Knowledge and Practice of Solid Healthcare Waste Management Among Waste Handlers in Hospitals in Southern Ghana: A Qualitative Study.

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Michael Affordofe, Emilia A. Udofia, Francis Ofosu Koranteng, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5140379/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Feb, 2025 Read the published version in BMC Public Health → Version 1 posted 4 You are reading this latest preprint version Abstract Background Despite Ghana's healthcare waste management guidelines, improper solid waste management remains a public health concern. Although there is extant evidence of the knowledge and practices of healthcare waste management among medical waste handlers elsewhere, evidence in Ghana is sparse. This study sought to assess the knowledge, and practices of waste handlers involved in solid healthcare waste management in selected health facilities in Accra, Ghana. Methods This study employed a descriptive phenomenology study design. We conducted three levels of sampling: facility-level sampling, departmental sampling, and a sample of study participants. We recruited medical waste handlers from Korle Bu Teaching Hospital, Tema General Hospital, and Shai-Osu-Doku Hospital for the study. To facilitate the discussion, we used a focus group discussion guide. We transcribed the audio-recorded interviews and uploaded the data into NVivo 14 software for coding. We synthesized the output into themes, sub-themes, and verbatim quotes to bolster the narrative. Results While the Waste handlers could describe the different types of healthcare waste, they could not label the colour codes according to the national colours used to identify the waste to be placed in a particular liner and container. In many cases, there was no attempt at managing infectious and sharp wastes, which resulted in needle pricks, falls, or even injuries due to poor transport systems. Although they were not familiar with the treatment processes for healthcare waste, they were aware of the frequency of bin cleaning. Most of the Waste handlers lacked infection-fighting vaccinations. Personal protective equipment, colour-coded bags, and a supply of disinfectants/soap needed to be improved. Conclusions Waste handlers are central to effective healthcare waste management and must be more adequately informed and protected against infections. Targeted training programs should be organized for health workers, emphasizing the importance of proper waste disposal and safety protocols to improve healthcare waste management practices. Solid healthcare waste Waste handlers Medical waste handlers Knowledge and Practices Figures Figure 1 Introduction Waste handlers (WHs) play a critical role in ensuring the cleanliness of healthcare facilities, including the safe disposal of waste for quality service delivery [1]. However, their line of duty exposes them to injuries and other hazards during the collection, transportation, and disposal of waste [2]. According to the World Health Organization (WHO), healthcare facilities categorize about 15% of their total waste as hazardous, and the remaining 85% as non-hazardous [3]. The situation in Ghana is different, as 49.65% of healthcare waste generated is hazardous [4]. Due to improper healthcare waste management, Healthcare Workers (HCWs), including Waste handlers, are exposed to infectious waste components of hazardous waste through cuts, splashes, contact, inhalation, and ingestion [5]. The challenges experienced by Waste handlers can be averted if they have adequate knowledge of the protocols for handling healthcare waste and can practice them [3]. However, healthcare workers, including Waste handlers, often understand waste categorization and management differently. While many HCWs can differentiate between general and hazardous waste, they might not thoroughly understand the subcategories [6]. As a result, it is imperative to properly segregate waste at the point of generation in healthcare facilities. Personal protective equipment (PPE), such as gloves, masks, and boots, is essential for Waste handlers' safety. While awareness of the importance of PPE is generally high, actual adherence to proper use is often suboptimal [7]. Possessing sufficient knowledge, a positive attitude, and appropriate waste management techniques are critical for ensuring effective hazardous waste and safeguarding individuals from potential exposure to hazardous substances [8]. However, studies on the knowledge, attitude, and practices of waste handlers associated with hospital solid waste are few and mostly reported in advanced countries [8,9]. Therefore, this study seeks to assess the knowledge and practices of solid healthcare waste among Waste handlers in selected healthcare facilities in Accra, Ghana. Evaluating Waste handlers' knowledge and practices related to solid healthcare waste management can inform the development of targeted interventions to address the Waste handlers' salient behavioural, normative, and control beliefs and ultimately improve their solid healthcare waste management practices. Materials and Methods Study design This study employed a descriptive phenomenology study design to explore the knowledge, and practices of Waste handlers related to solid healthcare waste management. Theoretical Framework of the study ---Fig. 1 ---- The Theory of Planned Behavior (TPB) proposed by Icek Ajzen provides a useful framework for understanding the knowledge and practices of Waste handlers regarding solid healthcare waste management in the Greater Accra Region of Ghana [10]. This theory suggests that an individual's behaviour is influenced by three key factors: attitude towards the behaviour, subjective norms, and perceived behavioural control (Fig. 1). In the context of waste management, this theory suggests that Waste handlers' behaviours are shaped by their attitudes towards waste management practices, the influence of social norms within their work environment, and their perceived ability to carry out proper waste management procedures. Each waste handler has their own personal beliefs regarding the results and ramifications of correctly handling solid healthcare waste. These beliefs shape their attitude towards compliance with standard protocols required for healthcare waste management. For instance, if the Waste handlers believe that proper waste management can reduce the risks of disease transmission and reduction of its environmental impact, they are more likely to have a favourable attitude towards engaging in this practice [10]. Also, the Waste handlers' normative beliefs, or beliefs about the expectations and opinions of important references, such as healthcare facility management, colleagues, and regulatory bodies, will influence their subjective norms. The extent to which the Waste handlers are motivated to comply with these normative beliefs will determine the strength of the subjective norm [10]. Lastly, the Waste handlers' control beliefs, which are their beliefs about the presence of facilitators and barriers to proper solid healthcare waste management, will shape their perceived behavioral control. If the Waste handlers believe that they have access to necessary resources, such as personal protective equipment, waste disposal facilities, and organizational support, they will perceive greater control over their behaviour [10]. Similarly, Deress et al. [11] emphasized that adequate knowledge, positive attitudes, and proper practices among Waste handlers are crucial for effective medical waste management. These findings align with the theory of planned behaviour as they underscore the significance of shaping Waste handlers' attitudes and behaviours through education and training. Furthermore, a study in Nigeria integrated the TPB into assessing healthcare waste management strategies in hospitals. By incorporating the TPB alongside the waste management theory, the study aimed to predict and explain behaviours related to healthcare waste management operations [12]. This approach demonstrates the utility of the TPB in understanding and influencing Waste handlers' practices. The combination of the waste Handlers' attitudes, subjective norms, and perceived behavioural control will then determine their intention to engage in proper solid healthcare waste management practices. Finally, this behavioural intention, along with their perceived behavioural control, will predict the waste Handlers' actual behaviour in managing solid healthcare waste [10]. Sampling and study site The Ghana health system encompasses a range of facility types organized into tertiary, secondary, and primary to provide a spectrum of healthcare services to meet the population's needs at various points of care [13]. We conducted three (3) levels of sampling: facility-level sampling, departmental/unit-level sampling, and study participant sampling. We randomly selected a facility at each of the three (3) hospital classification levels, and a high-risk and a low-risk department in each facility (Appendix 1). However, in each of the high- and low-risk departments, all the Waste Handlers available during the data collection were recruited. A high-risk department is defined as one in which the risk of exposure to blood or body fluid through cuts, splashes, contact, and inhalation is high. On the other hand, a low-risk department is one where there is a reduced risk of exposure to blood or body fluid [3]. At the Shai-Osudoku and the Tema General hospitals, the waste handlers work in both departments in shifts. The current study sites are Korle-Bu Teaching Hospital (Tertiary; 5.5375191º N, -0.2234616º E & 5.5371054º N, -0.2266542º E), Tema General Hospital (Secondary; 5.6417065º N, -0.00071º E & 5.6739145º N, -0.025579º E), and Shai-Osudoku (Primary; 5.8995944º N, -0.0918088º E & 5.89988º N, -0.0913983º E). In each facility, we recruited participants from the Accident and Emergency (A&E) as well as the Out-Patient Departments (OPD). These facilities are located in the southern, south-eastern and south-western parts of Accra respectively. Data Collection A Focused Group Discussion Guide [FGDG]) was developed for this study [3] (FGDG attached in Appendix 2). We arranged the participants in a circular configuration in a quiet hospital office on the day of data collection. Meanwhile, a recorder was placed in the center of the participants to ensure a clear capture of their responses. Two facilitators conducted the focused group discussion, with one facilitating and the other taking field notes. The facilitator taking the note observed participants' reactions during the ongoing discussion as the facilitator leading the discussion applied probing techniques and rephrasing questions to ensure clear comprehension. During the focus group discussions (FGDs), which typically lasted approximately 90 minutes, the facilitator translated the questions into the local language to facilitate comprehension. We listened to all audios after each interview to ensure clarity before departing the hospital. We transcribed the interviews verbatim after listening to them twice. The research team printed out the transcripts after reviewing them. Data Analysis A codebook was developed based on the review of the data that was collected. The transcribed data was uploaded into NVivo 14 software for coding. Guided by the codebook, the data was coded as free codes and then transformed into tree codes. Thematic analysis was adopted for this study. Descriptive coding was used to obtain codes arranged according to similarities and differences. Categories were compared, and meaningful and comprehensive categories were combined to form themes. Themes are given under various sub-headings in the findings and interpretations. Direct quotes were used to reveal participants' viewpoints. To select the quotes, we looked at the number of participants expressing similar ideas and examined their level of emphasis and tone of voice. Results Background characteristics of MWH Table 1 shows the background characteristics of hospital Waste handlers. Most of the study participants were female and married. Most of them attained a secondary level of education, with having worked for over ten years and a few less than 5 five years. Table 1: Background characteristics of healthcare waste Handlers Facility No. Sex Years of experience Marital Status Educational level Shai Osu-d oku (SODH) 1 Female 7 Married JHS 2 Female 5 Married JHS 3 Male 4 Married JHS 4 Female 4 Married JHS 5 Male 2 Married SHS 6 Male 2 Single Dip Admin Tema General Hospital (TGH) 1 Female 7 Married JHS 2 Female 7 Married JHS 3 Male 15 Married SHS 4 Female 10 Married JHS 5 Male 6 Married JHS 6 Female 9 Married JHS Korle Bu Polyclinic (KBPC) 1 Female 13 Married SHS 2 Female 1.5 Single SHS 3 Female 9 Married SHS 4 Female 25 Single JHS 5 Female 9 Married SHS 6 Female 22 Married JHS 7 Female 25 Single JHS 8 Male 1.5 Single SHS 9 Male 2.5 Married JHS 10 Male 24 Married JHS 11 Male 9 Single SHS Korle Bu Teaching Hospital Accident and Emergency (KBTHA&E) 1 Female 11 Married JHS 2 Female 27 Married SHS 3 Female 1. 6 Single None 4 Female 7 Single None 5 Male 11 Married SHS 6 Male 16 Married JHS 7 Male 11 Married SHS 8 Female 13 Married Primary JHS: Junior High School; SHS: Senior High Schools; Dip Admin: Diploma in Administration THEMES SUB-THEMES VERBATIM QUOTES Knowledge and practices of healthcare waste management Colour coding of bins and segregation of healthcare waste Handling of infectious waste and sharp waste Transportation of healthcare waste Healthcare waste treatment Bin Cleaning we have one bin for general waste, the yellow bin for infectious waste, and the black bin for general waste and hazardous waste (FDG1, SODH) Every day, you will find sharps on the floor (FGD 2, KBPC) Infectious waste must be kept in the yellow bins, but now, if you go around, you will see that they have mixed it with general waste (FGD1, SODH) At times we are using the Kuffour gallon (A plastic container used to store sharp waste in place of the sharp boxes due to shortages of the sharp boxes (FGD 4, KBTH A&E) We transport the infectious waste before the general waste (FGD1, SODH) When the car picks it up, they go and burn it; they have a bigger refuse dump where they burn all the waste (FGD1, SODH) We wash our dustbins every weekend, and we use the solution to wash them and dry them in the sun (FGD3, TGH) Thematic content analysis structure The researcher employed thematic content analysis to generate three (3) main themes with twelve (12) sub-themes (Table 2). Sorting and coding were done for all three (3) major themes. THEMES SUB-THEMES VERBATIM QUOTES Occupational health or risk associated with healthcare waste management Route of exposure Needle pricks Vaccinations I get rashes on my body while sweeping and water splashed on my skin which led to this, so they gave me medication, so now it's gone (FGD3, TGH) Last time I got injected by some of when I was trying to dump the dust bin, and it affected my leg so that a very big challenge for us here (FGD 2, KBPC) I have only been vaccinated with tetanus, and it was free." (FGD3, TGH) Challenges associated with healthcare waste management Disposal challenges Logistic issues Waste segregation-related challenges. Sharp waste disposal-associated challenges At times, the bins inwards can overflow, then they will come and call us, please come, and change the bin for us. ” (FGD3, TGH) At times, the bins inwards can overflow, then they will come and call us, please come, and change the bin for us. ” (FGD 2, KBPC) They put the infectious waste in the kitchen dust bin. Sometimes, too, they forget and put the sharps in the general waste." (FGD3, TGH) sometimes you will find some of the sharps on the floor especially when the box is full (FGD3, TGH) Table 2 Themes and Sub-themes for the Focused Group Discussion Theme A: Knowledge and practices of healthcare waste management This theme emerged from five (5) sub-themes: Colour coding of bins and segregation, handling of Infectious and sharp waste, transportation of healthcare waste, treatment of healthcare waste, and bin cleaning. Colour coding and Segregation of healthcare waste In general, Waste handlers could not identify all the various categories of waste with their corresponding national colour of bins and liners utilized for its storage and disposal. Some of the remarks made here reflect a moderate awareness of the different types of waste in the hospitals. "Before you get to the ward, they have labelled the bins over there, so no one will tell you this is this. They have labelled all the bins. The yellow one is for the theatre, and the black one is for the general waste, and then the red too is for the infectious." ( FGD 4, KBTH A&E) "Okay, so all the bins in the hospital have their labels and uses. So, if you pick something, you should know where to put it” (FDG1, SODH) All the Waste handlers were aware of the shortcomings in managing healthcare waste in the hospital. They spoke about intermittent 'littering and scattering of healthcare waste in the hospital premises' instead of aggregating them at predefined storage places in a segregated form. They unanimously agreed that strict adherence to the suggested practice of segregation at the source is necessary and that the current practice of mixing and sorting waste should be completely prohibited. “Even if I am to send you to the female ward right now, we will see some of the sharp objects on the floor. So, whenever I'm about to work, I always make sure that it has been cleared before I start work because even if you tell the nurses, they won't do it" (FGD 2, KBPC) "We are supposed to have two bin liners so that we will see the difference, but we are using the same bin liner to do the infectious waste and the general waste, which is wrong. We have been complaining, but we are still not getting any response. Sometimes, after reporting to the person in charge so they would be aware of it, we would try as much as possible to put on your gloves and try to separate them to various other bins." (FGD 4, KBTH A&E) “Sometimes some of the patients mix them [waste] up. For example, a patient will eat waakye (boiled rice and bins) after that, instead of putting it [wrapper] into the black dust bin, they rather put them into the yellow one because they see all the colours as the same dust bins. When you experience something like that, you can't remove the food because the infectious waste has already contaminated it, so you leave it like that." (FGD 2, KBPC) "Okay, the Nurses are supposed to segregate the waste, but sometimes, before you realize it, they put general waste into infectious waste containers or vice versa. So that's one of the challenges we encounter, and sometimes, too, they don't segregate the waste well." (FGD1, SODH) “I wear gloves and remove it from the general waste and put it into the rightful container.” (FGD3, TGH) Infectious and sharp waste management The discussions on the management of healthcare waste suggested that Waste handlers must be made aware of the appropriate way of managing infectious and sharp wastes and how they were disposed of, as they indicated. "Wastes like used gauze, cotton with blood and others go into the yellow bin while the sharp waste also goes into the sharp containers. Sometimes, we have a shortage of bins, so we use other ways to collect the waste. So, the black bin has to be covered with black rubber before you put the waste inside, but because there are insufficient yellow bins, they turn to put the infectious wastes inside the black bins too." (FGD1, SODH) From the discussion, it was noticed that some of the selected hospitals needed sharp boxes to dispose of used sharps. As a result of the shortage of these boxes, Waste handlers had to improvise such containers using plastic containers. Some participants shared their views as follows: "For the sharps, we get a box and make a hole on the top, then we put the sharp inside, since the sharp boxes are insufficient." (FGD 4, KBTH A&E) "This is because sometimes there is a shortage of sharp boxes, so they replace these stuff with the normal gallons or boxes. We use the normal saline boxes for the sharps too." (FGD 2, KBPC) "The sharp boxes are not available, so we use boxes from the finished drug, so it's a normal empty box with the needle waste. They don't wait for the bin to be full before they discard it, so it is not easy for it to tear in the process of picking it up or anything because the bin isn't full." (FGD1, SODH) Transportation of waste Waste handlers shared how the waste is transported from the wards to the final destination. They also indicated that the means of transporting waste could result in needle pricks, falls, or even injuries because of how they carry the liner with the waste on their back. According to some participants, they transfer infectious waste ahead of general waste. They also used wheelbarrows for internal transportation of healthcare waste. They added that in some cases, sharp containers do overflow and thorned. "The waste is already in rubber, so you have to take it from the bin; you have to be very careful that it will not hurt you because of what we said earlier concerning the mixture of both general and infectious waste. Maybe there is a needle in it, so you have to be very careful when taking the rubber out of the bin. It should be somehow far from you so that the needle will not prick you. The waste is dangerous, so we are always careful in handling it; we slip, we fall, it’s normal, it's not really a serious thing. There is a process we use to tie it, so it gives us space to hold it, and it's easy that way” (FGD1, SODH). "If I go and meet it like that, I will wear my gloves and then open the bin, then I will gather all the bin liner on the top then will hold it, then come outside with the bin, then I will change it and put another bin liner into the bin. After, I will pick it up with my two hands and transfer it from the ward to the backyard of the building. I will put it in a wheelbarrow and then throw it away" (FGD 4, KBTH A&E). "The dust bin is covered with a bin liner, so we just tie the liner from the dust bin and lift it; after tying the liner, we just pick it to where the car will come and collect them; we have a particular place that we keep all rubbish then a car will come and pick it up. If the sharp container overflows or gets torn in the process, we leave it there and then go for another rubber to come and collect it ” (FDG1, SODH) . Waste Treatment During the discussion, participants shared their facility's system used to treat healthcare waste before disposal. Even though the Waste handlers seem to have a fair knowledge of the treatment process used by the facility, majority do not have information on whether the waste is treated or not. Even though there was an incinerator present for treating waste in one of the hospitals, the participants said they do not treat their waste but rather burnt it. They mentioned that most solid healthcare waste is treated onsite in some cases and offsite in others through incineration, but the details of the process needed to be explained. They also confirm the risk associated with untreated waste. "As for this hospital, we have the incinerator, so we don't treat it. We take it there for it to be burnt, which is the general and infectious waste. A car picks [up] the general waste to discard it (FGD3, TGH). " It's done with a machine. It's around the old hospital; they have a place where they burn the waste using a machine. They even reopen one here" (FGD1, SODH). They also shared how these actions are unhealthy for the environment and the health of those who live near where these wastes are disposed of. "it can bring diseases; you know this waste contains blood and other infectious waste, so it's been carried untreated throughout the town. It can cause disease even from inhaling the smell of it." (FGD3, TGH) Bin cleaning The Waste handlers provided insights into the practices employed in cleaning healthcare waste bins to mitigate the risk of infections. They emphasized that cleaning these bins constitutes a significant aspect of their responsibilities as Waste handlers. They provided specific details regarding the frequency and duration of bin washing and cleaning, as outlined below: " We do that every weekend, even if I am not the one on duty. The person washes the bin every weekend and holidays because those days aren't busy ” (FGD3, TGH) Waste handlers from FGD1 indicated that the bin is only washed when stained, as they narrated. "in case after removing the rubber out of the bin and the container is stained, we take a dust bin and wash; if you take the rubber out and you find out that the bean is dirty, then you wash it, so if you see that is dirty every day then you will have to wash the bin every day" (FGD1, SODH). Waste handlers also shared processes by which the bin cleaning is done and the detergents used. "We wash the dust bins with liquid soap while using the mob to clean inside, then you rinse it about 3 times, and the bin will be cleaned, then bend it to dry well. When it dries, then you put the rubber inside then return it to the place for use" (FGD1, SODH). “I wash them with bleach and then leave it to dry in the sun before I use it to line the dustbin” (FGD3, TGH). Theme B: Occupational health or risk associated with healthcare waste management. This theme emerged from three sub-themes: the subject of the route of exposure, needle prick, and vaccination. This theme aims to assess the various routes of exposure to hazards from the handling of solid infectious waste, evaluate the management of needle pricks in hospitals, and the frequency of screening or vaccination of the Waste handlers against infectious illnesses, specifically Hepatitis A, B, and C. These diseases pose a significant risk to Waste handlers due to the inherent nature of their occupation. Waste handlers share some of the risks associated with their field of work. Route of exposure Waste handlers shared how they get exposed to healthcare waste in their line of duty within the health facility. From the discussion, the most common routes of exposure indicated were skin and eye contact through splashes. They also indicated the effects of this exposure on their health and the immediate actions they take upon exposure. The participants' responses are indicated below; “yes, water can splash to my legs, but we were warned to wear socks while working. When I come into contact with blood, I will wash it. I first wash it with water. After that, I will add soap to wash it away, then dry the place with a dry towel" (FDG1, SODH). Also, some of them complained about the materials used in cleaning the hospital and their effect on their health, as was shared in one of the focused group discussions: "The chemical I use for scrubbing the washroom is very strong, so one day when I used it affected my eyes, which got me tearing the whole day" (FGD3, TGH) . Needle pricks. Waste handlers shared their experiences with needle prick injuries and the various measures they adopted when the event happened. They indicated that anytime they have needle prick injuries, they wash the site under running water and finally make an official complaint to the in charge for clinical actions to be taken. Some of their responses are captured below, “ If you have a needle prick injury, you just wash it under running water and then make a complaint to the in-charge where you will be sent to the public health unit for an injection, which is for free ” (FGD 4, KBTH A&E). "The incident happened on Saturday, so on Monday, I reported the case to my boss, who directed me to the public health unit. They gave me a form, which I brought for them to fill out. Then, I went to run some lab tests to see whether the needle had infected me with any disease. After, by the grace of God, when the results came, the doctors said I was fine, and there was nothing to worry about" (FGD 2, KBPC). Waste Handlers express that the absence of hospital waste segregation poses a significant challenge within the hospital setting, rendering them vulnerable to infection during their duties as hospital cleaners. "I even encountered some this morning, which I found a used syringe in a locker. They leave it everywhere, and we have spoken about it for a long time. Sometimes, when you are cleaning the bed, there will be a syringe on it, and sometimes you will open lockers, and there will be a used string in them ” (FGD 2, KBPC). "The nurses just dropped the needle into the dust bin after using it, so when I was removing the rubbish from the dust bin, I got scratched by the needle. When it happened like that, I applied bleach, and then later I applied spirit to it" (FGD 2, KBPC). Vaccination During the discussions, the level of knowledge among Waste Handlers regarding available vaccinations against infections was examined. It was found that a significant number of waste Handlers have not received any vaccinations for the infections they are susceptible to due to the nature of their work. They provided reasons for not getting vaccinated, citing financial constraints and insufficient salary to cover the cost of the vaccines. Consequently, most Waste Handlers work without protection against infections such as Hepatitis A, B, and C. "At times, between two to three months, they will call all of us to come for the screening, then they will inject us. I learnt it is every four months, but it is not continuous . We will be there, and then we will be called to come and screen. Yellow fever is normally treated in the public health unit. If you want to do it, you will pay 80cedis, but hepatitis B is free, and Covid-19 too is free." (FGD 4, KBTH A&E). "No. It is only COVID-19 that we have been vaccinated against. Apart from that, hepatitis B, even with that one, I used my own money. It's been three years since I started working here. The only vaccination I have had is the COVID vaccination. It's God who is protecting me" (FGD 2, KBPC). "…. about the vaccines, when we go to take them, they say it's not free, and the amount we are paid isn't enough for us to use some for vaccination; we have children and families to care for, and this work requires a lot of energy. You have to be satisfied before you can work, but since our money isn't enough, we can't even eat well, and we have been complaining about our pay, and nothing has been done about it, so we are pleading that something should be done about our money" (FDG1, SODH). Theme C: Challenges associated with healthcare waste management. Participants observed that the organization's attitude towards HCWM needed to be improved due to the absence of work protocols. These challenges were sub-themes such as logistic-related, infectious waste disposal challenges, patient-related challenges, sharp waste disposal, and motivation. Waste disposal challenges. Hospital Waste handlers discussed how the bins can remain full for days without emptying, which deters them. They said that this practice raises the risk of diseases within the hospital and exposes it to possible visitors who may come into contact with hospital waste. "Sometimes when the dust bin is full, the trucks responsible for the damping of waste is sometimes comes late to pick up the rubbish, and sometimes these boys come around and they will be removing some of the things from the dust bins" (FGD 2, KBPC). Logistic related challenges Healthcare Waste Handlers also expressed that most challenges are associated with inadequate logistics, such as the absence of colour-coded bags in the respective bins, failure to provide Personal Protective Equipment, and inadequate supply of disinfectants/soap. Therefore, these practices are considered significant factors contributing to inadequate hospital-based healthcare waste management (HCWM). "Inside the theatre, the work we do is blood work, so we are supposed to use utility gloves but no utility gloves, so we normally use surgical gloves. We put on two or double because our work is blood. When they finish the cases, then we will remove all the blood stains inside the gowns. So, our work is risky, but we don't have utility gloves to work with it. We don't have the materials for the work so we are always complaining. Can you believe that the whole week they can give us five bin liners to use for the whole week? So, we are suffering here, so when you people come here, try and help us" (FGD 4, KBTH A&E). "Again, Sometimes, the equipment that we are supposed to use to work is difficult to access, and even getting detergents to work is very difficult, so we have to mix liquid soap with water and use it as a detergent for cleaning without any para zone [disinfectant] so please try and do something about it for us” (FGD 2, KBPC). "……. Also, the apron given to us did not help us; they gave us the rubber apron, but we wanted something heavy. It's very light and can't really cover us; it can easily fly away when the wind blows. The scrubs that are given to us aren't enough when you come fresh, and they give you two, that's all, and now the scrubs alone are expensive its 70 to 120cedis (4-8 US Dollars) which we have to buy ourselves, so we want them to supply it to us” (FDG1, SODH). "Sometimes, when you don't have logistics and you ask the in-charges, they will insult you. So, we have managed and done the work like that by finding ways and means to do the work. Then we must buy washing powder (Omo) and add it to the water to clean it with any bleach or chemicals. We know that bleach, even if you mob 100 times, is still ineffective, so after cleaning, the place will still look unclean, and then they will blame the cleaners. Sometimes, we cut carbolic soap into smaller pieces and use them to clean. We don't have masks, and if you ask your In-charge, they will also ask if stores didn't give you, so you have to use your money to buy masks. If not, you will have to work without a mask, which is not good. As we say now, my mob bucket is broken, and when I asked for a new one, they couldn't get me one, and they are not willing to give me money to go and buy a new one too, so I now have to leave the bucket outside and mob without it. This is a very big challenge for us ” (FGD3, TGH). Waste segregation-related challenges. Hospital Waste Handlers face difficulties when patients and staff mix up segregated waste, compelling them to retrieve it and store it in the appropriate bins. They also share the mixture of waste that may impact outsiders after it has been disposed of in the refused dump, as other people go to the refused dump to search for items. "Okay, the nurses are supposed to segregate the waste, but sometimes, before you realize it, they put general waste into infectious waste containers or vice versa. So that's one of the challenges we encounter, and sometimes, too, they don't segregate the waste well." (FDG1, SODH). "Sometimes even with the general waste, there could be a needle in it so if they dump it on the refuse dump and maybe those children who search for things, the needle can hurt these children and he or she will become sick" (FGD 4, KBTH A&E). "Sometimes, when patients come to the hospital and feel like vomiting, they vomit into rubber and then dump it into the dust bin in the wards, and the nurses’ put gloves and other waste in the general waste bin. Same as when the patients eat soupy foods; they drop the liquid waste into the dust bin instead of the gutter. So, when you are going to pick that waste, you wouldn't know it contains that, so it can splash on you" (FGD 2, KBPC). Sharp waste disposal Waste Handlers thoroughly discussed the difficulties surrounding needle stick injuries, inappropriate sharps disposal, and the necessity of establishing protocols for safety measures both before and during injection administration. Among the concerns raised were that sharps are kept in the dustbin rather than in a sharps box. Waste handlers stated that picking up the waste is when they sustain injuries more regularly. They explained how taking such action leads to problems with occupational health. Sharps disposal on the floor was brought up as another concern. "One of our challenges is that sometimes when the Nurses are done using the syringes, they put them into the dust bin instead of the sharp box. So, sometimes, when we are going to empty the dustbin, we come into contact with these things, and then they scratch us. Again, the syringes that are being dumped into the dustbin are very risky for us. I work at the ward. The issue of this syringe is rampant in various health centres. I would also like to address the syringe issue because it is very risky. You can even find some on the sinks." (FGD 2, KBPC) "So, for the sharp box, I wear my gloves (Surgical gloves) and my nose mask so I pick the box and then put it in a black rubber and tie it then I take it to where we discard it" (FGD3, TGH) Discussion Main findings This study assessed the knowledge and practices of Waste handlers as it relates to the management of solid healthcare waste in selected hospitals in the Greater Accra Region, Ghana. Findings revealed moderate knowledge and awareness of medical waste segregation among Waste handlers at some of the facilities. The color codes were mixed up in few instances. Knowledge about the handling of waste during transportation was low. They mentioned that, they transport infectious waste before transporting general waste. This contradicts the national protocol of transporting low-risk waste before high-risk waste. Some of the Waste handlers expressed poor knowledge of the use of incinerators by saying even though present, their waste needs to be treated meaning they do not know what the incinerator is used for. They understood the routes of exposure to infections as skin and eye. They expressed varied ways of handling post-exposure issues. While some can follow the protocol, others wash the site with bleach and add spirit. Regarding the practices, however, waste handlers are made to clean sharps on the floor. Due to the unavailability of colour-coded liners, the same bin liner is used to store both infectious and general waste. Sharp waste is often stored in improvised containers. Sharp containers often overflow and get thorn, making Waste handlers use rubbers to collect them. Waste is transported by wheelbarrow. Waste bins are washed every weekend with bleach. However, stained bins are washed intermittently. Regarding the challenges they encounter in the facility, they mentioned the shortage of logistics, such as liners, personal protective equipment (gloves, apron, etc.), detergents for cleaning, mobs, and bins. Some complained of the delay by trucks in picking up the waste. Waste handlers are often verbally abused when they complain of the unavailability of logistics. According to the focus group discussion, most Waste handlers have not been vaccinated for HBV and other infectious diseases to protect themselves. Although vaccines are available in some facilities, Waste handlers have to pay for them. Improper disposal of waste in hospitals can have catastrophic consequences. The transmission of infectious illnesses from contaminated hospital wastes is a significant danger associated with inadequate waste management in healthcare institutions. Methodological validity The study's utilization of a descriptive phenomenology study design was one of its strengths. These were essential in recording Waste handlers' opinions and real-world experiences with solid healthcare waste management. This design respects and maintains the richness of the participants' experiences while enabling an in-depth examination of their knowledge and behaviours in line with the goals of the study. Furthermore, the findings were guaranteed to be representative and generalizable through the implementation of a three-level sampling approach. For example, the facility-level sample method, which involved the selection of Waste handlers from all three levels of care, made sure that tertiary, secondary, and primary healthcare settings were included, representing the many strata within the Ghanaian health system. Each facility's departmental/unit-level sample, which focused on both high-risk and low-risk departments based on the possibility of coming into contact with blood or bodily fluids, increased the validity of the results. Additionally, the administration of the focus group discussion guide reinforced the legitimacy of the data collection method. The focus group discussions were carried out in a controlled setting, which encouraged candid and open communication among participants. Participants were arranged in a circle, local language translations were used, and two facilitators; one facilitating the conversation and the other taking thorough field notes ensured that the conversations were not only thorough but also accurately recorded. By rewording questions and using probing tactics, it was possible to gain a deeper knowledge of the participants' experiences while minimizing misunderstandings. Despite these advantages, there were still drawbacks. The study may not be applicable to smaller facilities because it focused on a limited number of Waste handlers in Ghanaian urban and semi-urban populations. Comparing results with previous studies Findings from the present study revealed an overall moderate knowledge of healthcare waste management practices among Waste handlers in the selected hospitals, as some of the Waste handlers could not identify all the various categories of waste with their corresponding national colours of bins and liners. This is consistent with a study conducted in India, which reported that participants exhibited knowledge of four-colour and three-colour bin codes in the hospital, however, some respondents incorrectly identified the bags as a different colour [ 14 ]. This resonates with the present study, which found poor waste segregation in various hospitals, as Waste handlers could not describe how to properly segregate healthcare waste in the various coloured bins in the hospitals. This finding is consistent with a study conducted in Ethiopia indicating that merely half of the healthcare Waste handlers were able to successfully segregate healthcare waste in the various coloured bins, which is of low satisfaction. It also agrees with Ibrahim et al. [ 15 ] as its finding indicates poor healthcare waste segregation procedures were deemed inadequate. Current study findings show that both the healthcare professionals and patients do not separate their waste which put them at risk as they are forced to pick them up and store them in the right bins, especially with the sharp wastes. This corresponds with a case study at the Ho teaching hospital which reveals that waste segregation at source and the use of colour-coded waste receptacles were not strictly followed by healthcare professional and patients [ 16 ]. Irrespective of the final method selected for waste treatment and disposal, it is imperative to segregate waste streams to safeguard human health and the environment [ 17 ]. Needle prick is one of the main risks associated with hospital waste handling, and it occurs mostly due to the negligence and improper segregation of hospital waste by nurses and other healthcare professionals. Through the discussion, it was revealed that some of the Waste handlers had needle pricks. Needle prick injuries are associated with various kinds of diseases, such as HIV, Hepatitis B, and Hepatitis C [ 18 ]. The Waste handlers outlined various post-exposure prophylaxis measures, such as washing the pricked sites under running water immediately after the event and then reporting to superiors for clinical actions such as injections. This measure conforms to the standard operating guidelines outlined by the Infection Prevention and Control (IPC) national policy and guidelines in healthcare settings in 2015 [ 19 ]. The policy states that, in the event of exposure to needle prick, the following steps should be taken immediately: the wounded site must be cleaned with soap and water or, in case of mucous membranes, flush with water. Also, if therapy is necessary, it should be initiated promptly, preferably 1–2 hours after exposure. The incident should be reported immediately to the supervisor. Also, all participants agreed that harmful and infectious diseases can spread through infectious waste and their susceptibility to infection due to the nature of their work; therefore, personal protective equipment is used to carry out their daily activities in the hospital. However, the study findings revealed that due to a shortage of logistics and how uncomfortable the PPEs can be, most waste handlers failed to wear them to work. This agrees with a study conducted in the United Kingdom (UK), where most waste handlers do not wear the appropriate gloves for handling waste because certain types of ballistic gloves are uncomfortable when used for extended periods and have been associated with interdigital skin abrasions due to elevated internal stitching (20). The unlined gloves exhibited significant perspiration throughout extended usage periods while also being permeable to liquids and allowing for the potential contamination of skin surfaces during prolonged exposure to blood or bodily fluids containing waste materials (20). Current findings also revealed frequent splashes of contaminated droplets from waste handling on the legs and the chest of the healthcare waste handlers during the work. This is in line with another study (21), where all waste handlers reported frequent splash or droplet contamination while handling waste sacks; however, it varied, but there was consensus that this would have occurred several times daily. Chest, arms, and legs were the common sites for splash contamination. Also, in a case study conducted in Ghana, only 11% of the waste handlers were always completely dressed in personal protective equipment (16). According to the present study, needle pricks are prevalent among healthcare waste handlers due to poor segregation and lack of sharp containers in the hospital. This agrees with a case study done in Ho Teaching Hospital, which shows about 77% of the waste handlers always sustained sharp injuries (16). The incidence of needle pricks and lack of HBV vaccination was prevalent among current study participants as most healthcare waste handlers were not vaccinated against hepatitis B due to the cost involved; studies have shown a high prevalence of hepatitis B virus among healthcare workers more than other healthcare professionals (22, 23). Present findings indicate several challenges faced by healthcare waste handlers as they shared through the focused group discussion that hospital waste is kept in the hospitals for hours before being disposed of. This coincides with a study conducted in Tanzania where healthcare professionals shared how waste is kept long overdue to breed infection in the hospital, putting both the patients and professionals at risk of hospital-acquired infections (24). Sharps injuries among waste handlers are deemed excessively elevated due to the lack of logistics and improper segregation of the hospital waste. Preventive measures can be implemented by employing ballistic gloves and trousers. However, it is important to acknowledge that significant shortcomings exist in the initial segregation and disposal of waste by healthcare professionals, which should serve as the primary control strategy. Proper and timely utilization of PPE is of utmost significance, and sufficient training and oversight by management must guarantee adherence to glove usage and other PPE regulations. Conclusions This study seeks to identify the knowledge and practices of healthcare waste management among Waste handlers in three selected hospitals in Accra, Ghana. Findings indicate that Waste handlers' knowledge, and practices significantly influence the overall effectiveness of healthcare waste management, with a lack of logistics and improper segregation of healthcare waste. Therefore, to improve HCW management practices, targeted training programs should be organized for health workers, emphasizing the importance of proper waste disposal and safety protocols. Abbreviations A&E Accident and Emergency FGDs Focus Group Discussions FGDG Focused Group Discussion Guide HBV Hepatitis B Virus HCWs Healthcare Workers HCWM Healthcare Waste Management HIV Human Immune Virus IPC Infection Prevention and Control KBPC Korle Bu Polyclinic KBTH Korle Bu Teaching Hospital OPD Out-Patient Departments PPEs Personal protective equipment SODH Shai Osu-duke Hospital TGH Tema General Hospital TPB Theory of Planned Behavior UK United Kingdom WHs Waste handlers WHO World Health Organization Declarations Ethics approval and consent to participate Approval will be obtained from the Ghana Health Service - Ethics Review Committee (GHS-IRC) number GHS-ERC: 0233/06/22 and Korle-Bu Teaching Hospital-Scientific and Technical Committee (KBTH-STC) number KBTH-STC 00065/2022 Consent for publication Not applicable Availability of data and materials Available on request from the Lead Author (Michael Affordofe (MA)) Competing interests The authors declare that they have no competing interests Funding The West African Health Organization funded MA. The funding bodies had no role in the study's design, data collection, analysis, interpretation, or manuscript writing. Authors Contribution Introduction: Michael Affordofe, Enoch Acheampong, Hope Yaw Attah & Elijah Kwasi Peprah Methodology: Reginal Quansah, Michael Affordofe, Philip & Godfred Results: Emilia A. Udofia, Theresah Andoh & Prudence Tettey Discussion: Reginald Quansah, Michael Affordofe, Paul K. Botwe & Francis Ofosu-Koranteng Conceptualization: Michael Affordofe & Reginald Quansah Acknowledgments We thank all authors of the eligible studies. References Abah SO, Ohimain EI. Healthcare waste management in Nigeria: A case study. 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Occurrence of needlestick and injuries among health-care workers of a tertiary care teaching hospital in North India. J Lab physicians. 2017;9(01):020–5. 10.4103/0974-2727.187917 . Ministry of Health, Ghana Health Service, USAID, Systems for Health. National Policy and Guidelines for Infection Prevention and Control in Health Care Settings. 2015;1–143. Blenkharn JI, Odd DC. Ballistic gloves and their role in protecting waste handlers. J Hosp Infect. 2008;68(4):347–. https://doi.org/10.1016/j.jhin.2008.04.003 . 51. Odd DC. Contamination risks in waste handling. Waste Manag. 2008;28(7):1291–8. https://doi.org/10.1016/j.wasman.2007.08.013 . Mol A, Sanders B, Van der Meer J. Hepatitis B prevalence among healthcare workers in the Netherlands. Infect Control Hosp Epidemiol. 2016;37(3):295–302. https://doi.org/10.1017/ice.2015.268 . Sohrab Hossain S, Karim F, Rahman M, Uddin J. Hepatitis B vaccination coverage among healthcare professionals in Bangladesh. Vaccine. 2013;31(4):734–9. https://doi.org/10.1016/j.vaccine.2012.11.073 . Kabyemera R, Kalolo A, Fernando G, Bergson S. Occupational exposures and utilisation of HIV postexposure prophylaxis amongst health workers of three hospitals in Tanzania’s Lake Zone. Afr Evaluation J. 2015;3(2):8. https://doi.org/10.4102/aej.v3i2.152 . Additional Declarations No competing interests reported. Supplementary Files APPENDIX1.docx Cite Share Download PDF Status: Published Journal Publication published 20 Feb, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 01 Oct, 2024 Editor assigned by journal 30 Sep, 2024 Submission checks completed at journal 29 Sep, 2024 First submitted to journal 23 Sep, 2024 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-5140379","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":360925551,"identity":"f85b2325-5fc8-4c3c-909d-16c0296a7397","order_by":0,"name":"Michael Affordofe","email":"","orcid":"","institution":"Department of Biological, Environmental \u0026 Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Affordofe","suffix":""},{"id":360925555,"identity":"655c3b0a-e82e-469f-8461-e04b73c4c01a","order_by":1,"name":"Emilia A. 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","content":"\u003cp\u003eWaste handlers (WHs) play a critical role in ensuring the cleanliness of healthcare facilities, including the safe disposal of waste for quality service delivery [1]. However, their line of duty exposes them to injuries and other hazards during the collection, transportation, and disposal of waste [2]. According to the World Health Organization (WHO), healthcare facilities categorize about 15% of their total waste as hazardous, and the remaining 85% as non-hazardous [3]. The situation in Ghana is different, as 49.65% of healthcare waste generated is hazardous [4]. Due to improper healthcare waste management, Healthcare Workers (HCWs), including Waste handlers, are exposed to infectious waste components of hazardous waste through cuts, splashes, contact, inhalation, and ingestion [5].\u003c/p\u003e\n\u003cp\u003eThe challenges experienced by Waste handlers can be averted if they have adequate knowledge of the protocols for handling healthcare waste and can practice them [3]. However, healthcare workers, including Waste handlers, often understand waste categorization and management differently. While many HCWs can differentiate between general and hazardous waste, they might not thoroughly understand the subcategories [6]. As a result, it is imperative to properly segregate waste at the point of generation in healthcare facilities. Personal protective equipment (PPE), such as gloves, masks, and boots, is essential for Waste handlers\u0026apos; safety. While awareness of the importance of PPE is generally high, actual adherence to proper use is often suboptimal [7].\u003c/p\u003e\n\u003cp\u003ePossessing sufficient knowledge, a positive attitude, and appropriate waste management techniques are critical for ensuring effective hazardous waste and safeguarding individuals from potential exposure to hazardous substances [8]. However, studies on the knowledge, attitude, and practices of waste handlers associated with hospital solid waste are few and mostly reported in advanced countries [8,9]. Therefore, this study seeks to assess the knowledge and practices of solid healthcare waste among Waste handlers in selected healthcare facilities in Accra, Ghana. Evaluating Waste handlers\u0026apos; knowledge and practices related to solid healthcare waste management can inform the development of targeted interventions to address the Waste handlers\u0026apos; salient behavioural, normative, and control beliefs and ultimately improve their solid healthcare waste management practices.\u003c/p\u003e"},{"header":"Materials and Methods ","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a descriptive phenomenology study design to explore the knowledge, and practices of Waste handlers related to solid healthcare waste management.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheoretical Framework of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e---Fig. 1 ----\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Theory of Planned Behavior (TPB) proposed by Icek Ajzen provides a useful framework for understanding the knowledge and practices of Waste handlers regarding solid healthcare waste management in the Greater Accra Region of Ghana [10]. This theory suggests that an individual's behaviour is influenced by three key factors: attitude towards the behaviour, subjective norms, and perceived behavioural control (Fig. 1). In the context of waste management, this theory suggests that Waste handlers' behaviours are shaped by their attitudes towards waste management practices, the influence of social norms within their work environment, and their perceived ability to carry out proper waste management procedures.\u003c/p\u003e\n\u003cp\u003eEach waste handler has their own personal beliefs regarding the results and ramifications of correctly handling solid healthcare waste. These beliefs shape their attitude towards compliance with standard protocols required for healthcare waste management. For instance, if the Waste handlers believe that proper waste management can reduce the risks of disease transmission and reduction of its environmental impact, they are more likely to have a favourable attitude towards engaging in this practice [10]. Also, the Waste handlers' normative beliefs, or beliefs about the expectations and opinions of important references, such as healthcare facility management, colleagues, and regulatory bodies, will influence their subjective norms. The extent to which the Waste handlers are motivated to comply with these normative beliefs will determine the strength of the subjective norm [10]. Lastly, the Waste handlers' control beliefs, which are their beliefs about the presence of facilitators and barriers to proper solid healthcare waste management, will shape their perceived behavioral control. If the Waste handlers believe that they have access to necessary resources, such as personal protective equipment, waste disposal facilities, and organizational support, they will perceive greater control over their behaviour [10].\u003c/p\u003e\n\u003cp\u003eSimilarly, Deress et al. [11] emphasized that adequate knowledge, positive attitudes, and proper practices among Waste handlers are crucial for effective medical waste management. These findings align with the theory of planned behaviour as they underscore the significance of shaping Waste handlers' attitudes and behaviours through education and training. Furthermore, a study in Nigeria integrated the TPB into assessing healthcare waste management strategies in hospitals. By incorporating the TPB alongside the waste management theory, the study aimed to predict and explain behaviours related to healthcare waste management operations [12]. This approach demonstrates the utility of the TPB in understanding and influencing Waste handlers' practices. The combination of the waste Handlers' attitudes, subjective norms, and perceived behavioural control will then determine their intention to engage in proper solid healthcare waste management practices. Finally, this behavioural intention, along with their perceived behavioural control, will predict the waste Handlers' actual behaviour in managing solid healthcare waste [10].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling and study site\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ghana health system encompasses a range of facility types organized into tertiary, secondary, and primary to provide a spectrum of healthcare services to meet the population's needs at various points of care [13]. We conducted three (3) levels of sampling: facility-level sampling, departmental/unit-level sampling, and study participant sampling. We randomly selected a facility at each of the three (3) hospital classification levels, and a high-risk and a low-risk department in each facility (Appendix 1). However, in each of the high- and low-risk departments, all the Waste Handlers available during the data collection were recruited. A high-risk department is defined as one in which the risk of exposure to blood or body fluid through cuts, splashes, contact, and inhalation is high. On the other hand, a low-risk department is one where there is a reduced risk of exposure to blood or body fluid [3]. At the Shai-Osudoku and the Tema General hospitals, the waste handlers work in both departments in shifts. The current study sites are Korle-Bu Teaching Hospital (Tertiary; 5.5375191º N, -0.2234616º E \u0026amp; 5.5371054º N, -0.2266542º E), Tema General Hospital (Secondary; 5.6417065º N, -0.00071º E \u0026amp; 5.6739145º N, -0.025579º E), and Shai-Osudoku (Primary; 5.8995944º N, -0.0918088º E \u0026amp; 5.89988º N, -0.0913983º E). In each facility, we recruited participants from the Accident and Emergency (A\u0026amp;E) as well as the Out-Patient Departments (OPD). These facilities are located in the southern, south-eastern and south-western parts of Accra respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA Focused Group Discussion Guide [FGDG]) was developed for this study [3] (FGDG attached in Appendix 2). We arranged the participants in a circular configuration in a quiet hospital office on the day of data collection. Meanwhile, a recorder was placed in the center of the participants to ensure a clear capture of their responses. Two facilitators conducted the focused group discussion, with one facilitating and the other taking field notes. The facilitator taking the note observed participants' reactions during the ongoing discussion as the facilitator leading the discussion applied probing techniques and rephrasing questions to ensure clear comprehension. During the focus group discussions (FGDs), which typically lasted approximately 90 minutes, the facilitator translated the questions into the local language to facilitate comprehension. We listened to all audios after each interview to ensure clarity before departing the hospital. We transcribed the interviews verbatim after listening to them twice. The research team printed out the transcripts after reviewing them.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA codebook was developed based on the review of the data that was collected. The transcribed data was uploaded into NVivo 14 software for coding. Guided by the codebook, the data was coded as free codes and then transformed into tree codes. Thematic analysis was adopted for this study. Descriptive coding was used to obtain codes arranged according to similarities and differences. Categories were compared, and meaningful and comprehensive categories were combined to form themes. Themes are given under various sub-headings in the findings and interpretations. Direct quotes were used to reveal participants' viewpoints. To select the quotes, we looked at the number of participants expressing similar ideas and examined their level of emphasis and tone of voice.\u003c/p\u003e"},{"header":"Results ","content":"\u003cp\u003e\u003cstrong\u003eBackground characteristics of MWH\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 shows the background characteristics of hospital Waste handlers. Most of the study participants were female and married. Most of them attained a secondary level of education, with having worked for over ten years and a few less than 5 five years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Background characteristics of healthcare waste Handlers\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"643\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFacility\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of experience\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eShai Osu-d\u003c/strong\u003e\u003cstrong\u003eoku (SODH)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDip Admin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTema General Hospital\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(TGH)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKorle Bu Polyclinic\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(KBPC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKorle Bu Teaching Hospital\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAccident and Emergency (KBTHA\u0026amp;E)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1. 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSHS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eJHS: Junior High School; SHS: Senior High Schools; Dip Admin: Diploma in Administration\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"104%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTHEMES\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUB-THEMES \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVERBATIM QUOTES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge and practices of healthcare waste management\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eColour coding of bins and segregation of healthcare waste\u003c/li\u003e\n \u003cli\u003eHandling of infectious waste and sharp waste\u003c/li\u003e\n \u003cli\u003eTransportation of healthcare waste\u003c/li\u003e\n \u003cli\u003eHealthcare waste treatment\u003c/li\u003e\n \u003cli\u003eBin Cleaning\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ewe have one bin for general waste, the yellow bin for infectious waste, and the black bin for general waste and hazardous waste\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(FDG1, SODH)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eEvery day, you will find sharps on the floor\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(FGD 2, KBPC)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eInfectious waste must be kept in the yellow bins, but now, if you go around, you will see that they have mixed it with general waste\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(FGD1, SODH)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAt times we are using the Kuffour gallon (A plastic container used to store sharp waste in place of the sharp boxes due to shortages of the sharp boxes\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(FGD 4, KBTH A\u0026amp;E)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWe transport the infectious waste before the general waste\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(FGD1, SODH)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWhen the car picks it up, they go and burn it; they have a bigger refuse dump where they burn all the waste\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(FGD1, SODH)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWe wash our dustbins every weekend, and we use the solution to wash them and dry them in the sun\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(FGD3, TGH)\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\u003eThematic content analysis structure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researcher employed thematic content analysis to generate three (3) main themes with twelve (12) sub-themes (Table 2). Sorting and coding were done for all three (3) major themes.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"104%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTHEMES\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUB-THEMES \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVERBATIM QUOTES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupational health or risk associated with healthcare waste management\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eRoute of exposure\u003c/li\u003e\n \u003cli\u003eNeedle pricks\u003c/li\u003e\n \u003cli\u003eVaccinations\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eI get rashes on my body while sweeping and water splashed on my skin which led to this, so they gave me medication, so now it\u0026apos;s gone\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(FGD3, TGH)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eLast time I got injected by some of when I was trying to dump the dust bin, and it affected my leg so that a very big challenge for us here\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(FGD 2, KBPC)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI have only been vaccinated with tetanus, and it was free.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD3, TGH)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChallenges associated with healthcare waste management\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eDisposal challenges\u003c/li\u003e\n \u003cli\u003eLogistic issues\u003c/li\u003e\n \u003cli\u003eWaste segregation-related challenges.\u003c/li\u003e\n \u003cli\u003eSharp waste disposal-associated challenges\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eAt times, the bins inwards can overflow, then they will come and call us, please come, and change the bin for us.\u003c/em\u003e\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(FGD3, TGH)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAt times, the bins inwards can overflow, then they will come and call us, please come, and change the bin for us.\u003c/em\u003e\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003cem\u003e(FGD 2, KBPC)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThey put the infectious waste in the kitchen dust bin. Sometimes, too, they forget and put the sharps in the general waste.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD3, TGH)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;sometimes you will find some of the sharps on the floor especially when the box is full\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(FGD3, TGH)\u003c/strong\u003e\u003c/p\u003e\u0026nbsp;\u0026nbsp;\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Themes and Sub-themes for the Focused Group Discussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme A: \u0026nbsp;Knowledge and practices of healthcare waste management\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme emerged from five (5) sub-themes: Colour coding of bins and segregation, handling of Infectious and sharp waste, transportation of healthcare waste, treatment of healthcare waste, and bin cleaning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eColour coding and Segregation of healthcare waste\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn general, Waste handlers could not identify all the various categories of waste with their corresponding national colour of bins and liners utilized for its storage and disposal. Some of the remarks made here reflect a moderate awareness of the different types of waste in the hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Before you get to the ward, they have labelled the bins over there, so no one will tell you this is this. They have labelled all the bins. The yellow one is for the theatre, and the black one is for the general waste, and then the red too is for the infectious.\u0026quot;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003eFGD 4, KBTH A\u0026amp;E)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Okay, so all the bins in the hospital have their labels and uses. So, if you pick something, you should know where to put it\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FDG1, SODH)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the Waste handlers were aware of the shortcomings in managing healthcare waste in the hospital. They spoke about intermittent \u0026apos;littering and scattering of healthcare waste in the hospital premises\u0026apos; instead of aggregating them at predefined storage places in a segregated form. They unanimously agreed that strict adherence to the suggested practice of segregation at the source is necessary and that the current practice of mixing and sorting waste should be completely prohibited.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Even if I am to send you to the female ward right now, we will see some of the sharp objects on the floor. So, whenever I\u0026apos;m about to work, I always make sure that it has been cleared before I start work because even if you tell the nurses, they won\u0026apos;t do it\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 2, KBPC)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;We are supposed to have two bin liners so that we will see the difference, but we are using the same bin liner to do the infectious waste and the general waste, which is wrong. We have been complaining, but we are still not getting any response. Sometimes, after reporting to the person in charge so they would be aware of it, we would try as much as possible to put on your gloves and try to separate them to various other bins.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 4, KBTH A\u0026amp;E)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes some of the patients mix them [waste] up. For example, a patient will eat waakye (boiled rice and bins) after that, instead of putting it [wrapper] into the black dust bin, they rather put them into the yellow one because they see all the colours as the same dust bins. When you experience something like that, you can\u0026apos;t remove the food because the infectious waste has already contaminated it, so you leave it like that.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 2, KBPC)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Okay, the Nurses are supposed to segregate the waste, but sometimes, before you realize it, they put general waste into infectious waste containers or vice versa. So that\u0026apos;s one of the challenges we encounter, and sometimes, too, they don\u0026apos;t segregate the waste well.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD1, SODH)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I wear gloves and remove it from the general waste and put it into the rightful container.\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD3, TGH)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInfectious and sharp waste management \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe discussions on the management of healthcare waste suggested that Waste handlers must be made aware of the appropriate way of managing infectious and sharp wastes and how they were disposed of, as they indicated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Wastes like used gauze, cotton with blood and others go into the yellow bin while the sharp waste also goes into the sharp containers. Sometimes, we have a shortage of bins, so we use other ways to collect the waste. So, the black bin has to be covered with black rubber before you put the waste inside, but because there are insufficient yellow bins, they turn to put the infectious wastes inside the black bins too.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD1, SODH)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the discussion, it was noticed that some of the selected hospitals needed sharp boxes to dispose of used sharps. As a result of the shortage of these boxes, Waste handlers had to improvise such containers using plastic containers. Some participants shared their views as follows: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;For the sharps, we get a box and make a hole on the top, then we put the sharp inside, since the sharp boxes are insufficient.\u0026quot;\u003c/em\u003e\u003cstrong\u003e(FGD 4, KBTH A\u0026amp;E)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;This is because sometimes there is a shortage of sharp boxes, so they replace these stuff with the normal gallons or boxes. We use the normal saline boxes for the sharps too.\u0026quot;\u003c/em\u003e \u003cstrong\u003e(FGD 2, KBPC)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;The sharp boxes are not available, so we use boxes from the finished drug, so it\u0026apos;s a normal empty box with the needle waste. They don\u0026apos;t wait for the bin to be full before they discard it, so it is not easy for it to tear in the process of picking it up or anything because the bin isn\u0026apos;t full.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD1, SODH)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTransportation of waste\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWaste handlers shared how the waste is transported from the wards to the final destination. They also indicated that the means of transporting waste could result in needle pricks, falls, or even injuries because of how they carry the liner with the waste on their back. According to some participants, they transfer infectious waste ahead of general waste. They also used wheelbarrows for internal transportation of healthcare waste. They added that in some cases, sharp containers do overflow and thorned.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;The waste is already in rubber, so you have to take it from the bin; you have to be very careful that it will not hurt you because of what we said earlier concerning the mixture of both general and infectious waste. Maybe there is a needle in it, so you have to be very careful when taking the rubber out of the bin. It should be somehow far from you so that the needle will not prick you. The waste is dangerous, so we are always careful in handling it; we slip, we fall, it\u0026rsquo;s normal, it\u0026apos;s not really a serious thing. There is a process we use to tie it, so it gives us space to hold it, and it\u0026apos;s easy that way\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD1, SODH).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;If I go and meet it like that, I will wear my gloves and then open the bin, then I will gather all the bin liner on the top then will hold it, then come outside with the bin, then I will change it and put another bin liner into the bin. After, I will pick it up with my two hands and transfer it from the ward to the backyard of the building. I will put it in a wheelbarrow and then throw it away\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 4, KBTH A\u0026amp;E).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;The dust bin is covered with a bin liner, so we just tie the liner from the dust bin and lift it; after tying the liner, we just pick it to where the car will come and collect them; we have a particular place that we keep all rubbish then a car will come and pick it up.\u003c/em\u003e\u003cem\u003eIf the sharp container overflows or gets torn in the process, we leave it there and then go for another rubber to come and collect it\u003c/em\u003e\u0026rdquo;\u003cstrong\u003e(FDG1, SODH)\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWaste Treatment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the discussion, participants shared their facility\u0026apos;s system used to treat healthcare waste before disposal. Even though the Waste handlers seem to have a fair knowledge of the treatment process used by the facility, majority do not have information on whether the waste is treated or not. Even though there was an incinerator present for treating waste in one of the hospitals, the participants said they do not treat their waste but rather burnt it. They mentioned that most solid healthcare waste is treated onsite in some cases and offsite in others through incineration, but the details of the process needed to be explained. They also confirm the risk associated with untreated waste.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;As for this hospital, we have the incinerator, so we don\u0026apos;t treat it. We take it there for it to be burnt, which is the general and infectious waste. A car picks [up] the general waste to discard it\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(FGD3, TGH).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot; It\u0026apos;s done with a machine. It\u0026apos;s around the old hospital; they have a place where they burn the waste using a machine. They even reopen one here\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD1, SODH).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThey also shared how these actions are unhealthy for the environment and the health of those who live near where these wastes are disposed of.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;it can bring diseases; you know this waste contains blood and other infectious waste, so it\u0026apos;s been carried untreated throughout the town. It can cause disease even from inhaling the smell of it.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003cem\u003e(FGD3, TGH)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBin cleaning\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Waste handlers provided insights into the practices employed in cleaning healthcare waste bins to mitigate the risk of infections. They emphasized that cleaning these bins constitutes a significant aspect of their responsibilities as Waste handlers. They provided specific details regarding the frequency and duration of bin washing and cleaning, as outlined below:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot; We do that every weekend, even if I am not the one on duty. The person washes the bin every weekend and holidays because those days aren\u0026apos;t busy\u003c/em\u003e\u0026rdquo; \u003cstrong\u003e(FGD3, TGH)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWaste handlers from FGD1 indicated that the bin is only washed when stained, as they narrated.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;in case after removing the rubber out of the bin and the container is stained, we take a dust bin and wash; if you take the rubber out and you find out that the bean is dirty, then you wash it, so if you see that is dirty every day then you will have to wash the bin every day\u0026quot;\u003c/em\u003e \u003cstrong\u003e(FGD1, SODH).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWaste handlers also shared processes by which the bin cleaning is done and the detergents used.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026quot;We wash the dust bins with liquid soap while using the mob to clean inside, then you rinse it about 3 times, and the bin will be cleaned, then bend it to dry well. When it dries, then you put the rubber inside then return it to the place for use\u0026quot;\u003c/em\u003e \u003cstrong\u003e(FGD1, SODH).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I wash them with bleach and then leave it to dry in the sun before I use it to line the dustbin\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD3, TGH).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme B: Occupational health or risk associated with healthcare waste management.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme emerged from three sub-themes: the subject of the route of exposure, needle prick, and vaccination. This theme aims to assess the various routes of exposure to hazards from the handling of solid infectious waste, evaluate the management of needle pricks in hospitals, and the frequency of screening or vaccination of the Waste handlers against infectious illnesses, specifically Hepatitis A, B, and C. These diseases pose a significant risk to Waste handlers due to the inherent nature of their occupation. Waste handlers share some of the risks associated with their field of work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRoute of exposure\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWaste handlers shared how they get exposed to healthcare waste in their line of duty within the health facility. From the discussion, the most common routes of exposure indicated were skin and eye contact through splashes. They also indicated the effects of this exposure on their health and the immediate actions they take upon exposure. The participants\u0026apos; responses are indicated below;\u003cem\u003e\u0026nbsp;\u0026ldquo;yes, water can splash to my legs, but we were warned to wear socks while working. When I come into contact with blood, I will wash it. I first wash it with water. After that, I will add soap to wash it away, then dry the place with a dry towel\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FDG1, SODH).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlso, some of them complained about the materials used in cleaning the hospital and their effect on their health, as was shared in one of the focused group discussions:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;The chemical I use for scrubbing the washroom is very strong, so one day when I used it affected my eyes, which got me tearing the whole day\u0026quot;\u003c/em\u003e\u003cstrong\u003e(FGD3, TGH)\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNeedle pricks.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWaste handlers shared their experiences with needle prick injuries and the various measures they adopted when the event happened. They indicated that anytime they have needle prick injuries, they wash the site under running water and finally make an official complaint to the in charge for clinical actions to be taken. Some of their responses are captured below,\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eIf you have a needle prick injury, you just wash it under running water and then make a complaint to the in-charge where you will be sent to the public health unit for an injection, which is for free\u003c/em\u003e\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(FGD 4, KBTH A\u0026amp;E).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;The incident happened on Saturday, so on Monday, I reported the case to my boss, who directed me to the public health unit. They gave me a form, which I brought for them to fill out. Then, I went to run some lab tests to see whether the needle had infected me with any disease. After, by the grace of God, when the results came, the doctors said I was fine, and there was nothing to worry about\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 2, KBPC).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWaste Handlers express that the absence of hospital waste segregation poses a significant challenge within the hospital setting, rendering them vulnerable to infection during their duties as hospital cleaners.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I even encountered some this morning, which I found a used syringe in a locker. They leave it everywhere, and we have spoken about it for a long time. Sometimes, when you are cleaning the bed, there will be a syringe on it, and sometimes you will open lockers, and there will be a used string in them\u003c/em\u003e\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(FGD 2, KBPC).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;The nurses just dropped the needle into the dust bin after using it, so when I was removing the rubbish from the dust bin, I got scratched by the needle. When it happened like that, I applied bleach, and then later I applied spirit to it\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 2, KBPC).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eVaccination\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the discussions, the level of knowledge among Waste Handlers regarding available vaccinations against infections was examined. It was found that a significant number of waste Handlers have not received any vaccinations for the infections they are susceptible to due to the nature of their work. They provided reasons for not getting vaccinated, citing financial constraints and insufficient salary to cover the cost of the vaccines. Consequently, most Waste Handlers work without protection against infections such as Hepatitis A, B, and C.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;At times, between two to three months, they will call all of us to come for the screening, then they will inject us. I learnt it is every four months, but it is not continuous\u003c/em\u003e\u003cem\u003e. We will be there, and then we will be called to come and screen.\u003c/em\u003e \u003cem\u003eYellow fever is normally treated in the public health unit. If you want to do it, you will pay 80cedis, but hepatitis B is free, and Covid-19 too is free.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 4, KBTH A\u0026amp;E).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;No. It is only COVID-19 that we have been vaccinated against. Apart from that, hepatitis B, even with that one, I used my own money. It\u0026apos;s been three years since I started working here. The only vaccination I have had is the COVID vaccination. It\u0026apos;s God who is protecting me\u0026quot;\u003c/em\u003e\u003cstrong\u003e(FGD 2, KBPC).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u0026hellip;. about the vaccines, when we go to take them, they say it\u0026apos;s not free, and the amount we are paid isn\u0026apos;t enough for us to use some for vaccination; we have children and families to care for, and this work requires a lot of energy. You have to be satisfied before you can work, but since our money isn\u0026apos;t enough, we can\u0026apos;t even eat well, and we have been complaining about our pay, and nothing has been done about it, so we are pleading that something should be done about our money\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FDG1, SODH).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme C: Challenges associated with healthcare waste management.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants observed that the organization\u0026apos;s attitude towards HCWM needed to be improved due to the absence of work protocols. These challenges were sub-themes such as logistic-related, infectious waste\u0026nbsp;disposal challenges, patient-related challenges, sharp waste disposal, and motivation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWaste disposal challenges.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHospital Waste handlers discussed how the bins can remain full for days without emptying, which deters them. They said that this practice raises the risk of diseases within the hospital and exposes it to possible visitors who may come into contact with hospital waste.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Sometimes when the dust bin is full, the trucks responsible for the damping of waste is sometimes comes late to pick up the rubbish, and sometimes these boys come around and they will be removing some of the things from the dust bins\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 2, KBPC).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLogistic related challenges\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealthcare Waste Handlers also expressed that most challenges are associated with inadequate logistics, such as the absence of colour-coded bags in the respective bins, failure to provide Personal Protective Equipment, and inadequate supply of disinfectants/soap. Therefore, these practices are considered significant factors contributing to inadequate hospital-based healthcare waste management (HCWM).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Inside the theatre, the work we do is blood work, so we are supposed to use utility gloves but no utility gloves, so we normally use surgical gloves. We put on two or double because our work is blood. When they finish the cases, then we will remove all the blood stains inside the gowns. So, our work is risky, but we don\u0026apos;t have utility gloves to work with it.\u003c/em\u003e \u003cem\u003eWe don\u0026apos;t have the materials for the work so we are always complaining. Can you believe that the whole week they can give us five bin liners to use for the whole week? So, we are suffering here, so when you people come here, try and help us\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 4, KBTH A\u0026amp;E).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Again, Sometimes, the equipment that we are supposed to use to work is difficult to access, and even getting detergents to work is very difficult, so we have to mix liquid soap with water and use it as a detergent for cleaning without any para zone [disinfectant] so please try and do something about it for us\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(FGD 2, KBPC).\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u0026hellip;\u0026hellip;. Also, the apron given to us did not help us; they gave us the rubber apron, but we wanted something heavy. It\u0026apos;s very light and can\u0026apos;t really cover us; it can easily fly away when the wind blows. The scrubs that are given to us aren\u0026apos;t enough when you come fresh, and they give you two, that\u0026apos;s all, and now the scrubs alone are expensive its 70 to 120cedis (4-8 US Dollars) which we have to buy ourselves, so we want them to supply it to us\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FDG1, SODH).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Sometimes, when you don\u0026apos;t have logistics and you ask the in-charges, they will insult you. So, we have managed and done the work like that by finding ways and means to do the work.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThen we must buy washing powder (Omo) and add it to the water to clean it with any bleach or chemicals. We know that bleach, even if you mob 100 times, is still ineffective, so after cleaning, the place will still look unclean, and then they will blame the cleaners. Sometimes, we cut carbolic soap into smaller pieces and use them to clean. We don\u0026apos;t have masks, and if you ask your In-charge, they will also ask if stores didn\u0026apos;t give you, so you have to use your money to buy masks. If not, you will have to work without a mask, which is not good. As we say now, my mob bucket is broken, and when I asked for a new one, they couldn\u0026apos;t get me one, and they are not willing to give me money to go and buy a new one too, so I now have to leave the bucket outside and mob without it. This is a very big challenge for us\u003c/em\u003e\u0026rdquo; \u003cstrong\u003e(FGD3, TGH).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWaste segregation-related challenges.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHospital Waste Handlers face difficulties when patients and staff mix up segregated waste, compelling them to retrieve it and store it in the appropriate bins. They also share the mixture of waste that may impact outsiders after it has been disposed of in the refused dump, as other people go to the refused dump to search for items.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Okay, the nurses are supposed to segregate the waste, but sometimes, before you realize it, they put general waste into infectious waste containers or vice versa. So that\u0026apos;s one of the challenges we encounter, and sometimes, too, they don\u0026apos;t segregate the waste well.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FDG1, SODH).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Sometimes even with the general waste, there could be a needle in it so if they dump it on the refuse dump and maybe those children who search for things, the needle can hurt these children and he or she will become sick\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 4, KBTH A\u0026amp;E).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Sometimes, when patients come to the hospital and feel like vomiting, they vomit into rubber and then dump it into the dust bin in the wards, and the nurses\u0026rsquo; put gloves and other waste in the general waste bin. Same as when the patients eat soupy foods; they drop the liquid waste into the dust bin instead of the gutter. So, when you are going to pick that waste, you wouldn\u0026apos;t know it contains that, so it can splash on you\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 2, KBPC).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSharp waste disposal\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWaste Handlers thoroughly discussed the difficulties surrounding needle stick injuries, inappropriate sharps disposal, and the necessity of establishing protocols for safety measures both before and during injection administration. Among the concerns raised were that sharps are kept in the dustbin rather than in a sharps box. Waste handlers stated that picking up the waste is when they sustain injuries more regularly. They explained how taking such action leads to problems with occupational health. Sharps disposal on the floor was brought up as another concern.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;One of our challenges is that sometimes when the Nurses are done using the syringes, they put them into the dust bin instead of the sharp box. So, sometimes, when we are going to empty the dustbin, we come into contact with these things, and then they scratch\u0026nbsp;\u003c/em\u003eus.\u0026nbsp;\u003cem\u003eAgain, the syringes that are being dumped into the dustbin are very risky for us. I work at the ward. The issue of this syringe is rampant in various health centres. I would also like to address the syringe issue because it is very risky. You can even find some on the sinks.\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD 2, KBPC)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;So, for the sharp box, I wear my gloves (Surgical gloves) and my nose mask so I pick the box and then put it in a black rubber and tie it then I take it to where we discard it\u0026quot;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(FGD3, TGH)\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eMain findings\u003c/h2\u003e \u003cp\u003eThis study assessed the knowledge and practices of Waste handlers as it relates to the management of solid healthcare waste in selected hospitals in the Greater Accra Region, Ghana. Findings revealed moderate knowledge and awareness of medical waste segregation among Waste handlers at some of the facilities. The color codes were mixed up in few instances. Knowledge about the handling of waste during transportation was low. They mentioned that, they transport infectious waste before transporting general waste. This contradicts the national protocol of transporting low-risk waste before high-risk waste. Some of the Waste handlers expressed poor knowledge of the use of incinerators by saying even though present, their waste needs to be treated meaning they do not know what the incinerator is used for. They understood the routes of exposure to infections as skin and eye. They expressed varied ways of handling post-exposure issues. While some can follow the protocol, others wash the site with bleach and add spirit.\u003c/p\u003e \u003cp\u003eRegarding the practices, however, waste handlers are made to clean sharps on the floor. Due to the unavailability of colour-coded liners, the same bin liner is used to store both infectious and general waste. Sharp waste is often stored in improvised containers. Sharp containers often overflow and get thorn, making Waste handlers use rubbers to collect them. Waste is transported by wheelbarrow. Waste bins are washed every weekend with bleach. However, stained bins are washed intermittently.\u003c/p\u003e \u003cp\u003eRegarding the challenges they encounter in the facility, they mentioned the shortage of logistics, such as liners, personal protective equipment (gloves, apron, etc.), detergents for cleaning, mobs, and bins. Some complained of the delay by trucks in picking up the waste. Waste handlers are often verbally abused when they complain of the unavailability of logistics. According to the focus group discussion, most Waste handlers have not been vaccinated for HBV and other infectious diseases to protect themselves. Although vaccines are available in some facilities, Waste handlers have to pay for them. Improper disposal of waste in hospitals can have catastrophic consequences. The transmission of infectious illnesses from contaminated hospital wastes is a significant danger associated with inadequate waste management in healthcare institutions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eMethodological validity\u003c/h2\u003e \u003cp\u003eThe study's utilization of a descriptive phenomenology study design was one of its strengths. These were essential in recording Waste handlers' opinions and real-world experiences with solid healthcare waste management. This design respects and maintains the richness of the participants' experiences while enabling an in-depth examination of their knowledge and behaviours in line with the goals of the study.\u003c/p\u003e \u003cp\u003eFurthermore, the findings were guaranteed to be representative and generalizable through the implementation of a three-level sampling approach. For example, the facility-level sample method, which involved the selection of Waste handlers from all three levels of care, made sure that tertiary, secondary, and primary healthcare settings were included, representing the many strata within the Ghanaian health system. Each facility's departmental/unit-level sample, which focused on both high-risk and low-risk departments based on the possibility of coming into contact with blood or bodily fluids, increased the validity of the results.\u003c/p\u003e \u003cp\u003eAdditionally, the administration of the focus group discussion guide reinforced the legitimacy of the data collection method. The focus group discussions were carried out in a controlled setting, which encouraged candid and open communication among participants. Participants were arranged in a circle, local language translations were used, and two facilitators; one facilitating the conversation and the other taking thorough field notes ensured that the conversations were not only thorough but also accurately recorded. By rewording questions and using probing tactics, it was possible to gain a deeper knowledge of the participants' experiences while minimizing misunderstandings.\u003c/p\u003e \u003cp\u003eDespite these advantages, there were still drawbacks. The study may not be applicable to smaller facilities because it focused on a limited number of Waste handlers in Ghanaian urban and semi-urban populations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eComparing results with previous studies\u003c/h2\u003e \u003cp\u003eFindings from the present study revealed an overall moderate knowledge of healthcare waste management practices among Waste handlers in the selected hospitals, as some of the Waste handlers could not identify all the various categories of waste with their corresponding national colours of bins and liners. This is consistent with a study conducted in India, which reported that participants exhibited knowledge of four-colour and three-colour bin codes in the hospital, however, some respondents incorrectly identified the bags as a different colour [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This resonates with the present study, which found poor waste segregation in various hospitals, as Waste handlers could not describe how to properly segregate healthcare waste in the various coloured bins in the hospitals. This finding is consistent with a study conducted in Ethiopia indicating that merely half of the healthcare Waste handlers were able to successfully segregate healthcare waste in the various coloured bins, which is of low satisfaction. It also agrees with Ibrahim et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] as its finding indicates poor healthcare waste segregation procedures were deemed inadequate.\u003c/p\u003e \u003cp\u003eCurrent study findings show that both the healthcare professionals and patients do not separate their waste which put them at risk as they are forced to pick them up and store them in the right bins, especially with the sharp wastes. This corresponds with a case study at the Ho teaching hospital which reveals that waste segregation at source and the use of colour-coded waste receptacles were not strictly followed by healthcare professional and patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Irrespective of the final method selected for waste treatment and disposal, it is imperative to segregate waste streams to safeguard human health and the environment [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNeedle prick is one of the main risks associated with hospital waste handling, and it occurs mostly due to the negligence and improper segregation of hospital waste by nurses and other healthcare professionals. Through the discussion, it was revealed that some of the Waste handlers had needle pricks. Needle prick injuries are associated with various kinds of diseases, such as HIV, Hepatitis B, and Hepatitis C [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The Waste handlers outlined various post-exposure prophylaxis measures, such as washing the pricked sites under running water immediately after the event and then reporting to superiors for clinical actions such as injections. This measure conforms to the standard operating guidelines outlined by the Infection Prevention and Control (IPC) national policy and guidelines in healthcare settings in 2015 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The policy states that, in the event of exposure to needle prick, the following steps should be taken immediately: the wounded site must be cleaned with soap and water or, in case of mucous membranes, flush with water.\u003c/p\u003e \u003cp\u003eAlso, if therapy is necessary, it should be initiated promptly, preferably 1\u0026ndash;2 hours after exposure. The incident should be reported immediately to the supervisor. Also, all participants agreed that harmful and infectious diseases can spread through infectious waste and their susceptibility to infection due to the nature of their work; therefore, personal protective equipment is used to carry out their daily activities in the hospital. However, the study findings revealed that due to a shortage of logistics and how uncomfortable the PPEs can be, most waste handlers failed to wear them to work. This agrees with a study conducted in the United Kingdom (UK), where most waste handlers do not wear the appropriate gloves for handling waste because certain types of ballistic gloves are uncomfortable when used for extended periods and have been associated with interdigital skin abrasions due to elevated internal stitching (20). The unlined gloves exhibited significant perspiration throughout extended usage periods while also being permeable to liquids and allowing for the potential contamination of skin surfaces during prolonged exposure to blood or bodily fluids containing waste materials (20). Current findings also revealed frequent splashes of contaminated droplets from waste handling on the legs and the chest of the healthcare waste handlers during the work. This is in line with another study (21), where all waste handlers reported frequent splash or droplet contamination while handling waste sacks; however, it varied, but there was consensus that this would have occurred several times daily. Chest, arms, and legs were the common sites for splash contamination. Also, in a case study conducted in Ghana, only 11% of the waste handlers were always completely dressed in personal protective equipment (16). According to the present study, needle pricks are prevalent among healthcare waste handlers due to poor segregation and lack of sharp containers in the hospital. This agrees with a case study done in Ho Teaching Hospital, which shows about 77% of the waste handlers always sustained sharp injuries (16). The incidence of needle pricks and lack of HBV vaccination was prevalent among current study participants as most healthcare waste handlers were not vaccinated against hepatitis B due to the cost involved; studies have shown a high prevalence of hepatitis B virus among healthcare workers more than other healthcare professionals (22, 23).\u003c/p\u003e \u003cp\u003ePresent findings indicate several challenges faced by healthcare waste handlers as they shared through the focused group discussion that hospital waste is kept in the hospitals for hours before being disposed of. This coincides with a study conducted in Tanzania where healthcare professionals shared how waste is kept long overdue to breed infection in the hospital, putting both the patients and professionals at risk of hospital-acquired infections (24). Sharps injuries among waste handlers are deemed excessively elevated due to the lack of logistics and improper segregation of the hospital waste. Preventive measures can be implemented by employing ballistic gloves and trousers. However, it is important to acknowledge that significant shortcomings exist in the initial segregation and disposal of waste by healthcare professionals, which should serve as the primary control strategy. Proper and timely utilization of PPE is of utmost significance, and sufficient training and oversight by management must guarantee adherence to glove usage and other PPE regulations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study seeks to identify the knowledge and practices of healthcare waste management among Waste handlers in three selected hospitals in Accra, Ghana. Findings indicate that Waste handlers' knowledge, and practices significantly influence the overall effectiveness of healthcare waste management, with a lack of logistics and improper segregation of healthcare waste. Therefore, to improve HCW management practices, targeted training programs should be organized for health workers, emphasizing the importance of proper waste disposal and safety protocols.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eA\u0026amp;E\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Accident and Emergency\u003c/p\u003e\n\u003cp\u003eFGDs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Focus Group Discussions\u003c/p\u003e\n\u003cp\u003eFGDG\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Focused Group Discussion Guide\u003c/p\u003e\n\u003cp\u003eHBV\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hepatitis B Virus\u003c/p\u003e\n\u003cp\u003eHCWs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Healthcare Workers\u003c/p\u003e\n\u003cp\u003eHCWM\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Healthcare Waste Management\u003c/p\u003e\n\u003cp\u003eHIV\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Human Immune Virus\u003c/p\u003e\n\u003cp\u003eIPC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Infection Prevention and Control\u003c/p\u003e\n\u003cp\u003eKBPC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Korle Bu Polyclinic\u003c/p\u003e\n\u003cp\u003eKBTH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Korle Bu Teaching Hospital\u003c/p\u003e\n\u003cp\u003eOPD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Out-Patient Departments\u003c/p\u003e\n\u003cp\u003ePPEs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Personal protective equipment\u003c/p\u003e\n\u003cp\u003eSODH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Shai Osu-duke Hospital\u003c/p\u003e\n\u003cp\u003eTGH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Tema General Hospital\u003c/p\u003e\n\u003cp\u003eTPB\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Theory of Planned Behavior\u003c/p\u003e\n\u003cp\u003eUK\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;United Kingdom\u003c/p\u003e\n\u003cp\u003eWHs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Waste handlers\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval will be obtained from the Ghana Health Service - Ethics Review Committee (GHS-IRC) number \u003cstrong\u003eGHS-ERC: 0233/06/22\u003c/strong\u003e and Korle-Bu Teaching Hospital-Scientific and Technical Committee (KBTH-STC) number \u003cstrong\u003eKBTH-STC 00065/2022\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAvailable on request from the Lead Author (Michael Affordofe (MA))\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe West African Health Organization funded MA. The funding bodies had no role in the study\u0026apos;s design, data collection, analysis, interpretation, or manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntroduction: Michael Affordofe, Enoch Acheampong, Hope Yaw Attah \u0026amp; Elijah Kwasi Peprah\u003c/p\u003e\n\u003cp\u003eMethodology: Reginal Quansah, Michael Affordofe, Philip \u0026amp; Godfred\u003c/p\u003e\n\u003cp\u003eResults: Emilia A. Udofia, Theresah Andoh \u0026amp; Prudence Tettey\u003c/p\u003e\n\u003cp\u003eDiscussion: Reginald Quansah, Michael Affordofe, Paul K. Botwe \u0026amp; Francis Ofosu-Koranteng\u003c/p\u003e\n\u003cp\u003eConceptualization: Michael Affordofe \u0026amp; Reginald Quansah\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all authors of the eligible studies. \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbah SO, Ohimain EI. Healthcare waste management in Nigeria: A case study. 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Afr Evaluation J. 2015;3(2):8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4102/aej.v3i2.152\u003c/span\u003e\u003cspan address=\"10.4102/aej.v3i2.152\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Solid healthcare waste, Waste handlers, Medical waste handlers, Knowledge and Practices","lastPublishedDoi":"10.21203/rs.3.rs-5140379/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5140379/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e Despite Ghana's healthcare waste management guidelines, improper solid waste management remains a public health concern. Although there is extant evidence of the knowledge and practices of healthcare waste management among medical waste handlers elsewhere, evidence in Ghana is sparse. This study sought to assess the knowledge, and practices of waste handlers involved in solid healthcare waste management in selected health facilities in Accra, Ghana.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study employed a descriptive phenomenology study design. We conducted three levels of sampling: facility-level sampling, departmental sampling, and a sample of study participants. We recruited medical waste handlers from Korle Bu Teaching Hospital, Tema General Hospital, and Shai-Osu-Doku Hospital for the study. To facilitate the discussion, we used a focus group discussion guide. We transcribed the audio-recorded interviews and uploaded the data into NVivo 14 software for coding. We synthesized the output into themes, sub-themes, and verbatim quotes to bolster the narrative.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWhile the Waste handlers could describe the different types of healthcare waste, they could not label the colour codes according to the national colours used to identify the waste to be placed in a particular liner and container. In many cases, there was no attempt at managing infectious and sharp wastes, which resulted in needle pricks, falls, or even injuries due to poor transport systems. Although they were not familiar with the treatment processes for healthcare waste, they were aware of the frequency of bin cleaning. Most of the Waste handlers lacked infection-fighting vaccinations. Personal protective equipment, colour-coded bags, and a supply of disinfectants/soap needed to be improved.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWaste handlers are central to effective healthcare waste management and must be more adequately informed and protected against infections. Targeted training programs should be organized for health workers, emphasizing the importance of proper waste disposal and safety protocols to improve healthcare waste management practices.\u003c/p\u003e","manuscriptTitle":"Knowledge and Practice of Solid Healthcare Waste Management Among Waste Handlers in Hospitals in Southern Ghana: A Qualitative Study.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 13:15:08","doi":"10.21203/rs.3.rs-5140379/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-01T05:16:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-30T10:52:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-30T02:40:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-09-23T21:11:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c542f1b2-8384-4c9d-91f1-d0deeb8cf4c7","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T16:02:44+00:00","versionOfRecord":{"articleIdentity":"rs-5140379","link":"https://doi.org/10.1186/s12889-025-21874-6","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-02-20 15:57:39","publishedOnDateReadable":"February 20th, 2025"},"versionCreatedAt":"2024-12-09 13:15:08","video":"","vorDoi":"10.1186/s12889-025-21874-6","vorDoiUrl":"https://doi.org/10.1186/s12889-025-21874-6","workflowStages":[]},"version":"v1","identity":"rs-5140379","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5140379","identity":"rs-5140379","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}