KNOWLEDGE, ATTITUDE AND PRACTICES OF PRIVATE DENTAL PRACTIONERS REGARDING THE BIOMEDICAL WASTE MANAGEMENT IN NCR REGION OF INDIA: A CROSS SECTIONAL STUDY DR SHAMIMUL HASAN (BDS; MDS) DR SHAZINA SAEED ASSISTANT PROFESSOR ASSISTANT PROFESSOR DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY AMITY INSTITUTE OF PUBLIC HEALTH FACULTY OF DENTISTRY AMITY UNIVERSITY JAMIA MILLIA ISLAMIA

INTRODUCTION

The term biomedical waste has been defined as “any waste that is generated during the 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 Biomedical Waste (Management and Handling) rules 1998”

WASTE GENERATED IN HOSPITALS Hospitals generate enormous amounts of waste. Estimate : 1.0kg/bed/day - India 4.5kg/bed/day - U.S.A. Non-Hazardous waste - 80% Biomedical waste (Hazardous &infectious ) - 15% Hazardous but non infectious - 5%

The indiscriminate health care waste disposal has lead to a global rise in infections such as AIDS and Hepatitis B. Changes in microbial ecology and spread of antibiotic resistance may also occur as a result of improper waste management.

WHO CLASSIFICATION OF WASTE

Infectious waste (suspected to contain pathogens): Generated during Diagnosis , Treatment & Immunization. Laboratory cultures, Waste from isolation wards Tissue-swabs Material in contact with infected patient Excreta. Pathological Waste : Human tissue e.g. body parts ,blood and other body fluids, foetuses.     Genotoxic waste : Waste containing cytotoxic drugs Chemical waste : Laboratory reagents , film developer ,expired disinfectants, solvents.       Waste with heavy metals: Batteries; broken thermometer ;    mercury containing waste (mercury, amalgam), lead containing waste (lead foil packets, lead aprons) Pressurized containers: Gas cylinders , gas cartridges, aerosol cans.   Radioactive material: Unused liquid from radiotherapy , contaminated glass ware ,urine ,excreta from patient treated with unsealed radio nucleotides

AIMS AND OBJECTIVES

This study aims to assess the Knowledge, attitude and practices of the private dental practitioners regarding the biomedical waste management in NCR region of India. This study also aims to evaluate the ongoing biomedical waste disposal practices and implement the best management practices in relation to the findings of the questionnaire based survey for efficient biomedical waste management. HOW ? Appropriate segregation Collection Transport

MATERIALS AND METHODS

A cross-sectional survey was carried out among the private dental practitioners in NCR region of India. A total of 589 dental practitioners were registered with the different dental councils of NCR region, out of which 100 private dental practitioners were selected for the study by simple random sampling. The study was carried out for a period of 2 months from November 2015 to December 2015. The private dental practitioners were approached to fill the self administered questionnaire after taking the informed verbal consent. The validity of the questionnaire was checked by doing a pilot study on 20 dental healthcare personnel. The percentage response for each question from all the participants was obtained and the data was calculated using Microsoft excel.  

RESULT

Age and Gender distribution 53.75% 62.5% 38.75% 37.5% No .of Practitioners No .of Practitioners 7.45% Age- Groups Gender Distribution

KNOWLEDGE RESPONSE AMONG BDS AND MDS S.No QUESTION BDS (%) MDS(%) 1. Are you familiar with the biomedical waste legislation and its generations? 54.5 66.7 2. Are you aware about the agency (ies) that regulate health care generated waste management? 34.2 42.2 3. Which of the following statements hold true for BM waste? 100 91.1 4. Mercury, a major constituent of dental amalgam is a known: 91.4 5. Exposure of the contaminated sharps poses a high risk of- 94.2 95.6 6. Extracted teeth for preclinical exercises (cavity preparation) should be - 25.7 24.4 7. Microbiological waste, human anatomical waste, and soiled plastic waste should be placed in- 57.1 42.3 8. The plastic bags used for waste disposal are- 97.8

ATTITUDE RESPONSE AMONG BDS AND MDS s.no QUESTION BDS (%) MDS ( %) 1. Do you agree that BM waste generation, hazards and legislation are important public health issues? 97.1 100 2. Do you think that biomedical waste should be disposed according to color coding system? 85.7 95.6 3. Do you think that labelling the container before filling it with waste is of any clinical significance? 94.3 84.4 4. Do you think that infected plastic syringes and gloves should be autoclaved before shredding and disposal? 42.8 33.3 5. Have you attended any training programme on biomedical waste management? 91.4 6. Your opinion whether biomedical waste management programme should be made a part of the academic curriculum? 82.7 97.8 7. Do you think that training on biomedical waste practices aid in effective biomedical waste management?

PRACTICES RESPONSE AMONG BDS AND MDS S.NO QUESTIONS BDS (%) MDS (%) 1. Do you practice that the Biomedical Waste should not be stored beyond 72 hours? 45.7 51.1 2. Does your clinic follow any biomedical waste disposal policy? 77.1 86.7 3. Where do you dispose sharps, needles and orthodontic wires? 2 91.1 4. Where do you dispose Blood-soaked / dripping gauze in your clinic? 25.7 55.5 5. How do you dispose mercury in your clinic? 5.7 62.2 6. How do you manage silver waste in your clinic? 40 60 7. What do you do with the lead shield from the film packets? 82.2

84.37% 86% 60.3% 70.1% 65.3% 39.7% MDS BDS

CONCLUSION

Proper awareness and knowledge of biomedical waste management and handling rules among the people and health care workers is essential. Lack of awareness and knowledge about the health hazards from biomedical waste, improper practices of waste disposal and poor control of waste disposal are the most critical problems associated with health care waste disposal. The present study is expected to enhance the existing knowledge of biomedical waste management and will enforce awareness among the dental health care personell regarding proper and effective disposal of biomedical wastes.

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