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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 15
| Issue : 1 | Page : 40-47 |
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Comparative cross-sectional study regarding the knowledge and attitude of dental students toward biomedical waste legislation, segregation, and management practice
Santosh Mahajan1, Harsimran Singh Kapoor2, Jagtar Singh1
1 Department of Biochemistry, Baba Jaswant Singh Dental College, Ludhiana, Punjab, India
2 Intern, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab, India
| Date of Submission | 10-Aug-2022 |
| Date of Decision | 10-Oct-2022 |
| Date of Acceptance | 11-Oct-2022 |
| Date of Web Publication | 29-Dec-2022 |
Correspondence Address:
Santosh Mahajan
Department of Biochemistry, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jorr.jorr_42_22
Introduction: Dental practices generate a huge amount of biomedical waste (BMW) and dental waste contaminated with body fluids and many toxic chemicals. Improper handling of these wastes affects the surroundings and health of all living beings of that area. It is, therefore, important for budding dentists to be well versed with the existing rules and regulations of BMW management and the harmful effects of these wastes.
Materials and Methods: A cross-sectional questionnaire-based study was carried out among undergraduates, interns, and postgraduate students pursuing dentistry in a dental institute in Punjab. The responses of the student were recorded and analyzed statistically using Chi-square test and Student's t-test.
Results: The mean knowledge score of the students about the segregation of BMW is significantly more than legislation (P = 0.003) and management (P = 0.03). The knowledge of preclinical students is found to be less than other students. More than 80% opined that and there should be a regular program on BMW management and it should be made a compulsory part of the college education.
Conclusion: Although the knowledge of students attending patients is more than the preclinical students, their overall awareness is less than adequate. It is envisaged through this study that implementing BMW management to be a compulsory part of college education could help to fill the lacuna in the knowledge of the present scenario.
Keywords: Attitude, biomedical waste, dental students, knowledge
How to cite this article:
Mahajan S, Kapoor HS, Singh J. Comparative cross-sectional study regarding the knowledge and attitude of dental students toward biomedical waste legislation, segregation, and management practice. J Oral Res Rev 2023;15:40-7 |
How to cite this URL:
Mahajan S, Kapoor HS, Singh J. Comparative cross-sectional study regarding the knowledge and attitude of dental students toward biomedical waste legislation, segregation, and management practice. J Oral Res Rev [serial online] 2023 [cited 2023 May 31];15:40-7. Available from: https://www.jorr.org/text.asp?2023/15/1/40/365919 |
| Introduction | |  |
Although civilization and advancement in the medical technology have provided a better health-care facilities to the people,[1] it has threatened the community due to the generation of a large amount of biomedical wastes (BMW)/health-care wastes (HCW).[2] It has been documented by the World Health Organization that about three-fourth of the hospital waste is nonhazardous; while the remaining one-fourth is hazardous.[3] Although the proportion of the hazardous waste produced is less than the total amount of HCW, inappropriate waste management leads to the rapid spread of infectious diseases, threatening the life of the people and the environment.[4] Dentists are at higher risk of being infected while treating their patients by the infectious agents present in salivary secretions.[5] Wastes generated during dental treatment are usually contaminated with blood or saliva.[6] Improper handling of the substances used in dentistry affects human health and pollutes the environment.[7],[8] Guidelines for the handling of BMWs, framed by the Union Ministry of Environment and Forests under the provision of the Environment Protection Act (1986), came into force in India in 1998. Everyone involved in the generation and handling of these wastes are to abide by these rules.[9]
As dental students are the upcoming dental professionals and most of them aspire to set up their own clinics, they must, therefore, be well aware of the existing rules and regulations of BMW management and proper handling of these wastes, failing which may affect their health and the environment around them.
The present survey was designed to assess the knowledge and attitude of the dental students regarding legislation, segregation, and management of BMW and to compare the knowledge of clinical and nonclinical year students. The study will also help find the area where the students were lacking in their knowledge and the ways to improve the same.
| Materials and Methods | | |
A descriptive, cross-sectional study was carried out among undergraduate (first to final year and interns) and postgraduate (first to the third year) students pursuing dentistry in a dental institute in Punjab. Random Sampling was done, and the students who consented were included in the study. Ethical clearance to conduct the research was obtained from the Review Board Committee of the institute. The study material was a questionnaire consisting of 36 multiple-choice questions (each with one correct option) taken from various studies in the literature with a few modifications/additions. It comprised five sections. Section-1 described the information of the student participants. Section-2 assessed the perception of the students regarding legislation of the BMW management (nine questions). The next 14 questions (Section-3) assessed their knowledge of BMW segregation practices. Section-4 (nine questions) was regarding their alertness while handling BMW and Section-5 (four questions) evaluated the attitude of the participants. The importance of the study was detailed to the participants, and the questionnaire was administered to them in the department of biochemistry. The students were allotted 15 min to complete the questionnaire with the best possible option and were taken back on the same day.
The data obtained were tabulated in MS Excel. The students were divided into four groups: preclinical (students of 1st and 2nd years), clinical (students of 3rd and 4th years), interns, and postgraduate students (1st to 3rd years). The number and percentage of students taking part in the study and their responses to each question were calculated and scored. Each Correct/Yes response was given one mark and each Incorrect/No response was marked as zero. The total knowledge scores ranged from 0 to 32. The score for attitude ranged from 0 to 4.
The mean score per student and the percentage of the scores were calculated. The knowledge score was interpreted into four categories describing poor (<25%) to excellent (>75%) knowledge. The attitude score was interpreted as positive (>75%), passive (50%–75%), and negative (<50%). Intergroup comparison was made using Chi-square and Student's t-test. The Spearman correlation coefficient was applied to compute the correlation of attitude with legislation, segregation, and management practice. P < 0.05 was considered significant statistically.
| Results | | |
A total of 224 students, including 47 (21%) males and 177 (79%) females [Figure 1] of the age group of 19.1–26.7 years (mean age 22.7 ± 3.1 years), participated in the study. The distribution of students in different groups is presented in [Figure 2].
The knowledge score of the students about different aspects of BMW is >50% indicating their good knowledge. However, their knowledge of segregation (70%±17) is significantly more than legislation (57.5% ± 7.9%) (P = 0.003) and management practice (62.7% ± 8.8%) (P = 0.03) when compared between students attending the patients. The knowledge of preclinical year students (57.4 ± 2) is significantly less than the students of other subgroups at P < 0.01 [Table 1]. | Table 1: Knowledge score (%) of the students regarding biomedical waste legislation, segregation, and management practice
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Intergroup analysis of the responses of students revealed that 92% of the students were familiar with the symbol of biohazards (P < 0.05) and 77% knew the categories of BMW (P < 0.001); however, 41% were not aware of any legislation of BMW management (P < 0.01) and 71% of students could not answer the organization that frames the guidelines for BMW management (P < 0.05). Less than 50% of the students were aware of the thickness of plastic bags used for waste segregation ((P = 0.5), and half of the students knew that these bags should be nonchlorinated (P = 0.2). Furthermore, more than 50% of the students were not aware of the distance between health-care facility generating BMW and Common Biomedical Medical Waste Treatment Facility (CBMWTF) (P = 0.3). However, apart from preclinical students, more than 50% of students answered correctly that the wastes should not be stored beyond 48 h [Table 2].
Although 96% of students knew the meaning of BMW, the knowledge regarding the segregation of BMW of preclinical students is found to be less than other students. Only 10% were aware of why X-ray fixer is hazardous and 13% answered correctly about the percentage of infectious waste of the total waste produced in the medical/dental institute in contrast to more than 50% of the students of other groups. Furthermore, 63% were ignorant about the correct sequence of BMW management. More than 60% were not aware of the colored bins used to segregate recyclable waste (statement 4), X-ray films, metal crown, orthodontic bands, brackets, and lead foils (statement 13), and more than 70% could not answer that the waste sharps that may cause cut and puncture are disposed of by shredding after autoclave (statement 11). However, more than 50% of the preclinical students were able to spot the colored bins used to dispose of discarded and contaminated sharps (statement 6), extracted teeth, human tissue, Plaster of Paris, dressings, infected cotton and used impression materials, (statement 7), broken glasswares (statement 8), expired medicines and cytotoxic drugs (statement 10), and the differences were highly significant at P < 0.001 [Table 3]. | Table 3: Responses of the students about biomedical waste segregation practices
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Statistically significant differences are also observed in the responses of the students on the management of BMW. Eighty percent of students responded that the BMW is finally disposed of by handing over to the BMW Management Agency (P < 0.01), and 96% knew the full form of personal protective equipment (PPE) kit (<0.01). More than 60% were aware that the PPE kit is used for liquid spill management (P < 0.001) and the pH of the liquids is adjusted to more than 5 before draining from the laboratories (P < 0.05). Incorrect responses were given by more than 50% of the students on statement 2 (infectious waste is sterilized by autoclaving before shredding and disposal), statement 6 (what is the full form of CBMWTF?), and statement 9 (what should be the minimum temperature required for the incinerators to operate?), and the maximum incorrect responses were given by preclinical students [Table 4].
[Figure 3] and [Figure 4] are regarding the statements, for which students of different dentistry groups had maximum and least awareness about BMW legislation, segregation, and management, respectively. The maximum incorrect responses were given by the students of preclinical years. | Figure 3: Statements having maximum correct responses on different aspects of BMW
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 | Figure 4: Statements having maximum incorrect responses on different aspects of BMW
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The attitude of the students toward BMW management is shown in [Figure 5]. More than 60% of students agreed that managing dental waste safely is a teamwork (P < 0.001) and is not an extra burden on work. More than 80% of students desired regular educational training on BMW handling and that it should be made a compulsory part of the college education. A direct correlation was found between attitude, legislation, and segregation (r = 0.4, P = 0.7) and attitude and management (r = 0.8, P = 0.5) [Table 5]. | Figure 5: Attitude of the students towards BMW management. NS: non-significant difference, * significant difference at p≤0.05, *** significant difference at 0.001
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 | Table 5: The Spearman rank correlation coefficient (r) between attitude-legislation, attitude-segregation, and attitude-management scores of the students regarding biomedical waste
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| Discussion | | |
A proper management of BMWs involves an active involvement and synchronization between government and nongovernment organizations, health-care institutions, and health-care personnel. According to the “safe management of healthcare waste” rules, segregation of BMW at the site of its generation reduces the degree of risk faced by the person involved in its generation, handling, and disposal.[10] Students working in the clinical laboratories should be well versed with the guidelines and handling of the waste they generate, and its strict implementation is required to be initiated from the beginning of their professional life.[11] The present study revealed that the knowledge score of the participants about the segregation of BMW is significantly more than legislation (P = 0.003) and management (P = 0.03). They had a widespread awareness about the correct meaning of BMW, universally accepted biomedical hazardous symbols, and the use of PPE kits [Figure 3]; however, their knowledge regarding the organization that frames rules for BMW management, why the X-ray fixer is dangerous, and the minimum temperature required for incinerators to operate is significantly less in all study groups [Figure 4]. However, our students responded better than many studies in the literature. About 60% of our students were cognizant of the legislation of BMW management in India, in contrast to 32.8% and 28.6% of the participants in earlier studies.[12],[13] Whereas our findings were poor than those reported by Jamkhande et al.[14] and Reddy et al.[15] More than 50% of students knew the time period beyond which the wastes should not be stored, and 43% of students answered correctly about the percentage of hazardous waste of the total HCW. These observations were better than 20.7% and 22% of correct responses for these statements, respectively, by clinical dental students of the dental teaching hospital, Kerala.[13] Correct responses regarding the maximum time period of 48 h for the storage of waste has been reported by 11.3% of dental students and practicing clinicians,[12] and more than 50% of participants claimed that all HCW are hazardous.[13],[16] However, our student's knowledge regarding the organization that frames rules for BMW management in India was insufficient and was in line with the earlier studies.[17],[18] A statistical significant difference was observed in the responses of preclinical students compared to their seniors, who scored better in their knowledge, justifying that education and practice make the man perfect. The study finds support from similar findings in the literature,[12] where a better knowledge of postgraduate students and house surgeons has been reported and attributed to their more time spent in the clinic compared to undergraduate students.[13]
Less awareness of more than 60% of preclinical year students regarding the correct sequence of BMW management, disposal of X-ray films, metal crown, orthodontic bands, brackets, lead foils, and waste sharps by shredding (cut or tear) after autoclave could be attributed to their nonclinical experience and not being taught by the departments generating these wastes. Correct responses, however, were given by more than half of the preclinical participants for the disposal of discarded and contaminated sharps, extracted teeth, human tissue, Plaster of Paris, dressings, infected cotton, used impression materials, broken glasswares, expired medicines, and cytotoxic drugs. This is because they are taught and trained regarding the correct disposal of these wastes by the departments generating it in the 1st and 2nd years of dentistry.
Incorrect responses by more than 50% of the students regarding sterilization of infectious waste by autoclaving before shredding and disposal, full form of CBMWTF, and the minimum temperature required for the incinerators to operate is due to the fact the students are trained only for the segregation of wastes. Furthermore, the institute does not have its own disposal setup and the wastes after segregation are handed over to the BMW Management Agency. Eighty percent of students responded correctly for this statement, and this is in concurrent with 84.4% of dental students and practicing clinicians of Manipal Dental College, Manipal.[12]
Majority of the students believed that the waste management is a collaborative task and is not an extra loading on work, indicating their positive attitude for the development of a healthier and safer environment. Further, their willingness for the regular educational programs on BMW management and that it should be a compulsory part of the education curriculum indicated that they were not satisfied with the information they possess and wanted to enhance their knowledge. Willingness of the dental students/practitioners to have a continued education program as a part of their curriculum to enable them to improve their awareness of dental waste management has been documented in the literature.[7],[19] A linear correlation between attitude and knowledge is further suggestive of the fact that added to the teaching on BMW management being done frequently in most of the institutes, including ours; training the students by their visit to BMW treatment facility from the initial years of their academic career and regular monitoring of a proper BMW management by the Institutional BMW Management Board would help decrease the “Know-do-gap”[4] between nonclinical and clinical year students.
| Conclusion | | |
Although the students possessed acceptable knowledge and positive attitude towards BMW, regular education programs and visits to BMW treatment plants are the need of their curriculum from the early years of their dentistry to update their knowledge. In addition, health-care institutes must have random checks on the way the waste are discarded by the students and must impose fine or penalty in any form to keep them alert during the disposal of waste. This would further help reduce the burden of improper waste disposal on the environment and the spread of infectious diseases.
Acknowledgment
We are highly thankful to the institute for providing all the facilities needed during the course of the study. The authors would like to thank the students of the institute for their willingness to participate in the study and their cooperation during the collection of data. Nonteaching staffs of the department of biochemistry are highly acknowledged for their help in collecting the data. We express our appreciation to the computer operator of the institute for his time-to-time help.
Ethical statement
The study was approved by the institutional Ethics Committee of Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab, India (Approval No. BJSRI/21/137).
Financial support and sponsorship
Baba Jaswant Singh Dental College Hospital and Research Institute, Ludhiana.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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