Determination of COVID-19 Effects on Biomedical Waste Generation at Selected Hospitals from Three Provinces in South Africa (2017-2022)

Bio-Medical Waste (BMW) collection has been delayed in the referring clinics of the hospitals of interest due to a change from one waste collection company to another at the end of the contract between the user (health care facility) and the service provider (BMW collector). During this transition between collection agencies, BMW piles up in the healthcare facilities before it can be taken to landfills. Subsequently, while in transit, BMW has the potential to pollute the environment and pose risks to those exposed to it. This situation worsened during the COVID-19 era due to restricted movement within the country and curfews, which limited most companies’ service-delivery hours, including those of BMW collectors. Since BMW is generated from non-biodegradable medical consumables, recycling and other innovative interventions should be explored to manage this challenge. BMW is part of the total waste burden in South Africa, and it has negative implications for environmental health and global warming. The presence of COVID-19 and the safety measures that medical personnel had to apply may have contributed to the increase in BMW. Similarly, a lack of training among HCPs in BMW management is a concern that should be prioritised. Hence, the researcher intended to quantify the volume of BMW generated before and during the epidemic’s peak and determine HCPs’ knowledge, attitudes and practices in managing BMW. This information would provide evidence to motivate for alternative measures to be implemented to reduce BMW production at the point of generation, especially while dealing with infectious diseases like COVID-19. This study aimed to determine COVID-19’s effect on biomedical waste generation in selected hospitals from three provinces in South Africa, and explore health care professionals (HCPs’) knowledge, attitudes, and practices in its management. A descriptive, quantitative, cross-sectional research design was used, with self-administered, closed-ended questionnaire. Secondary data of receipts of BMW collected from the selected hospitals for 2017–2022 to quantify the volume of BMW generated. A stratified random sampling method to determine sample of doctors and nurses (N=202) who met the study’s inclusion criteria was selected. Results: (60.7%) HCP’s attended in-service training. 86.9% stated having a Standard Working Procedure for Biomedical waste management in their hospital. (50.5%) HCPs believed BMW management was their responsibility. 49.0% of HCPs strongly agreed that they wore extra PPE during COVID-19. 91.0% of HCPs the correct colour-coded bin to use for BMW and sharps. Summer months had highest levels of waste production; January (10.91%) and February (11.46%) ranked among the top months for waste totals. Poor record-keeping affected quantifying the volume of BMW generated. Those with 16-20 years’ experience had 2.02 times higher odds of always practising proper waste management than the <5-year reference group (95% CI 0.11-0.93, p=0.036). Those with a degree had 1.78 times higher odds of always practising proper waste management versus the diploma reference group (95% CI 1.43-2.01, p=0.023). Conclusion: Improved record-keeping of BMW certificates/receipts is required in digital form can limit loss of data. HCPs’ knowledge, attitudes and practices in BMW management at the three hospitals were sufficient. Continued training to ensure consistency is recommended. COVID-19 pandemic had an impact on respondents, since it made them to be more careful in discarding of BMW. The practice of HCPs in terms of discarding waste correctly was not affected by the pressure that they worked under during the COVID-19 pandemic.