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European Journal of Applied Sciences – Vol. 11, No. 1
Publication Date: January 25, 2023
DOI:10.14738/aivp.111.13717.
Pitkin, F., Brown, G., Lewis, D., Jacobs, S., Wray, C., Benjamin, C., & Williams, A. (2023). Assessment of Knowledge, Attitude and
Practice on Biomedical Waste Management Among Healthcare Workers at Approved Covid Testing Sites in Jamaica. European
Journal of Applied Sciences, Vol - 11(1). 218-227.
.
Services for Science and Education – United Kingdom
Assessment of Knowledge, Attitude and Practice on
Biomedical Waste Management Among Healthcare
Workers at Approved Covid Testing Sites in Jamaica
Fabian Pitkin
Assistant Professor/Chair,
Department of Medical Technology, Northern Caribbean University
Gillian Brown
Medical Technologists,
Department of Medical Technology, Northern Caribbean University
Danielle Lewis
Medical Technologists,
Department of Medical Technology, Northern Caribbean University
Sabrina Jacobs
Medical Technologists,
Department of Medical Technology, Northern Caribbean University
Chantal Wray
Medical Technologists,
Department of Medical Technology, Northern Caribbean University
Chrissanna Benjamin
Medical Technologists,
Department of Medical Technology, Northern Caribbean University
Abigail Williams
Medical Technologists,
Department of Medical Technology, Northern Caribbean University
ABSTRACT
For most developing countries the onset of the Covid -19 pandemic increased the
need for testing and subsequently, an increased in approved testing sites. Most sites
during the height of the pandemic, handled large quantities of biomedical waste.
Like all other biomedical wastes, those generated from the testing of Covid-19
patients, pose a significant risk for infection and injury when they are improperly
handled. Such infections can easily spread among healthcare personnel, patients,
visitors, and the wider society. This research aimed at highlighting the importance
of proper biological waste management (BWM) and investigating the knowledge,
attitude, and practice of healthcare workers as it relates BWM at approved covid
testing site in Jamaica. Healthcare workers at these testing sites are first contact
with infected patients and the resultant biomedical waste generated during the
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Pitkin, F., Brown, G., Lewis, D., Jacobs, S., Wray, C., Benjamin, C., & Williams, A. (2023). Assessment of Knowledge, Attitude and Practice on
Biomedical Waste Management Among Healthcare Workers at Approved Covid Testing Sites in Jamaica. European Journal of Applied Sciences, Vol
- 11(1). 218-227.
URL: http://dx.doi.org/10.14738/aivp.111.13717
testing process, as such their knowledge, attitude, and practices with regards to
appropriate BWM is crucial in understanding areas of potential spread of the deadly
infection. A cross-sectional study was carried out in which a valid three step self- reporting questionnaire was designed through a review of literature and was
distributed among 60 randomly selected healthcare workers at approved sites
across the island. The findings revealed that most (86.7%) HW had excellent
knowledge of proper biomedical waste management. In relation to their attitude,
most of the respondents (91.7%) indicated that the guidelines were necessary for
their own safety as well as for others. With respect to practices, majority (98.3%) of
the HWs indicated that they were compliant with the established standards for
biomedical waste management. Overall, training appears to be the major
determinant of knowledge, attitude, and practice among the participants.
Key Terms: Biomedical waste management, covid-19 testing sites, healthcare workers
INTRODUCTION
The term biomedical waste refers to the waste matter that id generated in health care facilities,
research centers, and medical laboratories during the course of diagnosis, treatment and
immunization of humans or animals as well as the production or testing of biological material.
They include human or animal tissue, blood as well as other body fluids. Additionally, this waste
also consists of pharmaceutical products, swabs or dressing syringes and sharps [1][3][4][7].
These biomedical wastes pose a high potential risk for infection and injury not only among
healthcare workers but also the environment as a whole [1[9]]. As such, it is imperative that
those persons working at the different covid testing sites have a proper knowledge on how to
treat, handle and dispose of these wastes as an improper knowledge on how to handle this
healthcare generated wastes can result in grave consequences [1][2][3]. Many issues arise
concerning healthcare waste when there is an absence of proper waste management, when
there is a lack of proper waste disposal, a lack of financial and human resources and also when
there is a lack of awareness of the dangers biomedical wastes can brin [2][3][4]. When these
wastes are improperly disposed of, diseases such as Tuberculosis, Hepatitis and AIDS can be
easily spread not only among healthcare personnel but also those who are waste handlers.
Additionally, contamination can not only occur among the sick and their visitors, but the
community at large where we find a vast number of wastes being deposited [2][4].
The proper handling, treatment and disposal of biomedical waste is very crucial, because if
improperly managed it poses a health hazard to those in direct contact with the waste due to
the risk of it containing potentially dangerous microorganisms and the increased risk of
infection transmission. [1][2].
Jamaica saw its first Covid 19 case on March 10, 2020, and since then the number of cases across
the island has been on the rise. Amidst the Covid 19 pandemic, and the efforts to subsequently
fight the virus an increasing amount of biomedical waste is being generated and as such there
is a need for proper biomedical waste management especially with regard to healthcare
workers. Healthcare workers are first in line when it comes to the handling of biomedical waste.
Consequently, their knowledge, attitude, and practices with regards to biomedical waste
management plays a very crucial role in assessing the risk of potential hazard to the worker,
the patients and to a larger extent the environment [2][3]. As such there is a pulsating need to
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European Journal of Applied Sciences (EJAS) Vol. 11, Issue 1, January-2023
Services for Science and Education – United Kingdom
assess the knowledge, practices, and attitudes about biomedical waste management among
healthcare workers at approved covid-19 testing sites in Jamaica.
The results of this study will assist the government of Jamaica in further planning as it continues
to take the appropriate actions to help mitigate problems related the management of covid-19
outbreaks.
LITERATURE REVIEW
Biomedical waste refers to contaminated or potentially contaminated matter that is generated
in health care facilities, research centers, and medical laboratories during the course of
diagnosis, treatment and immunization of humans or animals as well as the production or
testing of biological materials [1][3][4][5][7], including blood and other body fluids tissues,
swabs, needles, and other sharp objects [1][2]. Biomedical waste holds a high priority in waste
management due to its hazardous nature. Studies have shown that 10-25% of biomedical waste
are hazardous and affect humans and the environment [1][2][4][6]. These waste materials may
be potentially hazardous to person through direct contact and to the environment as they may
contain dangerous microorganism and may also result in the transmission of infection [1]4]. As
a result, proper biomedical waste management is critical to infection control. Biomedical waste
management involves managing the waste from the point of generation, through separation,
collection, transportation, treatment and eventually disposal [1]. Biomedical waste should be
properly managed, and every healthcare worker must have a working knowledge of biomedical
waste management to reduce the risk of transmitting infections and limit the harmful effects
its mismanagement may have on the environment. 3][5].
Covid 19 emerged in 2019 and was officially declared a pandemic by the World Health
Organization (WHO) in March 2020 [3]. The first case in Jamaica was confirmed on March 10,
2020, and since then the cases have increased drastically. This pandemic has resulted in an
increasing amount of biomedical waste [5][7] which has placed a burden on healthcare systems
worldwide, Jamaica’s healthcare system being no exception. Additionally, the pandemic has
resulted in different challenges to the existing regulations and practices with regards to
biomedical waste management worldwide [7]. Healthcare workers are first contact with an
infectious patient and with the handling of biomedical waste [3][6]. As such their knowledge,
attitude, and practices with regards to biomedical waste is critical to infection control and an
assessment of these variables could provide valuable information with regards to risk of
infection exposure and transmission. A lack of knowledge on how to properly handle, collect
and dispose biomedical waste, lack of awareness regarding the potential risk involved in the
mismanagement of biomedical waste as well as improper practices with regards to biomedical
waste among healthcare workers plays a very significant role in the mismanagement of
biomedical waste [2] [3][4]. According to the WHO, all individuals who come in close contact
with biomedical waste are potentially at risk from exposure to a hazard. These include
individuals working in health-care facilities that generate hazardous waste, and those who
either handle this waste or are exposed to it due to mismanagement. The increased production
of biomedical waste due to the pandemic is unpreventable as such healthcare workers must
give precedence to the safe handling, treatment, and disposal of these waste as to reduce
contamination [7][1].
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Pitkin, F., Brown, G., Lewis, D., Jacobs, S., Wray, C., Benjamin, C., & Williams, A. (2023). Assessment of Knowledge, Attitude and Practice on
Biomedical Waste Management Among Healthcare Workers at Approved Covid Testing Sites in Jamaica. European Journal of Applied Sciences, Vol
- 11(1). 218-227.
URL: http://dx.doi.org/10.14738/aivp.111.13717
Studies have shown that developing countries like Jamaica are at greater risk of occupational
exposure to hazardous biomedical waste and that about 90% of the healthcare workers are at
risk [1] [2]. A lack of awareness and training on how to efficiently handle biomedical waste can
contribute significantly to occupational exposure [1] [2]. Thus, to aid in the prevention of
exposure to potentially harmful microorganisms, healthcare workers must adhere to the
various guidelines on biomedical waste management [2] [4]. There is a financial burden on
healthcare systems globally - developing countries being impacted significantly with respect to
availability of resources for efficient management of biomedical waste and training and
retraining of workers on effective biomedical waste management. Consequently, the risk of
biomedical waste hazard is significantly increased [1][2]. This is predominantly as a result of
non-compliance with operational codes as well as a lack of formal training in environmental
health and safety awareness [1] [4]
The guidelines as established by the Center for Disease Prevention (CDC) proposes that
regardless of the status of the patient healthcare workers must follow strict adherence to the
universal precautions inclusive of wearing PPE (face shield, mask, gloves, and gowns), and
proper hand hygiene [2][5]. Since the emergence of the novel coronavirus the Ministry of
Health Jamaica, has published guidelines for healthcare workers to adhere to during the
collection of samples from patients suspected of having Covid-19. These include ensuring that
samples are collected in a properly ventilated room, the healthcare worker is donned with face
shield, disposable coats, gloves, and N95 respirator [2].
Every specimen that is collected at these testing sites for investigation must be treated as being
infectious potentially hazardous. It is also imperative that all healthcare workers who are
involved in the collection, transportation, handling, and disposal of these clinical specimens
follow strict adherence to the guidelines thus preventing possible exposure to pathogens. The
Covid-19 virus can survive on surfaces as well as mask and gloves. Therefore, healthcare
workers must have a working knowledge of the modes of transmission and the correct
techniques with regards to handling the biomedical waste. Additionally, they must practice safe
disposal in order to protect themselves and the environment [5][6].
RESEARCH DESIGN AND METHOD
The researchers investigated the Knowledge, Practice and Attitude about Biomedical Waste
Management among healthcare workers at Covid testing sites in Jamaica. To achieve the
objectives of this research, cross-sectional research was conducted.
As a means for collecting data for the investigation, a self-reporting questionnaire was used to
assess the knowledge, practice, and attitude about biomedical waste management among
healthcare workers at various Covid testing sites in Jamaica. This questionnaire was separated
into three (3) sections: Part A - Knowledge, Part B - Practice, and Part C - Attitude, which
included demographic questions, multiple choice questions, yes or no questions, and open- ended and closed-ended questions.
A questionnaire was selected as the main tool to collect information on this study as it is reliable
and can be completed in a short period of time. It is also confidential as it does not reveal the
identity of the participants and so allows for an honest response which will lead to a better
analysis of data.
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A total of one hundred (100) questionnaires were issued to healthcare workers at the various
approved covid testing sites in Jamaica and was conducted over a three (3) week period in the
month of February 2022.
Statistical Package for the Social Sciences (SPSS) version 28 was used for data entry and
analysis. Codes were assigned to differentiate between positively and negatively worded
responses. Descriptive statistics were used to describe the general sample characteristics, in
which frequency and percentage were used for categorical variables, while mean and standard
deviation were used for numerical variables. Pearson’s test was used to assess the correlation
between individuals with formal training and practice scores, while the one-way ANOVA was
used to assess the association between training, knowledge, and attitude scores and the Paired
t-test was used to assess the relation between training and practice scores. Significance level
was set at ≤ 0.05.
RESULTS
A total of 60 persons from different approved covid testing sites in Jamaica participated in the
study. The major of the respondents were females (90%), 41.7% of the respondents were
between ages 30 to 39, 35% were ages 18 to 29, 13.3% were ages 40 to 49 and 10% were over
49 years. Of the total, 63.3% were nurses, 23.3% were medical technologist, 6.7% were doctors,
6.7 % were classified as other. Based on the results gathered majority (86.7%) of the
respondents seemed to have working knowledge as to what constitute biomedical waste and
responded positively to questions related to the handling of same. Only a few respondents were
not entirely sure how to define biomedical waste and this was reflected in their responses to
questions regarding handling of same. Most of the participants (80.0%) stated that they had
received formal training.
Table 1 Distribution of respondents based on their overall score for knowledge of what
constitutes biomedical waste and how it should be managed (n=60)
Knowledge
Frequency Percent Valid Percent Cumulative
Percent
Valid 40.0 1 1.7 1.7 1.7
80.0 7 11.7 11.7 13.3
100.0 52 86.7 86.7 100.0
Total 60 100.0 100.0
Participants of this research were asked a few general questions assessing their knowledge
about medical waste. These questions involved asking them what containers they would store
sharps, what organization(s) maintains laws concerning biomedical waste and how much
should biomedical wastes be filled. The participants were also asked if they were aware of the
biohazard symbol of which the mass population (98.7%) knew the symbol while 1.7% of the
population were not aware of such symbol. They were asked to state the maximum time that
was required to store biomedical wastes before disposal of which there was variability in
responses, ranging from 1 day to 3 days, while some persons stated that it depends on the
temperature of the environment while others were not sure. They were also asked if they knew
the colour code for biomedical wastes and general wastes respectively. Based on the data
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Pitkin, F., Brown, G., Lewis, D., Jacobs, S., Wray, C., Benjamin, C., & Williams, A. (2023). Assessment of Knowledge, Attitude and Practice on
Biomedical Waste Management Among Healthcare Workers at Approved Covid Testing Sites in Jamaica. European Journal of Applied Sciences, Vol
- 11(1). 218-227.
URL: http://dx.doi.org/10.14738/aivp.111.13717
gathered, 99% of the population stated that they know the colour code for biomedical wastes
and 1% stated that they do not know the colour code for biomedical wastes; 99% stated that
they are aware of the colour code for general wastes with 1% of the population not knowing
the colour code for general waste. All positive/correct responses were scored at one point each
and negative/incorrect responses attracted a score of zero. When the scores were tallied 86.7%
of the respondents scored maximum points, 11.7% scored 80 out of 100 points, and 1.7%
scored 40 out of 100 points.
Table 2 Distribution of respondents based on their overall score for attitude towards
biomedical waste management (n=60)
Participants of this research were assessed on their attitude towards biomedical waste
management. Questions involved asking them if they believe that proper disposal of biomedical
waste is necessary, if they believe that it is necessary to label containers before placing wastes
in them, if they believe that biomedical wastes should be colour coded and if they believe that
improper waste management can be hazardous. Based on the results gathered, 95% stated that
they strongly agree that proper disposal of biomedical waste is necessary while the remaining
5% stated that they agree that it is necessary. Majority of the respondents, 81.7%, stated that
they strongly agree that it is important to label the containers before placing waste in them,
13.3% agreed while 5% were neutral. Concerning colour coding biomedical wastes, majority of
the respondents, 85% said they strongly agree that biomedical wastes should be colour coded
while 15% stated that they agreed. The study revealed that majority of the persons (95%)
strongly agreed that improper waste management can be hazardous, not only to themselves
but to the population at large, and the remaining 5% stated that they agreed that improper
waste management can be harmful to both themselves and to a greater extent the population.
The respondents were asked if they believe that heavy workload could reduce the time devoted
to proper waste management. Of the 60 respondents, 47.5% stated that they strongly agreed,
39% stated that they agreed, 8.5% were neutral, 3.45 disagreed while the remaining 1.4%
strongly disagreed. When asked if whether they believe that they were consistent with
following biomedical waste protocols, majority of the respondents strongly agreed that they
were (51.7%), 38.3% stated that they agreed while 10% was neutral. When the scores were
tallied 91.7% of the respondents scored maximum points, 6.7% scored 80 out of 100 points,
and 1.7% scored 60 out of 100 points.
Attitude
Frequency Percent Valid Percent Cumulative Percent
Valid 60.0 1 1.7 1.7 1.7
80.0 4 6.7 6.7 8.3
100.0 55 91.7 91.7 100.0
Total 60 100.0 100.0
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Table 3 Distribution of respondents based on their overall score for attitude towards
biomedical waste management (n=60)
Attitude
Frequency Percent Valid Percent Cumulative
Percent
Valid 60.0 1 1.7 1.7 1.7
80.0 4 6.7 6.7 8.3
100.0 55 91.7 91.7 100.0
Total 60 100.0 100.0
With regards to the practice of biomedical waste management, a variety of questions were
asked to assess if the participants were following the correct protocols. Participants were asked
if they wore PPE’s while handling biomedical waste. Seventy eight point three percent (78.3%)
stated that they always wear their PPEs, 16.7% stated that they wear it most of the time while
5% stated that they only wear it sometimes. Persons were also asked if they took practice in
using colour coded bags for the disposal of the various biomedical wastes they are being
exposed to of which 76.7% of the population stated that they always use colour coded bags,
18.3% stated that they use it most times, and 5% stated that they use colour coded bags
sometimes. As it concerns the labelling of biomedical waste containers, 70% stated that they
always label biomedical waste containers, 15% stated they label it most times, another 15%
stated that they label it sometimes. Participants were asked if they adhere to guidelines that
have been set by the Ministry of Health regarding biomedical waste management, 67.8% of the
participants stated that they always adhere to the guidelines that have been set, 28.8% stated
they follow the guidelines most of the time while 3.4% follow the guidelines only sometimes.
Persons were asked if they practiced proper hand hygiene before and after performing a
procedure of which 91.5% of the respondents stated that they always practice proper hand
hygiene while 8.5% indicated that they did most of the time. When the scores were tallied
98.3% of the respondents scored maximum points and 1.7% scored 80 out of 100 points.
Our results indicated that there were significant differences (p<0.05) among the respondents
with respect to their scores knowledge and practice of proper biomedical waste management
as determined by the paired T- Test. Females’ knowledge was significantly higher than that of
the males (97.1% and 93.3% respectively). Additionally, Medical Technologists and Nurses had
the highest average scores (97.3% and 97.0% respectively). As determined by one-way ANOVA
there was a statistically significance difference (p = 0.008) in knowledge scores of the
participants who received formal training when compared to those who had no formal training.
On the other hand, there was no statistically significant difference (p=0.101) in attitude scores
of the participants who received formal training when compared to those who had no formal
training. There was a very weak positive correlation (r = 0.065) between participants who were
formally trained and their practice scores.
DISCUSSION
The covid 19 pandemic saw significant increase in the amount of biomedical waste being
generated and it could be deduced that health care workers would have been potential
transmitters of the virus on account of the very high exposure rate. According to an article
published on The Lancet.com, when compared to the general population more health care
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Pitkin, F., Brown, G., Lewis, D., Jacobs, S., Wray, C., Benjamin, C., & Williams, A. (2023). Assessment of Knowledge, Attitude and Practice on
Biomedical Waste Management Among Healthcare Workers at Approved Covid Testing Sites in Jamaica. European Journal of Applied Sciences, Vol
- 11(1). 218-227.
URL: http://dx.doi.org/10.14738/aivp.111.13717
workers were tested positive for the Covid 19 virus. Health care workers are first in line with
the handling of infectious patients as well as biomedical waste [3]; consequently, their
knowledge, attitude and practices regarding biomedical waste could be strong indicators of the
risk they pose to the general population. A lack of knowledge on how to properly handle, collect
and dispose of biomedical waste, lack of awareness regarding the potential risk involved in the
mismanagement of biomedical waste as well as improper practices with regards to biomedical
waste among healthcare workers plays a very significant role in the mismanagement of
biomedical waste [2]. Studies have shown that developing countries like Jamaica are at greater
risk of occupational exposure to hazardous biomedical waste and that about 90% of the
healthcare workers are at risk. [10,11]. Consequently, the risk exposure due to improper
handling of biomedical waste significantly increased within pandemic such as Covid-19. A lack
of awareness and formal training on how to efficiently handle biomedical waste can contribute
significantly to occupational exposure [2]. Thus, to aid in the prevention of exposure to
potentially harmful microorganisms, healthcare workers must be adequately trained and at all
times comply with the established guidelines on biomedical waste management.
The study revealed that majority of the respondents had a clear knowledge of what biomedical
waste is and had a working knowledge on how to properly manage biomedical waste. However,
significant differences among the respondents with respect to their scores on knowledge and
practice of proper biomedical waste management indicates that persons were not always
compliant with guidelines delivered to them in formal training. Furthermore, it was observed
that those who had formal training had greater knowledge of biomedical waste management
which makes such indispensable. From the study, it was observed that majority of the health
care workers received formal training in biomedical waste management. It is imperative that
all healthcare workers be formally trained in biomedical waste management; this should be
emphasized as a lack of knowledge regarding biomedical waste management can impact
negatively not only on the healthcare workers, but also on the wider environment.
Biomedical waste should be properly managed, and every healthcare worker must be
knowledgeable on how to do this to reduce the risk of transmitting infections and limit the
harmful effects its mismanagement may have on the environment. [1[[5].
Concerning the practice of biomedical waste management among the healthcare workers at
approved testing sites in Jamaica, the results obtained showed that there is much room for
improvement. Areas that need urgent attention are the wearing of personal protective
equipment (PPEs) while handling patients and biomedical wastes, utilizing the correct colour
coding scheme storage of biomedical waste containers for disposal, and compliance with other
guidelines set by the Ministry of Health (MOH) Jamaica. In the current pandemic, it is very
important to comply with established guidelines the handling of biomedical waste as Covid-19
can be transmitted by way of inanimate objects that has been contaminated by the virus [1].
Consequently, it is important that an adequate personal protective measure be taken while
handling biomedical waste. Wearing gloves, face shield, and frequent handwashing are widely
recognized as practices which are effective in preventing the spread of cross-infection in
healthcare facilities [1]. Our results show that although some individuals did not receive formal
training, they were very compliant in the practices. Seeing that maximum compliance with
wearing PPEs while handling biomedical wastes was not indicated by all respondents, the
researchers have derived that there is a high possibility that some healthcare workers were
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potential transmitters of the disease since they are first in line to engage patients and are
frequent handlers of biomedical wastes. Discovering that only a small population were
consistent with labelling containers and adhering to guidelines, researchers are aware of the
grave implications this could have as the act of not labelling biomedical waste containers can
result in the disposal biomedical medical waste in the general waste bin, the contents of which
would not undergo sufficiently high-temperature incineration to inactivate the microbial agent,
and insufficient heating at the municipal incinerator may lead to further environmental
problems due to those pathogens [1].
Overall, the respondents had a good attitude towards biomedical waste management. There
were a few responses that did not show favourable viewpoint. Based on this information even
though some of the workers were not formally trained, they seem to have developed a good
attitude. From the data gathered, it is observed that the majority of responded believed that
they were consistent with following biomedical waste protocols. Researchers believe that this
could be due to the general fear associated with the life-threatening nature of the virus.
CONCLUSION
The COVID-19 pandemic has overwhelmed numerous medical facilities throughout Jamaica,
undoubtedly increasing the likelihood for some health care workers to become less than rigid
with their management of biomedical waste. This paper provided an overall assessment of the
knowledge, attitude, and practices about biomedical waste management among sixty (60)
healthcare workers at approved testing sites in Jamaica. After assessing each parameter, we
would have realized that even though most of the health care personnel at these sites are
formally trained in biomedical waste management, there is still room for improvement in
relation to their practices and attitude. Proper biomedical waste management systems can help
to produce a safer, cleaner, and healthier environment.
The researchers believe that the overall finding for approved testing sites were fair and with
additional training, the risk of transmission of infection can be significantly reduced. We
researchers recommends that the government make training mandatory at all testing sites and
conduct compliance assessments to ensure these health care professionals are doing their part
to stem the spread of the Covid -19 virus. Contribution to biomedical waste management also
helps individuals to stay compliant, stay environmentally responsible, protect patients and
staff, positively affect public health as well as improve operational efficiency.
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Pitkin, F., Brown, G., Lewis, D., Jacobs, S., Wray, C., Benjamin, C., & Williams, A. (2023). Assessment of Knowledge, Attitude and Practice on
Biomedical Waste Management Among Healthcare Workers at Approved Covid Testing Sites in Jamaica. European Journal of Applied Sciences, Vol
- 11(1). 218-227.
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