| dc.description.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. | en_US |
