|Year : 2017 | Volume
| Issue : 2 | Page : 65-70
Assessment of awareness regarding biomedical waste management among students and interns of dental institute
Anita Rama Kahar1, Amishi Arora2, Usha Radke1, Jayashree Joshi1
1 Department of Prosthodontics and Crown & Bridge, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
2 Central Institute of Business Management Research and Development, Nagpur, Maharashtra, India
|Date of Web Publication||28-Dec-2017|
Dr. Anita Rama Kahar
Hansapuri, Jyotinagar Khadan, Near Durga Devi Temple, Nagpur, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: In teaching institutes, most of the patients got treated by the students and the interns. They are the budding dentist of dental health-care profession. As these students and the interns work in direct contact with biomedical waste (BMW), they should have proper knowledge about its management to avoid the associated risk.
Aims and Objectives: The aim of this study was to evaluate BMW education/awareness, awareness of BMW generation, hazard, and legislation and its management practices among the final BDS students and interns of VSPM Dental College and Research Centre, Nagpur, Maharashtra, India.
Methodology: A cross-sectional questionnaire-based study was designed. The study was approved by the Institutional Ethical Committee. The questionnaire was consisted of 19 close-ended questions and one open-ended question. It was distributed anonymously among BDS final year students and interns. The solved questionnaire was collected back after 10 min and the data were analyzed.
Results and Conclusion: The present study showed that awareness regarding the BMW was good and awareness about its generation; hazards, legislation, and awareness about BMW practices were moderate to poor.
Keywords: Awareness; biomedical waste; dental institute; interns; students
|How to cite this article:|
Kahar AR, Arora A, Radke U, Joshi J. Assessment of awareness regarding biomedical waste management among students and interns of dental institute. Indian J Multidiscip Dent 2017;7:65-70
|How to cite this URL:|
Kahar AR, Arora A, Radke U, Joshi J. Assessment of awareness regarding biomedical waste management among students and interns of dental institute. Indian J Multidiscip Dent [serial online] 2017 [cited 2018 Jun 21];7:65-70. Available from: http://www.ijmdent.com/text.asp?2017/7/2/65/221757
| Introduction|| |
The term “biomedical waste” (BMW) is defined as “any waste that is generated during diagnosis, treatment, or immunization of human beings or animals, or in the research activities pertaining to or in the production or testing of biological and includes categories mentioned in schedule I of the Government of India's BMW (Management and Handling) rules 1998.” Dental waste is a subset of hazardous BMW. Dental practices generate large amounts of cotton, plastic, latex, glass, sharps, extracted teeth, and other materials, much of which may be contaminated with body fluids.
In teaching institutes, most of the patients got treated by the students and the interns. They are the budding dentist of dental health-care profession. As these students and the interns work in direct contact with BMW, they should have proper knowledge about its management to avoid the associated risk. As the BMW management is in the syllabus of the final BDS. They should be well aware of BMW management. Hence, to assess the awareness about BMW management, the present study had conducted among the final BDS students and interns of VSPM Dental College and Research Centre, Nagpur (Maharashtra), India.
Aims and objectives
The study had the following aims and objectives relating to final BDS students and interns of VSPM Dental College and Research Centre, Nagpur (Maharashtra), India.
- To evaluate the BMW education/awareness
- To evaluate awareness of BMW hazards and legislation
- To evaluate the awareness of BMW management practices.
| Research Methodology|| |
A cross-sectional questionnaire study was designed. The study was approved by the Institutional Ethical Committee of VSPM Dental College, Nagpur, Maharashtra, India and written consent was taken from all the subjects before they were given the questionnaire. The samples were all the final BDS students and interns. The students and interns who do not want to participate in the study was the only exclusion criterion for the sample selection; by doing this; the sample size came to 160.
The questionnaire was designed by including some of the questions which were already been used in other studies.,, The questions were selected by keeping in mind the study group. The validation of questionnaire was done. The ready study instrument was the 20-item questionnaire in which 19 are closed ended and one is open ended. The closed questionnaire was divided into three heads. First part dealt with the BMW education/awareness which includes four questions. Second part dealt with the BMW generation, hazards, and legislation which include six questions. The third part dealt with the BMW management practices which include nine questions. It was distributed anonymously among participants.
The solved questionnaire was collected back after 10 min. The data were calculated using MS-Excel and analysis was done.
Observations, interpretation, and data analysis
The present study was conducted among the final BDS students and interns. The purpose of study was that the students of final BDS have BMW management in their syllabus curricula. Hence, their knowledge about BMW must be good.
I. Result on biomedical waste education/awareness
The study result showed that one hundred and forty five (91%) of respondents were aware about that their hospital/institute generates BMW. One hundred and fifty (94%) of respondents were aware about that improper waste management causes various health hazards. One hundred and forty-four (90%) of them agree that there should be regular educational programs on BMW management. One hundred and thirty-one (82%) of respondents were aware about the universally accepted symbol for biohazard.
II. Result on biomedical waste generation, hazards, and legislation
The knowledge of BMW management generation and legislation seems to be poor which showed in the result that only 50 (31%) of respondents were aware about BMW generation and legislation. Ninety-nine (62%) of respondents had knowledge about the first proposal of BMW (Management and Handling) rules was made in 1998. The statement which describes the BMW was known to only 93 (58%) of respondents.
One hundred and fifty-two (95%) of respondents thought that it is important to know about BMW generation, hazards, and legislation. The respondents had poor knowledge about that the storage of BMW that it should not be stored beyond 48 h, only 78 (49%) of them were aware about that.
Respondents also had very less knowledge about BMW categories had reduced to eight (according to BMW rule 2011), only 46 (29%) had knowledge about that.
III. Result on biomedical waste management practices
Only 44% (70) of them were aware about that the waste disposal practice correct in their hospital. Furthermore, the respondents had poor knowledge about that the approximately 10%–20% of waste are the infectious waste among total waste generated from a healthcare facility, as only 31% (50) of respondents had given correct answer. Seventy-nine percent (126) of respondents were aware about color-coding segregation of BMW and 75% (120) of respondents follow it. The awareness regarding the disposal of used impression materials (compound, alginate, and shellac), soiled dental casts (disinfected), discarded medicine, and expired dental materials was found to be very poor as only 31% (50) of them had responded correctly that it should be disposed of in yellow bags. The next question regarding the disposal of used radiographic films, metal (crowns, orthodontic bands and brackets, matrix bands), glass bottles, lead foils, and gloves had also poor knowledge as only 25% (40) of respondents knew the disposal of it in red-colored bags. Forty-eight percent (77) of respondents knew about that used sharps and needles are disposed of in rigid/puncture-proof container. Forty-six percent (74) of respondents had knowledge about the extracted teeth and human tissues are disposed of in yellow bags. Fifty-four percent (86) of respondents were aware about that the mercury or scrap of silver amalgam is disposed of in water/glycerin. The detailed result is shown in [Table 1]. In the last open-ended question, respondents wrote various methods of BMW management such as incineration, autoclaving, shredding, and deep burial.
| Discussion|| |
Waste generated in a dental teaching hospital is similar to that generated by other hospitals which include a large component of general waste and a smaller proportion of hazardous waste. Dental professionals are at a greater risk for acquiring cross infection while treating patients. This is evident from the fact that most of the human pathogens have been isolated from oral secretions. Dental hospitals use instruments and materials that are directly exposed to blood and saliva and are therefore potential sources of infection. Many chemicals such as acrylics, impression materials, and mercury used for restorative purposes may have a possible environmental and human health impact if not handled properly.,
Concern regarding BMW is mainly due to the presence of pathogenic organisms and organic substances having adverse effect on human health. There could be significant numbers of organisms in the waste, including virulent strains of viruses and pathogenic bacteria. Dental practice involves many hazardous exposures and this calls for proper segregation and disposal of BMW.
The United Nations Conference on Environment and Development in 1992 recommended the following measures:
- Prevent and minimize waste production
- Reuse or recycle the waste to the extent possible
- Treat waste by safe and environmentally sound methods and
- Dispose of the final residue by landfill in confined and carefully designed sites.
Biomedical waste management in India
BMW (Management and Handling) rule 1998, prescribed by the Ministry of Environment and Forests, Government of India, came into force on July 28, 1998.
This rule applies to those who generate, collect, receive, store, dispose, treat, or handle BMW, types of waste and treatment and disposal options under rule 1998.
The BMW should be segregated into containers/bags at the point of generation of the waste. The label for biohazards symbol and cytotoxic hazard symbol should be prominently visible and nonwashable.
The Ministry of Environment and Forests has revised the BMW (Management and Handling) rules promulgated under the Environment Protection Act of 1986. The rules now called the BMWs (Management and Handling) rules 2011 has been notified.,,
Review of literature
Radha  in her study revealed that the dentists were well aware that the dental hospitals/clinics generate BMW and that improper waste management can cause various health hazards; 61.4% of respondents like to undergo a training program on management of BMW. The study done by Narang et al. showed that all the dentists were well aware of the various health hazards caused by improper BMW management; 100% of dentist had the opinion of regular educational programs. In the present study also, 91% of respondents knew that that their hospital generates BMW and 94% respondents thought that various health hazard can cause health hazard; 90% of respondents were in favor that there should be regular educational program.
Sharma et al. showed in his study that 30% dentists had excellent knowledge about BMW generation and legislation. A study by Kishore et al. conducted in New Delhi, India, among the 64 dentists reported that the majority of the respondents were not aware of the proper clinical waste management regulations.
Similar results were found in a study of hospital medical personnel in Agra by Sharma, which indicated a lack of knowledge and awareness toward legislation on BMW.
In the present study, only 31% of respondents had knowledge about BMW generation and legislation.
Radha  in her study showed that 51% of dentists know identification of biohazard symbol. In our study, 82% of respondents were aware about the biohazard symbol. In her study, 39.2% of dentists know waste should not be stored beyond 48 h; in our study, the awareness of this question was also less which is about only 49%.
Narang et al. showed the awareness regarding use of color-coded bags (85%), disposal of impression material and soiled dressings (52.5%), disposal of sharps and needles (60%), and disposal of extracted teeth and human tissues (47.5%).
In the present study, the respondents had awareness of color-coded segregation of BMW about 79%, disposal of impression material and soiled dental cast (31%), disposal of used sharps and needles (49%), and disposal of extracted teeth and human tissues (46%).
Saini et al. showed in his study to evaluate the knowledge and awareness of practice regarding BMW management. 59.23% had correct knowledge and 81.55% were aware about practice of BMW management, 82% of the subjects had awareness regarding the disposal of different types of BMW in the corresponding colored bags.
In the present study also, 75% of them of them follow corresponding colored bags. Whereas 88% of the dentists agreed to the fact that infectious waste should be put in yellow-colored plastic bag with a biohazard symbol in the study reports of Rudraswamy et al. In the present study, 46% of respondent told that they use yellow-colored plastic bag.
According to another study reports, 36% of the participants were using yellow bag for disposal of blood-soaked cotton or gauze. Color coding of waste was not done by 67% of the subjects in one of the studies conducted in Haryana. According to findings of another study conducted in Rajasthan, only 30% of dentists had excellent knowledge about BMW generation and segregation while 36% of the dental nurses had extremely poor knowledge about it. Only 28% of the subjects reported that yellow bag is used for infected waste in a study conducted in a dental teaching institution in New Delhi.
Almost all the subjects agreed to the fact that exposure to hazardous healthcare waste can result in disease or infection in the study reports of Sood and Sood, whereas only 84% of the subjects were of this opinion in the study reports of Kishore et al. In the present study, 94% of the respondents were agree with the fact of improper waste management cause various health hazard. Fifty-five percent of the subjects were aware of the fact that BMW and Handling law were established by the Government of India in 1998, in the study conducted by Saini et al. as compared to 23% of subjects who had awareness regarding any such law in the study findings of Kishore et al. Khatri et al. in his study was observed that the red container was used to lead foils, 13.11%; X-ray films, 13.59%. In the present study also, there were only 25% of the respondents aware that lead foils X-ray films should be disposed of in red container. American Dental Association (ADA) specification recommends that storing of scrap amalgam from restorative procedures under water, glycerin, or spent X-ray fixer in a tightly capped jar.
In the survey conducted by Raghuvendra et al. showed that 31% of dentist were storing amalgam under spent fixer solution. In the present study, the 54% respondents store their scrape of silver amalgam under water glycerin which is according to ADA specification.
Biomedical waste rules 2011
The new rules on BMW are elaborate, stringent, and several new provisions have been added in it. The rules are not applicable for the radioactive waste, hazardous waste, municipal solid waste, and battery waste which would be dealt under the respective rules. The differences between 2011 and 1998 rules are given in [Table 2].
| Conclusion|| |
The present study showed that the awareness regarding the BMW generation was good and about its hazards and legislation and management practices knowledge among the final BDS students and interns was moderate to poor in spite of its presence in their syllabus of final BDS. The samples included in the present study are the budding dental professionals, so their BMW awareness, knowledge, and practice should be good. While teaching the topic more effort will have to be taken to increase the knowledge and awareness among the students about it which is very important for the health of the people and an essential component of quality assurance of the hospitals.
We sincerely thank to final BDS students and interns for participating in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sharma A, Sharma V, Sharma S, Singh P. Awareness of biomedical waste management among health care personnel in Jaipur, India. Oral Health Dent Manag 2013;12:32-40.
Schaefer ME. Hazardous waste management. Dent Clin North Am 1991;35:383-90.
Narang RS, Manchanda A, Singh S, Verma N, Padda S. Awareness of biomedical waste management among dental professionals and auxiliary staff in Amritsar, India. Oral Health Dent Manag 2012;11:162-8.
Radha R. Assessment of existing knowledge, attitude, and practices regarding biomedical waste management among the health care workers in a tertiary care rural hospital. Int J Health Sci Res 2012;2:14-9. Available from: http://www.ijhsr.org
. [Last accessed on 2017 Apr 21].
Sudhakar V, Chandrashekar J. Dental health care waste disposal among private dental practices in Bangalore city, India. Int Dent J 2008;58:51-4.
Singh BP, Khan SA, Agrawal N, Siddharth R, Kumar L. Current biomedical waste management practices and cross-infection control procedures of dentists in India. Int Dent J 2012;62:111-6.
Mehta A, Gupta M, Upadhyaya N. Status of occupational hazards and their prevention among dental professionals in Chandigarh, India: A comprehensive questionnaire survey. Dent Res J (Isfahan) 2013;10:446-51.
Pandit NB, Mehta HK, Kartha GP, Choudhary SK. Management of bio-medical waste: Awareness and practices in a district of Gujarat. Indian J Public Health 2005;49:245-7.
] [Full text]
Park K. Hospital waste management. Park's Textbook of Preventive and Social Medicine. 20th
ed., Ch. 14. Jabalpur, Madhya Pradesh, India: M/S Banarsidas Bhanot Publishers; 2009. p. 698.
Sharma AK. Bio Medical Waste (Management and Handling) Rules. Bhopal: Suvidha Law House; 1998.
Acharya DB, Meeta S. The Book of Hospital Waste Management. New Delhi: Minerva Press; 2000. p. 15, 47.
Acharya DB, Singh M. Practical Handbook on Hospital Waste Management. 2nd
ed. JBA Publishers:New Delhi;2008.
Kishore J, Goel P, Sagar B, Joshi TK. Awareness about biomedical waste management and infection control among dentists of a teaching hospital in New Delhi, India. Indian J Dent Res 2000;11:157-61.
Sharma S. Awareness about bio-medical waste management among health care personnel of some important medical centers in Agra. Int J Environ Sci Dev 2010;1:251-5.
Saini R, Pithon MM, Singh HK, Popoff DV. Knowledge of biomedical waste management among the students of rural dental college, Maharashtra, India. Int J Exp Dent Sci 2013;2:24-6.
Rudraswamy S, Sampath N, Doggalli N. Staff's attitude regarding hospital waste management in the dental college hospitals of Bangalore city, India. Indian J Occup Environ Med 2012;16:75-8.
] [Full text]
Sood AG, Sood A. Dental perspective on biomedical waste and mercury management: A knowledge, attitude, and practice survey. Indian J Dent Res 2011;22:371-5.
] [Full text]
Bala S, Narwal A. Awareness of bio-medical waste management among hospital and dental college and hospital employees. A panoramic view. J Oral Health Community Dent 2013;7:1-7.
Khatri M, Agrawal R, Reddy MG, Khatri J, Kokil NS. Knowledge and practice adopted by dental practitioners and dental auxiliaries regarding biomedical waste management in Pune. J Dent Res Sci Dev 2014;1:34-9.
Raghuvendra SS, Ranadive N. Mercury hygiene practices followed in dental clinics in Pune: A survey. World J Dent 2013;4:92-5.
[Table 1], [Table 2]