Knowledge and awareness on biomedical waste management among students of four dental colleges in Chennai, India

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1 Research Article Knowledge and awareness on biomedical waste management among students of four dental colleges in Chennai, India V. Indhulekha 1, Dhanraj Ganapathy 2, Ashish R. Jain 2 * ABSTRACT Background: Dental waste is a subset of biomedical waste (BMW). It has been observed that most of the dental health facilities and the guidelines for proper management of dental waste are not adopted and not up to the prescribed standard. Aim: The aim of this study is to assess the current knowledge and awareness of undergraduate dental students regarding BMW management. Materials and Methods: The study was conducted during the academic year January March 2018 in randomly selected four dental colleges, Chennai. Undergraduate dental students who were willing to participate were included in the study after obtaining informed consent and ethical committee clearance. A total of 100 students were selected randomly, and a self administered questionnaire was given to the respondents. The questionnaire consisted of 16 structured questions to assess the students knowledge levels, attitude, and awareness regarding BMW management. Results: The survey was conducted on 100 dental students, of which 25 were 3 rd years, 40 from final year, and 35 were doing internship. The knowledge score according to the year of study was 64%, 52.5%, and 80% for 3 rd years, 4 th years, and interns, respectively. Overall, 67% of respondents were aware about the correct color coding management system for hospital waste management that prevails in India. Conclusion: The results indicate that not all dental students were aware of BMW management. A large population of the dental students were not practicing proper method of health care waste disposal; hence, there is an utmost need to educate almost the dental students and practitioners regarding proper practice of BMW management. KEY WORD: Awareness, Biomedical waste, Dental students, Management INTRODUCTION The biomedical waste (BMW) is defined as any solid, liquid, and waste material generated during the process of diagnosis, treatment, and immunization of human being or animal. This waste material could cause serious hazards and environment in case of improper management. All the hospital personnels are at the risk of developing fatal infections such as HIV, hepatitis B virus, and hepatitis C virus and injuries by these infectious materials. To avoid these hazards, BMW management system should be implemented in the hospital system. [1] Most of this waste is not more dangerous than regular household waste. However, some types of health care waste represent a higher risk to health. Access this article online Website: jprsolutions.info ISSN: The BMW generated in the dental clinics can be classified into sharp instruments, used disposable items, infectious waste (blood soaked cotton, gauze, etc.) hazardous waste such as mercury and lead, and chemical waste such as film developer, fixers, and disinfectant. The largest BMW in our field is handling of mercury and disposal of lead. Dentist and dental personnel have been directly and indirectly exposed to mercury (Hg) emission from incinerator and Hg from wastewater from different sources. The release of amalgam during practice in clinics and hospitals wastewater or in solid waste is an important concern as these particles could be released into the environment. [2] Hospital waste management has been brought into focus in India recently particularly with the notification of the BMW (BMW management and handling) rules, The rules make it mandatory for health care establishments to segregate, disinfect, 1 Departmetn of Prosthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India, 2 Department of Prosthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India *Corresponding author: Dr. Ashish. R. Jain, Department of Prosthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Poonamalle High Road, Chennai , Tamil Nadu, India. Phone: E mail: dr.ashishjain_r@yahoo.com Received on: ; Revised on: ; Accepted on:

2 and dispose their waste in eco friendly manner. [3] A major issue related to current BMW management in many hospitals is that practice of biowaste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner. Handling, segregation and mutilation, disinfection, storage, transportation, and final disposal are vital steps for safe and scientific management of BMW in any establishment. Health care associated infections result in increased length of stay, mortality, and health care costs. [4] The present study was designed to determine the knowledge and awareness of practice for hospital waste management among the undergraduate students of dental colleges in Chennai. MATERIALS AND METHODS A cross sectional observational study was conducted in the year 2018 among the students of four randomly selected dental colleges in Chennai following clearance from university human ethical committee. A total of 100 students voluntary participated in the study, and the subjects were fully informed about the design and the purpose of the study. A written informed consent was obtained from each student. The data were collected on a pre tested structured questionnaire. The questionnaire consisted of questions to assess the knowledge and awareness of practice toward BMW management. Questionnaire Knowledge and awareness related questions are as follows: 1. Where should dental waste be disposed a. Certified waste carrier service b. Common dustbin c. Open areas 2. The color of coding for hospital waste given BMW management in India is a. Yellow, red, white, and black b. Yellow, blue, green, and black c. Red, white, black, and green 3. The most effective way to remove accidental spill of mercury in the clinic is a. Mercury spill kit b. Common dustbin hydrogen peroxide solution 4. The cotton gauge used during extraction can be disposed by a. Burnt b. Dustbin c. Open area 5. Extracted tooth and used impression materials come under the infected category 6. Outdated and contaminated medicines come under cytotoxic chemical waste category 7. What do you think are the most common problem in the management of healthcare waste in your clinic a. Lack of information navailability of agency service c. Not well trained 8. Do you know about the existing medical waste management policy in india 9. Have you attended any course on dental waste management 10. Do you think you need more training regarding dental waste management 11. Which color code bags do you use to dispose syringes, needles, scalpels a. White b. Yellow c. Red 12. Do you use puncture proof containers to discard needles in your clinic 13. Do you segregate the waste before disposal 14. Do you hand over dental waste to the municipal garbage and waste collector 15. Do you discard extracted teeth directly into regular garbage 16. Do you follow manafacturer s recommendations on disposal of used fixer solution For every correct answer, a score of 1 was given and score of 0 for every incorrect answer. Total score of 75% and above, between 50% and 75%, between 25% and 50%, and < 25% was considered excellent, good, moderate, and weal knowledge, respectively. Similarly, their practices toward BMW management were also graded based on their responses. RESULTS The survey was conducted on 100 dental students, of which 25 were 3 rd years, 40 from final year, and 35 were doing internship. The knowledge score according to the year of the study was 64%, 2396

3 52.5%, and 80% for 3 rd years, 4 th years, and interns, respectively. Overall 67% of respondents were aware about the correct color coding management system for hospital waste management that prevails in India. 65% were aware about the proper technique of removing accidental spills of mercury, and 79% of them had correct knowledge about the disposal of cotton used during extraction. 86% of students knew about the dental waste categories of materials used in dentistry. Only 51% of them had attended training programs on dental waste management. 80% of students said that they needed more information on BMW practices. Only 5% of them handed over the daily dental waste properly to the municipal garbage collector center. Only 27% of the respondent discarded the extracted tooth in a proper way. 41% of the dental students were not disposing the needles, syringes, and sharps in the correct color coded bags. However, 100% of the students followed the manufacturer s recommendations on disposal of used fixer solution, and all of them segregated the waste material before disposal [Tables 1-3]. DISCUSSION The BMW produced in the course of health care activities carries a higher risk for infection and injury than any other type of waste. Insufficient and inappropriate knowledge of handling healthcare waste may have serious health consequences and a significant impact on the environment as well. Infectious, chemical, and hazardous content in dental health care waste makes its management very complex. Improper dental waste management exposes the workers of health care facility, waste handlers, and community as a whole to infection, toxic effect, and injury. [5] Lack of information leads the dental professionals to contribute toward environmental degradation. This study was conducted as an effort to assess the knowledge and awareness of dental students toward dental waste management. In our study, the majority of dental students were aware about the term BMW management and 67% of them were aware about the existing BMW management policy in India. This correlates with the study done by Charania and Ingle, in which 72% of dentist knew about the BMW management and handling laws in India. [6] About 86% of students in our study knew about the categories of dental waste materials generated in the clinic, which is similar to the study by Bansal et al. [7] 79% of our students were aware of the methods of segregating and disposing extracted tooth and the cotton soaked in saliva and blood. In our study, 62% of students were aware about the color coding for hospital waste management, whereas 72% of participants knew about the color coding system according to the study conducted by Chaerul et al. [8] In our study, the majority of students had a good level of knowledge and awareness toward dental waste management when compared to a final year and 3 rd year students. Table 1: Knowledge level of students regarding BMW management Level of knowledge 3 rd year 4 th year Intern Total Poor knowledge count % year 4 (16.0) 8 (20.0) 2 (5.7) 14 (14.0) Moderate knowledge count % year 6 (24.0) 1 (2.5) 5 (14.29) 12.0 (12.0) Good knowledge count % yeart 1 (4.0) 10 (25.0) 0 (0.0) 11.0 (11.0) Excellent knowledge count % year 14 (56.0) 21 (52.5) 28 (80.0) 63.0 (63.0) Total count % year 25 (100.0) 40 (100.0) 35 (100.0) 100 (100.0) Table 2: Correct knowledge and awareness of students regarding hospital waste management Questions 3 rd year 4 th year Interns Total Where should the dental waste be disposed? 16 (64.0) 31 (77.5) 27 (77.1) 74 The color coding for hospital waste given by BMW management in 19 (76.0) 20 (50.0) 23 (65.71) 62 India is? The most effective way to remove accidental spill of mercury in the 20 (80.0) 18 (72.0) 27 (77.14) 65 clinic is? The cotton gauge used during extraction can be disposed in? 18 (72.0) 32 (80.0) 29 (82.86) 79 Extracted tooth and used impression materials comes under infected 24 (96.0) 30 (75.0) 32 (91.43) 86 category Outdated and contaminated medicines come under cytotoxic/chemical 24 (96.0) 30 (75.0) 32 (80.0) 86 waste category What do you think the most common problems in the management of 21 (84.0) 30 (85.71) 29 (72.5) 80 health care waste in your clinic? Are you aware of the existing medical waste management policy in India? 21 (84.0) 22 (55.0) 24 (60.0) 67 Have you attended any previous training programs on dental waste 14 (56.0) 19 (47.50) 34 (97.14) 51 management? Do you think you need more training regarding dental waste management? 26 (104.0) 23 ( (88.57)

4 Table 3: Correct practice of students regarding BMW management Questions 3 rd year 4 th year Intern Total Which color code bag do you use to dispose syringes, needles, and 17 (68.0) 20 (50.0) 22 (62.86) 59 scalpels? Do you use puncture proof containers to discard needles in your clinic? Do you segregate the waste before disposal? Do you hand over the dental waste to the municipal garbage collector 5 (20.0) Do you discard extracted teeth directly into regular garbage 11 (44.0) 15 (37.5) 1 (2.86) 27 80% of students in our study felt that they need more training on BMW management, whereas 97% were interested in receiving further training on the same according to the study by Sanjeev et al. [9] Thus, overall students showed a very positive attitude toward BMW management. In our study, only 5% of them followed proper dental waste management by handling the waste to the municipal garbage collection center. Only 27% of the students disposed the extracted tooth in a proper way. 41% of dental students were not disposing the needles, syringes, and sharps in the correct color coded bags. Thus, the large population of students in this study did not practice the correct method of dental waste segregation and disposal methods, although intern students exhibited better practices compared to a final year and 3 rd year students. Although most of our dental students were aware of the harmful effect of improper disposal of waste, a large proportion of them did not practice proper guidelines of BMW disposal which is similar to the studies by Bangennavar et al. [10] Exposures to many risk factors are possible in workplaces. Occupational diseases can be caused by chemical, physical, biological, and accidents caused by incorrect procedures. Ancient risk factors, such as biological agents, still cause concern in workplaces despite advancement in technologies. [11] Hospitals have a duty of care for the environment and public health and have particular responsibilities in relation to the waste they produce. Safe management of health care waste becomes very important when it comes to environmental conservation and health of the community. [12] According to the WHO, the humans element is more important than the technology. Almost any system of treatment and disposal that is operated by well trained staff can provide more protection for staff patients and community. [13] According to the WHO Southeast Asia Regional Office, the 11 Southeast Asian Countries together produce some 350,000 tons of health care waste per year close to 1000 tons a day which is both hazardous and non hazardous. [14] The current study showed that knowledge and awareness level of subjects were inadequate and there is a considerable variation in practice and management regarding BMW management among different studies. Safe and effective disposal of waste management is not only a legal necessity but also a social responsibility. Short courses on cross infection and BMW management are suitable means of improving of dental students. The government should also take responsibility to bring in the awareness regarding BMW management to the dentist dental students and also in medical hospitals. CONCLUSION The results of the present study indicate that not all dental students were aware of BMW management. A great amount of the dental students were not the following proper method of health care waste disposal; hence, there is an utmost need to educate almost the dental students and practitioners regarding proper practice of BMW management. REFERENCES 1. Hossain MS, Santhanam A, Norulaini NN, Omar AM. Clinical solid waste management practices and its impact on human health and environment A review. Waste Manag 2011;31: Sood AG, Sood A. 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