Restricted accessResearch articleFirst published online 2025
Knowledge-practice disparity in healthcare waste management: A comparative survey during and after the COVID-19 pandemic in a Tunisian university hospital
Non-adherence to proper Healthcare Waste Management (HCWM) has the capacity to trigger healthcare-associated infections, posing a threat to the well-being of both patients and medical staff. Thus, the aim of this research is to compare healthcare worker knowledge and practices related to waste management during and after the Covid-pandemic in a Tunisian university hospital.
Methods
We performed two cross-sectional surveys in September of 2021 and October of 2023. We used a standardized grid to assess the availability of resources and the compliance with practices. A self-administered questionnaire, validated by the Regional Office for Nosocomial Infection Control in France, was used to assess HCWM knowledge.
Results
We recruited 160 healthcare workers in 2021 and 114 in 2023. A decline was observed in the proper on-site sorting from 2021 to 2023 (84.4% vs 71.9%; p = 0.01). The availability of resources and materials improved from 2021 to 2023. However, there was a significant decrease in adherence to proper waste management practices between 2021 and 2023 (61% vs 39.1%; p = 0.01).
Conclusion
This study sheds light on HCWM knowledge and practices gap. Addressing this through multidimensional strategies is needed for safer healthcare environments for the community.
Guidelines for Environmental Infection Control in Health-Care Facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) [Internet]. [cited 2024 Oct 15]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm
4.
CaniatoMTudorTVaccariM. International governance structures for health-care waste management: a systematic review of scientific literature. J Environ Manage2015; 153: 93–107.
5.
RajanRRobinDTVM. Biomedical waste management in ayurveda hospitals – current practices and future prospectives. J Ayurveda Integr Med2019; 10: 214–221.
6.
KhashabaEEl-GilanyAHDenewarK. Effect of a waste management intervention program on knowledge, attitude, and practice (KAP) of nurses and housekeepers: a quasi-experimental study, Egypt. J Egypt Public Health Assoc2023; 98: 15.
DuQZhangDHuW, et al.Nosocomial infection of COVID-19: a new challenge for healthcare professionals (review). Int J Mol Med2021; 47: 1–1.
9.
BensonNUFred-AhmaduOHBasseyDE, et al.COVID-19 pandemic and emerging plastic-based personal protective equipment waste pollution and management in Africa. J Environ Chem Eng2021; 9: 105222.
10.
de Aguiar HugoALima R daS. Healthcare waste management assessment: challenges for hospitals in COVID-19 pandemic times. Waste Manag Res2021; 39: 56–63.
11.
Hospital waste management in developing countries: A mini review - Mustafa Ali, Wenping Wang, Nawaz Chaudhry, Yong Geng, 2017 [Internet]. [cited 2024 Oct 15]. Available from: https://journals.sagepub.com/doi/10.1177/0734242X17691344
12.
MorhitAEMorhitMEMourabitN, et al.Biomedical waste management (BMW) assessment at the RHC regional hospital in tangier, Morocco. E3S Web Conf2021; 240: 02001.
13.
ChisholmJMZamaniRNegmAM, et al.Sustainable waste management of medical waste in African developing countries: a narrative review. Waste Manag Res2021; 39: 1149–1163.
14.
TrimJCElliottTSJ. A review of sharps injuries and preventative strategies. J Hosp Infect2003; 53: 237–242.
MloukiIAyedSBChebbiF, et al.Hand hygiene and biomedical waste management among medical students: a quasi-experimental study evaluating two training methods. BMC Med Educ2023; 23: 634.
17.
ChellySSaffarSMabroukR, et al.Evaluation of a training programme on the management of infectious and sharp healthcare waste in Tunisia. BMJ Open Qual2024; 13: e002793.
18.
JmaaMBAyedHBHmidaMB, et al.Effectiveness of a training intervention about healthcare waste management on the knowledge and practical skills of healthcare professionals in a teaching hospital of Southern Tunisia. Hosp Top2023; 101: 55–64.
19.
NathDBDasDMBoroDA, et al. Knowledge, attitude and practice of biomedical waste management among health care workers in tezpur medical college & hospital, tezpur. Eur J Cardiovasc Med2024; 14: 665–672.
(PDF) Assessment of Health Care Staff Knowledge Regarding Medical Waste Management in Basrah Hospitals [Internet]. [cited 2024 Oct 19]. Available from: https://www.researchgate.net/publication/356776374
22.
TurkiMOualiREllouzeS, et al.Perceived stigma among Tunisian healthcare workers during the COVID-19 pandemic. L’Encéphale2023; 49: 582–588.
23.
MotlatlaMMalulekeTX. Assessment of knowledge about healthcare risk waste management at a tertiary hospital in the northern cape province, South Africa. Int J Environ Res Public Health2021; 18: 449.
SepetisAZazaPNRizosF, et al.Identifying and predicting healthcare waste management costs for an optimal sustainable management system: evidence from the Greek public sector. Int J Environ Res Public Health2022; 19: 9821.
29.
BargerLKAyasNTCadeBE, et al.Impact of extended-duration shifts on medical errors, adverse events, and attentional failures. PLoS Med2006; 3: e487.
30.
MaaroufiKTudorTVaccariM, et al.An evaluation of staff engagement with infectious healthcare waste management policies: a case study of Tunisia. Int J Environ Res Public Health2020; 17: 1704.
SepahvandMJJavadiMMokhtariJ, et al.Assessment of job stress and its relationship with demographic and recruitment parameters in Iranian navy personnel. J Mar Med2019; 1: 141–148.
33.
ShekoohiyanSParsaeeFGhayourS. Assessment of knowledge, attitude and practice about biomedical waste management among healthcare staff of fasa educational hospitals in COVID-19 pandemic. Case Stud Chem Environ Eng2022; 6: 100207.
34.
SangkhamS. Face mask and medical waste disposal during the novel COVID-19 pandemic in Asia. Case Stud Chem Environ Eng2020; 2: 100052.
MostafaGMAShazlyMMSheriefWI. Development of a waste management protocol based on assessment of knowledge and practice of healthcare personnel in surgical departments. Waste Manag2009; 29: 430–439.
GowdaNRSiddharthVInquillabiK, et al.War on waste: challenges and experiences in COVID-19 waste management. Disaster Med Public Health Prep2021; 16: 2358–2362.
39.
SinghEKumarAMishraR, et al.Solid waste management during COVID-19 pandemic: recovery techniques and responses. Chemosphere2022; 288: 132451.
40.
LechnerMHarrapIEmanuelO, et al.Waste management in healthcare: during and beyond a global pandemic. BMJ Lead2023; 7: 56–60.
41.
DasAKIslamMBillahM, et al.COVID-19 pandemic and healthcare solid waste management strategy–A mini-review. Sci Total Environ2021; 778: 146220.
42.
TusharSRAlamMFBBariABMM, et al.Assessing the challenges to medical waste management during the COVID-19 pandemic: implications for the environmental sustainability in the emerging economies. SocioeconPlann Sci2023; 87: 101513.
43.
OlaifaAGovenderRDRossAJ. Knowledge, attitudes and practices of healthcare workers about healthcare waste management at a district hospital in KwaZulu-natal. South Afr Fam Pract2018; 60: 137–145.
44.
UchechukwuEEBabatundeIOAnneCN. Investigating knowledge, attitude and health care waste management by health workers in a Nigerian tertiary health institution. Glob J Health Sci2017; 9: 222.
45.
FaisalTKBanuGEmmanuelS, et al.Knowledge and practice of healthcare workers regarding the healthcare waste management. Pak J Med Health Sci2023; 17: 97–100.
46.
KumarRShaikhBTSomrongthongR, et al.Practices and challenges of infectious waste management: a qualitative descriptive study from tertiary care hospitals in Pakistan. Pak J Med Sci2015; 31: 795–798.
47.
ThirunavukkarasuAAl-HazmiAHDarUF, et al.Knowledge, attitude and practice towards bio-medical waste management among healthcare workers: a northern Saudi study. PeerJ2022; 10: 1–19.
48.
NwankwoC. Knowledge and practice of waste management among hospital cleaners. Occup Med2018; 68: 360–363.
49.
MekonnenBSolomonNWondimuW. Healthcare waste status and handling practices during COVID-19 pandemic in Tepi General Hospital, Ethiopia. J Environ Public Health2021; 2021: 6612436.
50.
KothariRSahabSSinghHM, et al.COVID-19 and waste management in Indian scenario: challenges and possible solutions. Environ SciPollutRes2021; 28: 52702–52723.
51.
El-RamadyHBrevikECElbasiounyH, et al.Planning for disposal of COVID-19 pandemic wastes in developing countries: a review of current challenges. Environ Monit Assess2021; 193: 190.
52.
CapoorMRParidaA. Current perspectives of biomedical waste management in context of COVID-19”. Indian J Med Microbiol2021; 39: 171–178.
53.
SharmaHBVanapalliKRCheelaVS, et al.Challenges, opportunities, and innovations for effective solid waste management during and post COVID-19 pandemic. ResourConservRecycl2020; 162: 105052.
54.
RanjbariMShams EsfandabadiZGautamS, et al.Waste management beyond the COVID-19 pandemic: bibliometric and text mining analyses. Gondwana Res2023; 114: 124–137.
55.
SinghNOgunseitanOATangY. Medical waste: current challenges and future opportunities for sustainable management. Crit Rev Environ SciTechnol2022; 52: 2000–2022.
