Development of practice guidelines for solid health care waste management in Ethiopia

Abstract

The purpose of this study was to investigate solid health care waste management practices in the health sector in order to develop guidelines for improving solid health care waste management practice. The setting is all health facilities found in Hossaena town. A convergent mixed-methods study design was used. For the quantitative part of this study a census method of study, which is all health care facilities found in the town was studied. All health facilities and health facility workers (540 in number) who are available in the study health facilities and having a role in HCW management practice were included in the quantitative phase of this study. Qualitative research sampling is purposive and relies on different methods. For the purpose of this study, small purposeful samples were used. The researcher of this study purposefully selected the research participants who have experienced the solid health care waste practice or key concept being explored in this study. One hospital, three government health centres, 17 medium clinics, 19 small clinics, and one surgical centre participated in this study. Both samples were drawn from the same population. The quantitative part of the study included all health facility staff who play a role in the practise of health care waste management In the qualitative phase of the data collection open-ended interviews, focus group discussions, and analysis of visual materials were used. Questionnaires were used for the quantitative phase. The data were analysed quantitatively by using relevant statistical tools. Descriptive statistics and Pearson correlation tests were used for the bivariate associations to assess the relationships between independent and dependent variables and analysis of variance to compare health care waste generation rates by the type of health facilities. In most of the variables, percentages and means were used to report the findings with a 95% confidence interval. Open-ended responses and focused group findings were undertaken by quantifying and coding the data to provide a thematic narrative explanation. These guidelines were designed and developed based on the study findings and the current knowledge available and reviewed in the literature. The purpose of these guidelines is to show the gap on SHCWMP and to provide the scientific recommendation to health facility workers, health facility managers, and regulatory bodies. The objectives of these guidelines are to improve and maintain public health safety by: Minimising solid HCW generation rate and impacts on the surrounding environment. These guidelines were developed based on the world health organization recommendation of the guide line development process and findings of this study and the extensive literature review. The final guidelines were tested and the comments from practical users were evaluated and incorporated into the guideline. In the light of the finding of this research, there are several gaps regarding proper SHCWM practice. Colour coded waste bins should be available, adequate awareness and training programmes for health facility workers, patients and visitors should be provided. Result: Health care waste segregation practice was not implemented in 78% of the health facilities. The qualitative observation asserted that inappropriate segregation practice was observed in 98.3% of the solid health care waste containers. The main problem that was encountered in the effective management of solid health care waste management practice was a lack of awareness and commitment. Observational findings revealed that in 97.6% of the health facilities, infectious wastes are collected daily. Pre-treatment before disposal was not practised. All health facilities used incineration by using brick or barrel incinerators, and all are not meet the minimum standards solid health care waste management. The qualitative observation shows that 97.6% of the health facilities were not using the colour-coded waste bin, which leads to the mixing of infectious and non-infectious waste. Focus group participant recommend that ‘’providing waste management training and creating awareness are the two aspects to improve SHCW segregation practice. health facility must avail all the necessary supplies that used for SHCWMP, punishment for those violating the rule of SHCWMP, Mask, disposable gloves and changing gowns are a critical shortage at all health facilities’’ Conclusions: Lack of knowledge, absence of training and orientation, lack of protective vaccinations, and inappropriately constructed incinerators are the leading causes of inappropriate solid health care waste management practice.