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Infectious Waste Management in the Face of COVID- 19 in a Rural Health Facility in Eastern Uganda

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Infectious Waste Management in the Face of COVID- 19 in a Rural Health Facility in Eastern Uganda Asian Journal of Medicine and Health 19(3): 22-36, 2021; Article no.AJMAH.67153 ISSN: 2456-8414 Infectious Waste Management in the Face of COVID- 19 in a Rural Health Facility in Eastern Uganda Okia David1*, Iramiot Jacob Stanley1, Kagoya Kawala Enid1, Nekaka Rebecca2, Karungi Veronica1, Musoki Drake1, Oteko Alfred1, Nakisuyi Janet1 and Aisu Emmanuel1 1Department of Public Health, Faculty of Health Science, Busitema University, Uganda. 2Amuria Hospital, Uganda. Authors’ contributions This work was carried out in collaboration among all authors. All authors designed the study, performed the statistical analysis, wrote the protocol and wrote the first draft of the manuscript. Authors OD and IJS managed the analyses of the study. Author OD managed the literature searches. All authors read and approved the final manuscript. Article Information DOI: 10.9734/AJMAH/2021/v19i330310 Editor(s): (1) Dr. Janvier Gasana, Kuwait University, Kuwait. (2) Dr. Ashish Anand, GV Montgomery Veteran Affairs Medical Center,, USA. Reviewers: (1) Sunny, Chi Lik, Tung Wah Eastern Hospital, Hong Kong. (2) Rizka Ayu Setyani, Universitas Sebelas Maret, Indonesia. (3) Norfadilah Kamaruddin, University Teknologi Mara, Malaysia. Complete Peer review History: http://www.sdiarticle4.com/review-history/67153 Received 02 February 2021 Original Research Article Accepted 09 April 2021 Published 13 April 2021 ABSTRACT Aim: This study aimed to assess Infectious Waste Management in face of COVID-19, among Health care workers in Rural Health Facilities in Amuria district, Eastern Uganda. Little evidence exists of the challenges that occur while implementing Infectious waste management in the face of COVID-19 in resource-limited settings in Eastern Uganda. Our findings will close this apparent research gap and inform current district and national policies in Infectious Waste Management. Materials and Methods: We conducted cross-sectional survey in five health facilities in Amuria district, using modified CDC Infection Control Assessment Tool for health facility, and a validated structured questionnaire to assess the knowledge of health care workers present on Infectious waste management in the face of COVID-19. Observation and in-depth interviews were also conducted in addition to assess the practice and attitude of staff towards infectious waste management. _____________________________________________________________________________________________________ *Corresponding author: E-mail: [email protected]; David et al.; AJMAH, 19(3): 22-36, 2021; Article no.AJMAH.67153 Results: The five (100%) of the Health Facilities assessed in Amuria district lacked written infection prevention policies and procedures that are current, and are based on evidence-based guidelines. The facilities also had no competency-based training program that provides job-specific training on infection prevention policies and procedures to health care personnel. In terms of knowledge, Waste handlers had poor knowledge in infection control only 8.3% of the medical waste handlers could identify biohazard symbols and knew how infectious waste is segregated into the different categories at the point of generation. All (100%) of the health care workers were knowledgeable about the COVID-19 standard operating procedures. Conclusion: The doctors, nurses, clinical officers, and laboratory personnel had good knowledge of infectious waste Management and were up to date with COVID-19 standard operating procedures. The Medical Waste handlers had poor knowledge of Infectious Waste Management and COVID-19 standard operating procedures. Medical Waste handlers also had a poor attitude, towards the use of personal protective gear while on duty. All the Medical Waste handlers were willing to be trained in Infectious Waste Management. The facilities assessed had no enabling environment for infection control (no policies and in-service training in infection control for staff).We recommend Medical Waste Handlers to be trained in infection control and prevention before and after they are employed. Keywords: Infectious waste; medical waste handlers; COVID-19; Eastern Uganda. 1. INTRODUCTION in Wuhan, China [4].The virus is thought to spread when people are in close contact (within The World Health Organization estimates that 6 feet) through respiratory droplets produced out of every one hundred hospitalized patients at when an infected person coughs or sneezes. It’s a given time, seven in developed countries and also spread when you touch a surface or an ten in developing countries will acquire at least object that has a virus on it, and then one health care infection [1]. The World Health immediately touch your nose, mouth, or eyes [4] Organization also notes that at any given time From the time of declaration of the outbreak of the prevalence of hospital-acquired infections COVID-19, the government of Uganda varies from 5.7% and 19.1% in low and middle- immediately moved to put in place proactive income countries respectively [1]. A recent infection preventive measures at the airport and analysis by the World Health Organization has other entry points [5]. (On 18-3-2020 H.E the indicated that healthcare-associated infections president of Uganda declared a COVID-19 are more frequent in resource-limited settings as national emergency and has since issued compared to developed countries [1]. guidelines on preventive measures to suppress the spread of COVID-19 in Uganda. Uganda The World Health Organization defines Infectious registered her first case of COVID-19 on 21-3- waste as body fluids or secretions, contaminated 2020, the confirmed case was a 36-year-old sharp objects, biological laboratory waste, and Ugandan male who arrived from Dubai on 21-3- pathological specimens [2]. Studies have shown 2020 [5]. the presence of specific pathogenic organisms in clinical solid and general waste including In Africa, most hospitals have no effective opportunistic bacterial agents, viruses, and other infection control programs and there is a lack of communicable disease agents [2]. A study both awareness of the problem and personnel conducted in Penang Island Malaysia [3], trained in infection control practices [6].In sub- confirmed the presence of pathogenic bacteria in Saharan Africa, sometimes infectious waste may various types of clinical solid waste, general be handled and disposed off using bare hands waste, and clinical sharp waste. The harm together with domestic waste, this creates a caused by improper management of wastes health risk to health workers, the general public, includes infections through contaminated and the environment. It’s important to note that syringes (Hepatitis B, Hepatitis C, and HIV), [3]. the infectious waste segregation rate normally depends on the size of the hospital, number of Corona Virus disease 2019 (COVID-19) is a patients coming to that particular facility, number respiratory illness that can spread from person to of beds available, segregation steps, and the person, it is caused by a novel virus that was first kind of care provided to patients [1]. As a result, identified during an investigation into an outbreak proper segregation of infectious waste is not only 23 David et al.; AJMAH, 19(3): 22-36, 2021; Article no.AJMAH.67153 a matter of hospital and environmental concern handling biomedical waste was not adequate but also a matter of economic importance among the participants, variations were observed because of the costs the country incurs in the between the nurses and the doctors [14]. A study management of patients with nosocomial in Thailand [9], indicated that the quality of infections as a result of poor infectious waste Nosocomial Infection control in the country had management [7] concluded that nosocomial yet to be improved regarding structure and infections are associated with a substantial process. To achieve these improvements there increase in the costs of inpatient care, even was the need for better co-operation between the when estimates are corrected for potential nosocomial infection control team and Health confounding. According to the World Health facility personnel. Ministry of Health Uganda Organization, low-income countries (Uganda considers five basic standard precaution inclusive), generate only 0.2kg per hospital per measures that enhance infection control within bed per day, however, health care waste is not health facilities. These are hand hygiene, proper often separated into infectious and non-infectious sterilization, safe waste management, proper waste, this makes the real quantity of infectious sharps disposal, and adequate protective gear waste potentially higher than 0.2 kg [2]. Besides, [15]. studies done in developing countries reveal that the collection and segregation of infectious waste Although previous studies have pointed out the using recommended color-coded containers is main challenges associated with poor infectious not done in most health facilities, and storage of waste management, little evidence exists of the infectious waste in isolated areas is not specific challenges that exist while implementing ,this is based on report by making medical Infectious waste management in the face of injections safer project in Uganda. In 2015, a COVID-19 in resource-limited settings in Eastern joint WHO/UNICEF assessment found that just Uganda. There are virtually no studies (Infectious half (58%) of sampled facilities from twenty-four waste management in face of COVID-19) that countries had adequate systems in place for the have been conducted
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