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 Epidemiology and Society Health Review| ESHR 
Vol. 4, No. 2, 2022, pp. 48-53 ISSN 2656-6052 (online) | 2656-1107 (print) 

 
 

 

       10.26555/eshr.v4i2.5038 

  
 

 

48 

Research Article 
 
Knowledge, Attitude, and Practice of Health Care Workers 
in Management of Bio-Medical Waste – A Cross-Sectional 
Study 
Priyanka Sharma1, Rachana Raina2, Shweta Purbi3*, Shashi Sudhan Sharma4 

1 Department of Microbiology, GMC Jammu, India 
2 Department of Pharmacology, GMC Jammu, India 
3 Department of ENT, GMC Jammu, India 
4 Department of Microbiology, GMC Jammu, India 
 
*Correspondence: shwetapurbi070991@gmail.com. Phone: (+91) 8825070804 
 
Received 12 November 2021; Accepted 26 July 2022; Published 2 August 2022 
 

ABSTRACT 

Background: Management of Bio-Medical Waste involves a great concern. Therefore, 
awareness of Health-Care Workers (HCWs) becomes very important as improper 
management leads to injuries and the spread of infection to the staff, patients, and 
environment. The objective is to assess the Knowledge, Attitude, and Practice (KAP) 
among Health Care Professionals regarding Bio-Medical Waste Management (BMWM). 
Method: This cross-sectional survey was conducted among HCWs at GMC Jammu, India. 
Study participants were divided into III groups (Group I- 32 Doctors, group II- 48 
Paramedical staff including nurses & laboratory technicians, and group III- 20 sanitary 
workers). Data was collected using a pre-designed questionnaire regarding BMWM and 
scored as good, average, and poor. 
Results: In our study, knowledge regarding symbols of BMWM and awareness regarding 
categories and segregation of BMW was good in I and II groups but averaged in group III. 
None in group III has attended CME regarding BMWM in the past. In contrast, this 
percentage was 61% in group II and 31% in group I. Regarding the capping and 
destroying of needles, 88% of Paramedics were doing it correctly. None of the class IV 
employees received the booster dose of HBV vaccination. 
Conclusion: Knowledge regarding BMWM was average in Group I and Group II, whereas 
Group III had the slightest knowledge. Attitude regarding the BMW was good in the case 
of groups I and II, Whereas Group III scored average. Practices were scored average in 
Group I, good in Group II, and poor in group III. 

Keywords: KAP studies; Bio-Medical Waste; Health Care Professionals 

 



 
Sharma (Knowledge, Attitude, and Practice of Health Care Workers in Management of Bio-Medical Waste – A Cross-Sectional Study) 

 
 

 
Vol. 4, No. 2, 2022, pp. 48-53 49 10.26555/eshr.v4i2.5038 
 

INTRODUCTION 

Bio-Medical Waste (BMW) is any waste generated during the diagnosis, treatment, or 
immunization of human beings or animals, research activities, or in the production or testing 
of biological or health camps (1). This type of waste which has the potential to harm the 
environment or fitness of a person, is regarded as infectious, and this waste has to be 
managed as per BMWM Rules, 2016 (2), which was further amended in 2018 (3), 2019 (4). 
It is estimated that out of the total waste generated in healthcare sectors, 85% is 
nonhazardous, and 15% is bio-hazardous waste. The hazardous part of the waste poses 
physical, chemical, and/or microbiological risks to the general population and healthcare 
workers associated with handling, treating, and disposing of waste (5). The waste generation 
rate ranges from 0.5 to 2.0 kg/bed/day (6). 

Waste includes the materials mixed with the patient’s blood, secretions, infected anatomical 
parts, biological liquids such as chemicals, medical supplies, medicines, lab discharge, 
sharps, metallic and glassware, plastics, etc. Segregation, collection, in-house 
transportation, pre-treatment of waste, and storage of waste, before such waste is collected 
by Common Bio-medical Waste Treatment Facility (CBWTF) Operator becomes very 
important after waste generation. Therefore, the understanding of waste handling needs to 
be known, understood, and practiced by each staff category according to the updated 
guidelines (2)(3)(4). 

Due to its potential to spread the infection to patients, attendants, nursing, paramedical staff, 
and doctors, its effects extend beyond medical establishments' boundaries to the general 
population and environment (7). And its application became indispensable during the 
pandemic times like COVID-19, where strict awareness and management of BMW are 
required to halt the spread of infection to the patients, staff, and environment. 

Research on this critical issue has been minimal; therefore, there is an urgent need for 
planning and policy decisions in the future on this matter (8). With the above objective in 
mind, this study was performed to assess the Knowledge, Attitude, and Practice (KAP) 
regarding the BMWM among the HCWs working in Government Medical College, Jammu, so 
that policies can be made in the hospital to curb its lack if it is present in any form. 

METHOD 

This cross-sectional survey was conducted by the Department of Microbiology, Government 
Medical College, Jammu, Jammu and Kashmir on 100 HCW comprised of 32 Doctors, 48 
Paramedical staff (including Technicians and Nurses), 20 Class IV, i.e., Sanitary staff 
working in the institute dealing with biomedical waste. Health Care Workers (HCWs) willing 
to participate and relatively free during that session were selected randomly and included in 
the study. Three determinants, Knowledge, Attitude, and Practices, were assessed using a 
pre-designed questionnaire containing 18 questions, eight on Knowledge and six on 
Attitude, and four on practice. Sanitary staff was asked questions in their native language. 
The participants were told to return the questionnaire after filling it out immediately. 
Confidentiality of the participants was maintained in every step. The data was compiled on 
an excel sheet. Each correct response was given one mark. The percentage of the score 



 
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Vol. 4, No. 2, 2022, pp. 48-53 50 10.26555/eshr.v4i2.5038 
 

was calculated for total correct answers, and then their average rate was categorized as 
good, average, and poor performance (0-25% poor, 26-75% average, and above 76% as 
good). The Ethical Committee granted permission, and informed consent was taken from all 
study participants. 

RESULTS 

Study participants were divided into III groups (group I-32 Doctors, group II-48 
Paramedical staff including nurses and laboratory technicians, and group III-20 
sanitary workers) belonging to our Institution. Group I and II were distributed 
pamphlets, whereas group III was asked questions verbally. Results were compiled 
in a tabular form on an excel sheet. Knowledge, Attitude and Practice among the 
groups are presented in Table 1, 2 and 3, respectively.  

Table 1. Knowledge of Health Care Professionals of BMWM 
 

Variable Group I 
(n = 32) 

Group II 
(n = 48) 

Group III 
(n = 20) 

Knowledge about Biomedical Waste generation 8 (25%) 10 (21%)         0 
Knowledge of bio-medical waste symbols 26 (82%) 40 (84%) 7 (20%) 

Knowledge of categories of BMW 27 (85%) 39 (82%) 13 (65%) 

Masks (N95, surgical) disposal 24 (75%) 32 (67%) 10 (50%) 

Sharp disposal method 16 (50%) 40 (84%) 6 (30%) 

Time for storing biomedical waste 8 (25%) 2 (5%) 1 (5%) 

Ideas on cleaning of blood spillage 10 (32%) 8 (17%) 0 

Percentage of hypochlorite for disinfection of glassware 4 (13%) 1 (3%) 0 

 

Table 2. Attitude of Health Care Professionals of BMWM 

Variable Group I 
(n = 32) 

 

Group II 
(n = 48) 

Group III 
(n = 20) 

BMWM adds to your work burden (yes) 2 (7%) 4 (9%) 5 (25%) 

BMWM is teamwork (yes) 32 (100%) 48 (100%) 20 (100%) 

Have you attended any CME regarding BMWM in the past 
(yes) 

10 (31%) 29 (61%) 0 (0%) 

Is there any need for further training on Biomedical Waste 
Management (yes) 

32 (100%) 46 (96%) 20 (100%) 

Will you inform to sanitary staff to transport waste once the 
bag is full (yes) 

24 (75%) 46 (96%) 20 (100%) 

Will you advise your sub-ordinates to adopt color coding for 
waste disposal (yes) 

32 (100%) 46 (96%) 7 (35%) 

 

 

 



 
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Vol. 4, No. 2, 2022, pp. 48-53 51 10.26555/eshr.v4i2.5038 
 

Table 3. Practice of Health Care Professionals of BMWM 
 

Variable Group I 
(n=32) 

 

Group II 
(n=48) 

Group III 
(n=20) 

The practice of capping the needles and using a needle 
destroyer 

2 (7%) 48 (100%) 0 

Vaccinated against Hepatitis B virus booster dose 10 (32%) 24 (50%) 0 

Practicing hand hygiene in between every activity 32 (100%) 48 (100%) 2(10%) 

Reporting of accidental needle stick injury 22 (69%) 46 (96%) 1(5%) 

DISCUSSION  

Using the three determinants, the management of BMW was analyzed. Knowledge 
regarding the legislature of BMW was found to be poor in all groups, which correlated with 
the study of Bala et al. (9). The knowledge of BMW symbols was found to be good in the 
case of doctors (82%) and nurses (84%) as compared to sweepers (20%). Similar findings 
were reported in a study by Sharma K et al. (10), where 70% of the doctors answered 
correctly. In our research, awareness regarding categories and segregation of BMW was 
pretty good in all groups. 75% of doctors, 67% of paramedics, and 50% of Class IV knew 
about the disposal of different types of masks in a yellow bag and the knowledge of sharp 
disposal; 50% of doctors and 84% of paramedics knew that the needles should be destroyed 
by needle cutter and syringes have to be discarded in white bags, this finding was in 
correlation with the study of Sharma K et al.(10). Majority of our participants didn’t have an 
idea that BMWs should not be stored beyond 48 hours, which was consistent with the 
findings by Malini et al. (11). Also, the knowledge regarding the cleaning of Blood spills by 
10% Sodium Hypochlorite and Disinfection of Glasswares was poor in all groups, also 
observed in the study of Sharma K et al. (10). This finding can be attributed to the fewer 
numbers of departmental lectures or CME on BMWM. 

The attitude was very positive in all the groups regarding BMWM. The majority of different 
categories of HCW feel that BMWM is teamwork. It did not create an extra burden on their 
work, a similar finding by Malini et al. (11). None in group III has attended CME regarding 
BMWM in the past, whereas this percentage was 61% in group II and 31% in group I. The 
study conducted by Ananthachari KR et al., Srivastav S, and Dudi M et al. (12)(13)(14) have 
shown that 28%, 30%, and 37% of their participants had attended BMWM training, 
respectively. Therefore, for this reason, every group favored enhancing their knowledge, and 
they are ready to give their 100% attendance on BMW trainings in the future. This finding 
was similar to the studies by Sharma K et al. (10)and Sood et al.(15), in which they also 
concluded that health care staff wanted to attend more training programs. They were also 
very enthusiastic about informing their sanitary inspector once the bag was full. The 
motivation to teach the junior staff to follow the BMWM rule was higher in group II, followed 
by group I. Still, group III was slightly hesitant, which can be because they had the slightest 
knowledge about the gravity of the situation. They were never taught the same. During the 
pandemic of COVID-19, the commitment to learn more was tested when we conducted 



 
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Vol. 4, No. 2, 2022, pp. 48-53 52 10.26555/eshr.v4i2.5038 
 

different sessions like CME and seminars on wearing and discarding PPE and maintaining 
hand hygiene. We recorded 100% attendance in other groups. 

BMWM Practices were poor in group IV and average in the case of doctors. Paramedics 
were following the rules religiously. Regarding the capping and destroying of needles, 88% 
of Paramedics were doing it correctly. The result can be attributed to the activity being 
restricted to the nursing staff only. This is similar to the study of Sharma K et al. (10), where 
80% of paramedics discarded needles by needle cutter. But in a survey by Nirupama N et 
al.(16), 100% of paramedics performed this activity correctly on a routine basis. Only 32% of 
doctors were vaccinated against Hepatitis B Virus (HBV) booster dose, which is low. This 
contrasts with Soyam GC et al. (17)and Vincent S et al.(18), whose percentage was 64.5% 
and 85.7%, respectively. None of the class IV employees received the booster dose of HBV 
vaccination. Injury reporting due to needle sticks was high among groups I and II, similar to 
the Mathur et al. (19) study, where approximately 60% of doctors reported injury due to 
harps. Our study showed good hand hygiene practices in between the activity in groups I 
and II as compared to group III, which correlated with the study of Sharma K et al. (10). Our 
study showed that sanitary staff had poor KAP values among all groups of health care 
workers which is similar to the findings of Madhukumar S et al. (20). 

CONCLUSION 

To conclude, it is seen that Knowledge regarding BMWM was found to be average in Group 
I and Group II, whereas Group III had the slightest knowledge. Attitude regarding the BMW 
was good in the case of groups I and II, Whereas Group III scored average. Practices were 
scored average in Group I, good in Group II, and poor in group III, and they are needed to 
be educated in all spheres of BMWM. It was observed that knowledge regarding Hospital 
control practices like cleaning blood spillage and glasswares requires the focus for which 
everyone was in favor of attending the regular trainings. So Continued Medical Education 
should be held at regular intervals, hands-on training programs should be held to train all the 
HCWs, and sessions including raising questions and problem solving should be arranged. 
Further Booster of HBV dose should be given to all concerned HCWs to avoid its risk of 
exposure. 

Authors' contribution 

PS did the research design and manuscript. SP did the data collection. RR and SS did the 
analysis. 

Funding Statement 

This research has not received external funding.  

Conflict of interest 

There is no conflict of interest in this research. 

 



 
Sharma (Knowledge, Attitude, and Practice of Health Care Workers in Management of Bio-Medical Waste – A Cross-Sectional Study) 

 
 

 
Vol. 4, No. 2, 2022, pp. 48-53 53 10.26555/eshr.v4i2.5038 
 

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