Staff Perception on Biomedical or Health Care Waste Management: A Qualitative Study in a Rural Tertiary Care Hospital in India

Background
Health care or biomedical waste, if not managed properly, can be of high risk to the hospital staff, the patients, the community, public health and the environment, especially in low and middle income settings where proper disposal norms are often not followed. Our aim was to explore perceptions of staff of an Indian rural tertiary care teaching hospital on hospital waste management.
Method
A qualitative study was conducted using 10 focus group discussions (FGDs), with different professional groups, cleaning staff, nurses, medical students, doctors and administrators. The FGD guide included the following topics: (i) role of Health Care Waste Management (HCWM) in prevention of health care associated infections, (ii) awareness of and views about HCWM-related guidelines/legislation, (iii) current HCWM practices, (iv) perception and preparedness related to improvements of the current practices, and (v) proper implementation of the available guidelines/legislation. The FGDs were recorded, transcribed verbatim, translated to English (when conducted in Hindi) and analysed using content analysis.
Results
Two themes were identified: Theme (A), ‘Challenges in integration of HCWM in organizational practice,’ with the categories (I) Awareness and views about HCWM, (II) Organizational practices regarding HCWM, and (III) Challenges in Implementation of HCWM; and Theme (B), ‘Interventions to improve HCWM,’ with three categories, (I) Educational and motivational interventions, (II) Organizational culture change, and (III) Policy-related interventions.
Conclusion
A gap between knowledge and actual practice regarding HCWM was highlighted in the perception of the hospital staff. The participants suggested organizational changes, training and monitoring to address this. The information generated is relevant not merely to the microsystem studied but to other institutions in similar settings.

背景
医疗保健废物或生物医学废物若管理不当，将对医院工作人员、患者、社区、公共卫生及环境构成极高风险，在中低收入地区尤为如此——此类地区往往未能遵循规范的处置准则。本研究旨在探究印度某农村三级教学医院的工作人员对医疗废物管理（Health Care Waste Management, HCWM）的认知情况。

方法
本研究采用质性研究方法，针对不同职业群体开展10场焦点小组讨论（Focus Group Discussion, FGDs），参与对象涵盖保洁人员、护士、医学生、医生及行政管理人员。焦点小组讨论指南包含以下主题：(i) 医疗废物管理在预防医疗相关感染中的作用；(ii) 对医疗废物管理相关指南/法规的认知与看法；(iii) 当前医疗废物管理实践现状；(iv) 对改进现有实践的认知与筹备情况；(v) 现有指南/法规的有效落实。所有焦点小组讨论均进行录音、逐字转录，若讨论以印地语开展则将其译为英文，并采用内容分析法开展数据分析。

结果
研究共识别出两大核心主题：主题A为「医疗废物管理融入组织实践的挑战」，下设三个子类别：(I) 对医疗废物管理的认知与看法；(II) 医疗废物管理相关的组织实践；(III) 医疗废物管理落地过程中的挑战。主题B为「改进医疗废物管理的干预举措」，下设三个子类别：(I) 教育与激励性干预举措；(II) 组织文化变革；(III) 政策相关干预举措。

结论
医院工作人员的认知反馈显示，医疗废物管理领域的知识储备与实际操作之间存在显著差距。参与者建议通过组织变革、专项培训及监测机制来弥补这一差距。本研究生成的信息不仅适用于本次研究的微观医疗系统，也可为同类环境下的其他医疗机构提供参考。