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NEWPORT INTERNATIONAL JOURNAL OF SCIENTIFIC AND

EXPERIMENTAL SCIENCES (NIJSES)
Volume 3 Issue 3 2023
Page | 58

Assessment of knowledge, attitude and practice of

medical staff towards medical waste management in
Jinja Regional Referral Hospital in Jinja District
Uganda
Twakiire Clare

Faculty of Medicine and Surgery Kampala International University

Western Campus Uganda.

ABSTRACT
The study was to assess the medical staff's knowledge, attitude and practice towards medical waste management.
Also to determine the knowledge of medical staff on medical waste disposal, to evaluate attitudes of medical staff on
medical waste disposal and to determine the practice of medical staff on medical waste disposal. The study was of a
Cross-sectional type using a questionnaire with closed-ended questions that was availed to respondents. The design
helped the researcher to obtain more information in a short time as it took little time to conduct. The study included
the population of all medical staff both male and female in Jinja Regional Referral hospital. While undertaking this
research, the researcher used questionnaires for data collection. The choice of this method was determined and was
interpreted by the nature of data collected, the time available as well as by the objectives of the study. Data were
collated, tallied and analyzed with the aid of a Statistical Package for Social Sciences. Descriptive and inferential
statistics were used to analyze the data. The results were presented in tables as percentages, means and standard
deviation. From the study findings, on the knowledge of medical staff on medical waste disposal, respondents 5%
revealed that personal protective equipment must be used routinely when handling medical waste and that
rules/Act for Bio Medical Waste Management don’t exist, 10% revealed that medical waste includes used, cartoons,
papers, and plastics, 8.75% showed that placing medical waste in wrong bin is not high risk. Conclusion: Medical
waste management is affected by knowledge, attitude and practice of medical workers. Some of the health care
workers had knowledge gap and did not practice health care wastes management. The study recommended that
Training programs need to focus on empowering the nursing professionals on biomedical waste management with
broad scope and practical knowledge in all aspects. The right practices and other activities of biomedical waste
management and its ramifications in the form of avoiding of injuries, importance of vaccinations and following of
universal precautions can be achieved when adequately supported by IEC (information, education and
communication) strategies like handouts, stickers, charts, celebrations of various days like hand hygiene day and
other days can help in improving the practices of the employees of the organizations.
Keywords: Medical staff, Medical waste disposal, Personal protective equipment, Healthcare workers, Biomedical
waste management.

INTRODUCTION
Medical waste is waste that is generated by healthcare workers when carrying out healthcare activities in health
institutions [1-4]. Healthcare workers produce various types of waste in different health departments such as
laboratories, medical research facilities, dental practices, veterinary clinics, physicians’ offices, outpatient
departments, on wards and immunization clinics [5-9]. Medical waste can be classified as chemical waste,

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radioactive waste, genotoxic waste, pathological waste, cytotoxic waste, pharmaceutical waste and general waste.
Medical waste includes sharps, bodily fluids like blood, swabs, excreta, lab cultures, body parts, expired or
contaminated vaccines and drugs, human tissue and carcasses used for research purposes. Each classification must
be disposed according to the prescribed guidelines [10-13]. Methods of disposal of waste are incineration,
sterilization, chemical disinfection and secured landfill. Segregation of medical waste must be done at the point of
generation. This should be done by discarding the medical waste in colour-coded containers. Incineration, chemical
disinfection and microwaving are methods of disposing of sharps. Radioactive waste must be handled, stored and Page | 59
disposed of in accordance with the prescribed legislature [14-17]. Laboratory and associated waste directly involved
in specimen processing can be disposed of either through incineration or chemical disinfection. Human tissue must
be disposed of through incineration. The disposal of pharmaceutical waste depends on the composition of the
materials. It must be stored in non-reactive containers and disposed of through incineration [2]. There is a need to
prevent injuries to other medical staff, and patients and to protect the environment from medical waste thus medical
staff must have adequate knowledge on disposal of medical waste which in turn affects their attitude and practice
toward hospital medical waste [13-16]. A study which was conducted among healthcare workers in Iganga general
hospital, Uganda on medical waste management indicates the respondents had fairly good knowledge, a fairly keen
attitude on the subject and somewhat fair practice on hospital waste management [3]. The existing legal provisions
do not ensure that medical institutions, Local Government Authorities and Central Government units associated
with the generation and management of HCW ensure a duty of care and take precautionary measures to protect
health workers, waste handlers, the general public and the environment from adverse effects of improper handling
of HCW. This lack of provisions makes it difficult for medical institutions to set up integrated HCWM plans and
treatment and disposal facilities since there is no legal framework or codified penalties for improper conduct [4].
Statement of Problem
Globally, it is estimated that accidents caused by sharps account for 66,000 cases of infection with the hepatitis B
virus, 16,000 cases of infection with the hepatitis C virus and 200 to 5,000 cases of HIV infection amongst the
personnel of healthcare facilities [5]. One of the problems Uganda faces today is the improper handling and disposal
of solid wastes. During the evaluation of injection safety and health care waste management (HCWM) in Uganda,
it was found that 92 per cent of waste handlers have poor waste disposal methods, 3.4 percent have acceptable waste
disposal methods and 4.6 percent have good waste disposal methods [6]. In most cases there is inadequate training
of primary health care workers on hospital waste management practices and nonexistent segregation of hospital
waste and risky disposal system. A study which was conducted among healthcare workers in Iganga general
hospital, Uganda medical waste management indicates the respondent had a fairly good knowledge, a fairly keen
attitude on the subject and somewhat fair practice on hospital waste management [7]. This motivated the researcher
to carry out research assessing medical staff knowledge, attitude and practice towards medical waste management
in Jinja Regional Referral Hospital so as to improve the ways through which waste management is done in this
region.
Aim
The study is designed to assess the knowledge, attitude and practice of medical staff towards medical waste
management.
Specific Objectives
 To determine the knowledge of the medical staff on medical waste disposal.

 To evaluate the attitudes of medical staff on medical waste disposal.

 To determine the practice of medical staff on medical waste disposal.
Research Questions.
i. What is the level of knowledge of the medical staff on medical waste disposal?
ii. What are the attitudes of medical staff on medical waste disposal?
iii. What is the practice of medical staff on medical waste disposal?
METHODOLOGY
Research design.
The study was of a Cross-sectional type using a questionnaire with closed-ended questions that was availed to
respondents. The design helped the researcher obtain more information quickly as it took little time to conduct. It
used a quantitative research approach to determine the knowledge, attitudes and practices of medical staff on medical
waste disposal in Jinja Regional Referral Hospital. Quantitative research is defined as a formal, objective and
systematic process in which numerical data are used to obtain information about the world [8].

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Study population
The study included the population of all medical staff both male and female in Jinja Regional Referral Hospital.
Inclusion Criteria
The study only included all medical staff in Jinja Regional Referral Hospital.
Exclusion Criteria
The study excluded all people not authorized to provide medical care for example patients, and attendants among
others. Page | 60
Sample Size
The sample size of 80 respondents was determined using [9].

Table 1: Table for Determining Sample Size for a Finite

Population

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Sampling procedure
Sampling is the process of choosing the units of the target population which are to be included in the study [10].
The respondents were selected randomly to administer the questionnaires.
Data collection methods
While undertaking this research, the researcher used questionnaires for data collection. The choice of this method
was determined and interpreted by the nature of the data collected, the time available as well as the objectives of the
study. Page | 61
Questionnaires
A questionnaire is a research instrument consisting of a series of questions and other prompts for the purpose of
gathering information from respondents. It is also a carefully designed instrument for collecting data in accordance
with the specifications of the research objectives, questions and hypotheses [11[. Amin further argues that this data
collection method is less expensive compared to other methods. The researcher, therefore, used this method since it
increases the chances of getting valid information that is filled in at the respondent’s convenience. This tool was
used to collect data from medical staff at Jinja Regional Referral Hospital. The researcher used questionnaires with
close-ended questions. By use of the questionnaires, data was offered by respondents with limited interference on
the part of the researcher. Questionnaires were used because they are cheap to administer to respondents scattered
over a large area and quick in collecting information, within a short space of time. For the better collection of the
data, the designed questionnaires were distributed to the selected respondents to tick the best alternatives of their
choice hence reducing, uncalled vague responses, given its close-ended set up of questions. All the respondents were
asked the same questions.
Validity of instruments
Validity refers to the extent to which the study’s findings accurately depict the phenomenon being studied [12]. In
order to test and improve on the validity of the questionnaire, the researcher vialed the first draft to colleagues
pursuing rather similar investigations, as that of the researcher. The colleagues looked at the items and checked on
the language clarity, relevancy and comprehensiveness of the content and length of the questionnaire. Scrutinized
and developed under close guidance of the supervisor, with whom, the researcher made a number of adjustments in
respect to various comments made and advice given. The instruments were piloted on an appropriate population of
10 respondents selected randomly from target population.
Reliability of instruments
Reliability refers to the degree of consistency with which an instrument measures whatever it is measuring [12].
Reliability was ensured by testing the questionnaire on 10 participants from the target population. The questionnaire
was given to the participants to give comments on the clarity of the questions and give necessary corrections on the
questionnaire.
Ethical considerations
Ethics according to [13], are symptoms of moral principles or rules of behaviour that govern a person’s behaviour.
Ethics are meant to ensure the rights and welfare of persons and communities that are subject to scientific study. A
letter of introduction from the Department of clinical medicine and Dentistry through the Research and Ethical
Committee KIU Western campus was submitted to the Medical Supretendant of Jinja Regional Referral Hospital
for clearance to conduct the research in this hospital. The purpose of the study was clearly explained to the
respondents in order for them to be conversant with it and provide the required data. The researcher ensured utmost
confidentiality regarding the disclosure of respondents’ identities without their informed consent.
Process of data collection
Having sought and obtained ethical approval, the researcher visited the hospital and introduced questionnaires to
respondents that were used to collect data to assess medical staff’s knowledge, attitude and practices towards medical
waste management. The researcher used two research assistants that helped him with data collection.
Data analysis
Data were collated, tallied and analyzed with the aid of a Statistical Package for Social Sciences (SPSS, version 17).
Descriptive and inferential statistics were used to analyze the data. The results were presented in tables as
percentages, means and standard deviations.

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RESULTS
Socio-demographics of the respondents
Table 2: Socio-demographics of the respondents
AGE FREQUENCY PERCENTAGE
15-25 11 13.8
26-35 38 47.5 Page | 62
36-45 29 36.3
46 and above 2 2.5
Total 80 100
Marital status
Single 15 18.8
Married 65 81.2
Total 80 100
RELIGION
Christian 46 57.5
Muslim 10 12.5
Other Religion 24 30.0
Total 80 100
Level of education
Primary level 30 37.5
Secondary level 15 18.8
Tertiary institution 20 25.0
None 15 18.8
Total 80 100

Most of the participants were between the age of 26-35 (47.5%), and 36-45 (36.3%) followed by those of 26-35
(47.5%), 46 and above (2.5%) and 15-25 (13.8%). Most of the participants were married 81.2%) followed by those
living a single (18.8%) and widow (4%) life and then those who had separated/divorced (10%) Most of the
respondents were of the Christian denomination (57.5%) followed by others religions (30%) and then Muslims
(12.5%) For the case of education level, most of the respondents had attained primary level (37.5%), Secondary level
(18.5%), Tertiary institution (25%) and none (18.8%).
Table 3: Medical staff’s awareness of universal safety precautions
Awareness of universal safety Frequency Frequency
precautions
YES 50 62.5%
NO 30 37.5%
Total 80 100

The majority (62.5%) knew the universal safety precautions unlike (37.5 %) who did not know about those
precautions. According to the study findings students used laboratory safety precautions as most of them have had
about it. According to the figure below, the majority of respondents (63%) got information from lecture lessons,
(25%) have heard about safety measures in medical laboratories from senior lab technicians, and 11% got information
from radios unlike a few 1% have got knowledge from other sources. This result can be interpreted that the
participants are still students. Naturally, their most preferable information sources in the various fields, including
laboratory safety, are the university environment with its courses, faculty members, books, and specialized websites.

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Figure: 1

others
1%
Radio Page | 63
11%

Senior lab
technician
25% lecture lessons
63%

Table 4: The knowledge of the medical staff on medical waste disposal

Responses Frequencies Percentage

Personal protective equipment must be used routinely when handling 5
4
medical waste.
Medical waste includes used, cartoons, papers, and plastics. 8 10
Rules/Acts for Bio-Medical Waste Management don’t exist. 4 5
Placing medical waste in the wrong bin is not a high risk. 7 8.75
it is necessary to sort medical waste at the point of generation 10 12.5
Disposal of Anatomical waste should be in a black bag. 19 23.75
Improper waste disposal can lead to needle stick injuries. 16 20
TOTAL 80 100

From the study findings, on the knowledge of the medical staff on medical waste disposal, respondents 5% revealed
that personal protective equipment must be used routinely when handling medical waste and that rules/Acts for
Bio-Medical Waste Management don’t exist, 10% revealed that medical waste includes used, cartoons, papers, and
plastics, 8.75% showed that placing medical waste in the wrong bin is not high risk. 12.5% agreed that it is necessary
to sort medical waste at the point of generation, and 23.75% revealed that disposal of Anatomical waste should be
in the black bag unlike 20% of respondents showed that improper waste disposal can lead to needle stick injuries.
The findings implied that medical staff had new medical waste disposal management practices.
Attitudes of medical staff on medical waste disposal
Table 5: Support of waste management practice in the hospital to be done by health workers
Characteristics Frequency (Percent) Cumulative Percent

Support of waste management practice in the hospital to be done by health workers

Yes 54(67.5) 88.0

No 26 (32.5) 100.0

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Table 6: Medical staff’s attitude on medical waste disposal

Responses Frequencies Percentage Page | 64
Is it necessary to have Biomedical waste 10
8
Management rules?
Do you feel that Biomedical Waste management was 12.5
10
Compulsorily needed for healthcare delivery?
Do you think your teaching hospital doing well regarding Biomedical 6.25
5
Waste management
Do you think your knowledge regarding Biomedical Waste Management 3.75
3
is adequate?
Will you advise your juniors to Follow colour coding for waste disposal? 12 15
Will you inform to sanitary staff to transport waste once bag is full? 10 12.25
Do you think any special training is required on biomedical waste 10
8
management?
Would you volunteer to attend programs that enhance upgrade of 18.75
knowledge about waste management if arranged at JINJA REGIONAL 15
REFERRAL HOSPITAL?
Do you think you should be worried following a needle prick? 9 11.25
Total 80 100

On the attitudes of medical staff on medical waste disposal, 10% of respondents argued that it is necessary to have
Biomedical Waste Management rules, 12.5% revealed that Biomedical Waste management is compulsorily needed
for healthcare delivery, 6.25% revealed that their teaching hospital is doing well regarding Biomedical Waste
management, 3.75% showed that knowledge regarding Biomedical Waste Management is adequate, 15% agreed that
they can advise their juniors to follow colour coding for waste disposal, 12.25% agreed that they can inform to
sanitary staff to transport waste once the bag is full, 10% also showed that any special training is required on
biomedical waste management, 18.75% showed that they can volunteer to attend programs that enhance upgrade of
knowledge about waste management if arranged at JINJA REGIONAL REFERRAL HOSPITAL unlike it is
possible to be worried following a needle prick.

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The practice of medical staff on medical waste disposal.
Figure 2: Colour codes used in the disposal of waste management

35
Page | 65
30
25
Frequency

20
35
15
10
15 13
5 10
7
0
Yellow, Red, white Blue bins Other
Source of information

From the figure above, the majority 35% revealed that yellow is a colour code used, followed by 15% citing Blue
bins, 10% citing red colour, and 7% citing white bins unlike 13% citing other colour codes. Some other respondents
revealed that depending on how hazardous the waste is considered, there will need to use different types of containers
for collection, and different methods for disposal.

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Table 7: the practice of medical staff on medical waste disposal.
Responses Frequencies Percentage
I practice hand hygiene in between every activity in the hospital. 8 10
I use gloves while handling medical waste always. 20 25
Color coding is used for segregating medical waste before disposal. 12 15
Liquid wastes are collected together with other wastes. 2 2.5
Sharp containers are replaced when they are ¾ full. 11 13.75 Page | 66
Used needles are discarded immediately after use. 22 27.5
I don’t recap my needles before disposal into safety box. 5 6.25

From the table findings, majority 27.5% of respondents agreed that used needles are discarded immediately after
use, 25% agreed that they use gloves while handling medical waste always, 13.7% revealed that sharp containers
are replaced when they are ¾ full, 15% revealed that Color coding is used for segregating medical waste before
disposal. The findings implied that inadequate knowledge of health care waste management and poor health care
waste management practices are major negative findings yet they are fundamental elements in waste
management. The researcher recommends that everyone in the institution must be involved and share the
responsibility of an environmentally sound and sustainable waste management program.
DISCUSSION
Summary of findings
From the study findings, on the knowledge of medical staff on medical waste disposal, respondents 5% revealed
that personal protective equipment must be used routinely when handling medical waste and that rules/Act for
Bio Medical Waste Management don’t exist, 10% revealed that medical waste includes used, cartoons, papers, and
plastics, 8.75% showed that placing medical waste in wrong bin is not high risk. 12.5% agreed that it is necessary
to sort medical waste at point of generation, 23.75% revealed that disposal of Anatomical waste should be into the
black bag unlike 20% of respondents showed that improper waste disposal can lead to needle stick injuries. The
findings are in relation with another study conducted Iganga general hospital about the knowledge, attitude and
practice of health workers on medical management showed the respondents’ had generally good knowledge, a
fairly keen attitude on the subject and somewhat fair practice on medical waste management [7]. On the attitudes
of medical staff on medical waste disposal, 10% of respondents argued that it is necessary to have Biomedical
Waste Management rules, 12.5% revealed that Biomedical Waste management is compulsorily needed for
healthcare delivery, 6.25% revealed that their teaching hospital is doing well regarding Biomedical Waste
management, 3.75% showed that knowledge regarding Biomedical Waste Management is adequate, 15% agreed
that they can advise their juniors to follow colour coding for waste disposal, 12.25% agreed that they can inform
to sanitary staff to transport waste once the bag is full, 10% also showed that any special training is required on
biomedical waste management, 18.75% showed that they can volunteer to attend programs that enhance upgrade
of knowledge about waste management if arranged at Jinja Regional Referral Hospital. The findings are in line
with a Study conducted in Iganga general hospital about the knowledge, attitude and practice of health workers
on medical management showed the respondents had generally a fairly keen attitude toward medical waste
management [7]. From the table findings, the majority 27.5% of respondents agreed that used needles are
discarded immediately after use, 25% agreed that they use gloves while handling medical waste always, 13.7%
revealed that sharp containers are replaced when they are ¾ full, 15% revealed that Color coding is used for
segregating medical waste before disposal. The findings implied that inadequate knowledge of healthcare waste
management and poor healthcare waste management practices are major negative findings yet they are
fundamental elements in waste management. The findings are also in line with a study which was conducted in
Ghana on the disposal of medical waste revealed that both public and private hospitals have got waste management
policies and teams. They have got internal storage facilities for storing the waste before it is finally disposed of,
which is in line with the waste management guidelines [14-17].
CONCLUSION
Conclusion: Medical waste management is affected by knowledge, attitude and practice of medical workers. Some
of the health care workers had knowledge gap and did not practice health care wastes management. Hence,
providing adequate numbers of waste bins, regular training and supervision on medical waste management are
recommended to improve the problems of poor management of medical wastes.

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RECOMMENDATIONS
Training programs need to focus on empowering nursing professionals in biomedical waste management with
broad scope and practical knowledge in all aspects. The right practices and other activities of biomedical waste
management and its ramifications in the form of avoiding injuries, the importance of vaccinations and following
universal precautions can be achieved when adequately supported by IEC (information, education and
communication) strategies like handouts, stickers, charts, celebrations of various days like hand hygiene day and
other days can help in improving the practices of the employees of the organizations. Training the staff with Page | 67
Checklists and regular inspections can bring about accountability in the staff.
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Twakiire Clare (2023). Assessment of knowledge, attitude and practice of medical staff towards medical
waste management in Jinja Regional Referral Hospital in Jinja District Uganda. NEWPORT
INTERNATIONAL JOURNAL OF SCIENTIFIC AND EXPERIMENTAL SCIENCES (NIJSES) 3(3):58-
67.

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