Assessment of Hospital Waste and the Associated Antibacterial Resistance Gene: A Case Study of Federal University Teaching Hospital, Owerri

Assessment of Hospital Waste and the Associated Antibacterial Resistance Gene: A Case Study of Federal University Teaching Hospital, Owerri | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Hospital Waste and the Associated Antibacterial Resistance Gene: A Case Study of Federal University Teaching Hospital, Owerri Uzochukwu Godswill Ekeleme, Queeneth Chiamaka Onuoha, Uchechukwu (M) Chukwuocha, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5339259/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Hospital waste management is critical for minimizing health risks and environmental damage, particularly in developing countries where inadequate training and resources exacerbate these issues. The Federal University Teaching Hospital, Owerri, serves as a case study to assess hospital waste and associated antibacterial resistance genes. Objectives: This study aimed to evaluate healthcare workers' knowledge, attitudes, and perceptions regarding waste management; identify waste types and disposal methods; assess bacterial contamination; and characterize antibacterial resistance genes in pathogens in hospital waste. Methods: A cross-sectional descriptive and experimental study design was employed. Data were collected from 347 healthcare workers through stratified random sampling, and hospital waste samples were analysed for bacterial contamination and antibiotic resistance via microbiological standards. The data were analysed via the Statistical Package for Social Sciences (SPSS) computer software version 25, and the chi-square test was used to test for associations between hospital waste types, disposal methods, and bacterial characteristics for significant relationships. A p value less than 0.05 was considered statistically significant. Results: This study revealed that 66.3% of healthcare workers possessed good knowledge of waste management, 79.2% had a positive attitude toward waste management, with females (82.0%) being slightly more positive than males (76.0%), and 72.1% perceived the waste management system as effective. Infectious and pathological wastes are primarily treated through incineration and autoclaving, with incineration being used 25 times per month, autoclaving 15 times, and landfilling 20 times for infectious waste. The infectious waste had the highest total viable count (9.86±0.28 CFU/g), indicating a high level of microbial presence, whereas the sharps waste presented a much lower total viable count of 5.40±0.52 CFU/g. The highest number of infectious waste isolates was 45 (30.2), followed by general waste 41 (27.5) and chemical waste 8 (5.4). Among the infectious waste, Enterobacter cloacae (50%) was the most common bacteria, followed by Staphylococcus Scuri ssp. Lentus (32%). Among the sharps waste, Staphylococcus gallinarum (12%) was the most common, followed by Staphylococcus xylosus and Escherichia coli (11%). In general, waste, Pantoea ananatis (100%) was the most prevalent bacteria, followed by Escherichia coli (38.9%), and the least prevalent bacterium was Staphylococcus Scuri ssp. Lentus (20%). We detected isolates harboring blaSHV and blaTEM resistance genes; of these, 2 (50%) had bla TEM, 2 (50%) had only bla SHV , and 1 (25%) had both the bla TEM and bla SHV genes. The p values ( < 0.05 ) indicate a statistically significant association between the type of hospital waste, disposal method, bacterial count, distribution, and antibiotic resistance pattern, which supports the alternative hypothesis (H₁) that these factors have a significant impact on bacterial characteristics. Conclusion: This study highlights the need for improved training on hospital waste management and stricter adherence to disposal protocols to mitigate the spread of resistant pathogens. Continuous monitoring and updated waste management strategies are essential to protect public health and the environment. Hospital waste knowledge attitudes perceptions susceptibility and resistance genes Figures Figure 1 Figure 2 1. Background Information Hospitals play an essential role in the welfare of mankind; they contribute to health by offering frequent services to address complicated health problems [ 1 ]. Hospital waste management has become a critical issue because it poses potential health risks and damage to the environment [ 2 ]. It continues to be a major challenge, particularly in most healthcare facilities in developing countries where it is limited by technological, economic, and social difficulties and inadequate training of staff responsible for handling waste [ 3 ]. Poor conduct, inappropriate management and disposal methods exercised during the handling and disposal of medical waste are increasing health and environmental hazards due to the infectious nature and unpleasant smell of the waste [ 4 ]. In Nigeria, hospital waste management has not received satisfactory attention because of limited economic resources, poor policy regimes, inadequate public infrastructure, and the absence of other critical capacities [ 3 ]. Approximately 15% of the waste generated in hospitals is hazardous; 85% of the waste is nonhazardous [ 5 ]. Pathogens present in untreated waste can also leach out and contaminate the soil and surface water [ 6 ]. In 2015, a joint WHO/UNICEF assessment revealed that just over half (58%) of the facilities sampled from 24 countries had adequate disposal of healthcare waste [ 7 ]. Disposing medical waste in a landfill without segregation and processing results in the entry of harmful microorganisms, chemicals or pharmaceuticals into the soil and groundwater, causing their contamination. Open burning or incinerator malfunction results in the emission of toxic substances, such as dioxins and furans, into the air [ 8 ]. The risk of hospital waste and its management has become a global cause of concern, as antimicrobial resistance (AMR) continues to be the most pressing public health issue worldwide. Antibiotic resistance is increasing too dangerously high worldwide, according to the World Health Organization (WHO), Geneva, Switzerland, which is causing an increase in morbidity and mortality [ 9 ]. Thus, in 2019, 929,000 deaths attributable to antimicrobial resistance (AMR) and 3.57 million deaths associated with AMR were caused by the six leading pathogens that cause mortality: Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii , and Pseudomonas aeruginosa [ 10 ]. The World Health Organization projects that by 2050, this number might reach 10 million. Therefore, this study aimed to assess hospital waste and associated antibacterial resistance genes: a case study of Federal University Teaching Hospital, Owerri. 2. Research Methodology 2.1. Study Design The study employed a cross-sectional descriptive and experimental design. A cross-sectional descriptive design was used to assess the sociodemographic characteristics, knowledge, attitudes, and perceptions of healthcare workers regarding hospital waste management at Federal University Teaching Hospital, Owerri, whereas an experimental design was used to study the resistant pathogens associated with waste disposal methods at Federal University Teaching Hospital, Owerri. The designs were chosen to capture a snapshot of the current practices and opinions among healthcare workers, allowing for the identification of areas for potential improvement in waste management practices and the determination of resistant pathogens associated with waste from October 2023 to May 2024. 2.2. Area of Study The Federal University Teaching Hospital is located in Owerri city, Imo State, southeastern Nigeria. In 1903, Federal University Teaching Hospital, Owerri was founded as a colonial dispensary [ 11 ]. It was promoted to a district hospital, then a general hospital, before finally becoming a Federal Medical Centre in 1995 [ 12 ]. It is a 700 bed capacity hospital. This hospital is a tertiary healthcare facility that provides a wide range of medical services and serves as a training ground for various healthcare professionals. 2.3. Study population The study population comprised healthcare workers at Federal University Teaching Hospital, Owerri. This group includes doctors, nurses, pharmacists, medical laboratory scientists, healthcare attendants, waste collectors, community health workers, and health record officers working in hospitals aged 18 years and above. Hospital waste samples were collected from infectious waste, pathological waste, sharps, chemical waste, pharmaceutical waste, radioactive waste and general waste. 2.4. Sample size and sampling methods 2.4.1. Sample size A total of 347 healthcare workers were included in the study via Taro Yamane's formula, with a population size of 2,619 and a 5% margin of error, ensuring adequate representation across different professions and departments within the hospital. Where n = sample size, N = population, e = margin of error (in decimal form) Rounded to the nearest whole number n ≈ 347. Therefore, the sample size is 347 . For hospital waste, the sample size was 21. This was based on categories that included infectious waste, pathological waste, sharps, chemical waste, pharmaceutical waste, radioactive waste and general waste. 2.4.2. Sampling methods To obtain a representative sample of the population, the sampling method adopted for health workers was a stratified random sampling method. The health care workers were stratified according to their professional groups: Doctor, Nurse, Pharmacist, Medical Lab Scientist, Healthcare Attendant, Waste Collector, Community Health Workers, and Health Record Officers, which included 8 categories of health professionals. The respondents were then selected via simple random sampling via a computer-generated table of random numbers. There were lists of staff in each stratum in all the selected professions. A serial number was assigned to each staff member to maintain the order of the list. Using the computer-generated table of random numbers, respondents were selected on a daily basis from each stratum until the total sample size was reached, ensuring a fair and unbiased representation of the entire population. Hospital waste was categorized into infectious waste, pathological waste, sharps, chemical waste, pharmaceutical waste, radioactive waste and general waste. Samples were collected from these different wastes and taken to a laboratory for further testing. 2.5. Method of Data Collection Data collection from healthcare workers Data collection was carried out through the administration of structured questionnaires to the selected healthcare workers. The questionnaires were distributed in person by the researchers, and the participants were given sufficient time to complete them. The completed questionnaires were then collected, and the data were subsequently analysed to identify patterns and trends in the responses. Collection of hospital waste The waste was collected from specially designated containers, which were colour-coded and labelled to identify the type of waste they contained. This waste is typically segregated at the point of generation into categories such as infectious waste, pathological waste, sharps, chemical waste, pharmaceutical waste, radioactive waste and general waste. Staff trained in proper waste handling procedures performed the collection. 2.6 Microbiological analysis The enumeration and identification of bacteria were performed aseptically at the Laboratory of Infectious Disease and Molecular Epidemiology at the Department of Public Health, Federal University of Technology, Owerri, Imo State, Nigeria. First, the waste samples were separated on a Biosafety Cabinet II. One gram of solid hospital waste was added to a sterile tube with 5 ml of Stuart transport medium, and the sample was allowed to wet completely. The tube was tightly closed to prevent leakage and contamination. The samples were vortexed, and 90 µL of eluate was used for culture inoculation per plate/test condition [ 13 ]. The following culture media were inoculated into all the samples: MacConkey agar with cefotaxime (Hardy), cetrimide agar (Hardy), mannitol salt agar, Salmonella Shigella agar, blood agar and chocolate agar. In an air incubator, the plates were incubated at 37°C for up to 48 hours before being discarded if there was no growth [ 14 ]. All the isolates recovered were stored at − 80°C in TSB with glycerol. Isolated microorganisms were identified via a combination of morphological, biochemical, and microscopic examinations of colony morphology, cell shape, and size, which provided initial clues for identification. Biochemical assays such as Gram staining, catalase tests, oxidase tests, and sugar fermentation tests were performed to further classify the isolates [ 15 ]. 2.7 Antimicrobial susceptibility testing (AST) The susceptibility of the identified pathogens was tested against various antibiotics. It was performed via the single disk diffusion method [ 16 ], in line with the guidelines of the Clinical and Laboratory Standards Institute [ 17 ]. A fresh subculture of each isolate was first made on nutrient agar. A sterile straight wire was used to touch 5 colonies of each isolate, which were subsequently suspended in a sterile Bijou bottle containing 5 mL of peptone water (Lab M), which was subsequently incubated overnight at 37°C. The overnight broth cultures were diluted with sterile saline to 10 6 colony-forming units per mL by comparing the turbidity of the inoculum with 0.5 McFarland turbidity standards. A sterile cotton-tipped applicator was introduced into a standardized inoculum and used to inoculate dried plates of Mueller‒Hinton agar (Oxoid, England). Single sterile antibiotic discs were placed on each plate and incubated for 24 h aerobically at 37°C. The antibiotics used for the gram-positive isolates were gentamicin (10 µg, Gen), erythromycin (10 µg, ER), sulfamethoxazole (125 µg, SXT), ciprofloxacin (10 µg, CIP), ampicillin (AMP), tetracycline (30 µg, TE) and cefotoxine (10 µg, CTX), whereas the antibiotics used for the gram-negative isolates were erythromycin (10 µg, ER), sulfamethoxazole (125 µg, SXT), ciprofloxacin (10 µg), ampicillin (10 µg, AMP), tetracycline (10 µg, TE), cefotoxine (5 µg, CTX) and ampicillin-subitan (30 µg, SAM). The diameter of the zone of inhibition of each isolate to the disc was read with a calibrated ruler according to the standardized CLSI 2021 guidelines [ 18 ]. Gentamicin resistance among staphylococcal isolates was detected on Mueller‒Hinton agar supplemented with 2% NaCl as previously described by [ 19 ]. 2.8 Genomic DNA extraction The resistant isolates obtained from antimicrobial susceptibility testing (AST) were subjected to genomic DNA extraction. One hundred microliters (100 µl) of the isolate was added to a microcentrifuge tube. First, 500 µl of lysis buffer was added, followed by vortexing and incubation at 56°C for 10 minutes. After incubation, the mixture was centrifuged at 10,000 rpm for 1 minute. Following centrifugation, 200 µl of absolute ethanol was added to the tube, and the resulting mixture was transferred into the spin column. The spin column was centrifuged at 10,000 rpm for 30 seconds. The flow-through was then discarded, and the collection tube was blotted on tissue paper. Afterward, 500 µl of Wash Buffer 1 was added to the spin column, and the sample was centrifuged at 10,000 rpm for 1 minute. The flow-through was again discarded, and the collection tube was blotted. This process was repeated with 500 µl of Wash Buffer 2, followed by another centrifugation at 10,000 rpm for 1 minute. After the flow-through was discarded, the spin column was centrifuged at 12,000 to 14,000 rpm for 3 minutes to remove any remaining ethanol. The spin column was then placed into a new microcentrifuge tube, and 50 µl of elution buffer (nuclease-free water) was added to the center of the column. The sample was incubated at room temperature for 1 to 2 minutes and subsequently centrifuged at 10,000 rpm for 1 minute to elute the DNA. Finally, the extracted DNA was stored at -20°C. 2.9 Analysis of Genes Genotypic analysis of the erythromycin ribosome methylation gene F (ermF), erythromycin ribosome methylation gene X (ermX), erythromycin ribosome methylation gene A (ereA), beta-lactamase methicillin-resistant Staphylococcus scurissplentus (blaMsrS), extended-spectrum beta-lactamase (VEB), cefotaximase-type extended-spectrum beta-lactamase (CTX-M), betal-lactamase Klebsiella pneumonia (blaSHV), and beta-lactamase and enzyme (blaTEM) genes was performed. The primers used for the genes are described below. Sequences of Primers used for resistance gene detection Targets Forward Sequence Reverse Sequence Band size ermF CGA CAC AGC TTT GGT TGA AC QQA CCT ACC TCA TAG ACA AG 309 ermX GAG ATC GGR CCA GGA AGC GTG TGC ACC ATC GCC TGA 488 ereA GCC GGT GCT CAT CAT GAA CTT GAG CGA CTC TAT TCG ATC AGA GGC 420 MsrS GCA CTT ATT GGG GGT AAT GG GTC TAT AAG TGC TCT ATC GTG 384 VEB GAT GGT GTT TGG TCG CAT ATC GCA AC CAT CGC TGT TGG GGT TGC CCA ATT TT 391 CTX-M ATG TGC AGY ACC AGT AAR GTK ATGGC GGT RAA RTA RGT SACC AGA AYC AGC GG 590 SHV TGT ATT ATCTC(C/T) CTG TTA GCC(A/G) CCCTG GCT CTG CTT TGT TAT TCG GGC CAA GC 739 TEM TCG CCG CAT ACA CTA TTC TCA AGA ATGAC CAG CAA TAA ACC AGC CAG CCG GAA G 422 The amplified DNA was analysed for the presence of antibacterial resistance genes via gel electrophoresis. Finally, the results were compared with known resistance gene sequences to confirm the presence of specific resistance genes. 2.10. Method of Data Analysis The data were analysed via the Statistical Package for Social Sciences (SPSS) computer software version 25. Frequencies and percentages were used to analyse the variables, level of knowledge, attitudes and perceptions regarding hospital waste management among healthcare workers at the Federal University Teaching Hospital, Owerri. The chi-square test and odds ratio were used to test for associations among hospital waste types, disposal methods, and bacterial characteristics for significant relationships. A p value less than 0.05 was considered statistically significant. 3. Results 3.1 Results overview This section presents the analyses and interpretation of the data obtained from the fieldwork. The questionnaires were administered to 367 respondents, of whom 347 were retrieved, most of whom were self-administered; for those who were not literate, the researcher assisted them. Laboratory analyses were carried out to determine the resistant pathogens associated with the waste at the Federal University Teaching Hospital, Owerri . 3.1.1 Sociodemographic characteristics of the respondents This section presents the sociodemographic characteristics of the respondents, such as sex, age, marital status, religion, educational level, and professions of the health workers at Federal University Teaching Hospital, Owerri. The gender distribution of the respondents, as indicated in Table 3.1, shows that of the 347 respondents, females constituted the majority, with 189 (54.5%) compared with 158 (45.5%) males. This implies that the females were more willing to participate in the study than their male counterparts were; this is related to the fact that the nursing staff were the greatest number of females, which may also explain the greater representation of females in the study. The age of the respondents shows that the majority (152, 43.8%) are forty-six years and above, followed by 100 (28.8%), who are within the age brackets of 26 and 35 years; 57 (16.4%), who are within the age brackets of 36 and 45 years; and 38 (11%), who are within the age brackets of twenty-five years and below. The age distribution revealed that mature health professionals constituted the majority of the respondents. Table 3.1.1: Sociodemographic characteristics of the respondents Variables Frequency Percentage (%) Gender Male (M) Female (F) Total 158 189 347 45.5 54.5 100.0 Age Below 25 yrs 26 – 35 yrs 36 – 45 yrs 46 and above Total M 26 32 28 72 F 12 68 29 80 Total 38 100 57 152 347 11 28.8 16.4 43.8 100.0 Marital Status Married Single Widowed Divorced Total M 100 55 0 3 F 148 32 5 4 Total 248 87 5 7 347 71.5 25.1 1.4 2.0 100.0 Religion Christianity Islam Traditional Total M 149 8 1 F 177 10 2 Total 326 18 3 347 93.9 5.2 0.9 100.0 Level of Education Primary Secondary Tertiary Total M 0 15 143 F 1 3 185 Total 1 18 328 347 0.3 5.2 94.5 100.0 Profession Doctor Nurse Pharmacist Medical Lab Scientist Healthcare Attendant Waste Collector Community Health Workers Health Record Officers Total M 55 40 4 15 1 13 20 10 F 30 121 5 9 9 0 8 7 Total 85 161 9 24 10 13 28 17 347 24.5 46.4 2.6 6.9 2.9 3.7 8.1 4.9 100.0 3.1.2 Knowledge Regarding Hospital Waste Management The results indicate that the majority of healthcare workers at Federal University Teaching Hospital, Owerri, possess a good level of knowledge regarding hospital waste management. Specifically, 66.3% were knowledgeable about the types of hospital waste, 72.0% understood proper waste segregation, 63.4% were familiar with colour coding for waste bins, and 83.6% were aware of the health risks associated with improper waste disposal. Additionally, 61.9% were aware of the hospital's waste management policy. Across most parameters, females demonstrate slightly higher knowledge levels than males do. Notably, no respondents rated themselves as "very knowledgeable," highlighting an opportunity for further training and improvement. Table 3.1.2: Knowledge regarding hospital waste management Parameters/Gender Not Knowledgeable Somewhat Knowledgeable Knowledgeable Very Knowledgeable Total Responses Aware of the types of hospital waste 42 (12.1%) 75 (21.6%) 230 (66.3%) 0 (0.0%) 347 - Males 20 (12.7%) 38 (24.1%) 100 (63.3%) 0 (0.0%) 158 - Females 22 (11.6%) 37 (19.6%) 130 (68.8%) 0 (0.0%) 189 Knowledge of proper waste segregation 37 (10.7%) 60 (17.3%) 250 (72.0%) 0 (0.0%) 347 - Males 20 (12.7%) 28 (17.7%) 110 (69.6%) 0 (0.0%) 158 - Females 17 (9.0%) 32 (16.9%) 140 (74.1%) 0 (0.0%) 189 Familiar with colour coding for waste bins 40 (11.5%) 87 (25.1%) 220 (63.4%) 0 (0.0%) 347 - Males 18 (11.4%) 45 (28.5%) 95 (60.1%) 0 (0.0%) 158 - Females 22 (11.6%) 42 (22.2%) 125 (66.1%) 0 (0.0%) 189 Aware of health risks associated with improper waste disposal 27 (7.8%) 30 (8.6%) 290 (83.6%) 0 (0.0%) 347 - Males 14 (8.9%) 14 (8.9%) 130 (82.3%) 0 (0.0%) 158 - Females 13 (6.9%) 16 (8.5%) 160 (84.7%) 0 (0.0%) 189 Knows the hospital's waste management policy 37 (10.7%) 95 (27.4%) 215 (61.9%) 0 (0.0%) 347 - Males 18 (11.4%) 40 (25.3%) 100 (63.3%) 0 (0.0%) 158 - Females 19 (10.1%) 55 (29.1%) 115 (60.8%) 0 (0.0%) 189 3.1.3 Attitude towards Hospital Waste Management The data on attitudes reflect a generally positive outlook towards waste management among healthcare workers. Overall, 79.2% agree/strongly agree on the importance of proper waste management, with females (82.0%) being slightly more positive than males (76.0%). This high level of agreement underscores the recognition of the role of waste management in hospital safety. In accordance with the Waste Segregation Guidelines, 74.9% agree/strongly agree, with females (79.4%) being more compliant than males (69.6%). This positive attitude aligns with the knowledge data, showing a correlation between knowledge and practice. In terms of mandatory training on waste management, 80.7% agree/strongly agree, with females (82.1%) being more supportive than males (79.1%). The strong support for mandatory training reflects a willingness to enhance their knowledge and practices. Most healthcare workers disagree that waste management is solely the responsibility of sanitation staff, recognizing it as a shared responsibility; only 28.8% agree/strongly agree, with slightly higher agreement among males (28.5%) than females (29.1%). A total of 80.7% agree/strongly agree that they have confidence in waste management practices, with females (82.0%) being more confident than males (79.1%). This high level of confidence is encouraging, indicating that most healthcare workers feel well prepared to manage waste effectively. Table 3.1.3: Attitudes towards hospital waste management Parameters/Gender Strongly Agree Agree Neutral Disagree Strongly Disagree Total Responses Proper waste management is essential for hospital safety 175 (50.4%) 100 (28.8%) 40 (11.5%) 20 (5.8%) 12 (3.5%) 347 - Males 75 (47.5%) 45 (28.5%) 20 (12.7%) 10 (6.3%) 8 (5.1%) 158 - Females 100 (52.9%) 55 (29.1%) 20 (10.6%) 10 (5.3%) 4 (2.1%) 189 I always follow the waste segregation guidelines 150 (43.2%) 110 (31.7%) 47 (13.5%) 25 (7.2%) 15 (4.3%) 347 - Males 65 (41.1%) 45 (28.5%) 23 (14.6%) 15 (9.5%) 10 (6.3%) 158 - Females 85 (45.0%) 65 (34.4%) 24 (12.7%) 10 (5.3%) 5 (2.6%) 189 Training on waste management should be mandatory 190 (54.8%) 90 (25.9%) 40 (11.5%) 15 (4.3%) 12 (3.5%) 347 - Males 85 (53.8%) 40 (25.3%) 20 (12.7%) 8 (5.1%) 5 (3.2%) 158 - Females 105 (55.6%) 50 (26.5%) 20 (10.6%) 7 (3.7%) 7 (3.7%) 189 Waste management is the sole responsibility of sanitation staff 40 (11.5%) 60 (17.3%) 40 (11.5%) 100 (28.8%) 107 (30.8%) 347 - Males 20 (12.7%) 25 (15.8%) 15 (9.5%) 48 (30.4%) 50 (31.6%) 158 - Females 20 (10.6%) 35 (18.5%) 25 (13.2%) 52 (27.5%) 57 (30.2%) 189 I feel confident in my knowledge of waste management practices 160 (46.1%) 120 (34.6%) 37 (10.7%) 20 (5.8%) 10 (2.9%) 347 - Males 70 (44.3%) 55 (34.8%) 20 (12.7%) 10 (6.3%) 3 (1.9%) 158 - Females 90 (47.6%) 65 (34.4%) 17 (9.0%) 10 (5.3%) 7 (3.7%) 189 The parameters were assessed on a 5-point Likert scale: 1= Strongly disagree, 2= Disagree, 3= Neutral, 4= Agree, 5 = Strongly agree. 3.1.4 Perception of Hospital Waste Management The data on perceptions highlight varying levels of satisfaction and awareness regarding waste management practices and resources. Regarding the effectiveness of the waste management system, 72.1% of the respondents agreed/strongly agreed, with females (76.7%) being more positive than males (66.4%). While a majority view the system as effective, a notable portion remains neutral or negative, pointing to areas for improvement.63.4% agree/strongly agree on the training on waste management, with males (63.2%) and females (63.4%) showing similar perceptions. This reflects a moderate level of satisfaction with training, suggesting the need for more comprehensive or frequent training sessions. With respect to awareness of waste management policy, 69.2% agreed/strongly agreed, with females (68.8%) and males (69.6%) showing similar perceptions. This aligns with the knowledge data, indicating that while a majority are aware, a significant minority are not aware, suggesting a need for better communication of the policy. Table 3.1.4: Perception of hospital waste management Parameters/Gender Strongly Agree Agree Neutral Disagree Strongly Disagree Total Responses The hospital's waste management system is effective 120 (34.6%) 130 (37.5%) 60 (17.3%) 25 (7.2%) 12 (3.5%) 347 - Males 50 (31.6%) 55 (34.8%) 35 (22.2%) 10 (6.3%) 8 (5.1%) 158 - Females 70 (37.0%) 75 (39.7%) 25 (13.2%) 15 (7.9%) 4 (2.1%) 189 There is adequate training provided on waste management 110 (31.7%) 110 (31.7%) 77 (22.2%) 30 (8.6%) 20 (5.8%) 347 - Males 50 (31.6%) 50 (31.6%) 30 (19.0%) 15 (9.5%) 13 (8.2%) 158 - Females 60 (31.7%) 60 (31.7%) 47 (24.9%) 15 (7.9%) 7 (3.7%) 189 Resources for waste management are sufficient 100 (28.8%) 120 (34.6%) 80 (23.1%) 30 (8.6%) 17 (4.9%) 347 - Males 45 (28.5%) 55 (34.8%) 35 (22.2%) 13 (8.2%) 10 (6.3%) 158 - Females 55 (29.1%) 65 (34.4%) 45 (23.8%) 17 (9.0%) 7 (3.7%) 189 I am aware of the hospital's policy on waste management 130 (37.5%) 110 (31.7%) 50 (14.4%) 35 (10.1%) 22 (6.3%) 347 - Males 55 (34.8%) 55 (34.8%) 20 (12.7%) 15 (9.5%) 13 (8.2%) 158 - Females 75 (39.7%) 55 (29.1%) 30 (15.9%) 20 (10.6%) 9 (4.8%) 189 Parameters were assessed on a 5-point Likert scale: 1= Strongly disagree, 2= Disagree, 3= Neutral, 4= Agree, 5 = Strongly agree 3.1.5 Types of hospital waste, disposal methods, and frequency of disposal methods Table 3.5 provides an overview of hospital waste management practices at the Federal University Teaching Hospital, Owerri, detailing the types of waste, their disposal methods, and the frequency of these methods. Infectious and pathological wastes are primarily treated through incineration and autoclaving, with incineration being used 25 times per month, autoclaving 15 times, and landfilling 20 times for infectious waste. Sharps are mostly incinerated (25 times per month) and encapsulated (10 times), whereas chemical waste is managed by chemical disinfection (5 times) or landfilling (20 times). Pharmaceutical waste is incinerated (25 times), and radioactive waste is allowed to decay in storage (1 time) or disposed of in landfills (20 times). General waste is primarily landfilled (20 times), with substantial recycling efforts (18 times). This diverse range of disposal methods underscores the hospital's commitment to effective and compliant waste management practices. Table 3.1.5: Types of hospital waste, disposal methods, and frequency of disposal methods Waste Type Disposal Method Frequency (Times per Month) Infectious Waste Incineration, Autoclaving, Landfill Incineration: 25 Autoclaving: 15 Landfill: 20 Pathological Waste Incineration, Autoclaving Incineration: 25 Autoclaving: 15 Sharps Incineration, Encapsulation Incineration: 25 Encapsulation: 10 Chemical Waste Chemical Disinfection, Landfill Chemical Disinfection: 5 Landfill: 20 Pharmaceutical Waste Incineration Incineration: 25 Radioactive Waste Decay in Storage, Disposal in Landfill Decay in Storage: 1 Landfill: 20 General Waste Landfill Landfill: 20 3.1.6: Mean Bacteria Counts for Different Waste Types (CFU/g) Table 3.1.6 presents the mean bacterial counts for various types of hospital waste, including the total viable count, coliform count, and total bacterial count, measured in colony-forming units per gram (CFU/g). In general, the data highlight that infectious and general wastes are the most microbially contaminated, whereas chemical waste is the least contaminated, reflecting differences in waste types and handling practices. The infectious waste had the highest total viable count (9.86±0.28 CFU/g), indicating a high level of microbial presence. It has a coliform count of 3.40±0.31 CFU/g and a total bacterial count of 4.60±0.20 CFU/g, reflecting significant microbial contamination and a potential risk of infection. The sharps presented a much lower total viable count of 5.40±0.52 CFU/g. The coliform count was notably low at 1.20±0.22 CFU/g, and the total bacterial count was also relatively low at 2.15±0.14 CFU/g. This suggests that sharps are less contaminated with microorganisms than other waste types are, possibly due to their nature and handling. The total viable count of pathological waste was 6.45±0.18 CFU/g, indicating moderate microbial contamination. The coliform count was 2.20±0.33 CFU/g, and the total bacterial count was 3.31±0.40 CFU/g, both of which are higher than those of sharps but lower than those of infectious waste. Chemical waste had the lowest microbial count, with a total viable count of 4.10±0.52 CFU/g and zero coliform and bacterial counts. This finding indicates that chemical waste is generally well controlled and less prone to microbial contamination, likely because of the chemical nature of its contents, which may inhibit microbial growth. Pharmaceutical waste has a total viable count of 2.40±0.22 CFU/g, which is the lowest among all waste types. It has a coliform count of 1.10±0.20 CFU/g and a total bacterial count of 2.10±0.10 CFU/g, suggesting relatively low levels of microbial contamination. The total viable count of general waste was 7.86±0.28 CFU/g, with a coliform count of 2.40±0.32 CFU/g and a total bacterial count of 4.50±0.24 CFU/g. This indicates moderate to high microbial contamination, similar to infectious waste but with slightly lower counts. Table 3.1.6: Mean bacterial counts of the various types of hospital waste Waste Type Total viable count (cfu/g) × 10 2 Coliform count (cfu/g) × 10 1 Total bacteria count (cfu/g) × 10 2 Infectious Waste 9.86±0.28 3.40±0.31 4.60±0.20 Sharps 5.40±0.52 1.20±0.22 2.15±0.14 Pathological Waste 6.45±0.18 2.20±0.33 3.31±0.40 Chemical Waste 4.10±0.52 0.0 1.0±0.20 Pharmaceutical Waste 2.40±0.22 1.10±0.20 2.10±0.10 General Waste 7.86±0.28 2.40±0.32 4.50±0.24 3.1.7 Cultural Morphology and Biochemical Characteristics of the Bacterial Isolates Table 3.1.7 provides detailed information on the cultural morphology, microscopic characteristics, biochemical characteristics, and carbohydrate utilization profiles of various bacterial isolates found in hospital waste at Federal University Teaching Hospital, Owerri. It includes descriptions of colony features, such as smooth, circular, creamy colonies of Staphylococcus species on nutrient agar (NA) and small, pink, shiny colonies of Escherichia coli on MacConkey agar (MA). Microscopic examination revealed cell arrangements, such as gram-positive oval cells for Staphylococcus species and gram-negative short rods for Escherichia coli . Biochemical reactions indicate the presence or absence of specific enzymes and metabolic pathways, with Staphylococcus aureus testing positive for catalase and coagulase. Carbohydrate utilization tests revealed the ability of bacteria to ferment different sugars, with Staphylococcus saprophyticus and Enterococcus species utilizing glucose, sucrose, lactose, maltose, mannitol, and xylose. This comprehensive profiling aids in identifying bacterial isolates crucial for managing hospital waste and controlling resistant pathogens. 3.1.8 Distribution of bacterial isolates among the various types of hospital waste Table 3.1.8 shows the distribution of bacterial isolates among the various types of hospital waste; infectious waste had the highest number of isolates at 45 (30.2), followed by general waste at 41 (27.5) and chemical waste at 8 (5.4). Among the infectious waste, Enterobacter cloacae (50%) was the most common bacteria, followed by Staphylococcus Scuri ssp. Lentus (32%), and the least common species was Pantoea ananatis , which was absent. Among the sharps waste, Staphylococcus gallinarum (12%) was the most common, followed by Staphylococcus xylosus and Escherichia coli (11%). In general waste, Pantoea ananatis (100%) was the most prevalent bacteria, followed by Escherichia coli (38.9%), and the least prevalent bacterium was Staphylococcus Scuri ssp. Lentus (20%). Table 3.1.8: Distribution of bacterial isolates among the various types of hospital waste Waste Type Bacteria Infectious Waste Sharps Pathological Waste Chemical Waste Pharmaceutical Waste General Waste Raoultella ornithinolytica (n=30) 9 (30.0) 3 (10) 6 (20) 1 (3.3) 4 (13.3) 7 (23.3) Klebsiella pneumonia (n=20) 5 (25.0) 2 (10.0) 3 (15.0) 2 (10.0) 3 (15.0) 5 (25.0) Staphylococcus gallinarum (n=25) 7 (28.0) 3 (12.0) 3 (12.0) 3 (12.0) 2 (8.0) 7 (28.0) Enterobacter cloacae (n=12) 6 (50.0) 0 (0.0) 2 (16.7) 0 (0.0) 0 (0.0) 4 (33.3) Staphylococcus Scuri ssp. Lentus (n=25) 8 (32.0) 2 (8.0) 4 (16.0) 1 (4.0) 2 (8.0) 5 (20.0) Staphylococcus xylosus (n=17) 5 (29.4) 2 (11.8) 3 (17.6) 1 (5.9) 2 (11.8) 4 (23.5) Escherichia coli (n=18) 5 (27.8) 2 (11.1) 3 (16.7) 0 (0.0) 1 (5.5) 7 (38.9) Pantoea ananatis (n=2) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100.0) Total=149 45 (30.2) 14(9.4) 24 (16.1) 8 (5.4) 14 (9.4) 41 (27.5) Among the bacteria subjected to antibiotic susceptibility testing (AST), the highest number of Staphylococcus gallinarum (n=25) were found to be sensitive to amikacin (24) but resistant to other antibiotics used. All 30 isolates of Raoultella ornithinolytica were resistant to antibiotics, except for amikacin, for which Raoultella ornithinolytica was sensitive. The isolates of Klebsiella pneumoniae (n=20) were sensitive to the entire antibiotic used. The isolates of Pantoea ananatis (n=2) were sensitive to all the antibiotics except for ampicillin, which produced resistance, whereas the Escherichia coli isolates (n=18) were resistant to trimethoprim and ampicillin. The bacterial isolates were highly resistant to ampicillin, with the exception of Klebsiella pneumoniae, followed by tetracycline and trimethoprim (Table 3.1.9). Table 3.1.9: Antibiotic susceptibility pattern of the bacteria isolates from the hospital wastes (mm) Bacteria LEV (30 µg) CN (30 µg) CIP (5 µg) E (30 µg) SAM (30 µg) SXT (125 µg) CTX (30 µg) TE (30 µg) AK (30 µg) AMP (10 µg) S R S R S R S R S R S R S R S R S R S R Raoultella ornithinolytica (n=30) 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 20 10 0 30 Klebsiella pneumonia (n=20) 20 0 20 0 20 0 20 0 20 0 20 0 20 0 20 0 20 0 19 1 Staphylococcus gallinarum (n=25) 0 25 0 25 0 25 0 25 0 25 0 25 0 25 0 25 24 1 0 25 Enterobacter cloacae (n=12) 12 0 12 0 12 0 12 0 12 0 12 0 12 0 12 0 12 0 9 3 Staphylococcus Scuri ssp. Lentus (n=25) 20 5 20 5 22 3 0 25 0 25 0 25 24 1 0 25 22 3 0 25 Staphylococcus xylosus (n=17) 17 0 17 0 17 0 17 0 17 0 17 0 17 0 17 0 17 0 0 17 Escherichia coli (n=18) 18 0 18 0 18 0 18 0 18 0 0 18 18 0 18 0 18 0 0 18 Pantoea ananatis (n=2) 2 0 2 0 2 0 2 0 2 0 2 0 2 0 0 2 2 0 0 2 CN= cefalexin, E= erythromycin, CTX= cefotaxime, SXT=trimethoprim/sulfamethoxazole, TE=tetracycline, AMP = ampicillin, AK = amikacin, CIP = ciprofloxacin. The interpretative standard for S= Sensitive, R=Resistant is the Clinical and Laboratory Standards Institute (17). Detection of antibiotic resistance genes ( MsrA, ermF and ermX ) The molecular analysis of antibiotic resistance genes in bacterial isolates provides critical insights into the mechanisms of resistance and the distribution of specific resistance genes. The results revealed the absence of certain resistance genes while highlighting the presence and co-occurrence of other genes, particularly those associated with beta-lactam antibiotic resistance. We did not detect any isolates harboring energy-dependent efflux of the erythromycin (MsrA) gene, rRNA methyltransferase erythromycin/clindamycin resistance (ermF) gene, RNA adenine N-6-methyl-transferase, or erythromycin/clindamycin resistance ( ermX ) gene (Fig 3.1.1). Detection of antibiotic resistance genes ( blaSHV and blaTEM) We detected isolates harboring blaSHV and blaTEM; of these, 2 (50%) had bla TEM, 2 (50%) had only bla SHV , while 1 (25%) had both the bla TEM and bla SHV genes (Fig. 3.1.2 and Table 3.1.10). Table 3.1.10: Antibiotic resistance genes MsrA, bla CTX−M , bla VEB, bla SHV and bla TEM LAB ID Bacteria ErmF ErmX EreA MsrA VEB CTX-M SHV TEM 11 Escherichia coli - - - - - - + + 10 Enterobacter cloacae - - - - - - - + 12 Klebsiella pneumonia - - - - - - - + 3.1.11 Justification of Hypothesis Table 3.1.11 clearly shows that the types of hospital waste, their disposal methods, and the frequency of these methods have a significant effect on the bacterial count, distribution, and antibiotic resistance patterns. Infectious waste has the highest bacterial load, followed by general waste, which is correlated with the frequency and method of disposal (e.g., incineration and landfill for infectious and general wastes, respectively). The distribution of bacterial isolates varies significantly by waste type, with certain bacteria, such as Enterobacter cloacae and Pantoea ananatis, being predominant in specific waste types. There is a clear variation in antibiotic resistance patterns based on the type of waste and the bacteria present, with infectious waste showing the highest resistance levels. The p values ( < 0.05 ) indicate a statistically significant association between the types of hospital waste, disposal methods, bacterial counts, distribution, and antibiotic resistance patterns at the Federal University Teaching Hospital, Owerri. This finding supports the alternative hypothesis (H₁) that these factors have a significant effect on bacterial characteristics. Table 3.1.11 : Association between hospital waste type, disposal method, and bacterial characteristics Waste Type Disposal Methods Frequency (Times/Month) Mean Total Viable Count (CFU/g) Distribution of Bacterial Isolates (%) Antibiotic Resistance Patterns (Selected Antibiotics) p Value Infectious Waste Incineration, Autoclaving, Landfill Incineration: 25 9.86 ± 0.28 45 (30.2%) - Enterobacter cloacae : 50% - Staphylococcus Scuri ssp. Lentus: 32% - Raoultella ornithinolytica: 30% Resistant to most antibiotics except amikacin < 0.05 Pathological Waste Incineration, Autoclaving Autoclaving: 15 6.45 ± 0.18 24 (16.1%) - Staphylococcus gallinarum: 12% - Staphylococcus Scuri ssp. Lentus: 16% - Raoultella ornithinolytica: 20% General resistance patterns observed; Klebsiella pneumonia sensitive to most antibiotics < 0.05 Sharps Incineration, Encapsulation Incineration: 25 5.40 ± 0.52 14 (9.4%) - Staphylococcus gallinarum: 12% - Escherichia coli : 11% - Raoultella ornithinolytica: 10% High resistance except amikacin; Staphylococcus xylosus sensitive to most antibiotics < 0.05 Chemical Waste Chemical Disinfection, Landfill Landfill: 20 4.10 ± 0.52 8 (5.4%) - Raoultella ornithinolytica: 3.3% - Staphylococcus Scuri ssp. Lentus: 4% - Klebsiella pneumonia: 10% Lowest bacterial counts and lower resistance levels < 0.05 Pharmaceutical Waste Incineration Incineration: 25 2.40 ± 0.22 14 (9.4%) - Raoultella ornithinolytica: 13.3% - Staphylococcus Scuri ssp. Lentus: 8% - Klebsiella pneumonia: 15% Some resistance observed, but generally lower compared to other waste types < 0.05 General Waste Landfill Landfill: 20 7.86 ± 0.28 41 (27.5%) - Pantoea ananatis: 100% - Escherichia coli : 38.9% - Raoultella ornithinolytica: 23.3% Moderate resistance patterns, with Pantoea ananatis showing sensitivity to most antibiotics < 0.05 4. DISCUSSION The assessment of hospital waste and the associated resistant bacterial pathogens at the Federal University Teaching Hospital, Owerri, revealed a generally positive attitude and good knowledge among healthcare workers. The gender distribution of the respondents in the study revealed that females constituted the majority, with 189 out of 347 participants (54.5%), whereas males accounted for 158 (45.5%). This gender disparity suggests that females were more willing to participate in the study, which could be attributed to the greater representation of female nursing staff in the hospital. Nursing, a profession traditionally dominated by women, often plays a crucial role in hospital waste management, thus explaining their higher participation rate. This finding aligns with similar studies that noted greater female participation in healthcare-related research [ 20 ]. The age distribution indicates that mature health professionals, particularly those aged 46 years and above, constituted the majority of the respondents (43.8%). This demographic characteristic is often associated with greater experience and, consequently, a better understanding of hospital waste management protocols. The results demonstrate that healthcare workers at Federal University Teaching Hospital, Owerri, possess a good level of knowledge regarding hospital waste management, with 66.3% knowledgeable about the types of hospital waste and 83.6% aware of the health risks associated with improper waste disposal. The data on attitudes reflect a generally positive outlook towards waste management among healthcare workers. A significant majority (79.2%) agreed or strongly agreed on the importance of proper waste management, with females (82.0%) being slightly more positive than males (76.0%). This high level of agreement underscores the recognition of the role of waste management in hospital safety. The correlation between knowledge and practice is evident in the adherence to Waste Segregation Guidelines, with 74.9% of respondents agreeing or strongly agreeing to follow these guidelines. Strong support for mandatory training (80.7%) indicates a willingness among healthcare workers to enhance their knowledge and practices, which is crucial for maintaining an effective waste management system [ 21 ]. The perception data highlight varying levels of satisfaction and awareness regarding waste management practices and resources. In terms of the effectiveness of the waste management system, 72.1% of the respondents agreed or strongly agreed, with females (76.7%) being more positive than males (66.4%). While a majority view the system as effective, the presence of neutral or negative responses suggests areas for improvement, particularly in ensuring that all staff members are adequately trained and informed about waste management policies. The moderate level of satisfaction with training, as indicated by 63.4% of respondents, points to the need for more comprehensive or frequent training sessions to address gaps in knowledge and practice [ 22 ]. In terms of awareness of waste management policies 69.2% of the respondents agreed or strongly agreed that they were aware of the hospital's waste management policy, with similar perceptions among males (69.6%) and females (68.8%). This finding aligns with the knowledge data, indicating that while a majority are aware, a significant minority are not. This suggests a need for better communication of the policy to ensure that all healthcare workers are informed and can adhere to the guidelines. Effective communication and regular training are essential components of a successful waste management system, as they ensure that all staff members are equipped with the necessary knowledge and skills to manage waste safely and efficiently [ 23 ]. The Federal University Teaching Hospital, Owerri, employs a multifaceted approach to hospital waste management, as evidenced by the data presented in the results. Infectious and pathological wastes are primarily treated through incineration and autoclaving, with the former being employed 25 times per month and the latter 15 times per month. Landfilling is also utilized 20 times per month for infectious waste. The frequent use of incineration and autoclaving indicates that hospitals focus on reducing the risk of infection through thermal treatment, which is effective in destroying pathogens [ 24 ]. The landfilling of infectious waste, while less desirable due to potential environmental risks, is still practiced, possibly owing to limitations in resources or capacity for incineration. Sharps, which pose a significant risk of injury and infection, are primarily incinerated (25 times per month) and encapsulated (10 times per month). The preference for incineration aligns with best practices for sharp waste management, as it effectively reduces the risk of pathogen transmission [ 25 ]. Encapsulation further ensures the safe disposal of sharps by enclosing them in a solid block, thereby minimizing the risk of needle-stick injuries and environmental contamination. Chemical waste is managed through chemical disinfection (5 times per month) and landfilling (20 times per month). The limited use of chemical disinfection suggests that while this method is effective in neutralizing hazardous chemicals, it may be resource intensive or require specific infrastructure that the hospital may not always have at its disposal [ 26 ]. The landfilling of chemical waste, though less ideal, may be a necessary practice because of these constraints. Pharmaceutical waste is consistently incinerated (25 times per month), reflecting the hospital’s adherence to guidelines that recommend incineration as the most effective method for disposing of pharmaceutical waste to prevent environmental contamination and misuse [ 23 ]. Radioactive waste, owing to its hazardous nature, is allowed to decay in storage (1 time per month) or be disposed of in landfills (20 times per month) once it has reached a safe level of radioactivity. This method ensures that radioactive materials are managed responsibly to protect both public health and the environment [ 27 ]. General waste, which includes nonhazardous materials, is primarily managed through landfilling (20 times per month) and recycling (18 times per month). Substantial recycling efforts indicate a hospital’s commitment to sustainability and waste minimization, which are essential components of effective waste management practices [ 28 ]. The infectious waste presented the highest level of microbial contamination, with a total viable count of 9.86 ± 0.28 CFU/g, a coliform count of 3.40 ± 0.31 CFU/g, and a total bacterial count of 4.60 ± 0.20 CFU/g. These high microbial counts are expected given the nature of infectious waste, which often contains bodily fluids, tissues, and other materials that can harbor and transmit pathogens [ 25 ]. The significant microbial presence underscores the need for rigorous waste management practices, including the use of incineration and autoclaving, to minimize the risk of infection to healthcare workers and the community. Sharps, while posing a physical hazard, present much lower levels of microbial contamination, with a total viable count of 5.40 ± 0.52 CFU/g, a coliform count of 1.20 ± 0.22 CFU/g, and a total bacterial count of 2.15 ± 0.14 CFU/g. The lower microbial counts can be attributed to the nature of sharps, which are often single-use and discarded immediately after use, reducing the opportunity for microbial growth [24; 29]. However, the physical danger posed by sharps necessitates stringent disposal methods, as reflected in the hospital’s use of incineration and encapsulation. Pathological waste, with a total viable count of 6.45 ± 0.18 CFU/g, a coliform count of 2.20 ± 0.33 CFU/g, and a total bacterial count of 3.31 ± 0.40 CFU/g, indicated moderate microbial contamination. This type of waste, which includes human tissues and body parts, can be a significant source of pathogens if not properly managed. The use of incineration and autoclaving for pathological waste at the hospital is appropriate, as these methods are effective in reducing microbial loads and preventing the spread of infections [ 26 ]. Chemical waste had the lowest microbial contamination, with a total viable count of 4.10 ± 0.52 CFU/g and no detectable coliform or total bacteria counts. The low microbial counts reflect the effectiveness of chemical disinfection and the inhibitory effects of chemical substances on microbial growth. This finding aligns with the understanding that chemical waste, when properly managed, poses a lower risk of biological contamination [28; 2]. Pharmaceutical waste also results in relatively low microbial contamination, with a total viable count of 2.40 ± 0.22 CFU/g, a coliform count of 1.10 ± 0.20 CFU/g, and a total bacterial count of 2.10 ± 0.10 CFU/g. The low microbial counts suggest that pharmaceutical waste, particularly when incinerated, poses a minimal risk of infection. However, improper disposal of pharmaceutical waste could lead to environmental contamination and the development of antimicrobial resistance [ 30 ]. The total viable count of general waste was 7.86 ± 0.28 CFU/g, the coliform count was 2.40 ± 0.32 CFU/g, and the total bacterial count was 4.50 ± 0.24 CFU/g, indicating moderate to high microbial contamination. Although general waste is nonhazardous, the presence of significant microbial contamination highlights the importance of proper waste segregation and disposal practices to prevent the spread of infections within hospitals and the surrounding community [31; 25]. The findings from this assessment highlight several areas for improvement in hospital waste management practices. The high microbial contamination in infectious and general wastes suggests a need for enhanced training of healthcare workers in waste segregation and handling [ 26 ]. Additionally, hospitals may benefit from reviewing and updating their waste management policies, particularly regarding the use of landfilling for infectious, chemical, and radioactive wastes. While landfilling is a common disposal method, it poses environmental risks, particularly for hazardous wastes, and should be minimized where possible. Investing in additional incineration or autoclaving capacity could reduce the reliance on landfilling and improve overall waste management practices [ 28 ]. Furthermore, the hospital’s efforts in recycling general waste are commendable and should be expanded. Recycling not only reduces the environmental impact of waste disposal but also promotes sustainability within the healthcare sector. Hospitals could explore opportunities to increase recycling rates and reduce waste generation, such as implementing waste reduction programs and sourcing environmentally friendly materials [ 24 ]. The detailed analysis of the cultural morphology and biochemical characteristics of bacterial isolates from hospital waste provides a foundation for understanding the microbial hazards present in various waste types. The smooth, circular, creamy colonies of Staphylococcus species observed on nutrient agar (NA) and the small, pink, shiny colonies of Escherichia coli on MacConkey agar (MA) are indicative of their common presence in hospital environments. The Gram staining results further corroborate these findings, with Staphylococcus species showing gram-positive oval cells and Escherichia coli displaying gram-negative short rods. These observations align with previous studies that have identified these bacteria as frequent contaminants in healthcare settings [ 32 ]. Biochemical characteristics, such as positive catalase and coagulase reactions in Staphylococcus aureus , are crucial for distinguishing pathogenic strains from nonpathogenic strains. The carbohydrate utilization profiles also provide valuable information on the metabolic capabilities of these isolates, with Staphylococcus saprophyticus and Enterococcus species utilizing multiple sugars, including glucose, sucrose, lactose, maltose, mannitol, and xylose. These metabolic traits are essential for understanding the adaptability and survival of these bacteria in various waste environments [ 33 ]. The distribution of bacterial isolates among different types of hospital waste reveals significant variations in microbial contamination levels, which are closely linked to the nature and handling of the waste. Infectious waste, accounting for the greatest number of isolates (30.2%), poses the greatest risk, with Enterobacter cloacae (50%) being the most prevalent bacteria. This finding is concerning, given the known resistance of Enterobacter cloacae to multiple antibiotics and its association with hospital-acquired infections [ 34 ]. The presence of Staphylococcus Scuri ssp. The presence of Lentus (32%) in infectious waste further underscores the potential for the spread of resistant pathogens, as this species is often linked to resistance to methicillin and other beta-lactam antibiotics [ 35 ]. In sharp waste, Staphylococcus gallinarum (12%) and Escherichia coli (11%) were the most common isolates. The relatively lower contamination level in sharp waste could be attributed to the sterilization processes typically employed for sharp instruments before disposal. However, the presence of Escherichia coli , a known pathogen associated with urinary tract infections and other healthcare-related infections, still poses a significant risk, particularly in cases where sharps are not adequately sterilized [ 36 ]. General waste, which included a diverse range of materials, had the second-highest number of bacterial isolates (27.5%). Pantoea ananatis (100%) was notably the most prevalent bacterium in this category, followed by Escherichia coli (38.9%). The ubiquity of Pantoea ananatis in general waste is particularly concerning, given its emerging role as a human pathogen with documented resistance to multiple antibiotics [ 37 ]. The significant presence of Escherichia coli further highlights the potential public health risks associated with improper disposal and handling of general waste, which could serve as a reservoir for resistant pathogens. Chemical waste caused the least contamination, with only 8 isolates (5.4%). This low level of contamination can be attributed to the inherent antimicrobial properties of many chemicals used in healthcare settings, which inhibit bacterial growth. However, the detection of any bacterial contamination in chemical waste still warrants attention, as it indicates potential lapses in waste segregation or treatment processes [ 38 ]. The findings from this study have significant implications for hospital waste management practices at the Federal University Teaching Hospital, Owerri. The high microbial contamination levels in infectious and general waste underscore the need for stringent waste segregation, handling, and treatment protocols. The presence of resistant pathogens, particularly infectious waste, highlights the potential for nosocomial infections and the spread of antibiotic resistance within the hospital environment. This risk is exacerbated by the improper disposal or treatment of waste, which could lead to environmental contamination and subsequent public health threats [ 10 ]. The results of antibiotic susceptibility testing (AST) highlight a significant concern regarding the prevalence of antibiotic-resistant bacteria in hospital waste. Staphylococcus gallinarum , one of the most commonly isolated bacteria, was found to be sensitive to amikacin (24 out of 25 isolates) but resistant to all other antibiotics tested. This pattern is troubling, as it indicates a narrow spectrum of effective treatment options, underscoring the need for vigilant antibiotic stewardship and infection control practices within the hospital setting. Raoultella ornithinolytica , with 30 isolates tested, exhibited resistance to all antibiotics except amikacin. This resistance profile further complicates treatment options and suggests that bacteria may possess mechanisms such as efflux pumps or antibiotic-modifying enzymes that confer broad-spectrum resistance [ 39 ]. However, Klebsiella pneumoniae was sensitive to all the antibiotics tested, indicating that, at least among the tested isolates, this pathogen remains susceptible to available treatments. This finding contrasts with global trends where Klebsiella pneumoniae has increasingly shown resistance, particularly to carbapenems [ 40 ]. Pantoea ananatis displayed resistance to ampicillin while remaining sensitive to other antibiotics, a pattern that may be due to the presence of beta-lactamase enzymes that confer resistance to penicillin-class drugs [ 41 ]. Escherichia coli isolates are resistant to trimethoprim and ampicillin, which aligns with the global rise in resistance among E. coli strains, particularly in hospital environments where antibiotic pressure is high [ 42 ]. The resistance of these bacteria, especially to ampicillin, suggests the widespread presence of resistance genes, likely driven by the overuse and misuse of antibiotics. The overall pattern of resistance, particularly high resistance to ampicillin, tetracycline, and trimethoprim, indicates that these antibiotics may no longer be effective for treating infections caused by these pathogens. This resistance could lead to more severe healthcare-associated infections and complicated treatment protocols, requiring the use of more potent, often more toxic, or expensive antibiotics. These findings emphasize the need for continuous monitoring of antibiotic resistance patterns and the implementation of robust antimicrobial stewardship programs to mitigate the spread of resistant pathogens. The results of this study have significant implications for hospital waste management and infection control policies at the Federal University Teaching Hospital, Owerri. The presence of highly resistant bacteria in various waste types, particularly those that are not completely sterilized before disposal, raises concerns about the potential for environmental contamination and the spread of resistant pathogens. This calls for an urgent review of hospital waste management protocols, particularly in ensuring that all waste, especially infectious and pathological waste, undergoes complete sterilization before final disposal. The study did not detect any isolates harboring the MsrA gene, which is associated with energy-dependent efflux mechanisms conferring resistance to erythromycin, or the ermF and ermX genes, which are known to confer resistance to erythromycin and clindamycin through rRNA methylation mechanisms. The absence of these genes suggests that, within the sampled population, resistance to macrolides and lincosamides (erythromycin and clindamycin) is not mediated by these common resistance mechanisms. This finding is noteworthy, as erm genes, particularly ermF and ermX, are often implicated in resistance to erythromycin and clindamycin in various pathogenic bacteria [ 43 ]. The lack of these genes in the isolates could be attributed to the local antibiotic usage patterns, which may not exert sufficient selective pressure for the emergence and maintenance of these resistance determinants. Moreover, the absence of MsrA suggests that efflux-based resistance to erythromycin is not prevalent in this setting, which is consistent with reports from other regions where alternative resistance mechanisms, such as target site modification, predominate [ 44 ]. In contrast, the present study detected blaSHV and blaTEM genes, which are well-known mediators of resistance to beta-lactam antibiotics, including penicillins and cephalosporins. The detection of these genes is important, as they encode beta-lactamase enzymes that hydrolyse the beta-lactam ring, rendering these antibiotics ineffective [ 45 ]. The findings revealed that 2 (50%) of the isolates harboured only the blaTEM gene, whereas another 2 (50%) possessed only the blaSHV gene. Additionally, 1 (25%) of the isolates contained both the blaTEM and blaSHV genes. This co-occurrence of blaTEM and blaSHV is particularly concerning, as it suggests the potential for these isolates to exhibit a broader spectrum of resistance, including to extended-spectrum beta-lactam antibiotics [ 46 ]. The presence of both genes in a single isolate could also indicate the acquisition of multiple resistance plasmids or the occurrence of recombination events, leading to the clustering of resistance determinants. The detection of blaTEM is consistent with global trends in which blaTEM is one of the most frequently identified beta-lactamase genes, particularly in gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae [ 47 ]. Similarly, blaSHV is also commonly associated with resistance in hospital-acquired infections, often contributing to the spread of multidrug-resistant (MDR) strains [ 47 ]. The presence of blaSHV and blaTEM in the isolates underscores the need for vigilant antimicrobial stewardship and the prudent use of beta-lactam antibiotics in the clinical setting. The ability of these genes to confer resistance to a broad range of beta-lactam antibiotics, including those considered first-line treatments, poses a significant challenge for the management of bacterial infections. Moreover, the co-occurrence of blaTEM and blaSHV in certain isolates highlights the potential for the emergence of highly resistant strains that could limit treatment options and increase the risk of treatment failure. This finding necessitates the implementation of robust infection control measures to prevent the spread of these resistant pathogens within the hospital environment. The absence of macrolide and lincosamide resistance genes (MsrA, ermF, ermX) may provide a therapeutic window where these antibiotics could be considered for treatment, particularly in infections caused by isolates lacking beta-lactam resistance. However, this approach must be approached with caution, considering the potential for the emergence of resistance if these antibiotics are overused. 5. Conclusion and Recommendation 4.1 Conclusion The assessment of hospital waste and the associated bacterial contamination levels at the Federal University Teaching Hospital, Owerri, reveals a comprehensive approach to waste management that incorporates various disposal methods tailored to the type of waste generated. However, the presence of significant microbial contamination in certain waste types underscores the need for continuous improvement in waste management practices. By enhancing training, updating policies, and expanding recycling efforts, hospitals can further mitigate the risks associated with hospital waste and contribute to a safer and more sustainable healthcare environment. However, there are areas for improvement, particularly in the training and communication of waste management policies. The slightly greater degree of knowledge and positive attitudes among the female respondents may be attributed to their greater involvement in the nursing and sanitation roles. To ensure the effectiveness of a hospital's waste management system, it is crucial to address the gaps identified in training and policy awareness, thereby enhancing the overall safety and efficiency of waste management practices. The assessment of hospital waste disposal methods and the associated resistant bacterial pathogens underscores the critical need for effective waste management strategies to control the spread of resistant microorganisms. The findings from this study provide a valuable basis for improving waste management practices and reducing the risk of nosocomial infections and environmental contamination. Future research should focus on the development of more sustainable waste treatment technologies and the exploration of alternative methods for managing resistant pathogens in healthcare waste. The presence of significant microbial contamination and high levels of antibiotic resistance, particularly to commonly used antibiotics, underscores the need for enhanced waste management protocols and antimicrobial stewardship. Addressing these challenges is critical to safeguarding public health and preventing the further spread of antibiotic-resistant pathogens. The molecular assessment of antibiotic resistance genes in bacterial isolates revealed a concerning prevalence of beta-lactamase genes (blaSHV and blaTEM) while demonstrating the absence of certain erythromycin and clindamycin resistance genes. These findings have significant implications for antibiotic therapy and infection control within hospitals, emphasizing the need for targeted interventions to manage and mitigate the spread of antibiotic-resistant bacteria. 4.2 Recommendation To mitigate these risks, hospitals must prioritize the adoption of best practices in waste management, including the use of appropriate personal protective equipment (PPE) for waste handlers, regular training and capacity building for staff, and the implementation of effective waste treatment technologies, such as autoclaving and incineration. Additionally, there is a need for continuous monitoring and evaluation of waste management practices to ensure compliance with national and international standards. Given the high levels of microbial contamination found in infectious waste, hospitals should consider investing in additional incineration and autoclaving facilities. This will reduce the reliance on landfilling, which poses environmental risks, and ensure that hazardous waste is treated via the most effective methods. To ensure that all healthcare workers are aware of and adhere to waste management policies, hospitals should implement regular communication and refresher training sessions. Effective communication ensures that all staff members are informed about the latest guidelines and are equipped with the necessary knowledge to manage waste safely. Recommendations for Policy Improvement The findings of this study offer practical recommendations for improving waste management policies in healthcare settings. These recommendations, which are based on empirical data, contribute to the development of more effective and sustainable waste management strategies that can be applied in similar healthcare institutions. 4.3 Contribution to knowledge The study revealed a strong correlation between healthcare workers’ knowledge of waste management and their adherence to proper practices. This correlation underscores the importance of continuous education and training in maintaining effective waste management systems in healthcare settings. The detailed analysis of microbial contamination levels in various types of hospital waste contributes to the understanding of the risks associated with improper waste disposal. The identification of resistant bacteria, such as Enterobacter cloacae and Staphylococcus Scuri ssp. The presence of Lentus in hospital waste highlights the potential for hospital-acquired infections and the spread of antibiotic-resistant pathogens. This study provides a comprehensive evaluation of the waste disposal methods used at Federal University Teaching Hospital, Owerri, including incineration, autoclaving, and landfilling. This evaluation contributes to a broader understanding of the effectiveness and limitations of different waste disposal methods in reducing microbial contamination and environmental impact. By focusing on the assessment of hospital waste management practices and the associated bacterial hazards, this study contributes to the field of environmental health research. This study provides a basis for further studies on the impact of waste management practices on public health and the environment, particularly in resource-limited settings. Declarations Ethnical Consideration/Informed Consent Informed written consent was sought and obtained from all study participants. Additionally, approval to carry out the study was obtained from the Department of Public Health Technology, FUTO, and from management at Federal University Teaching Hospital, Owerri. Consent for publication: All the authors have approved the manuscript for submission and it has not been published, or submitted for publication elsewhere. Competing interests: There is no competing interest among the authors. Funding: This research was self-funded by the authors. Author Contribution UGE and UMC designed research; CQO, IGC, CCO, CCU, CLO, ABN conducted research; CCAO analyzed data; COA, CQO, IGC, and CLO wrote the paper; UMC and UGE had primary responsibility for the final content. All authors read and approved the final manuscript. Acknowledgements: Not applicable Authors' information : Not applicable Clinical trial number : Not applicable Availability of data and materials: All data generated or analysed during this study are included in this published article. References Kumari A, Maurya NS, Tiwari B. Hospital wastewater treatment scenario around the globe. Curr Developments Biotechnol Bioeng. 2019;549–70. doi.org/10.1016/B978-0-12-819722-6.00015-8 . Janik-Karpinska E, Brancaleoni R, Niemcewicz M, Wojtas W, Foco M, Podogrocki M, Bijak M. Healthcare Waste-A Serious Problem for Global Health. Healthc (Basel). 2023. 10.3390/healthcare11020242 . Ezeudu OB, Ezeudu TS, Ugochukwu UC, Tenebe IT, Ajogu AP, Nwadi UV. Ajaero, CC. Healthcare Waste Management in Nigeria: A Review. Recycling. 2022. https://doi.org/10.3390/recycling7060087 . Lee SM, Lee D. Effective Medical Waste Management for Sustainable Green Healthcare. Int J Environ Res Public Health. 2022. 10.3390/ijerph192214820 . Afesi-Dei C, Appiah-Brempong M, Awuah E. Health-care waste management practices: The case of Ho Teaching Hospital in Ghana. Heliyon. 2023. 10.1016/j.heliyon.2023.e15514 . Frederick E, Udofia EA, Ayivor J, Osei MM, Tetteh J, Tetteh-Quarcoo PB, Sampane-Donkor E. Disposal habits and microbial load of solid medical waste in subdistrict healthcare facilities and households in Yilo-Krobo municipality, Ghana. PLoS ONE. 2021. https://doi.org/10.1371/journal.pone.0261211 . WHO (World Health Organization). (2018). Healthcare waste. https://www.who.int/news-room/fact-sheets/detail/health-care-waste . Accessed 22 Sept 2024. Wang X, Firouzkouhi H, Chow JC, Watson JG, Ho SSH, Carter W, De Vos ASM. Chemically speciated air pollutant emissions from open burning of household solid waste from South Africa. Atmos Chem Phys. 2023;23:15375–93. https://doi.org/10.5194/acp-23-15375-2023 . World Health Organization (WHO). (2022). Healthcare waste management and infection control: A global perspective . WHO. https://www.who.int/publications/i/item/9789241550174 . Accessed 22 Sept 2024. Murray I. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2019;399(Suppl 10325):629–55. Nwaokoro JC. Risk factors associated with gestational diabetes among pregnant women in Owerri municipal council, south eastern Nigeria. Asia J Med Sci Asian J Med Sci. 2014;5(Suppl 1):39–46. 10.3126/ajms.v5i1.8302 . Nkwopara C. (2020). The Federal Medical Center Owerri gets 290 million equipment upgrade. In Wikipedia . https://en.wikipedia.org/wiki/Federal Medical Centre, Owerri. Accessed 18 Sept 2024. Ekeleme UG, Ikwuagwu VO, Chukwuocha UM, Nwakanma JC, Adiruo SA, Ogini IO, Ude IU. Detection and characterization of microorganisms linked to unsealed drugs sold in the Ihiagwa community, Owerri, Imo State, Nigeria. Access Microbiol. 2024. 10.1099/acmi.0.000752.v3 . Sukhum KV, Newcomer EP, Cass C. Antibiotic-resistant organisms establish reservoirs in new hospital environments and are related to patient blood infection isolates. Commun Med. 2022;2:62. Ekeleme UG, Ansari RA, Osaribie NA, Rabiu KM. Microbial load of domestic water sources treated with Moringa oleifera or Jatropha curcas seed powder. South Asian J Res Microbiol. 2020;7(Suppl 4):9–20. Khan ZA, Siddiqui MF, Park S. Current and Emerging Methods of Antibiotic Susceptibility Testing. Diagnostics (Basel, Switzerland) . https://doi.org/10.3390/diagnostics9020049 CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fifth Informational Supplement. Wayne: Clinical and Laboratory Standards Institute; 2021. pp. M100–S25. Humphries R, Bobenchik AM, Hindler JA, Schuetz AN. Overview of Changes to the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, M100, 31st Edition. J Clin Microbiol. 2021;59(Suppl 12):e0021321. https://doi.org/10.1128/JCM.00213-21 . Taiwo SS, Onile BA, Akanbi AA. Methicillin resistant Staphylococcus aureus (MRSA) in Ilorin, Nigeria. Afr J ClinExpMicrobiol. 2004;5(Suppl 2):189–97. Adeyemo O, Oloruntoba EO, Fawole O. Gender differences in knowledge and attitudes towards healthcare waste management among healthcare workers in a tertiary hospital in Nigeria. J Environ Sci Health Part A. 2018;53(Suppl 9):793–802. Akinwale AA, Salami KK, Ogundipe OA. Hospital waste management: Attitude, knowledge, and practice among healthcare workers in a tertiary hospital in South West Nigeria. Niger J Med. 2020;29(Suppl 3):403–9. Eze UR, Nwankwo BO, Obi OI. Assessment of healthcare waste management practices in a tertiary hospital in Nigeria. J Environ Manage Saf. 2017;8(Suppl 2):89–99. World Health Organization (WHO). Safe management of wastes from health-care activities: a summary. WHO Press. 2014; https://www.who.int/publications/i/item/9789241548564 . Accessed 10 Sept 2024. Chartier Y, Emmanuel J, Pieper U, Prüss A, Rushbrook P, Stringer R, Zghondi R, editors. Safe management of wastes from health-care activities. World Health Organization; 2014. Accessed 11 Sept 2024. World Health Organization (WHO). Healthcare waste: key facts. WHO Press. 2017; https://www.who.int/docs/default-source/wpro---documents/hae---regional-forum-(2016)/hcwmanagement-factsheet-rfhe.pdf?sfvrsn=6d59d7e_2 . Accessed 08 Sept 2024. Prüss-Ustün A, Rapiti E, Hutin Y. Sharps injuries: global burden of disease from sharps injuries to health-care workers. Environmental Burden of Disease Series, 3. 2019; World Health Organization. International Atomic Energy Agency (IAEA). Management of radioactive waste from the use of radionuclides in medicine. IAEA Safety Standards; 2018. McGain F, Naylor C. Environmental sustainability in hospitals – a systematic review and research agenda. J Health Serv Res Policy. 2014;19(Suppl 4):245–52. Ndimele EC, Ekeleme UG, Ogodo AC, Nwachukwu NC. Evaluation of the level of air microbial contamination in some teaching hospitals waste dump site in South-Eastern Nigeria. Nigerian Hosp Pract 201; 15 Suppl 4: 31–8. Kümmerer K. (2009). The presence of pharmaceuticals in the environment due to human use – present knowledge and future challenges. Journal of Environmental Management. 2009; 90 Suppl 8: 2354–2366. Ndimele EC, Ekeleme UG, Ogodo AC, Nwachukwu NC, Nnadi CJ, Otutu EA. Microbiological studies of wastedumpsite in Abia State University Teaching Hospital, Aba. J Med Investig Pract. 2014; 9:151-6. https://www.researchgate.net/publication/276420691_Microbiological_studies_of_waste_dumpsite_in_Abia_State_University_Teaching_Hospital_Aba [accessed Oct 16 2024]. Khan R, Ahmed M, Hassan A. Morphological and biochemical characterization of bacterial pathogens in hospital environments. J Clin Microbiol. 2021;59(Suppl 6):e01245–20. https://doi.org/10.1128/JCM.01245-20 . Jain A, Singh H, Sharma P. Hospital waste management: Biochemical profiling and its role in infection control. J Infect Public Health. 2022;15(Suppl 5):651–9. https://doi.org/10.1016/j.jiph.2021.11.009 . Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Monnet DL. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2020;18(Suppl 3):268–81. https://doi.org/10.1111/j.1469-0691.2020.03570.x . Neyra RC, Frisancho JA, Sánchez HF. Methicillin-resistant Staphylococcus aureus in healthcare waste: A study on its prevalence and resistance patterns. J Environ Health Sci Eng. 2019;17(Suppl 2):927–36. https://doi.org/10.1007/s40201-019-00456-2 . Raut S, Adhikari S, Pant ND. Prevalence and antibiogram of Escherichia coli from hospital waste in Nepal: A potential public health threat. BMC Infect Dis. 2023. https://doi.org/10.1186/s12879-023-07193-4 . 23 Suppl 1: 216. Weller CF, Archer MJ, Pelayo JL. Pantoea ananatis : An emerging human pathogen in healthcare waste. Infect Control Hosp Epidemiol. 2021;42(Suppl 8):953–8. https://doi.org/10.1017/ice.2021.137 . Aderemi MO, Adewuyi GO, Agboola OO. Evaluation of microbial contamination in healthcare waste: A case study of Lagos State, Nigeria. Environ Sci Pollut Res. 2019;26:8793–801. https://doi.org/10.1007/s11356-018-1836-4 . Hassuna NA, Abdelaziz A, Gaber SN. Mechanisms of antibiotic resistance in bacterial pathogens: A review. J Global Antimicrob Resist. 2022;30:307–20. https://doi.org/10.1016/j.jgar.2021.12.005 . Logan LK, Weinstein RA. The epidemiology of carbapenem-resistant enterobacteriaceae: The impact and evolution of a global menace. J Infect Dis. 2017. https://doi.org/10.1093/infdis/jiw282 . Yang Q, Liao J, Fang R. Resistance mechanisms of penicillin and ampicillin in gram-negative bacteria. Front Microbiol. 2023;13:846521. https://doi.org/10.3389/fmicb.2023.846521 . Kanj SS, Kanafani ZA. Current concepts in antimicrobial therapy against resistant gram-negative organisms: Extended-spectrum beta-lactamase–producing enterobacteriaceae, carbapenem-resistant enterobacteriaceae, and multidrug-resistant pseudomonas aeruginosa. Mayo Clinic Proceedings. 2020; 95 (1): 68–82. https://doi.org/10.1016/j.mayocp.2019.09.011 Lerner A, Adler A, Abu-Hanna J. The spread of multidrug-resistant bacteria in low- and middle-income countries: Trends, challenges, and possible interventions. Antimicrob Resist Infect Control. 2021. https://doi.org/10.1186/s13756-021-00937 . Alkhatib A, Awad M, El-Bahnasawy MA. Mechanisms of macrolide resistance in Streptococcus pneumoniae and Staphylococcus aureus isolates: A systematic review. J Global Antimicrob Resist. 2022;29:93–102. https://doi.org/10.1016/j.jgar.2021.12.006 . Harris PNA, Weiss J. The interplay between beta-lactam antibiotics and beta-lactamases: Insights from structural biology and drug design. Nat Rev Microbiol. 2020;18(Suppl 4):230–42. https://doi.org/10.1038/s41579-020-0327-7 . Djahmi N, Touati A, Pantel A. Epidemiology and surveillance of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Algeria. J Med Microbiol. 2019;68(Suppl 4):461–9. https://doi.org/10.1099/jmm.0.000939 . Pitout JDD, Peirano G, blaTEM. blaSHV and blaCTX-M extended-spectrum beta-lactamases in gram-negative bacteria: An updated review. J Global Antimicrob Resist. 2021;27:202–15. https://doi.org/10.1016/j.jgar.2021.09.012 . Table 3.1.7 Table 3.1.7 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table3.1.7.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5339259","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":374498985,"identity":"c75f901e-1663-48de-b3ab-3dcf633f11f8","order_by":0,"name":"Uzochukwu Godswill Ekeleme","email":"data:image/png;base64,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","orcid":"","institution":"Federal University of Technology Owerri","correspondingAuthor":true,"prefix":"","firstName":"Uzochukwu","middleName":"Godswill","lastName":"Ekeleme","suffix":""},{"id":374498986,"identity":"61db1a99-1a25-4f9c-8f0e-687ac24ca068","order_by":1,"name":"Queeneth Chiamaka Onuoha","email":"","orcid":"","institution":"Federal University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Queeneth","middleName":"Chiamaka","lastName":"Onuoha","suffix":""},{"id":374498987,"identity":"7b271f7e-a68b-4a53-b347-82a6341aadc9","order_by":2,"name":"Uchechukwu (M) Chukwuocha","email":"","orcid":"","institution":"Federal University of Technology Owerri","correspondingAuthor":false,"prefix":"","firstName":"Uchechukwu","middleName":"(M)","lastName":"Chukwuocha","suffix":""},{"id":374498988,"identity":"2f86ecee-b0a5-4998-8118-ec7e0e758498","order_by":3,"name":"Ijeoma (G.) 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Lane M: GeneRuler plus DNA ladder; lanes 1--12: representative bacterial isolate.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5339259/v1/222549a9373e33f2e7bd1dc4.jpg"},{"id":75003371,"identity":"90222fff-0020-4d01-84f3-c80d9516b473","added_by":"auto","created_at":"2025-01-29 10:09:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2850299,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5339259/v1/6c663d1d-80bd-4640-a113-b02e25434018.pdf"},{"id":69435371,"identity":"d5093d20-ec61-4eaa-a99f-b96417431610","added_by":"auto","created_at":"2024-11-20 10:28:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19527,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.1.7.docx","url":"https://assets-eu.researchsquare.com/files/rs-5339259/v1/a7621b5bef1909f92229b1b1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssessment of Hospital Waste and the Associated Antibacterial Resistance Gene: A Case Study of Federal University Teaching Hospital, Owerri\u003c/p\u003e","fulltext":[{"header":"1. Background Information","content":"\u003cp\u003eHospitals play an essential role in the welfare of mankind; they contribute to health by offering frequent services to address complicated health problems [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Hospital waste management has become a critical issue because it poses potential health risks and damage to the environment [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It continues to be a major challenge, particularly in most healthcare facilities in developing countries where it is limited by technological, economic, and social difficulties and inadequate training of staff responsible for handling waste [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Poor conduct, inappropriate management and disposal methods exercised during the handling and disposal of medical waste are increasing health and environmental hazards due to the infectious nature and unpleasant smell of the waste [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In Nigeria, hospital waste management has not received satisfactory attention because of limited economic resources, poor policy regimes, inadequate public infrastructure, and the absence of other critical capacities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Approximately 15% of the waste generated in hospitals is hazardous; 85% of the waste is nonhazardous [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePathogens present in untreated waste can also leach out and contaminate the soil and surface water [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In 2015, a joint WHO/UNICEF assessment revealed that just over half (58%) of the facilities sampled from 24 countries had adequate disposal of healthcare waste [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Disposing medical waste in a landfill without segregation and processing results in the entry of harmful microorganisms, chemicals or pharmaceuticals into the soil and groundwater, causing their contamination. Open burning or incinerator malfunction results in the emission of toxic substances, such as dioxins and furans, into the air [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe risk of hospital waste and its management has become a global cause of concern, as antimicrobial resistance (AMR) continues to be the most pressing public health issue worldwide. Antibiotic resistance is increasing too dangerously high worldwide, according to the World Health Organization (WHO), Geneva, Switzerland, which is causing an increase in morbidity and mortality [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Thus, in 2019, 929,000 deaths attributable to antimicrobial resistance (AMR) and 3.57\u0026nbsp;million deaths associated with AMR were caused by the six leading pathogens that cause mortality: \u003cem\u003eEscherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii\u003c/em\u003e, and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The World Health Organization projects that by 2050, this number might reach 10\u0026nbsp;million. Therefore, this study aimed to assess hospital waste and associated antibacterial resistance genes: a case study of Federal University Teaching Hospital, Owerri.\u003c/p\u003e"},{"header":"2. Research Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study Design\u003c/h2\u003e \u003cp\u003eThe study employed a cross-sectional descriptive and experimental design. A cross-sectional descriptive design was used to assess the sociodemographic characteristics, knowledge, attitudes, and perceptions of healthcare workers regarding hospital waste management at Federal University Teaching Hospital, Owerri, whereas an experimental design was used to study the resistant pathogens associated with waste disposal methods at Federal University Teaching Hospital, Owerri. The designs were chosen to capture a snapshot of the current practices and opinions among healthcare workers, allowing for the identification of areas for potential improvement in waste management practices and the determination of resistant pathogens associated with waste from October 2023 to May 2024.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Area of Study\u003c/h2\u003e \u003cp\u003eThe Federal University Teaching Hospital is located in Owerri city, Imo State, southeastern Nigeria. In 1903, Federal University Teaching Hospital, Owerri was founded as a colonial dispensary [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It was promoted to a district hospital, then a general hospital, before finally becoming a Federal Medical Centre in 1995 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It is a 700 bed capacity hospital. This hospital is a tertiary healthcare facility that provides a wide range of medical services and serves as a training ground for various healthcare professionals.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Study population\u003c/h2\u003e \u003cp\u003eThe study population comprised healthcare workers at Federal University Teaching Hospital, Owerri. This group includes doctors, nurses, pharmacists, medical laboratory scientists, healthcare attendants, waste collectors, community health workers, and health record officers working in hospitals aged 18 years and above. Hospital waste samples were collected from infectious waste, pathological waste, sharps, chemical waste, pharmaceutical waste, radioactive waste and general waste.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Sample size and sampling methods\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1. Sample size\u003c/h2\u003e \u003cp\u003eA total of 347 healthcare workers were included in the study via Taro Yamane's formula, with a population size of 2,619 and a 5% margin of error, ensuring adequate representation across different professions and departments within the hospital.\u003c/p\u003e \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"137\" height=\"69\"\u003e\u003c/p\u003e\n\u003cp\u003eWhere n\u0026thinsp;=\u0026thinsp;sample size, N\u0026thinsp;=\u0026thinsp;population, e\u0026thinsp;=\u0026thinsp;margin of error (in decimal form)\u003c/p\u003e \u003cp\u003e\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAIoAAABMCAYAAACyNi/NAAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAAJcEhZcwAADsMAAA7DAcdvqGQAAAcRSURBVHhe7Z09Tt1MFIbNtwyEIhSyBiqCIEVgARSIigqJLAAaShpQ6kRKlQpYAmlQxEUUrAEQihDb4PNj5sC5k7F9fDFcx5xHGtljj+f39cwZX3vuxH1O5jg1/Be2jlOJC8Ux4UJxTLhQHBMuFMeEC8Ux4UJxTLhQHBNvQigTExOP7ujoKBz9m/39/cdw19fX4egDy8vL2YcPH4JvGM7JdcTRS3gy22dmZmbC3v393t4eT6HvDw8Pw5EnOJ6qjqurq8dzOi5haWnpfnNzM/ge4iGdvtFroQwGg6KhNTS2bligcWnwKrgmFoqISIMI42N9oNdDz9zcXPb+/fvgeyAePr58+ZLlAsiOj4/DETsXFxdh74nZ2dlie3Z2Vmz7QqtCYaym4rEDZMwuswn0uJ5ynH8p5ufnw16Wff/+PdvY2BhKO7ZP6uibKJKEnuXZ0HUTHU669lR3PU4YKvQQw9BEfvUx8pvKc1lZ4uslTrZ9otXBlArT4z9GXZeEQv60zZKyJ8oaukwo2tjVrm+MzUZ57aGHaevOzs5fNkvM5ORk2LNBfHk9PrpcTFl+g4Sz/WFsQsF41BUcu1GMyzLETsK41VQZnk0FA/IMZWtrq9j2id4/cEMkp6enQ41HgyIOegPu/vX19XAmy75+/Zrlw0xtzxPDbGp7ezu7vLwMR3pGfve2AuM30eHEVhF/i8k0Qh6wxU4bn6Dzqm0sQV+LE/tF2yd9fMim8XdmHRO9H3qcdnChOCZcKI6Jztkoi4uL2e/fv4PP6QILCwvdE4rTPjwOYOoO+Uyt8dQffOjpOfIDJ/0Bz4z40XYk6FG6Bs85nvMbEcUSl3pJSdDPWfRvQFCVB87JdU2enxBeI3HEz3XKqAuv84WLywSUieNN67dTQtEPsOoKUlZZ+joRwrjfaJMfGnXD4ZcHd1xfJ5a68JyruikEuS6Vpyo62aPQEKMIhcLHBSee+GkrFVTXMKk8iIg0ljfa4gZJNTRhRAgxlvCpJ8oxxKPzwfV19Sz0ykbp4httpJc34lC+Tk5Osk+fPgXfA7kQsvPz8+Abpi48afMCFr+6l9kgYqvofFBfnz9/Nr0Q/iaM2XG+0UZ6a2trwffAr1+/snfv3gXfEzc3N2FvmLrw/NKd3/SFE8HoMrGPIPhhlH391iF18+PHj+Ar558RSvz+CpWn/an3V6SyVldXi600MHeoVCy9C5VoQeLZ3d0ttnB3dxf2/kbSG+WVhSboXoIy0dtIz0IeKGM+5BT1xL6UA+gROVd3s/wzQonfX6EytD81lFBZ3759C74su729LbY67M+fP4uKsvYShNUi/fjxY3E8ftcFJL1Rnls8B8pMHoF86XrCpagSPPR26OnyG22I/M+fP8H3AO+xTE9PB98wTcOTR/LVJr0USlfeaJuamiq2cbeOYcrwp6GnWllZCb5hmoYnvbKvGsuoLX9+V3SOUafHwHQ1nioyLZSpJPs6bsKmppZ1eeCcpfoIk5r26uNledA0CU/eciEFXzXUV11dQ+eEQoVol6rkMhBBfD0uFhWVLOdSFa6vxUkeqHw5RloWyhpVxxXnT8qhy14VHr+cw1lFAuTNUhb/UfAVwOjNG+/Vjdo6GKLy3qSwtep4E89Rxg0ioUGsM6vXQE+bLXiP8opgYHbhLX16Ep4dNcmLC8Ux4UOPY8KF4phwoTgmXCiOCReKY8KF4phwoTgmXCiOCReKY8KF4phwoTgmXCiOCReKY8KF4phwoTgmXCiOCReKY8KF4phwoTgmXCiOCReKY8KF4phwodTAB++yxAWuCpbZKFvxCGSNl7oPyHV6VR+NWeNrAxdKBTQSf+HCp0+4paWl0j+cIiyrHaXgHA0KxFP14RXhDg8Pi3CDwaBYfyUWS5P4WiNPyCkh/ti76st/PvbmY/H4g3Q+NKeaLR+CE3/8AbrEKzSJr016IxSpQHG6Imnw1IoCTSFOGjOG46SREgrCsqYdiwJIj/IITeJrk04PPXTzjPnaTtAL1WkODg6KblgcC8/INXyMrZfoGgVJV69/BjIspFYq4BwfgbMykuSlzp6QJbVSjBJfa6CWLsKdRfZwcgexLev6XxKdl/iO13d33KPQ03CN9G70Oro8MalhReLQ+9b42qSzQoFUxY9DKAJp0zA0KJAfGkuI88t+LCzd8ClkqNFO4hglvrbozaxHZgLi9CK7LPNQNW21Es8uWJ+VYU3SZNhIrfOqSa0Xq2Foy9ulcAwzwKKFZdTF1xa9EUpso7BYrzRgGzaKQFyyMB7C0Wnmd3uxSjX72Cws9puyOYjDAuImPlm08LnxPYu8UJ0l7srHPfSQvs5PTJxfiI+R/9TMSSO2RzzMwCjxtUFnhUIFUFlSYVSO+HGvQZwmQqkiJRTQZdGNGhuj2j4ROyhFWXwvia+45BjIsv8BjsN3DMetneAAAAAASUVORK5CYII=\" width=\"138\" height=\"76\"\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eRounded to the nearest whole number\u003c/strong\u003e \u003cp\u003en\u0026thinsp;\u0026asymp;\u0026thinsp;347. Therefore, the sample size is \u003cb\u003e347\u003c/b\u003e.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eFor hospital waste, the sample size was 21. This was based on categories that included infectious waste, pathological waste, sharps, chemical waste, pharmaceutical waste, radioactive waste and general waste.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.4.2. Sampling methods\u003c/h2\u003e \u003cp\u003eTo obtain a representative sample of the population, the sampling method adopted for health workers was a stratified random sampling method. The health care workers were stratified according to their professional groups: Doctor, Nurse, Pharmacist, Medical Lab Scientist, Healthcare Attendant, Waste Collector, Community Health Workers, and Health Record Officers, which included 8 categories of health professionals. The respondents were then selected via simple random sampling via a computer-generated table of random numbers. There were lists of staff in each stratum in all the selected professions. A serial number was assigned to each staff member to maintain the order of the list. Using the computer-generated table of random numbers, respondents were selected on a daily basis from each stratum until the total sample size was reached, ensuring a fair and unbiased representation of the entire population.\u003c/p\u003e \u003cp\u003eHospital waste was categorized into infectious waste, pathological waste, sharps, chemical waste, pharmaceutical waste, radioactive waste and general waste. Samples were collected from these different wastes and taken to a laboratory for further testing.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Method of Data Collection\u003c/h2\u003e \u003cp\u003e \u003cb\u003eData collection from healthcare workers\u003c/b\u003e \u003c/p\u003e \u003cp\u003eData collection was carried out through the administration of structured questionnaires to the selected healthcare workers. The questionnaires were distributed in person by the researchers, and the participants were given sufficient time to complete them. The completed questionnaires were then collected, and the data were subsequently analysed to identify patterns and trends in the responses.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCollection of hospital waste\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe waste was collected from specially designated containers, which were colour-coded and labelled to identify the type of waste they contained. This waste is typically segregated at the point of generation into categories such as infectious waste, pathological waste, sharps, chemical waste, pharmaceutical waste, radioactive waste and general waste. Staff trained in proper waste handling procedures performed the collection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Microbiological analysis\u003c/h2\u003e \u003cp\u003eThe enumeration and identification of bacteria were performed aseptically at the Laboratory of Infectious Disease and Molecular Epidemiology at the Department of Public Health, Federal University of Technology, Owerri, Imo State, Nigeria. First, the waste samples were separated on a Biosafety Cabinet II. One gram of solid hospital waste was added to a sterile tube with 5 ml of Stuart transport medium, and the sample was allowed to wet completely. The tube was tightly closed to prevent leakage and contamination. The samples were vortexed, and 90 \u0026micro;L of eluate was used for culture inoculation per plate/test condition [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The following culture media were inoculated into all the samples: MacConkey agar with cefotaxime (Hardy), cetrimide agar (Hardy), mannitol salt agar, Salmonella Shigella agar, blood agar and chocolate agar. In an air incubator, the plates were incubated at 37\u0026deg;C for up to 48 hours before being discarded if there was no growth [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. All the isolates recovered were stored at \u0026minus;\u0026thinsp;80\u0026deg;C in TSB with glycerol. Isolated microorganisms were identified via a combination of morphological, biochemical, and microscopic examinations of colony morphology, cell shape, and size, which provided initial clues for identification. Biochemical assays such as Gram staining, catalase tests, oxidase tests, and sugar fermentation tests were performed to further classify the isolates [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Antimicrobial susceptibility testing (AST)\u003c/h2\u003e \u003cp\u003eThe susceptibility of the identified pathogens was tested against various antibiotics. It was performed via the single disk diffusion method [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], in line with the guidelines of the Clinical and Laboratory Standards Institute [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A fresh subculture of each isolate was first made on nutrient agar. A sterile straight wire was used to touch 5 colonies of each isolate, which were subsequently suspended in a sterile Bijou bottle containing 5 mL of peptone water (Lab M), which was subsequently incubated overnight at 37\u0026deg;C. The overnight broth cultures were diluted with sterile saline to 10\u003csup\u003e6\u003c/sup\u003e colony-forming units per mL by comparing the turbidity of the inoculum with 0.5 McFarland turbidity standards. A sterile cotton-tipped applicator was introduced into a standardized inoculum and used to inoculate dried plates of Mueller‒Hinton agar (Oxoid, England). Single sterile antibiotic discs were placed on each plate and incubated for 24 h aerobically at 37\u0026deg;C. The antibiotics used for the gram-positive isolates were gentamicin (10 \u0026micro;g, Gen), erythromycin (10 \u0026micro;g, ER), sulfamethoxazole (125 \u0026micro;g, SXT), ciprofloxacin (10 \u0026micro;g, CIP), ampicillin (AMP), tetracycline (30 \u0026micro;g, TE) and cefotoxine (10 \u0026micro;g, CTX), whereas the antibiotics used for the gram-negative isolates were erythromycin (10 \u0026micro;g, ER), sulfamethoxazole (125 \u0026micro;g, SXT), ciprofloxacin (10 \u0026micro;g), ampicillin (10 \u0026micro;g, AMP), tetracycline (10 \u0026micro;g, TE), cefotoxine (5 \u0026micro;g, CTX) and ampicillin-subitan (30 \u0026micro;g, SAM). The diameter of the zone of inhibition of each isolate to the disc was read with a calibrated ruler according to the standardized CLSI 2021 guidelines [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Gentamicin resistance among staphylococcal isolates was detected on Mueller‒Hinton agar supplemented with 2% NaCl as previously described by [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.8 Genomic DNA extraction\u003c/h2\u003e \u003cp\u003eThe resistant isolates obtained from antimicrobial susceptibility testing (AST) were subjected to genomic DNA extraction. One hundred microliters (100 \u0026micro;l) of the isolate was added to a microcentrifuge tube. First, 500 \u0026micro;l of lysis buffer was added, followed by vortexing and incubation at 56\u0026deg;C for 10 minutes. After incubation, the mixture was centrifuged at 10,000 rpm for 1 minute. Following centrifugation, 200 \u0026micro;l of absolute ethanol was added to the tube, and the resulting mixture was transferred into the spin column. The spin column was centrifuged at 10,000 rpm for 30 seconds. The flow-through was then discarded, and the collection tube was blotted on tissue paper.\u003c/p\u003e \u003cp\u003eAfterward, 500 \u0026micro;l of Wash Buffer 1 was added to the spin column, and the sample was centrifuged at 10,000 rpm for 1 minute. The flow-through was again discarded, and the collection tube was blotted. This process was repeated with 500 \u0026micro;l of Wash Buffer 2, followed by another centrifugation at 10,000 rpm for 1 minute. After the flow-through was discarded, the spin column was centrifuged at 12,000 to 14,000 rpm for 3 minutes to remove any remaining ethanol.\u003c/p\u003e \u003cp\u003eThe spin column was then placed into a new microcentrifuge tube, and 50 \u0026micro;l of elution buffer (nuclease-free water) was added to the center of the column. The sample was incubated at room temperature for 1 to 2 minutes and subsequently centrifuged at 10,000 rpm for 1 minute to elute the DNA. Finally, the extracted DNA was stored at -20\u0026deg;C.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e2.9 Analysis of Genes\u003c/h2\u003e \u003cp\u003eGenotypic analysis of the erythromycin ribosome methylation gene F (ermF), erythromycin ribosome methylation gene X (ermX), erythromycin ribosome methylation gene A (ereA), beta-lactamase methicillin-resistant \u003cem\u003eStaphylococcus scurissplentus\u003c/em\u003e (blaMsrS), extended-spectrum beta-lactamase (VEB), cefotaximase-type extended-spectrum beta-lactamase (CTX-M), betal-lactamase \u003cem\u003eKlebsiella pneumonia\u003c/em\u003e (blaSHV), and beta-lactamase and enzyme (blaTEM) genes was performed. The primers used for the genes are described below.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSequences of Primers used for resistance gene detection\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTargets\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForward Sequence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReverse Sequence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBand size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eermF\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCGA CAC AGC TTT GGT TGA AC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQQA CCT ACC TCA TAG ACA AG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e309\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eermX\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGAG ATC GGR CCA GGA AGC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGTG TGC ACC ATC GCC TGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e488\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eereA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGCC GGT GCT CAT CAT GAA CTT GAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCGA CTC TAT TCG ATC AGA GGC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e420\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMsrS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGCA CTT ATT GGG GGT AAT GG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGTC TAT AAG TGC TCT ATC GTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVEB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGAT GGT GTT TGG TCG CAT ATC GCA AC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCAT CGC TGT TGG GGT TGC CCA ATT TT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e391\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCTX-M\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eATG TGC AGY ACC AGT AAR GTK ATGGC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGGT RAA RTA RGT SACC AGA AYC AGC GG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e590\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSHV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTGT ATT ATCTC(C/T) CTG TTA GCC(A/G) CCCTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGCT CTG CTT TGT TAT TCG GGC CAA GC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e739\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTEM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTCG CCG CAT ACA CTA TTC TCA AGA ATGAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCAG CAA TAA ACC AGC CAG CCG GAA G\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe amplified DNA was analysed for the presence of antibacterial resistance genes via gel electrophoresis. Finally, the results were compared with known resistance gene sequences to confirm the presence of specific resistance genes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e2.10. Method of Data Analysis\u003c/h2\u003e \u003cp\u003eThe data were analysed via the Statistical Package for Social Sciences (SPSS) computer software version 25. Frequencies and percentages were used to analyse the variables, level of knowledge, attitudes and perceptions regarding hospital waste management among healthcare workers at the Federal University Teaching Hospital, Owerri. The chi-square test and odds ratio were used to test for associations among hospital waste types, disposal methods, and bacterial characteristics for significant relationships. A p value less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 \u0026nbsp; \u0026nbsp; \u0026nbsp; Results overview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis section presents the analyses and interpretation of the data obtained from the fieldwork. The questionnaires were administered to 367 respondents, of whom 347 were retrieved, most of whom were self-administered; for those who were not literate, the researcher assisted them. Laboratory analyses were carried out to determine the resistant pathogens associated with the waste at the Federal University Teaching Hospital, Owerri\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.1 \u0026nbsp; \u0026nbsp;Sociodemographic characteristics of the respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis section presents the sociodemographic characteristics of the respondents, such as sex, age, marital status, religion, educational level, and professions of the health workers at Federal University Teaching Hospital, Owerri.\u003c/p\u003e\n\u003cp\u003eThe gender distribution of the respondents, as indicated in Table 3.1, shows that of the 347 respondents, females constituted the majority, with 189 (54.5%) compared with 158 (45.5%) males. This implies that the females were more willing to participate in the study than their male counterparts were; this is related to the fact that the nursing staff were the greatest number of females, which may also explain the greater representation of females in the study.\u003c/p\u003e\n\u003cp\u003eThe age of the respondents shows that the majority (152, 43.8%) are forty-six years and above, followed by 100 (28.8%), who are within the age brackets of 26 and 35 years; 57 (16.4%), who are within the age brackets of 36 and 45 years; and 38 (11%), who are within the age brackets of twenty-five years and below. The age distribution revealed that mature health professionals constituted the majority of the respondents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.1.1: Sociodemographic characteristics of the respondents\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\" style=\"margin-right: calc(10%); width: 90%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 341px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 28.276%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2538%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 341px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale (M)\u003c/p\u003e\n \u003cp\u003eFemale (F)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 28.276%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e347\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2538%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 45.5\u003c/p\u003e\n \u003cp\u003e54.5\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 341px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBelow 25 yrs\u003c/p\u003e\n \u003cp\u003e26 \u0026ndash; 35 yrs\u003c/p\u003e\n \u003cp\u003e36 \u0026ndash; 45 yrs\u003c/p\u003e\n \u003cp\u003e46 and above\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;26\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;28\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;72\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.817%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e347\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;28.8\u003c/p\u003e\n \u003cp\u003e16.4\u003c/p\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 341px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 32\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 4\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.817%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;87\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;7\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e347\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e71.5\u003c/p\u003e\n \u003cp\u003e25.1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1.4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;2.0\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 341px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eChristianity\u003c/p\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003cp\u003eTraditional\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.817%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e326\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e347\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e93.9\u003c/p\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.9\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 341px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Education\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.817%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e328\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e347\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;5.2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;94.5\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 341px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003cp\u003ePharmacist\u003c/p\u003e\n \u003cp\u003eMedical Lab Scientist\u003c/p\u003e\n \u003cp\u003eHealthcare Attendant\u003c/p\u003e\n \u003cp\u003eWaste Collector\u003c/p\u003e\n \u003cp\u003eCommunity Health Workers\u003c/p\u003e\n \u003cp\u003eHealth Record Officers\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.817%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e347\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2539%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24.5\u003c/p\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;2.6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;6.9\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;2.9\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3.7\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;8.1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;4.9\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.2 \u0026nbsp; \u0026nbsp;Knowledge Regarding Hospital Waste Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results indicate that the majority of healthcare workers at Federal University Teaching Hospital, Owerri, possess a good level of knowledge regarding hospital waste management. Specifically, 66.3% were knowledgeable about the types of hospital waste, 72.0% understood proper waste segregation, 63.4% were familiar with colour coding for waste bins, and 83.6% were aware of the health risks associated with improper waste disposal. Additionally, 61.9% were aware of the hospital\u0026apos;s waste management policy. Across most parameters, females demonstrate slightly higher knowledge levels than males do. Notably, no respondents rated themselves as \u0026quot;very knowledgeable,\u0026quot; highlighting an opportunity for further training and improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.1.2: Knowledge regarding hospital waste management\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" width=\"645\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eParameters/Gender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNot Knowledgeable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSomewhat Knowledgeable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledgeable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVery Knowledgeable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Responses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAware of the types of hospital waste\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42 (12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75 (21.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e230 (66.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100 (63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22 (11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e130 (68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge of proper waste segregation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e250 (72.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28 (17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110 (69.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e140 (74.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFamiliar with colour coding for waste bins\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e87 (25.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e220 (63.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45 (28.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e95 (60.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22 (11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e125 (66.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAware of health risks associated with improper waste disposal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e290 (83.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e130 (82.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e160 (84.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eKnows the hospital\u0026apos;s waste management policy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e95 (27.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e215 (61.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (25.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100 (63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19 (10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55 (29.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e115 (60.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.3 \u0026nbsp; \u0026nbsp;Attitude towards Hospital Waste Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data on attitudes reflect a generally positive outlook towards waste management among healthcare workers. Overall, 79.2% agree/strongly agree on the importance of proper waste management, with females (82.0%) being slightly more positive than males (76.0%). This high level of agreement underscores the recognition of the role of waste management in hospital safety. In accordance with the Waste Segregation Guidelines, 74.9% agree/strongly agree, with females (79.4%) being more compliant than males (69.6%). This positive attitude aligns with the knowledge data, showing a correlation between knowledge and practice. In terms of mandatory training on waste management, 80.7% agree/strongly agree, with females (82.1%) being more supportive than males (79.1%). The strong support for mandatory training reflects a willingness to enhance their knowledge and practices. Most healthcare workers disagree that waste management is solely the responsibility of sanitation staff, recognizing it as a shared responsibility; only 28.8% agree/strongly agree, with slightly higher agreement among males (28.5%) than females (29.1%). A total of 80.7% agree/strongly agree that they have confidence in waste management practices, with females (82.0%) being more confident than males (79.1%). This high level of confidence is encouraging, indicating that most healthcare workers feel well prepared to manage waste effectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.1.3: Attitudes towards hospital waste management\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" width=\"643\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eParameters/Gender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStrongly Agree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAgree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNeutral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDisagree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStrongly Disagree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Responses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eProper waste management is essential for hospital safety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e175 (50.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100 (28.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75 (47.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45 (28.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100 (52.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55 (29.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eI always follow the waste segregation guidelines\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e150 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45 (28.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23 (14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65 (34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTraining on waste management should be mandatory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e190 (54.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e90 (25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (25.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e105 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50 (26.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWaste management is the sole responsibility of sanitation staff\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100 (28.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e107 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 (15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 (13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57 (30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eI feel confident in my knowledge of waste management practices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e160 (46.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e120 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70 (44.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e90 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65 (34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe parameters were assessed on a 5-point Likert scale: 1=\u0026nbsp;Strongly disagree, 2= Disagree, 3= Neutral, 4= Agree, 5 = Strongly agree.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.4 \u0026nbsp; \u0026nbsp;Perception of Hospital Waste Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data on perceptions highlight varying levels of satisfaction and awareness regarding waste management practices and resources. Regarding the effectiveness of the waste management system, 72.1% of the respondents agreed/strongly agreed, with females (76.7%) being more positive than males (66.4%). While a majority view the system as effective, a notable portion remains neutral or negative, pointing to areas for improvement.63.4% agree/strongly agree on the training on waste management, with males (63.2%) and females (63.4%) showing similar perceptions. This reflects a moderate level of satisfaction with training, suggesting the need for more comprehensive or frequent training sessions. With respect to awareness of waste management policy, 69.2% agreed/strongly agreed, with females (68.8%) and males (69.6%) showing similar perceptions. This aligns with the knowledge data, indicating that while a majority are aware, a significant minority are not aware, suggesting a need for better communication of the policy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.1.4: Perception of hospital waste management\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" width=\"639\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eParameters/Gender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStrongly Agree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAgree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNeutral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDisagree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStrongly Disagree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Responses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eThe hospital\u0026apos;s waste management system is effective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e120 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e130 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70 (37.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75 (39.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 (13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eThere is adequate training provided on waste management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30 (19.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47 (24.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eResources for waste management are sufficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100 (28.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e120 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17 (4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45 (28.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55 (29.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65 (34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eI am aware of the hospital\u0026apos;s policy on waste management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e130 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50 (14.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35 (10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Males\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e- Females\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75 (39.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55 (29.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30 (15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eParameters were assessed on a 5-point Likert scale: 1=\u0026nbsp;Strongly disagree, 2= Disagree, 3= Neutral, 4= Agree, 5 = Strongly agree\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.5 Types of hospital waste, disposal methods, and frequency of disposal methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3.5 provides an overview of hospital waste management practices at the Federal University Teaching Hospital, Owerri, detailing the types of waste, their disposal methods, and the frequency of these methods. Infectious and pathological wastes are primarily treated through incineration and autoclaving, with incineration being used 25 times per month, autoclaving 15 times, and landfilling 20 times for infectious waste. Sharps are mostly incinerated (25 times per month) and encapsulated (10 times), whereas chemical waste is managed by chemical disinfection (5 times) or landfilling (20 times). Pharmaceutical waste is incinerated (25 times), and radioactive waste is allowed to decay in storage (1 time) or disposed of in landfills (20 times). General waste is primarily landfilled (20 times), with substantial recycling efforts (18 times). This diverse range of disposal methods underscores the hospital\u0026apos;s commitment to effective and compliant waste management practices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.1.5: Types of hospital waste, disposal methods, and frequency of disposal methods\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWaste Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDisposal Method\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (Times per Month)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eInfectious Waste\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration, Autoclaving, Landfill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration: 25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAutoclaving: 15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLandfill: 20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePathological Waste\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration, Autoclaving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration: 25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAutoclaving: 15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSharps\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration, Encapsulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration: 25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEncapsulation: 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eChemical Waste\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eChemical Disinfection, Landfill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eChemical Disinfection: 5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLandfill: 20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePharmaceutical Waste\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eIncineration: 25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRadioactive Waste\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDecay in Storage, Disposal in Landfill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDecay in Storage: 1\u003c/p\u003e\n \u003cp\u003eLandfill: 20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGeneral Waste\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLandfill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLandfill: 20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.6: Mean Bacteria Counts for Different Waste Types (CFU/g)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3.1.6 presents the mean bacterial counts for various types of hospital waste, including the total viable count, coliform count, and total bacterial count, measured in colony-forming units per gram (CFU/g). In general, the data highlight that infectious and general wastes are the most microbially contaminated, whereas chemical waste is the least contaminated, reflecting differences in waste types and handling practices. The infectious waste had the highest total viable count (9.86\u0026plusmn;0.28 CFU/g), indicating a high level of microbial presence. It has a coliform count of 3.40\u0026plusmn;0.31 CFU/g and a total bacterial count of 4.60\u0026plusmn;0.20 CFU/g, reflecting significant microbial contamination and a potential risk of infection. The sharps presented a much lower total viable count of 5.40\u0026plusmn;0.52 CFU/g. The coliform count was notably low at 1.20\u0026plusmn;0.22 CFU/g, and the total bacterial count was also relatively low at 2.15\u0026plusmn;0.14 CFU/g. This suggests that sharps are less contaminated with microorganisms than other waste types are, possibly due to their nature and handling. The total viable count of pathological waste was 6.45\u0026plusmn;0.18 CFU/g, indicating moderate microbial contamination. The coliform count was 2.20\u0026plusmn;0.33 CFU/g, and the total bacterial count was 3.31\u0026plusmn;0.40 CFU/g, both of which are higher than those of sharps but lower than those of infectious waste. Chemical waste had the lowest microbial count, with a total viable count of 4.10\u0026plusmn;0.52 CFU/g and zero coliform and bacterial counts. This finding indicates that chemical waste is generally well controlled and less prone to microbial contamination, likely because of the chemical nature of its contents, which may inhibit microbial growth. Pharmaceutical waste has a total viable count of 2.40\u0026plusmn;0.22 CFU/g, which is the lowest among all waste types. It has a coliform count of 1.10\u0026plusmn;0.20 CFU/g and a total bacterial count of 2.10\u0026plusmn;0.10 CFU/g, suggesting relatively low levels of microbial contamination. The total viable count of general waste was 7.86\u0026plusmn;0.28 CFU/g, with a coliform count of 2.40\u0026plusmn;0.32 CFU/g and a total bacterial count of 4.50\u0026plusmn;0.24 CFU/g. This indicates moderate to high microbial contamination, similar to infectious waste but with slightly lower counts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.1.6: \u0026nbsp; \u0026nbsp;Mean bacterial counts of the\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003evarious types of hospital waste\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"665\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8072%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWaste Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal viable count\u0026nbsp;\u003c/strong\u003e(cfu/g) \u0026times; 10\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eColiform count \u0026nbsp;\u003c/strong\u003e(cfu/g) \u0026times; 10\u003csup\u003e1\u003c/sup\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal bacteria count\u0026nbsp;\u003c/strong\u003e(cfu/g) \u0026times; 10\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8072%;\"\u003e\n \u003cp\u003eInfectious Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e9.86\u0026plusmn;0.28 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e3.40\u0026plusmn;0.31 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e4.60\u0026plusmn;0.20 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8072%;\"\u003e\n \u003cp\u003eSharps\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e5.40\u0026plusmn;0.52 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e1.20\u0026plusmn;0.22 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e2.15\u0026plusmn;0.14 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8072%;\"\u003e\n \u003cp\u003ePathological Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e6.45\u0026plusmn;0.18 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e2.20\u0026plusmn;0.33 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e3.31\u0026plusmn;0.40 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8072%;\"\u003e\n \u003cp\u003eChemical Waste\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e4.10\u0026plusmn;0.52 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e1.0\u0026plusmn;0.20 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8072%;\"\u003e\n \u003cp\u003ePharmaceutical Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e2.40\u0026plusmn;0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e1.10\u0026plusmn;0.20 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e2.10\u0026plusmn;0.10 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8072%;\"\u003e\n \u003cp\u003eGeneral Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e7.86\u0026plusmn;0.28 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e2.40\u0026plusmn;0.32 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.3976%;\"\u003e\n \u003cp\u003e4.50\u0026plusmn;0.24 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.7 Cultural Morphology and Biochemical Characteristics of the Bacterial Isolates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3.1.7 provides detailed information on the cultural morphology, microscopic characteristics, biochemical characteristics, and carbohydrate utilization profiles of various bacterial isolates found in hospital waste at Federal University Teaching Hospital, Owerri. It includes descriptions of colony features, such as smooth, circular, creamy colonies of \u003cem\u003eStaphylococcus\u0026nbsp;\u003c/em\u003especies on nutrient agar (NA) and small, pink, shiny colonies of \u003cem\u003eEscherichia coli\u003c/em\u003e on MacConkey agar (MA). Microscopic examination revealed cell arrangements, such as gram-positive oval cells for \u003cem\u003eStaphylococcus\u0026nbsp;\u003c/em\u003especies and gram-negative short rods for \u003cem\u003eEscherichia coli\u003c/em\u003e. Biochemical reactions indicate the presence or absence of specific enzymes and metabolic pathways, with \u003cem\u003eStaphylococcus aureus\u003c/em\u003e testing positive for catalase and coagulase. Carbohydrate utilization tests revealed the ability of bacteria to ferment different sugars, with \u003cem\u003eStaphylococcus saprophyticus\u003c/em\u003e and \u003cem\u003eEnterococcus\u003c/em\u003e species utilizing glucose, sucrose, lactose, maltose, mannitol, and xylose. This comprehensive profiling aids in identifying bacterial isolates crucial for managing hospital waste and controlling resistant pathogens.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.8 \u0026nbsp; \u0026nbsp;Distribution of bacterial isolates among the\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003evarious types of hospital waste\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3.1.8 shows the distribution of bacterial isolates among the various types of hospital waste; infectious waste had the highest number of isolates at 45 (30.2), followed by general waste at 41 (27.5) and chemical waste at 8 (5.4). Among the infectious waste, \u003cem\u003eEnterobacter cloacae\u0026nbsp;\u003c/em\u003e(50%) was\u003cem\u003e\u0026nbsp;\u003c/em\u003ethe most common bacteria, followed by \u003cem\u003eStaphylococcus Scuri\u003c/em\u003e ssp. \u003cem\u003eLentus\u0026nbsp;\u003c/em\u003e(32%), and the least common species was \u003cem\u003ePantoea ananatis\u003c/em\u003e, which was absent. Among\u003cem\u003e\u0026nbsp;\u003c/em\u003ethe sharps waste,\u003cem\u003e\u0026nbsp;Staphylococcus gallinarum\u0026nbsp;\u003c/em\u003e(12%) was the most common, followed by \u003cem\u003eStaphylococcus xylosus\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;Escherichia coli\u0026nbsp;\u003c/em\u003e(11%). In general waste, \u003cem\u003ePantoea ananatis\u0026nbsp;\u003c/em\u003e(100%) was the most prevalent bacteria, followed by \u003cem\u003eEscherichia coli\u0026nbsp;\u003c/em\u003e(38.9%), and the least prevalent bacterium was \u003cem\u003eStaphylococcus Scuri\u003c/em\u003e ssp. \u003cem\u003eLentus\u003c/em\u003e (20%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.1.8: \u0026nbsp; \u0026nbsp;Distribution of bacterial isolates among the\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003evarious types of hospital waste\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"888\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5591%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Waste Type\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBacteria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8234%;\"\u003e\n \u003cp\u003eInfectious Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003eSharps\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4736%;\"\u003e\n \u003cp\u003ePathological Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003eChemical Waste\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003ePharmaceutical Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003eGeneral Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5591%;\"\u003e\n \u003cp\u003e\u003cem\u003eRaoultella ornithinolytica\u0026nbsp;\u003c/em\u003e(n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8234%;\"\u003e\n \u003cp\u003e9 \u0026nbsp;(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e3 \u0026nbsp;(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4736%;\"\u003e\n \u003cp\u003e6 \u0026nbsp;(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e1 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e4 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e7 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5591%;\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella pneumonia\u0026nbsp;\u003c/em\u003e(n=20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8234%;\"\u003e\n \u003cp\u003e5 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e2 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4736%;\"\u003e\n \u003cp\u003e3 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e2 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e3 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e5 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5591%;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus gallinarum\u0026nbsp;\u003c/em\u003e(n=25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8234%;\"\u003e\n \u003cp\u003e7 (28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e3 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4736%;\"\u003e\n \u003cp\u003e3 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e3 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e2 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e7 (28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5591%;\"\u003e\n \u003cp\u003e\u003cem\u003eEnterobacter cloacae\u0026nbsp;\u003c/em\u003e(n=12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8234%;\"\u003e\n \u003cp\u003e6 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4736%;\"\u003e\n \u003cp\u003e2 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e4 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5591%;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus Scuri\u003c/em\u003e ssp. \u003cem\u003eLentus\u0026nbsp;\u003c/em\u003e(n=25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8234%;\"\u003e\n \u003cp\u003e8 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e2 \u0026nbsp;(8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4736%;\"\u003e\n \u003cp\u003e4 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e1 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e2 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e5 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5591%;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus xylosus\u0026nbsp;\u003c/em\u003e(n=17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8234%;\"\u003e\n \u003cp\u003e5 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e2 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4736%;\"\u003e\n \u003cp\u003e3 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e1 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e2 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e4 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5591%;\"\u003e\n \u003cp\u003e\u003cem\u003eEscherichia coli\u0026nbsp;\u003c/em\u003e(n=18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8234%;\"\u003e\n \u003cp\u003e5 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e2 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4736%;\"\u003e\n \u003cp\u003e3 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e1 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e7 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5591%;\"\u003e\n \u003cp\u003e\u003cem\u003ePantoea ananatis\u0026nbsp;\u003c/em\u003e(n=2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8234%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4736%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e2 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5591%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Total=149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8234%;\"\u003e\n \u003cp\u003e45 (30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e14(9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.4736%;\"\u003e\n \u003cp\u003e24 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3611%;\"\u003e\n \u003cp\u003e8 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e14 (9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.7109%;\"\u003e\n \u003cp\u003e41 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAmong the bacteria subjected to antibiotic susceptibility testing (AST), the highest number of \u003cem\u003eStaphylococcus gallinarum\u0026nbsp;\u003c/em\u003e(n=25) were found to be sensitive to amikacin (24) but\u003cem\u003e\u0026nbsp;\u003c/em\u003eresistant to\u003cem\u003e\u0026nbsp;\u003c/em\u003eother antibiotics used. All 30 isolates of \u003cem\u003eRaoultella ornithinolytica\u003c/em\u003e were resistant to antibiotics, except for amikacin, for which \u003cem\u003eRaoultella ornithinolytica was\u003c/em\u003e sensitive. The isolates of \u003cem\u003eKlebsiella pneumoniae\u0026nbsp;\u003c/em\u003e(n=20)\u003cem\u003e\u0026nbsp;\u003c/em\u003ewere sensitive to the entire antibiotic used. The\u003cem\u003e\u0026nbsp;\u003c/em\u003eisolates\u003cem\u003e\u0026nbsp;\u003c/em\u003eof\u003cem\u003e\u0026nbsp;Pantoea ananatis\u0026nbsp;\u003c/em\u003e(n=2)\u003cem\u003e\u0026nbsp;\u003c/em\u003ewere sensitive to all the antibiotics except for ampicillin, which produced resistance, whereas the \u003cem\u003eEscherichia coli\u0026nbsp;\u003c/em\u003eisolates (n=18) were resistant to trimethoprim and ampicillin. The bacterial isolates were highly resistant to ampicillin, with the exception of \u003cem\u003eKlebsiella pneumoniae,\u0026nbsp;\u003c/em\u003efollowed\u003cem\u003e\u0026nbsp;\u003c/em\u003eby tetracycline and trimethoprim (Table 3.1.9).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"965\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\" valign=\"top\" style=\"width: 965px;\"\u003e\n \u003cp\u003eTable 3.1.9: \u0026nbsp;Antibiotic susceptibility pattern of the bacteria isolates from the hospital wastes (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eBacteria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eLEV (30 \u0026micro;g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eCN (30 \u0026micro;g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eCIP (5 \u0026micro;g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eE (30 \u0026micro;g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eSAM (30 \u0026micro;g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eSXT (125 \u0026micro;g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eCTX (30 \u0026micro;g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eTE (30 \u0026micro;g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eAK (30 \u0026micro;g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eAMP (10 \u0026micro;g)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; R\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;R\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;R\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;R\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; R\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;R\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; R\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;R\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;R\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;R\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cem\u003eRaoultella ornithinolytica\u0026nbsp;\u003c/em\u003e(n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella pneumonia\u0026nbsp;\u003c/em\u003e(n=20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e19 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus gallinarum\u0026nbsp;\u003c/em\u003e(n=25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e24 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cem\u003eEnterobacter cloacae\u0026nbsp;\u003c/em\u003e(n=12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e12 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e12 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e12 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e12 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e12 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e12 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e12 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e12 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e12 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e9 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus Scuri\u003c/em\u003e ssp. \u003cem\u003eLentus\u0026nbsp;\u003c/em\u003e(n=25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e20 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e22 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e24 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e22 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus xylosus\u0026nbsp;\u003c/em\u003e(n=17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e17 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e17 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e17 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e17 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e17 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e17 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cem\u003eEscherichia coli\u0026nbsp;\u003c/em\u003e(n=18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cem\u003ePantoea ananatis\u0026nbsp;\u003c/em\u003e(n=2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCN= cefalexin, E= erythromycin, CTX= cefotaxime, SXT=trimethoprim/sulfamethoxazole, TE=tetracycline, AMP = ampicillin, AK = amikacin, CIP = ciprofloxacin. The interpretative standard for S= Sensitive, R=Resistant is the\u0026nbsp;Clinical and Laboratory Standards Institute (17).\u003cdel cite=\"mailto:Editor%202\" datetime=\"2024-10-21T06:25\"\u003e\u0026nbsp;\u003c/del\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDetection of antibiotic resistance genes (\u003c/strong\u003e\u003cstrong\u003eMsrA,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ermF and ermX\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe molecular analysis of antibiotic resistance genes in bacterial isolates provides critical insights into the mechanisms of resistance and the distribution of specific resistance genes. The results revealed the absence of certain resistance genes while highlighting the presence and co-occurrence of other genes, particularly those associated with beta-lactam antibiotic resistance.\u003c/p\u003e\n\u003cp\u003eWe did not detect any isolates harboring energy-dependent efflux of the erythromycin (MsrA) gene, rRNA methyltransferase \u0026nbsp;erythromycin/clindamycin resistance \u003cem\u003e(ermF)\u003c/em\u003e gene, RNA adenine N-6-methyl-transferase, or erythromycin/clindamycin resistance (\u003cem\u003eermX\u003c/em\u003e) gene (Fig 3.1.1).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDetection of antibiotic resistance genes (\u003c/strong\u003e\u003cstrong\u003eblaSHV\u0026nbsp;and blaTEM)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe detected isolates\u0026nbsp;harboring\u0026nbsp;blaSHV\u0026nbsp;and blaTEM;\u0026nbsp;of these, 2 (50%) had bla\u003csub\u003eTEM,\u0026nbsp;\u003c/sub\u003e2 (50%) had only bla\u003csub\u003eSHV\u003c/sub\u003e\u003csub\u003e,\u003c/sub\u003e while 1 (25%) had both the bla\u003csub\u003eTEM\u003c/sub\u003e and bla\u003csub\u003eSHV\u003c/sub\u003e genes (Fig. 3.1.2 and Table 3.1.10).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.1.10:\u003c/strong\u003e \u003cstrong\u003eAntibiotic\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eresistance genes\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;MsrA,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ebla\u003csub\u003eCTX\u0026minus;M\u003c/sub\u003e, bla\u003csub\u003eVEB,\u003c/sub\u003e bla\u003csub\u003eSHV\u003c/sub\u003e and bla\u003csub\u003eTEM\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"696\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59599%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLAB ID\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBacteria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0287%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eErmF\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59599%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eErmX\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEreA\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMsrA\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVEB\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3181%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCTX-M\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.3152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSHV\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTEM\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59599%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003e\u003cem\u003eEscherichia coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0287%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59599%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3181%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.3152%;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59599%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003e\u003cem\u003eEnterobacter cloacae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0287%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59599%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3181%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.3152%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59599%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.7593%;\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella pneumonia\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0287%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.59599%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.73925%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3181%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.3152%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.16905%;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.11 \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eJustification of Hypothesis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3.1.11\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e clearly shows that the types of hospital waste, their disposal methods, and the frequency of these methods have a significant effect on the bacterial count, distribution, and antibiotic resistance patterns. Infectious waste has the highest bacterial load, followed by general waste, which is correlated with the frequency and method of disposal (e.g., incineration and landfill for infectious and general wastes, respectively). The distribution of bacterial isolates varies significantly by waste type, with certain bacteria, such as \u003cem\u003eEnterobacter cloacae\u003c/em\u003e and \u003cem\u003ePantoea ananatis,\u003c/em\u003e being predominant in specific waste types. There is a clear variation in antibiotic resistance patterns based on the type of waste and the bacteria present, with infectious waste showing the highest resistance levels. The p values (\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e) indicate a statistically significant association between the types of hospital waste, disposal methods, bacterial counts, distribution, and antibiotic resistance patterns at the Federal University Teaching Hospital, Owerri. This finding supports the alternative hypothesis (H₁) that these factors have a significant effect on bacterial characteristics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3.1.11\u003c/strong\u003e\u003cstrong\u003e: Association between hospital waste type, disposal method, and bacterial characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWaste Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDisposal Methods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (Times/Month)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMean Total Viable Count (CFU/g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDistribution of Bacterial Isolates (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotic Resistance Patterns (Selected Antibiotics)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInfectious Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration, Autoclaving, Landfill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration: 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.86 \u0026plusmn; 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e45 (30.2%)\u003c/strong\u003e\u003cbr\u003e-\u0026nbsp;\u003cem\u003eEnterobacter cloacae\u003c/em\u003e: 50%\u003cbr\u003e\u0026nbsp;- Staphylococcus Scuri ssp. Lentus: 32%\u003cbr\u003e\u0026nbsp;- Raoultella ornithinolytica: 30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eResistant to most antibiotics except amikacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePathological Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration, Autoclaving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAutoclaving: 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.45 \u0026plusmn; 0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e24 (16.1%)\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;- Staphylococcus gallinarum: 12%\u003cbr\u003e\u0026nbsp;- Staphylococcus Scuri ssp. Lentus: 16%\u003cbr\u003e\u0026nbsp;- Raoultella ornithinolytica: 20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGeneral resistance patterns observed; Klebsiella pneumonia sensitive to most antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSharps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration, Encapsulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration: 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.40 \u0026plusmn; 0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e14 (9.4%)\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;- Staphylococcus gallinarum: 12%\u003cbr\u003e-\u0026nbsp;\u003cem\u003eEscherichia coli\u003c/em\u003e: 11%\u003cbr\u003e\u0026nbsp;- Raoultella ornithinolytica: 10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigh resistance except amikacin; Staphylococcus xylosus sensitive to most antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChemical Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eChemical Disinfection, Landfill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLandfill: 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.10 \u0026plusmn; 0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8 (5.4%)\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;- Raoultella ornithinolytica: 3.3%\u003cbr\u003e\u0026nbsp;- Staphylococcus Scuri ssp. Lentus: 4%\u003cbr\u003e\u0026nbsp;- Klebsiella pneumonia: 10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLowest bacterial counts and lower resistance levels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePharmaceutical Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIncineration: 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.40 \u0026plusmn; 0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e14 (9.4%)\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;- Raoultella ornithinolytica: 13.3%\u003cbr\u003e\u0026nbsp;- Staphylococcus Scuri ssp. Lentus: 8%\u003cbr\u003e\u0026nbsp;- Klebsiella pneumonia: 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSome resistance observed, but generally lower compared to other waste types\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGeneral Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLandfill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLandfill: 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.86 \u0026plusmn; 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e41 (27.5%)\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;- Pantoea ananatis: 100%\u003cbr\u003e-\u0026nbsp;\u003cem\u003eEscherichia coli\u003c/em\u003e: 38.9%\u003cbr\u003e\u0026nbsp;- Raoultella ornithinolytica: 23.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eModerate resistance patterns, with Pantoea ananatis showing sensitivity to most antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThe assessment of hospital waste and the associated resistant bacterial pathogens at the Federal University Teaching Hospital, Owerri, revealed a generally positive attitude and good knowledge among healthcare workers.\u003c/p\u003e \u003cp\u003eThe gender distribution of the respondents in the study revealed that females constituted the majority, with 189 out of 347 participants (54.5%), whereas males accounted for 158 (45.5%). This gender disparity suggests that females were more willing to participate in the study, which could be attributed to the greater representation of female nursing staff in the hospital. Nursing, a profession traditionally dominated by women, often plays a crucial role in hospital waste management, thus explaining their higher participation rate. This finding aligns with similar studies that noted greater female participation in healthcare-related research [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe age distribution indicates that mature health professionals, particularly those aged 46 years and above, constituted the majority of the respondents (43.8%). This demographic characteristic is often associated with greater experience and, consequently, a better understanding of hospital waste management protocols. The results demonstrate that healthcare workers at Federal University Teaching Hospital, Owerri, possess a good level of knowledge regarding hospital waste management, with 66.3% knowledgeable about the types of hospital waste and 83.6% aware of the health risks associated with improper waste disposal. The data on attitudes reflect a generally positive outlook towards waste management among healthcare workers. A significant majority (79.2%) agreed or strongly agreed on the importance of proper waste management, with females (82.0%) being slightly more positive than males (76.0%). This high level of agreement underscores the recognition of the role of waste management in hospital safety. The correlation between knowledge and practice is evident in the adherence to Waste Segregation Guidelines, with 74.9% of respondents agreeing or strongly agreeing to follow these guidelines. Strong support for mandatory training (80.7%) indicates a willingness among healthcare workers to enhance their knowledge and practices, which is crucial for maintaining an effective waste management system [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe perception data highlight varying levels of satisfaction and awareness regarding waste management practices and resources. In terms of the effectiveness of the waste management system, 72.1% of the respondents agreed or strongly agreed, with females (76.7%) being more positive than males (66.4%). While a majority view the system as effective, the presence of neutral or negative responses suggests areas for improvement, particularly in ensuring that all staff members are adequately trained and informed about waste management policies. The moderate level of satisfaction with training, as indicated by 63.4% of respondents, points to the need for more comprehensive or frequent training sessions to address gaps in knowledge and practice [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn terms of awareness of waste management policies 69.2% of the respondents agreed or strongly agreed that they were aware of the hospital's waste management policy, with similar perceptions among males (69.6%) and females (68.8%). This finding aligns with the knowledge data, indicating that while a majority are aware, a significant minority are not. This suggests a need for better communication of the policy to ensure that all healthcare workers are informed and can adhere to the guidelines. Effective communication and regular training are essential components of a successful waste management system, as they ensure that all staff members are equipped with the necessary knowledge and skills to manage waste safely and efficiently [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Federal University Teaching Hospital, Owerri, employs a multifaceted approach to hospital waste management, as evidenced by the data presented in the results. Infectious and pathological wastes are primarily treated through incineration and autoclaving, with the former being employed 25 times per month and the latter 15 times per month. Landfilling is also utilized 20 times per month for infectious waste. The frequent use of incineration and autoclaving indicates that hospitals focus on reducing the risk of infection through thermal treatment, which is effective in destroying pathogens [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The landfilling of infectious waste, while less desirable due to potential environmental risks, is still practiced, possibly owing to limitations in resources or capacity for incineration. Sharps, which pose a significant risk of injury and infection, are primarily incinerated (25 times per month) and encapsulated (10 times per month). The preference for incineration aligns with best practices for sharp waste management, as it effectively reduces the risk of pathogen transmission [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Encapsulation further ensures the safe disposal of sharps by enclosing them in a solid block, thereby minimizing the risk of needle-stick injuries and environmental contamination. Chemical waste is managed through chemical disinfection (5 times per month) and landfilling (20 times per month). The limited use of chemical disinfection suggests that while this method is effective in neutralizing hazardous chemicals, it may be resource intensive or require specific infrastructure that the hospital may not always have at its disposal [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The landfilling of chemical waste, though less ideal, may be a necessary practice because of these constraints. Pharmaceutical waste is consistently incinerated (25 times per month), reflecting the hospital\u0026rsquo;s adherence to guidelines that recommend incineration as the most effective method for disposing of pharmaceutical waste to prevent environmental contamination and misuse [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Radioactive waste, owing to its hazardous nature, is allowed to decay in storage (1 time per month) or be disposed of in landfills (20 times per month) once it has reached a safe level of radioactivity. This method ensures that radioactive materials are managed responsibly to protect both public health and the environment [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGeneral waste, which includes nonhazardous materials, is primarily managed through landfilling (20 times per month) and recycling (18 times per month). Substantial recycling efforts indicate a hospital\u0026rsquo;s commitment to sustainability and waste minimization, which are essential components of effective waste management practices [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The infectious waste presented the highest level of microbial contamination, with a total viable count of 9.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28 CFU/g, a coliform count of 3.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31 CFU/g, and a total bacterial count of 4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20 CFU/g. These high microbial counts are expected given the nature of infectious waste, which often contains bodily fluids, tissues, and other materials that can harbor and transmit pathogens [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The significant microbial presence underscores the need for rigorous waste management practices, including the use of incineration and autoclaving, to minimize the risk of infection to healthcare workers and the community. Sharps, while posing a physical hazard, present much lower levels of microbial contamination, with a total viable count of 5.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52 CFU/g, a coliform count of 1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22 CFU/g, and a total bacterial count of 2.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14 CFU/g. The lower microbial counts can be attributed to the nature of sharps, which are often single-use and discarded immediately after use, reducing the opportunity for microbial growth [24; 29]. However, the physical danger posed by sharps necessitates stringent disposal methods, as reflected in the hospital\u0026rsquo;s use of incineration and encapsulation. Pathological waste, with a total viable count of 6.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 CFU/g, a coliform count of 2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33 CFU/g, and a total bacterial count of 3.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40 CFU/g, indicated moderate microbial contamination. This type of waste, which includes human tissues and body parts, can be a significant source of pathogens if not properly managed. The use of incineration and autoclaving for pathological waste at the hospital is appropriate, as these methods are effective in reducing microbial loads and preventing the spread of infections [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Chemical waste had the lowest microbial contamination, with a total viable count of 4.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52 CFU/g and no detectable coliform or total bacteria counts. The low microbial counts reflect the effectiveness of chemical disinfection and the inhibitory effects of chemical substances on microbial growth. This finding aligns with the understanding that chemical waste, when properly managed, poses a lower risk of biological contamination [28; 2]. Pharmaceutical waste also results in relatively low microbial contamination, with a total viable count of 2.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22 CFU/g, a coliform count of 1.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20 CFU/g, and a total bacterial count of 2.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10 CFU/g. The low microbial counts suggest that pharmaceutical waste, particularly when incinerated, poses a minimal risk of infection. However, improper disposal of pharmaceutical waste could lead to environmental contamination and the development of antimicrobial resistance [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The total viable count of general waste was 7.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28 CFU/g, the coliform count was 2.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32 CFU/g, and the total bacterial count was 4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24 CFU/g, indicating moderate to high microbial contamination. Although general waste is nonhazardous, the presence of significant microbial contamination highlights the importance of proper waste segregation and disposal practices to prevent the spread of infections within hospitals and the surrounding community [31; 25]. The findings from this assessment highlight several areas for improvement in hospital waste management practices. The high microbial contamination in infectious and general wastes suggests a need for enhanced training of healthcare workers in waste segregation and handling [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditionally, hospitals may benefit from reviewing and updating their waste management policies, particularly regarding the use of landfilling for infectious, chemical, and radioactive wastes. While landfilling is a common disposal method, it poses environmental risks, particularly for hazardous wastes, and should be minimized where possible. Investing in additional incineration or autoclaving capacity could reduce the reliance on landfilling and improve overall waste management practices [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Furthermore, the hospital\u0026rsquo;s efforts in recycling general waste are commendable and should be expanded. Recycling not only reduces the environmental impact of waste disposal but also promotes sustainability within the healthcare sector. Hospitals could explore opportunities to increase recycling rates and reduce waste generation, such as implementing waste reduction programs and sourcing environmentally friendly materials [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe detailed analysis of the cultural morphology and biochemical characteristics of bacterial isolates from hospital waste provides a foundation for understanding the microbial hazards present in various waste types. The smooth, circular, creamy colonies of \u003cem\u003eStaphylococcus\u003c/em\u003e species observed on nutrient agar (NA) and the small, pink, shiny colonies of \u003cem\u003eEscherichia coli\u003c/em\u003e on MacConkey agar (MA) are indicative of their common presence in hospital environments. The Gram staining results further corroborate these findings, with \u003cem\u003eStaphylococcus\u003c/em\u003e species showing gram-positive oval cells and \u003cem\u003eEscherichia coli\u003c/em\u003e displaying gram-negative short rods. These observations align with previous studies that have identified these bacteria as frequent contaminants in healthcare settings [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Biochemical characteristics, such as positive catalase and coagulase reactions in \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, are crucial for distinguishing pathogenic strains from nonpathogenic strains. The carbohydrate utilization profiles also provide valuable information on the metabolic capabilities of these isolates, with \u003cem\u003eStaphylococcus saprophyticus\u003c/em\u003e and \u003cem\u003eEnterococcus\u003c/em\u003e species utilizing multiple sugars, including glucose, sucrose, lactose, maltose, mannitol, and xylose. These metabolic traits are essential for understanding the adaptability and survival of these bacteria in various waste environments [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe distribution of bacterial isolates among different types of hospital waste reveals significant variations in microbial contamination levels, which are closely linked to the nature and handling of the waste. Infectious waste, accounting for the greatest number of isolates (30.2%), poses the greatest risk, with \u003cem\u003eEnterobacter cloacae\u003c/em\u003e (50%) being the most prevalent bacteria. This finding is concerning, given the known resistance of \u003cem\u003eEnterobacter cloacae\u003c/em\u003e to multiple antibiotics and its association with hospital-acquired infections [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The presence of \u003cem\u003eStaphylococcus Scuri ssp. The presence of Lentus\u003c/em\u003e (32%) in infectious waste further underscores the potential for the spread of resistant pathogens, as this species is often linked to resistance to methicillin and other beta-lactam antibiotics [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In sharp waste, \u003cem\u003eStaphylococcus gallinarum\u003c/em\u003e (12%) and \u003cem\u003eEscherichia coli\u003c/em\u003e (11%) were the most common isolates. The relatively lower contamination level in sharp waste could be attributed to the sterilization processes typically employed for sharp instruments before disposal. However, the presence of \u003cem\u003eEscherichia coli\u003c/em\u003e, a known pathogen associated with urinary tract infections and other healthcare-related infections, still poses a significant risk, particularly in cases where sharps are not adequately sterilized [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. General waste, which included a diverse range of materials, had the second-highest number of bacterial isolates (27.5%). \u003cem\u003ePantoea ananatis\u003c/em\u003e (100%) was notably the most prevalent bacterium in this category, followed by \u003cem\u003eEscherichia coli\u003c/em\u003e (38.9%). The ubiquity of \u003cem\u003ePantoea ananatis\u003c/em\u003e in general waste is particularly concerning, given its emerging role as a human pathogen with documented resistance to multiple antibiotics [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The significant presence of \u003cem\u003eEscherichia coli\u003c/em\u003e further highlights the potential public health risks associated with improper disposal and handling of general waste, which could serve as a reservoir for resistant pathogens. Chemical waste caused the least contamination, with only 8 isolates (5.4%). This low level of contamination can be attributed to the inherent antimicrobial properties of many chemicals used in healthcare settings, which inhibit bacterial growth. However, the detection of any bacterial contamination in chemical waste still warrants attention, as it indicates potential lapses in waste segregation or treatment processes [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The findings from this study have significant implications for hospital waste management practices at the Federal University Teaching Hospital, Owerri. The high microbial contamination levels in infectious and general waste underscore the need for stringent waste segregation, handling, and treatment protocols. The presence of resistant pathogens, particularly infectious waste, highlights the potential for nosocomial infections and the spread of antibiotic resistance within the hospital environment. This risk is exacerbated by the improper disposal or treatment of waste, which could lead to environmental contamination and subsequent public health threats [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results of antibiotic susceptibility testing (AST) highlight a significant concern regarding the prevalence of antibiotic-resistant bacteria in hospital waste. \u003cem\u003eStaphylococcus gallinarum\u003c/em\u003e, one of the most commonly isolated bacteria, was found to be sensitive to amikacin (24 out of 25 isolates) but resistant to all other antibiotics tested. This pattern is troubling, as it indicates a narrow spectrum of effective treatment options, underscoring the need for vigilant antibiotic stewardship and infection control practices within the hospital setting. \u003cem\u003eRaoultella ornithinolytica\u003c/em\u003e, with 30 isolates tested, exhibited resistance to all antibiotics except amikacin. This resistance profile further complicates treatment options and suggests that bacteria may possess mechanisms such as efflux pumps or antibiotic-modifying enzymes that confer broad-spectrum resistance [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. However, \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e was sensitive to all the antibiotics tested, indicating that, at least among the tested isolates, this pathogen remains susceptible to available treatments. This finding contrasts with global trends where \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e has increasingly shown resistance, particularly to carbapenems [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. \u003cem\u003ePantoea ananatis\u003c/em\u003e displayed resistance to ampicillin while remaining sensitive to other antibiotics, a pattern that may be due to the presence of beta-lactamase enzymes that confer resistance to penicillin-class drugs [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. \u003cem\u003eEscherichia coli\u003c/em\u003e isolates are resistant to trimethoprim and ampicillin, which aligns with the global rise in resistance among \u003cem\u003eE. coli\u003c/em\u003e strains, particularly in hospital environments where antibiotic pressure is high [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The resistance of these bacteria, especially to ampicillin, suggests the widespread presence of resistance genes, likely driven by the overuse and misuse of antibiotics. The overall pattern of resistance, particularly high resistance to ampicillin, tetracycline, and trimethoprim, indicates that these antibiotics may no longer be effective for treating infections caused by these pathogens. This resistance could lead to more severe healthcare-associated infections and complicated treatment protocols, requiring the use of more potent, often more toxic, or expensive antibiotics. These findings emphasize the need for continuous monitoring of antibiotic resistance patterns and the implementation of robust antimicrobial stewardship programs to mitigate the spread of resistant pathogens. The results of this study have significant implications for hospital waste management and infection control policies at the Federal University Teaching Hospital, Owerri. The presence of highly resistant bacteria in various waste types, particularly those that are not completely sterilized before disposal, raises concerns about the potential for environmental contamination and the spread of resistant pathogens. This calls for an urgent review of hospital waste management protocols, particularly in ensuring that all waste, especially infectious and pathological waste, undergoes complete sterilization before final disposal.\u003c/p\u003e \u003cp\u003eThe study did not detect any isolates harboring the MsrA gene, which is associated with energy-dependent efflux mechanisms conferring resistance to erythromycin, or the ermF and ermX genes, which are known to confer resistance to erythromycin and clindamycin through rRNA methylation mechanisms. The absence of these genes suggests that, within the sampled population, resistance to macrolides and lincosamides (erythromycin and clindamycin) is not mediated by these common resistance mechanisms. This finding is noteworthy, as erm genes, particularly ermF and ermX, are often implicated in resistance to erythromycin and clindamycin in various pathogenic bacteria [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The lack of these genes in the isolates could be attributed to the local antibiotic usage patterns, which may not exert sufficient selective pressure for the emergence and maintenance of these resistance determinants. Moreover, the absence of MsrA suggests that efflux-based resistance to erythromycin is not prevalent in this setting, which is consistent with reports from other regions where alternative resistance mechanisms, such as target site modification, predominate [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn contrast, the present study detected blaSHV and blaTEM genes, which are well-known mediators of resistance to beta-lactam antibiotics, including penicillins and cephalosporins. The detection of these genes is important, as they encode beta-lactamase enzymes that hydrolyse the beta-lactam ring, rendering these antibiotics ineffective [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The findings revealed that 2 (50%) of the isolates harboured only the blaTEM gene, whereas another 2 (50%) possessed only the blaSHV gene. Additionally, 1 (25%) of the isolates contained both the blaTEM and blaSHV genes. This co-occurrence of blaTEM and blaSHV is particularly concerning, as it suggests the potential for these isolates to exhibit a broader spectrum of resistance, including to extended-spectrum beta-lactam antibiotics [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. The presence of both genes in a single isolate could also indicate the acquisition of multiple resistance plasmids or the occurrence of recombination events, leading to the clustering of resistance determinants. The detection of blaTEM is consistent with global trends in which blaTEM is one of the most frequently identified beta-lactamase genes, particularly in gram-negative bacteria such as \u003cem\u003eEscherichia coli\u003c/em\u003e and \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Similarly, blaSHV is also commonly associated with resistance in hospital-acquired infections, often contributing to the spread of multidrug-resistant (MDR) strains [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. The presence of blaSHV and blaTEM in the isolates underscores the need for vigilant antimicrobial stewardship and the prudent use of beta-lactam antibiotics in the clinical setting. The ability of these genes to confer resistance to a broad range of beta-lactam antibiotics, including those considered first-line treatments, poses a significant challenge for the management of bacterial infections. Moreover, the co-occurrence of blaTEM and blaSHV in certain isolates highlights the potential for the emergence of highly resistant strains that could limit treatment options and increase the risk of treatment failure. This finding necessitates the implementation of robust infection control measures to prevent the spread of these resistant pathogens within the hospital environment. The absence of macrolide and lincosamide resistance genes (MsrA, ermF, ermX) may provide a therapeutic window where these antibiotics could be considered for treatment, particularly in infections caused by isolates lacking beta-lactam resistance. However, this approach must be approached with caution, considering the potential for the emergence of resistance if these antibiotics are overused.\u003c/p\u003e"},{"header":"5. Conclusion and Recommendation","content":"\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Conclusion\u003c/h2\u003e \u003cp\u003eThe assessment of hospital waste and the associated bacterial contamination levels at the Federal University Teaching Hospital, Owerri, reveals a comprehensive approach to waste management that incorporates various disposal methods tailored to the type of waste generated. However, the presence of significant microbial contamination in certain waste types underscores the need for continuous improvement in waste management practices. By enhancing training, updating policies, and expanding recycling efforts, hospitals can further mitigate the risks associated with hospital waste and contribute to a safer and more sustainable healthcare environment.\u003c/p\u003e \u003cp\u003eHowever, there are areas for improvement, particularly in the training and communication of waste management policies. The slightly greater degree of knowledge and positive attitudes among the female respondents may be attributed to their greater involvement in the nursing and sanitation roles. To ensure the effectiveness of a hospital's waste management system, it is crucial to address the gaps identified in training and policy awareness, thereby enhancing the overall safety and efficiency of waste management practices.\u003c/p\u003e \u003cp\u003eThe assessment of hospital waste disposal methods and the associated resistant bacterial pathogens underscores the critical need for effective waste management strategies to control the spread of resistant microorganisms. The findings from this study provide a valuable basis for improving waste management practices and reducing the risk of nosocomial infections and environmental contamination. Future research should focus on the development of more sustainable waste treatment technologies and the exploration of alternative methods for managing resistant pathogens in healthcare waste.\u003c/p\u003e \u003cp\u003eThe presence of significant microbial contamination and high levels of antibiotic resistance, particularly to commonly used antibiotics, underscores the need for enhanced waste management protocols and antimicrobial stewardship. Addressing these challenges is critical to safeguarding public health and preventing the further spread of antibiotic-resistant pathogens.\u003c/p\u003e \u003cp\u003eThe molecular assessment of antibiotic resistance genes in bacterial isolates revealed a concerning prevalence of beta-lactamase genes (blaSHV and blaTEM) while demonstrating the absence of certain erythromycin and clindamycin resistance genes. These findings have significant implications for antibiotic therapy and infection control within hospitals, emphasizing the need for targeted interventions to manage and mitigate the spread of antibiotic-resistant bacteria.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec30\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Recommendation\u003c/h2\u003e \u003cp\u003eTo mitigate these risks, hospitals must prioritize the adoption of best practices in waste management, including the use of appropriate personal protective equipment (PPE) for waste handlers, regular training and capacity building for staff, and the implementation of effective waste treatment technologies, such as autoclaving and incineration. Additionally, there is a need for continuous monitoring and evaluation of waste management practices to ensure compliance with national and international standards.\u003c/p\u003e \u003cp\u003eGiven the high levels of microbial contamination found in infectious waste, hospitals should consider investing in additional incineration and autoclaving facilities. This will reduce the reliance on landfilling, which poses environmental risks, and ensure that hazardous waste is treated via the most effective methods.\u003c/p\u003e \u003cp\u003eTo ensure that all healthcare workers are aware of and adhere to waste management policies, hospitals should implement regular communication and refresher training sessions. Effective communication ensures that all staff members are informed about the latest guidelines and are equipped with the necessary knowledge to manage waste safely.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRecommendations for Policy Improvement\u003c/strong\u003e \u003cp\u003eThe findings of this study offer practical recommendations for improving waste management policies in healthcare settings. These recommendations, which are based on empirical data, contribute to the development of more effective and sustainable waste management strategies that can be applied in similar healthcare institutions.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Contribution to knowledge\u003c/h2\u003e \u003cp\u003eThe study revealed a strong correlation between healthcare workers\u0026rsquo; knowledge of waste management and their adherence to proper practices. This correlation underscores the importance of continuous education and training in maintaining effective waste management systems in healthcare settings.\u003c/p\u003e \u003cp\u003eThe detailed analysis of microbial contamination levels in various types of hospital waste contributes to the understanding of the risks associated with improper waste disposal. The identification of resistant bacteria, such as \u003cem\u003eEnterobacter cloacae\u003c/em\u003e and \u003cem\u003eStaphylococcus\u003c/em\u003e Scuri ssp. The presence of Lentus in hospital waste highlights the potential for hospital-acquired infections and the spread of antibiotic-resistant pathogens.\u003c/p\u003e \u003cp\u003eThis study provides a comprehensive evaluation of the waste disposal methods used at Federal University Teaching Hospital, Owerri, including incineration, autoclaving, and landfilling. This evaluation contributes to a broader understanding of the effectiveness and limitations of different waste disposal methods in reducing microbial contamination and environmental impact.\u003c/p\u003e \u003cp\u003eBy focusing on the assessment of hospital waste management practices and the associated bacterial hazards, this study contributes to the field of environmental health research. This study provides a basis for further studies on the impact of waste management practices on public health and the environment, particularly in resource-limited settings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cb\u003eEthnical Consideration/Informed Consent\u003c/b\u003e \u003c/p\u003e \u003cp\u003e Informed written consent was sought and obtained from all study participants. Additionally, approval to carry out the study was obtained from the Department of Public Health Technology, FUTO, and from management at Federal University Teaching Hospital, Owerri.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003e All the authors have approved the manuscript for submission and it has not been published, or submitted for publication elsewhere.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eThere is no competing interest among the authors.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis research was self-funded by the authors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eUGE and UMC designed research; CQO, IGC, CCO, CCU, CLO, ABN conducted research; CCAO analyzed data; COA, CQO, IGC, and CLO wrote the paper; UMC and UGE had primary responsibility for the final content. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003cp\u003e \u003cb\u003eAuthors' information\u003c/b\u003e: Not applicable\u003c/p\u003e \u003cp\u003e \u003cb\u003eClinical trial number\u003c/b\u003e: Not applicable\u003c/p\u003e\u003ch2\u003eAvailability of data and materials:\u003c/h2\u003e \u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKumari A, Maurya NS, Tiwari B. Hospital wastewater treatment scenario around the globe. Curr Developments Biotechnol Bioeng. 2019;549\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003edoi.org/10.1016/B978-0-12-819722-6.00015-8\u003c/span\u003e\u003cspan address=\"10.1016/B978-0-12-819722-6.00015-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanik-Karpinska E, Brancaleoni R, Niemcewicz M, Wojtas W, Foco M, Podogrocki M, Bijak M. Healthcare Waste-A Serious Problem for Global Health. Healthc (Basel). 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/healthcare11020242\u003c/span\u003e\u003cspan address=\"10.3390/healthcare11020242\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEzeudu OB, Ezeudu TS, Ugochukwu UC, Tenebe IT, Ajogu AP, Nwadi UV. Ajaero, CC. Healthcare Waste Management in Nigeria: A Review. Recycling. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/recycling7060087\u003c/span\u003e\u003cspan address=\"10.3390/recycling7060087\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee SM, Lee D. Effective Medical Waste Management for Sustainable Green Healthcare. Int J Environ Res Public Health. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph192214820\u003c/span\u003e\u003cspan address=\"10.3390/ijerph192214820\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAfesi-Dei C, Appiah-Brempong M, Awuah E. Health-care waste management practices: The case of Ho Teaching Hospital in Ghana. Heliyon. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.heliyon.2023.e15514\u003c/span\u003e\u003cspan address=\"10.1016/j.heliyon.2023.e15514\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrederick E, Udofia EA, Ayivor J, Osei MM, Tetteh J, Tetteh-Quarcoo PB, Sampane-Donkor E. Disposal habits and microbial load of solid medical waste in subdistrict healthcare facilities and households in Yilo-Krobo municipality, Ghana. PLoS ONE. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0261211\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0261211\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO (World Health Organization). (2018). Healthcare waste. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/health-care-waste\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/health-care-waste\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 22 Sept 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Firouzkouhi H, Chow JC, Watson JG, Ho SSH, Carter W, De Vos ASM. Chemically speciated air pollutant emissions from open burning of household solid waste from South Africa. Atmos Chem Phys. 2023;23:15375\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5194/acp-23-15375-2023\u003c/span\u003e\u003cspan address=\"10.5194/acp-23-15375-2023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). (2022). \u003cem\u003eHealthcare waste management and infection control: A global perspective\u003c/em\u003e. WHO. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789241550174\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789241550174\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 22 Sept 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurray I. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2019;399(Suppl 10325):629\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNwaokoro JC. Risk factors associated with gestational diabetes among pregnant women in Owerri municipal council, south eastern Nigeria. Asia J Med Sci Asian J Med Sci. 2014;5(Suppl 1):39\u0026ndash;46. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3126/ajms.v5i1.8302\u003c/span\u003e\u003cspan address=\"10.3126/ajms.v5i1.8302\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNkwopara C. (2020). The Federal Medical Center Owerri gets 290 million equipment upgrade. In \u003cem\u003eWikipedia\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://en.wikipedia.org/wiki/Federal\u003c/span\u003e\u003cspan address=\"https://en.wikipedia.org/wiki/Federal\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Medical Centre, Owerri. Accessed 18 Sept 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEkeleme UG, Ikwuagwu VO, Chukwuocha UM, Nwakanma JC, Adiruo SA, Ogini IO, Ude IU. Detection and characterization of microorganisms linked to unsealed drugs sold in the Ihiagwa community, Owerri, Imo State, Nigeria. Access Microbiol. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1099/acmi.0.000752.v3\u003c/span\u003e\u003cspan address=\"10.1099/acmi.0.000752.v3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSukhum KV, Newcomer EP, Cass C. Antibiotic-resistant organisms establish reservoirs in new hospital environments and are related to patient blood infection isolates. Commun Med. 2022;2:62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEkeleme UG, Ansari RA, Osaribie NA, Rabiu KM. Microbial load of domestic water sources treated with \u003cem\u003eMoringa oleifera\u003c/em\u003e or \u003cem\u003eJatropha curcas\u003c/em\u003e seed powder. South Asian J Res Microbiol. 2020;7(Suppl 4):9\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan ZA, Siddiqui MF, Park S. Current and Emerging Methods of Antibiotic Susceptibility Testing. \u003cem\u003eDiagnostics (Basel, Switzerland)\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/diagnostics9020049\u003c/span\u003e\u003cspan address=\"10.3390/diagnostics9020049\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fifth Informational Supplement. Wayne: Clinical and Laboratory Standards Institute; 2021. pp. M100\u0026ndash;S25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHumphries R, Bobenchik AM, Hindler JA, Schuetz AN. Overview of Changes to the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, M100, 31st Edition. J Clin Microbiol. 2021;59(Suppl 12):e0021321. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1128/JCM.00213-21\u003c/span\u003e\u003cspan address=\"10.1128/JCM.00213-21\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaiwo SS, Onile BA, Akanbi AA. Methicillin resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (MRSA) in Ilorin, Nigeria. Afr J ClinExpMicrobiol. 2004;5(Suppl 2):189\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdeyemo O, Oloruntoba EO, Fawole O. Gender differences in knowledge and attitudes towards healthcare waste management among healthcare workers in a tertiary hospital in Nigeria. J Environ Sci Health Part A. 2018;53(Suppl 9):793\u0026ndash;802.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkinwale AA, Salami KK, Ogundipe OA. Hospital waste management: Attitude, knowledge, and practice among healthcare workers in a tertiary hospital in South West Nigeria. Niger J Med. 2020;29(Suppl 3):403\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEze UR, Nwankwo BO, Obi OI. Assessment of healthcare waste management practices in a tertiary hospital in Nigeria. J Environ Manage Saf. 2017;8(Suppl 2):89\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). Safe management of wastes from health-care activities: a summary. WHO Press. 2014; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789241548564\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789241548564\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 10 Sept 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChartier Y, Emmanuel J, Pieper U, Pr\u0026uuml;ss A, Rushbrook P, Stringer R, Zghondi R, editors. Safe management of wastes from health-care activities. World Health Organization; 2014. Accessed 11 Sept 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). Healthcare waste: key facts. WHO Press. 2017; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/docs/default-source/wpro---documents/hae---regional-forum-(2016)/hcwmanagement-factsheet-rfhe.pdf?sfvrsn=6d59d7e_2\u003c/span\u003e\u003cspan address=\"https://www.who.int/docs/default-source/wpro---documents/hae---regional-forum-(2016)/hcwmanagement-factsheet-rfhe.pdf?sfvrsn=6d59d7e_2\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 08 Sept 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePr\u0026uuml;ss-Ust\u0026uuml;n A, Rapiti E, Hutin Y. Sharps injuries: global burden of disease from sharps injuries to health-care workers. Environmental Burden of Disease Series, 3. 2019; World Health Organization.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInternational Atomic Energy Agency (IAEA). Management of radioactive waste from the use of radionuclides in medicine. IAEA Safety Standards; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGain F, Naylor C. Environmental sustainability in hospitals \u0026ndash; a systematic review and research agenda. J Health Serv Res Policy. 2014;19(Suppl 4):245\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNdimele EC, Ekeleme UG, Ogodo AC, Nwachukwu NC. Evaluation of the level of air microbial contamination in some teaching hospitals waste dump site in South-Eastern Nigeria. Nigerian Hosp Pract 201; 15 Suppl 4: 31\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK\u0026uuml;mmerer K. (2009). The presence of pharmaceuticals in the environment due to human use \u0026ndash; present knowledge and future challenges. Journal of Environmental Management. 2009; 90 Suppl 8: 2354\u0026ndash;2366.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNdimele EC, Ekeleme UG, Ogodo AC, Nwachukwu NC, Nnadi CJ, Otutu EA. Microbiological studies of wastedumpsite in Abia State University Teaching Hospital, Aba. J Med Investig Pract. 2014; 9:151-6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchgate.net/publication/276420691_Microbiological_studies_of_waste_dumpsite_in_Abia_State_University_Teaching_Hospital_Aba\u003c/span\u003e\u003cspan address=\"https://www.researchgate.net/publication/276420691_Microbiological_studies_of_waste_dumpsite_in_Abia_State_University_Teaching_Hospital_Aba\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [accessed Oct 16 2024].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan R, Ahmed M, Hassan A. Morphological and biochemical characterization of bacterial pathogens in hospital environments. J Clin Microbiol. 2021;59(Suppl 6):e01245\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1128/JCM.01245-20\u003c/span\u003e\u003cspan address=\"10.1128/JCM.01245-20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain A, Singh H, Sharma P. Hospital waste management: Biochemical profiling and its role in infection control. J Infect Public Health. 2022;15(Suppl 5):651\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jiph.2021.11.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jiph.2021.11.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Monnet DL. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2020;18(Suppl 3):268\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1469-0691.2020.03570.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1469-0691.2020.03570.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeyra RC, Frisancho JA, S\u0026aacute;nchez HF. Methicillin-resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e in healthcare waste: A study on its prevalence and resistance patterns. J Environ Health Sci Eng. 2019;17(Suppl 2):927\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40201-019-00456-2\u003c/span\u003e\u003cspan address=\"10.1007/s40201-019-00456-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaut S, Adhikari S, Pant ND. Prevalence and antibiogram of \u003cem\u003eEscherichia coli\u003c/em\u003e from hospital waste in Nepal: A potential public health threat. BMC Infect Dis. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12879-023-07193-4\u003c/span\u003e\u003cspan address=\"10.1186/s12879-023-07193-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 23 Suppl 1: 216.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeller CF, Archer MJ, Pelayo JL. \u003cem\u003ePantoea ananatis\u003c/em\u003e: An emerging human pathogen in healthcare waste. Infect Control Hosp Epidemiol. 2021;42(Suppl 8):953\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/ice.2021.137\u003c/span\u003e\u003cspan address=\"10.1017/ice.2021.137\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAderemi MO, Adewuyi GO, Agboola OO. Evaluation of microbial contamination in healthcare waste: A case study of Lagos State, Nigeria. Environ Sci Pollut Res. 2019;26:8793\u0026ndash;801. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11356-018-1836-4\u003c/span\u003e\u003cspan address=\"10.1007/s11356-018-1836-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHassuna NA, Abdelaziz A, Gaber SN. Mechanisms of antibiotic resistance in bacterial pathogens: A review. J Global Antimicrob Resist. 2022;30:307\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jgar.2021.12.005\u003c/span\u003e\u003cspan address=\"10.1016/j.jgar.2021.12.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLogan LK, Weinstein RA. The epidemiology of carbapenem-resistant enterobacteriaceae: The impact and evolution of a global menace. J Infect Dis. 2017. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/infdis/jiw282\u003c/span\u003e\u003cspan address=\"10.1093/infdis/jiw282\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang Q, Liao J, Fang R. Resistance mechanisms of penicillin and ampicillin in gram-negative bacteria. Front Microbiol. 2023;13:846521. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fmicb.2023.846521\u003c/span\u003e\u003cspan address=\"10.3389/fmicb.2023.846521\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanj SS, Kanafani ZA. Current concepts in antimicrobial therapy against resistant gram-negative organisms: Extended-spectrum beta-lactamase\u0026ndash;producing enterobacteriaceae, carbapenem-resistant enterobacteriaceae, and multidrug-resistant pseudomonas aeruginosa. Mayo Clinic Proceedings. 2020; \u003cem\u003e95\u003c/em\u003e(1): 68\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.mayocp.2019.09.011\u003c/span\u003e\u003cspan address=\"10.1016/j.mayocp.2019.09.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLerner A, Adler A, Abu-Hanna J. The spread of multidrug-resistant bacteria in low- and middle-income countries: Trends, challenges, and possible interventions. Antimicrob Resist Infect Control. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13756-021-00937\u003c/span\u003e\u003cspan address=\"10.1186/s13756-021-00937\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlkhatib A, Awad M, El-Bahnasawy MA. Mechanisms of macrolide resistance in \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e and \u003cem\u003eStaphylococcus aureus\u003c/em\u003e isolates: A systematic review. J Global Antimicrob Resist. 2022;29:93\u0026ndash;102. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jgar.2021.12.006\u003c/span\u003e\u003cspan address=\"10.1016/j.jgar.2021.12.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarris PNA, Weiss J. The interplay between beta-lactam antibiotics and beta-lactamases: Insights from structural biology and drug design. Nat Rev Microbiol. 2020;18(Suppl 4):230\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41579-020-0327-7\u003c/span\u003e\u003cspan address=\"10.1038/s41579-020-0327-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDjahmi N, Touati A, Pantel A. Epidemiology and surveillance of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Algeria. J Med Microbiol. 2019;68(Suppl 4):461\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1099/jmm.0.000939\u003c/span\u003e\u003cspan address=\"10.1099/jmm.0.000939\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitout JDD, Peirano G, blaTEM. blaSHV and blaCTX-M extended-spectrum beta-lactamases in gram-negative bacteria: An updated review. J Global Antimicrob Resist. 2021;27:202\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jgar.2021.09.012\u003c/span\u003e\u003cspan address=\"10.1016/j.jgar.2021.09.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 3.1.7","content":"\u003cp\u003eTable 3.1.7 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hospital waste, knowledge, attitudes, perceptions, susceptibility and resistance genes","lastPublishedDoi":"10.21203/rs.3.rs-5339259/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5339259/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Hospital waste management is critical for minimizing health risks and environmental damage, particularly in developing countries where inadequate training and resources exacerbate these issues. The Federal University Teaching Hospital, Owerri, serves as a case study to assess hospital waste and associated antibacterial resistance genes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObjectives: This study aimed to evaluate healthcare workers' knowledge, attitudes, and perceptions regarding waste management; identify waste types and disposal methods; assess bacterial contamination; and characterize antibacterial resistance genes in pathogens in hospital waste.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: A cross-sectional descriptive and experimental study design was employed. Data were collected from 347 healthcare workers through stratified random sampling, and hospital waste samples were analysed for bacterial contamination and antibiotic resistance via microbiological standards. The data were analysed via the Statistical Package for Social Sciences (SPSS) computer software version 25, and the chi-square test was used to test for associations between hospital waste types, disposal methods, and bacterial characteristics for significant relationships. A p value less than 0.05 was considered statistically significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: This study revealed that 66.3% of healthcare workers possessed good knowledge of waste management, 79.2% had a positive attitude toward waste management, with females (82.0%) being slightly more positive than males (76.0%), and 72.1% perceived the waste management system as effective. Infectious and pathological wastes are primarily treated through incineration and autoclaving, with incineration being used 25 times per month, autoclaving 15 times, and landfilling 20 times for infectious waste. The infectious waste had the highest total viable count (9.86±0.28 CFU/g), indicating a high level of microbial presence, whereas the sharps waste presented a much lower total viable count of 5.40±0.52 CFU/g. The highest number of infectious waste isolates was 45 (30.2), followed by general waste 41 (27.5) and chemical waste 8 (5.4). Among the infectious waste, \u003cem\u003eEnterobacter cloacae \u003c/em\u003e(50%) was\u003cem\u003e \u003c/em\u003ethe most common bacteria, followed by \u003cem\u003eStaphylococcus Scuri\u003c/em\u003e ssp. \u003cem\u003eLentus \u003c/em\u003e(32%). Among\u003cem\u003e \u003c/em\u003ethe sharps waste,\u003cem\u003e Staphylococcus gallinarum \u003c/em\u003e(12%) was the most common, followed by \u003cem\u003eStaphylococcus xylosus \u003c/em\u003eand\u003cem\u003e Escherichia coli \u003c/em\u003e(11%). In general, waste, \u003cem\u003ePantoea ananatis \u003c/em\u003e(100%) was the most prevalent bacteria, followed by \u003cem\u003eEscherichia coli \u003c/em\u003e(38.9%), and the least prevalent bacterium was \u003cem\u003eStaphylococcus Scuri\u003c/em\u003e ssp. \u003cem\u003eLentus\u003c/em\u003e (20%). We detected isolates harboring blaSHV\u0026nbsp;and blaTEM resistance genes; of these, 2 (50%) had bla\u003csub\u003eTEM, \u003c/sub\u003e2 (50%) had only bla\u003csub\u003eSHV\u003c/sub\u003e,\u0026nbsp;and 1 (25%) had both the bla\u003csub\u003eTEM\u003c/sub\u003e\u0026nbsp;and bla\u003csub\u003eSHV\u003c/sub\u003e\u0026nbsp;genes. The p values (\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e) indicate a statistically significant association between the type of hospital waste, disposal method, bacterial count, distribution, and antibiotic resistance pattern, which supports the alternative hypothesis (H₁) that these factors have a significant impact on bacterial characteristics.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: This study highlights the need for improved training on hospital waste management and stricter adherence to disposal protocols to mitigate the spread of resistant pathogens. Continuous monitoring and updated waste management strategies are essential to protect public health and the environment.\u003c/p\u003e","manuscriptTitle":"Assessment of Hospital Waste and the Associated Antibacterial Resistance Gene: A Case Study of Federal University Teaching Hospital, Owerri","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-20 10:28:41","doi":"10.21203/rs.3.rs-5339259/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12e90a98-8573-4117-a91b-630e1658e795","owner":[],"postedDate":"November 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-29T10:08:27+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-20 10:28:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5339259","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5339259","identity":"rs-5339259","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}