Clinical laboratory waste management in Masaka region, Uganda: a cross sectional study on practices and associated factors among laboratory personnel

Abstract

Introduction: As evidence-based medicine picks pace in Uganda, clinical laboratory diagnosis is increasingly gaining prominence. With this comes an increase in waste generated by clinical laboratories. Improper management of this waste at generation, segregation, collection / storage, transportation and disposal could lead to disease transmission and other public health threats.

Objective: To assess clinical laboratory waste management practices and factors associated with segregation among laboratory personnel in health facilities in Masaka region, Uganda.

Methods: This was a cross-sectional study among 145 laboratory personnel in 60 health facilities. Structured questionnaires, observational checklists and in-depth interview tool were used. Theory of planned behavior (TPB) constructs together with sociodemographic characteristics (e.g. age and sex), institutional and operational factors (e.g. health facility level, presence of waste management manuals, waste management plans, laboratory log books and job aids, training and orientation of staff etc.) were independent variables. Univariable analysis was done using descriptive statistics. Internal reliability of TPB constructs was assessed using Cronbach’s alpha and mean scores computed for each construct. Multiple logistic regression (p≤0.05, 95% confidence level) was used to determine factors associated with segregation. Deductive thematic analysis was used to explain the motivators and barriers to good practices.

Findings: Majority (76.7%) of laboratories had suitable containers for waste segregation but proper segregation was in 38.3% of laboratories. Most personnel, 101 (69.7%), did not segregate CLW and the majority were in health centers II laboratories. Personnel who did not segregate waste had spent more years at work than those who did (t-test, p = 0.02). Disposal of liquid samples and reagents in water sinks was in 77.6% and 58.4% of the laboratories respectively. Only 38.6% of facilities had ever given training on any form of HCWM and test log books were kept in only 27.6% of laboratories. Waste management plans were found in 12% of laboratories. In addition, majority (49.3%) of personnel had fair knowledge on CLWM. Intention construct had the most strength in influencing practices (r = 0.852, p<0.05). Age [Adj. PR = 0.96: 95% CI: 0.92 – 0.99], knowledge [Adj. PR = 1.31: 95% CI: 1.06 – 2.69]; disposal instructions posted in the laboratory [Adj. PR = 1.11: 95% CI: 1.01 – 2.25]; training on hospital waste management [Adj. PR = 1.74: 95% CI: 1.73 – 3.31]; job descriptions with tasks [Adj. PR = 1.33: 95% CI: 0.73 – 2.42]; and presence of guidelines [Adj. PR = 2.71: 95% CI: 1.38 – 6.72] were associated with CLW segregation.

Conclusions and recommendations: Possession of CLWM facilities does not translate into segregation and lower facility level laboratories have poor segregation practices. Tracability of tests and disposal of liquid samples and reagents is poor. CLWM knowledge and job aids are still inadequate. We recommend targeted training, supervision, legal enforcement and increased investment in CLWM facilities as well as research into affordable technologies in CLW reduction and disposal.