled, 103 (72.5%) answered that they disposed of discarded sharps and needles in Safety boxes, 12.4 percent in Red boxes, 6.3% in Yellow bags, and 7.7 percent did not know. Ninety-seven respondents (68.3%) indicated red bags were used to dispose of human tissue and tooth extractions, nine (6.3%) answered yellow bags, five (3.5%) said black bags, and twenty-nine (20.8%) did not know. said red, and 37 (26.1%) claimed they didn't know.

Table 5 shows that inappropriate waste management is associated with a number of

employment history (p>0.05).

Table 6 shows that there is no statistically significant relationship between education level and attitude evaluation factors related to biomedical waste management.

Knowledge Evaluation for Healthcare Professionals: The majority of health care personnel in Riyadh, Saudi Arabia, have sufficient understanding about the dangers of inappropriate biomedical waste management to communities and the environment, according to the results of a recent research. The outcomes of this research suggested that most health professionals in Riyadh displayed good attitudes towards safe handling of biomedical waste. Similar results were found in a research on attitudes toward Hepatitis B virus (HBV) prevention in Ethiopia [8],‖ who found that, on the whole, participants had positive attitudes toward HBV prevention when prevention was linked to biomedical waste management. On the other hand, research conducted revealed that all hospital managers stated that their operations in regards to healthcare waste management and occupational safety measures had never been exposed to review by relevant government bodies. Everyone who participated in this survey expressed a desire to better protect the health of their employees, patients, and the surrounding community. All of the participants in this research adhered to universal measures while dealing with biological waste, and their results corroborate those of a comparable study conducted. However, the results of the current study are at odds with those of an Ethiopian study who found that hospital workers had negative attitudes toward BMWM and used few safety precautions and waste management tools. The majority of people in Botswana agreed that medical waste should be separated out at the

feeling that safe segregation of BMW is an additional burden at work, and all doctors feel that safe segregation of Health Care waste is an additional burden to their work, which can have negative consequences. A greater risk of infection and harm is associated with healthcare waste than with any other sort of trash, as shown in the current research. It bears repeating that an insufficient and unsuitable approach to managing health care waste may have severe health repercussions and a substantial impact on the environment. Therefore, Saudi typically has to develop positive attitudes, dedication and team effort in combating repercussions associated to ill-effects of health care wastes. From the data, it's clear that hospitals in general generate more trash than clinics of a lower quality. Shinyanga municipality, Saudi Arabia, was the site of a research [9] showing that, as the number of healthcare institutions has grown, so too have healthcare wastes, posing major hazards to the environment, the health condition of workers, and the general environment. While this research found that biological waste segregation was performed by many healthcare institutions, appropriate segregation practice was not observed in the vast majority of healthcare facilities. Sharps waste was found along with regular garbage in shared trash cans. The findings are consistent with those who found that in Nigeria, hazardous waste was not collected, segregated, and disposed of properly; there was widespread open dumping of potentially infectious materials; and there were no incinerators to treat waste. This confirms the findings [10] who conducted their own research in Shinyanga municipality and discovered that residents there still have a low level of knowledge about the health concerns associated with improper trash color coding. Another research done in Ethiopia [11] revealed that health care practice scores were inadequate despite their use of proper personal protective gear and waste management procedures. research on the real-world management of biomedical waste in Botswana mirrored the present study, especially with regards to the presence of a color-coding system in the hospitals sampled. These results are consistent with those of a research conducted in South-Eastern Nigeria by [12] which found that 98.1% of hospitals there engaged in the careless disposal of biological waste. Therefore, it is suggested that standardized techniques, in accordance with national and international criteria, be used for the correct segregation of healthcare waste. . The vast majority of healthcare providers in Riyadh city do not practice proper management of medical waste by not using the designated, color-coded bags. This study's findings did not support hypotheses about The aforementioned results, however, contradict those of a research done in Uganda [13] who found that health professionals' behavior and HCW management procedures were good. The Ugandan result is about respectable knowledge, since there was a statistically significant correlation between the two measures of competence (p 0.001). There is a severe deficiency in knowledge, appropriate attitudes, and practices for efficient BMW management among medical and health care workers, particularly in poor countries like Saudi Arabia, as shown by the many research reviewed in the literature.

CONCLUSION

Medical professionals in Riyadh, Saudi Arabia, have shown a high level of knowledge of the consequences of incorrect health care waste management. A total of 96.5% of health care personnel were aware that inappropriate waste management generates different health dangers and 97.9% were aware that improper waste management causes environmental difficulties. Also, many hospitals were found to rely on the two waste disposal procedures (dumping directly into trash cans and incineration) that pose the greatest threat to patients' health. The most common means of trash disposal were incineration (34.5%) and dumping (32.7%). Together, they accounted for 73.2% of all waste disposal techniques. Some of the medical centers in Riyadh City failed to properly execute waste management guidelines for biological materials. Flyers of various types were discovered with the goal of raising public awareness about the dangers of improperly handling biomedical wastes, but most health professionals were unaware of their presence since they were not posted in all sections of health facilities. It was fascinating to learn that the general mentality and attitude of health care personnel in Riyadh city was one that prioritized the proper disposal of medical waste. According to the results of the studies mentioned above, most healthcare professionals in Riyadh city, Saudi Arabia, did not engage in or exhibit safe management of health care waste. In most cases, they failed to properly utilize the designated color bags.

REFERENCES

1. Ministry of Environment and Forests, notification N.S.O.630 (E). (2019) Biomedical waste (management and handling) rules, 1998. The Gazette of India, Extraordinary, part II, section 3 (ii) 2. Ministry of Environment and Forests. Government of India. (2020) Draft bio-medical waste (management and handling)

AG, Abubakar MY. (2022) Poor Medical Waste Management (MWM) practices and its risks to human health and the environment: a literature review. Int J Environ Ealth Sci Eng. 5:1–8. 4. Gupta S, Boojh R, Mishra A, Chandra H. (2021) Rules and management of biomedical waste at Vivekananda Polyclinic: a case study. Waste Manag. 29:812–819. 5. Government of India, (2021)Environment Protection Act. 6. Jahnavi G, Raju PV (2022) Awareness and training need of biomedical waste management among undergraduate students, Andhra Pradesh.. https://pubmed.ncbi.nlm.nih.gov/17193765/ Indian journal of public health. 50:53–54. 7. Ministry of Environment, Forest and Climate Change. (2021) Notification. The Gazette of India, Extraordinary, part II, section 3, sub-section (I ). 8. Abdela, A., Woldu, B., Haile, K., Mathewos, B., &Deressa, T. (2018). Assessment of knowledge, attitudes and practices for the prevention of hepatitis B virus infection among students of medicine and health sciences in Northwest Ethiopia. BMC research notes, 9(1),410. 9. Kuchibanda, K., &Mayo, A. W. (2021). Public health risks from mismanagement of health care wastes in Shinyanga municipality health facilities, Tanzania. The Scientific World Journal, vol. 2015, Article ID 981756, 11 pages, 2015. 10. Deress, T., Hassen, F., Adane, K., &Tsegaye, A. (2018). Assessment of knowledge, attitude, and practice about biomedical waste management and associated factors among the healthcare professionals at DebreMarkosTown healthcare facilities, Northwest Ethiopia. Journal of environmental and public health,2018. 11. Mugabi, B., Hattingh, S., &Chima, S. C. (2018). Assessing knowledge, attitudes, and practices of health care workers regarding medical waste management at a tertiary hospital in Botswana: A cross-sectional quantitative study. Nigerian Journal of Clinical Practice, 21(12),1627-1638. 12. Anozie, O. B., Lawani, L. O., Eze, J. N., Mamah, E. J., Onoh, R. C., Ogah, E. O., ... &Anozie, R. O. (2017). Knowledge, attitude and practice of health care managers on medical waste management and occupational safety practices: Findings 13. Wafula, S. T., Musiime, J., &Oporia, F. (2019). Health care waste management among health workers and associated factors in primary health care facilities in KampalaCity, Uganda: a cross- sectional study. BMC public health, 19(1), 203.

Biomedical Engineering, Prince Sultan Military Medical City, Riyadh, KSA