This study is one of the few studies that dealt with the impact of training on HCWM practices in a university hospital in Tunisia.
All wastes produced by the health institutions constitute a health risk for the hospital employees, patients and the environment. If these wastes are not collected, stored and disposed of by appropriate methods, they will emerge as severe environment and public health problems[19].
According to WHO guidelines, successful waste management requires regular and effective training programs as well as the development of information systems [20]. In fact, one of the most efficient methods to minimize improper HCWM is continuous education of workers at their duty stations [21].
In Sahloul university hospital, hygiene indicators stewardship by the Department of Prevention and Security of Care (DPSC) began in 1991. The DPSC has been carrying yearly audits of practice of HCWM and organizing regularly training sessions. These sessions were reinforced during COVID-19 outbreak.
In our study, repeated training sessions in HCWM has improved the overall sorting practices.
As far as we know, this study is one of the few studies that dealt with the impact of training on HCWM practices in a university hospital in Tunisia. By reviewing the literature, we find several studies that have dealt with the impact of training on the knowledge attitudes and practical Skills of health professionals towards HCWM; in Tunisia [12,22] and around the world[9,11,16,19,23], but few studies have assessed daily HCWM practices on workplace.
In Sahloul University Hospital; we adopted the system of segregation of waste at source, into suitable colour-coded high density polyethylene bags and bins, for the easy identification and segregation of infectious and non-infectious wastes.
Infectious waste was packaged to prevent from potential injury and the spread of disease[24]. Empty plastic bags of standard colors (black color for general waste, and yellow color for infectious waste) as well as sharps containers were distributed regularly to different sections of the hospital. Plastic bags were kept inside the respective buckets. The buckets and plastic bags were labeled to indicate the place of generation, date of collection, and sample number. The collected wastes were removed every morning, and the weight was measured using a weighing scale. Each year, we tend to improve in the resources available in order to optimize HCWM; indeed between 2019 and 2021, we noted an improvement of the some of ressource indicators such as “Presence of yellow bags in sufficient numbers” (54.9% VS 83.3%; p = 0.003); “Presence of black bags in sufficient numbers” (63.9% VS 82.18%,p = 0.003) or “Presence of wheeled trolley for HCW transport” (34.1% VS 82%, p < 10− 3) .
Nevertheless; we noted a regression in the indicator “Presence of checklist of agents visit” (12.5% VS 7.2%, p < 10− 3).
Overall, the total surveyed units passed from 160 units in 2019 to 132 in 2021. This decrease in the number of audited units was explained by the exclusion of services hospitalizing COVID- 19 patients in 2021.
Our study revealed that, between 2019 and 2021, the compliance with recommended practices had improved after the training, which indicated the effectiveness of the training sessions. In fact, the amount of waste produced in the hospital increases day by day. To eliminate the danger posed by this growing amount to human and environment health, all healthcare personnel should be supplied with “Hospital Medical Waste Plan”, and regularly given trainings on where each type of waste should be deposited [25].
Worldwide, 16 billion injections are administered every year, approximatively, that presents potential infection source for HBV( with 30% of risk) ; HCV(1.8%), and HIV ( 0.3%). Therefore, it is strongly recommended to dispel used syringes/ needles in safety boxes [26].
In our study; the overall compliance rate for sorting sharps has gone from 60.3–77.6%; p < 10− 3.The two dimensions that had a significant improvement were “The Sharp container is fixed in its support” and “Absence of HCW other than Sharp in the containers”.
A study conducted in Pakistan evaluating innovative solution to sharp waste management concluded that regular training and monitoring of healthcare professional improved the Sharp waste management by almost 80% [18].
Concerning the sorting of soft and solid waste; the overall score passed from 32.5% in 2019 to 72.4% in 2021, (p < 10− 3) with a significant improvement in all of the four dimensions.
Concerning the intra-service collection step; a great improvement was noted in the indicators “Absence of HCW apart from sharps containers and waste bags (benches, flower beds, etc.)” that passed from 27–90.9% p = 0.05 or the “The wheeled trolley reserved for HCW is well labeled” that passed from 0–29.1% p < 10− 3.
Many studies suggested that repeated trainings presents a very important method to improve HCWM of the staff in hospitals [10]. Another study has reported that HCWM need regular information and reinforcing messages on the management of infectious waste [16]. Performance of health workforce could be enhances by intensive and then periodic training [27].
Nevertheless, we noted a persistence of inadequacies in the labeling of containers and bags as well as the traceability of the time of HCW collection. This lack of labeling has been reported by several studies such as the one carried out in Jordan [9]. This insufficiency can be explained by a lack of training targeting the workers responsible for the transport of this waste or even by the lack of means such as marker pens [28].
Similar to many studies, we found that the nurses attends the training session more frequently than physicians and had a higher compliance to HCWM recommendations than did the other professionals.
Making changes to HCWM practices, facing defective behaviors and pre established routines is challenging in our context. Although the HCWM consisted in adopting simple acts, it seems that it is hardly incorporated into clinical practice especially among physicians who showed no significant interest in HCWM training.
Therefore, in order to improve adherence to HCWM good practices we should understand the factors that prevent physicians from attending training sessions. Indeed, targeting this category of health professional currently presents an imperative.
At the end of this work and on the light of findings we recommend to:
-Continue and strengthen training programs by targeting all health professionals regardless of their grades.
-Involve hospital managers in HCWM to guarantee the sustainability of the adherence to the recommended practices.
- Searching for the causes of resistance to the adherence of employers to the recommendation regarding dimensions which present the most insufficient scores (labeling and traceability)
-Target and strengthen training regarding to indicators that persist insufficient.
- To integrate and reinforce the culture of safety and risk management in the basic training programs for paramedics and future doctors.