The Effectiveness of Educational Interventions in Improving Waste Management Knowledge, Attitudes, and Practices among Healthcare Workers: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Search Strategy
2.3. Eligibility Criteria
2.4. Article Screening and Study Selection
2.5. Quality Appraisal
2.6. Data Extraction
2.7. Interventions and Assessment Methods
2.8. Data Synthesis and Statistical Analysis
3. Results
3.1. Articles Included
3.2. Characteristics of Studies Included
3.3. Types of Educational Interventions to Improve Waste Management among HCWs
3.3.1. Mono-Component Educational Interventions
Lessons
Audits
Technology
3.3.2. Multi-Component Educational Interventions
Lessons and Training
Lessons/Audits and System Change
Lessons, Training, and Reminders
Lessons, Training, System Change, and Reminders
3.4. Assessment of Educational Interventions to Improve Waste Management among HCWs
3.5. Study Quality
3.6. Efficacy of Educational Interventions to Improve Waste Management among HCWs
3.6.1. Efficacy of Educational Interventions in Improving Knowledge among HCWs
3.6.2. Efficacy of Educational Interventions in Improving Practices among HCWs
3.6.3. Efficacy of Educational Interventions in Improving Attitudes among HCWs
3.7. Publication Bias and Sensitivity Analyses
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Author(s) (Country, Year) Quality | Study Design | Setting (s) | Participants (n) | Intervention (Duration/Time of Assessment) | Assessment Tool or Method (Self-Reported/Observed) | Main Results |
---|---|---|---|---|---|---|
Abdo et al. [40] (Kuwait, 2019) Moderate | Pre–post | Tertiary Hospital | Environmental workers (n = 102) | Multi-component (Lessons, training, and reminders) 3 days/3 months | Ad hoc KAP questionnaire Structured checklist (Self-reported and observed) | Improvement in all aspects of KAP regarding infectious and sharps wastes after intervention (p < 0.01) |
Ahmed et al. [41] (India, 2018) Moderate | Pre–post | Tertiary Hospital | Healthcare workers (n = 100) | Mono-component (Lessons) 1 day/immediate | Ad hoc KAP questionnaire (Self-reported) | Significant improvement in waste management after intervention; BMW disposal improvement was particularly highly significant (p < 0.001) |
Ara et al. [42] (Bangladesh, 2015) Weak | Pre–post | Community Hospital | Nurses (n = 96) | Multi-component (Lessons and training) Not reported | Ad hoc KAP questionnaire Structured checklist (Self-reported and observed) | Compliance to waste segregation improved significantly after intervention (p < 0.001) |
Ara et al. [43] (Bangladesh, 2022) Weak | Pre–post | Tertiary Hospital (n = 4) Community Hospital (n = 3) Primary Hospital (n = 2) | Healthcare workers Environmental workers (not reported) | Multi-component (Lessons, training, and system change) 6 months/3 months | Structured checklist (Observed) | Significant improvement in waste segregation, use of PPE during waste transportation, compliance with standardized methods for collection, transportation, and disposal (p < 0.001) |
El-Gilany et al. [44] (Egypt, 2017) Strong | Pre–post | Tertiary Hospital | Laboratory technicians (n = 20) | Mono-component (Lessons) 3 days/2 months | Ad hoc KAP questionnaire (Self-reported) | Significant improvements in knowledge (p = 0.01), attitudes (p = 0.013), and practices regarding waste management (p = 0.01) |
Elnour et al. [45] (Sudan, 2015) Strong | Pre–post | Tertiary Hospital (n = 3) | Nurses Environmental workers (n = 100) | Mono-component (Lessons) (15 days/immediate and at 3 months) | Ad hoc KAP questionnaire (Self-reported) | Moderate improvement in knowledge of waste management in immediate post-test period and at three months Scarce improvement in waste management practices in immediate post-test period after intervention, and moderate improvement at three months |
Fraifeld et al. [46]. (USA, 2021) Weak | Pre–post | Tertiary Hospital | Anesthesia staff (n = 172) | Multi-component (Lessons and system change) (15 min/6 weeks) | Previously used KAP questionnaire Weight of segregated waste (Self-reported and observed) | Significant increase in overall knowledge of waste management (p < 0.001), particularly in vial disposal, medication disposal, and sharps disposal (p < 0.05); significant decrease in overall weight of regulated healthcare waste (p < 0.001) |
Hosny et al. [47] (Egypt, 2018) Moderate | Pre–post | Tertiary Hospital | Environmental workers (n = 365) | Mono-component (Lessons) (Not reported) | Ad hoc KAP questionnaire Structured checklist (Self-reported and observed) | Significant increase in knowledge was detected (p < 0.001), except for items related to necessity to segregate healthcare waste, color coding system, disposal of general waste, and disposal of infectious waste; significant increase in waste management practices (p < 0.001) |
Jarvis et al. [48] (USA, 2009) Weak | Pre–post | Mixed (Hospitals and Primary Care) | Pharmacists (n = 158) | Mono-component (Lessons) (1 newsletter/3 months) | Ad hoc KAP questionnaire (Self-reported) | Significant improvement in perception of environmental problems connected to inappropriate medication disposal (p = 0.03) and methods of correct disposal (p < 0.01) |
Johnson et al. [49] (El Salvador, 2013) Moderate | Pre–post | Tertiary Hospital | Healthcare workers Environmental workers (n = 86) | Mono-component (Lessons) (20 min/1 year) | Ad hoc KAP questionnaire Weight of infectious waste (Self-reported and observed) | Significant improvement in knowledge of waste management (p = 0.012) and significant reduction in infectious waste disposal (p < 0.001) |
Joseph et al. [50] (India, 2015) Moderate | Pre–post | Tertiary Hospital | Healthcare workers (n = 90) | Mono-component (Audits) (2 months/3 years) | Structured questions (Self-reported and observed) | Improvement in segregation of cytotoxic drugs (p < 0.05), sharps, infectious plastic, and use of color bags for healthcare waste segregation |
Krishnan et al. [51] (India, 2015) Moderate | Pre–post | Mixed (Hospitals and Primary Care) | Healthcare workers (n = 1083) | Multi-component (Lessons and training) (Not reported/immediate) | Ad hoc KAP questionnaire (Self-reported) | Significant improvement in knowledge of waste management for all participants (p < 0.001) |
Kumar et al. [52] (Pakistan, 2015) Strong | Case-control | Tertiary Hospital | Healthcare workers Environmental workers (n = 138) | Multi-component (Lessons, training, and reminders) (3 months/3 months) | Modified WHO tool (Self-reported) | Significant improvement in knowledge, attitudes, and practices (p < 0.01) in both healthcare and environmental workers |
Kumar et al. [53] (Pakistan, 2016a) Weak | Case-control | Tertiary Hospital | Healthcare workers Environmental workers (n = 127) | Multi-component (Lessons, training, and reminders) 3 months/ 3 and 18 months) | Modified WHO tool (Self-reported) | Significant differences in knowledge, attitudes, and practices after 18 months compared to baseline (p < 0.001); these were retained over time by both healthcare and environmental workers |
Kumar et al. [54] (Pakistan, 2016b) Moderate | Case-control | Tertiary Hospital | Physicians Nurses and paramedics (n = 222) | Multi-component (Lessons, training, and reminders) (3 months/ 3 and 18 months) | Modified WHO tool (Self-reported) | Nurses and paramedics showed better knowledge and practices compared to physicians; they retained higher level of knowledge than physicians, who achieved and retained positive attitudes towards waste management after intervention |
Ozder et al. [55] (Turkey, 2013) Moderate | Pre–post | Mixed (Hospitals and Primary Care) | Healthcare managers (n = 240) | Multi-component (Lessons and training) (3 days/not reported) | Ad hoc KAP questionnaire (Self-reported) | Significant differences were found among managers who received healthcare waste management training and those who had not (p < 0.01); knowledge of managers who received healthcare waste management training improved significantly after intervention (p < 0.001) |
Robat et al. [56] (Iran, 2022) Strong | Case-control | Tertiary Hospital | Healthcare workers Environmental workers (n = 128) | Multi-component (Lessons and training) (2 months/3 months) | Ad hoc KAP questionnaire (Self-reported) | Significant changes were shown in knowledge, attitudes, self-efficacy, beliefs, and motivation (p < 0.001); specifically, behavioral intentions toward waste management improved (p = 0.001) |
Rohilla et al. [57] (India, 2021) Moderate | Retrospective | Tertiary Hospital | Healthcare workers (n = 450) | Multi-component (Lessons and training) (3 h/immediate) | Modified WHO tool Structured checklist (Self-reported and observed) | Significant increase in cognitive domain score from pre-test to post-test periods (p < 0.05) Overall change in psychomotor domains for all healthcare workers involved in intervention (p < 0.05) |
Sapkota et al. [58] (Nepal, 2014) Strong | Pre–post | Tertiary Hospital | Healthcare workers Environmental workers (n = 40) | Multi-component (Lessons, training, system change, and reminders) (Not reported/8 months) | Individualized Rapid assessment tool (Self-reported and observed) | Significant improvement from 26% pre-test to 86% post-test regarding waste management practices evaluation score |
Shaheen et al. [59] (Pakistan, 2020) Moderate | Pre–post | Tertiary Hospital | Nurses (n = 64) | Multi-component (Lessons and training) (3 days/1 month) | Ad hoc KAP questionnaire Structured checklist (Self-reported and observed) | Significant improvement in knowledge (p = 0.001) after intervention; one month after training sessions, practices showed significant improvement (p < 0.001) |
Singh et al. [60] (India, 2020) Weak | Pre–post | Tertiary Hospital | Nurses Laboratory technicians (n = 250) | Multi-component (Lessons and training) (1 day/immediate) | Ad hoc KAP questionnaire (Self-reported) | Significant improvement in knowledge about healthcare waste management and handling (p < 0.001) after intervention |
Tabash et al. [61] (Palestine, 2016) Moderate | Pre–post | Tertiary Hospital (n = 5) | Healthcare workers Environmental workers (n = 530) | Multi-component (Lessons and training) (3 h/immediate and at 6 months) | Ad hoc KAP questionnaire (Self-reported) | Significant improvement in knowledge, attitudes, and practices of staff regarding pharmaceutical waste management (p < 0.001) |
Tabrizi et al. [62] (Iran, 2019) Strong | Clinical audit cycle | Primary Care Community Health Centers (n = 87) | Healthcare workers Environmental workers (not reported) | Multi-component (Audits, system change, and reminders) (1 year/4 months) | Adherence of existing status with standards (Observed) | Adherence to healthcare waste management standards experienced 30% improvement after interventions; greatest improvements were for waste management, education, and separation and collection of healthcare waste, increasing from 28 to 30% |
Wu et al. [63] (Taiwan, 2021) Moderate | Pre–post | Tertiary Hospital | Physicians Laboratory technicians (n = 96) | Mono-component (Technology) (1 day/immediate) | Accuracy rate and time to complete the scenario (Self-reported and observed) | Significant improvement in accuracy as well as shorter time to complete scenario among junior physicians and male trainees compared to junior laboratory technicians |
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Conti, A.; Viottini, E.; Comoretto, R.I.; Piovan, C.; Martin, B.; Albanesi, B.; Clari, M.; Dimonte, V.; Campagna, S. The Effectiveness of Educational Interventions in Improving Waste Management Knowledge, Attitudes, and Practices among Healthcare Workers: A Systematic Review and Meta-Analysis. Sustainability 2024, 16, 3513. https://doi.org/10.3390/su16093513
Conti A, Viottini E, Comoretto RI, Piovan C, Martin B, Albanesi B, Clari M, Dimonte V, Campagna S. The Effectiveness of Educational Interventions in Improving Waste Management Knowledge, Attitudes, and Practices among Healthcare Workers: A Systematic Review and Meta-Analysis. Sustainability. 2024; 16(9):3513. https://doi.org/10.3390/su16093513
Chicago/Turabian StyleConti, Alessio, Elena Viottini, Rosanna Irene Comoretto, Chiara Piovan, Barbara Martin, Beatrice Albanesi, Marco Clari, Valerio Dimonte, and Sara Campagna. 2024. "The Effectiveness of Educational Interventions in Improving Waste Management Knowledge, Attitudes, and Practices among Healthcare Workers: A Systematic Review and Meta-Analysis" Sustainability 16, no. 9: 3513. https://doi.org/10.3390/su16093513