Infectious Healthcare Waste Management Practices and Associated Factors Among Waste Handlers in Addis Ababa,...

Infectious healthcare waste (IHCW) poses significant risks to healthcare workers, waste handlers, patients, and the environment. Despite growing awareness, suboptimal waste management practices remain common in Ethiopia, particularly among frontline waste handlers directly exposed to infectious materials. This study aimed to assess the magnitude of proper IHCW management practices among waste handlers in health facilities in Addis Ababa and to identify factors associated with these practices.

A facility-based cross-sectional study was conducted from July 1 to August 30, 2023, among healthcare waste handlers in selected public and private health facilities in Addis Ababa, Ethiopia. Health facilities were selected using proportional allocation and simple random sampling. A total of 422 waste handlers were sampled from the selected facilities using proportional allocation followed by simple random sampling, of whom 379 participated in the study. Data were collected using a structured interviewer-administered questionnaire, a direct observation checklist, and a review of relevant waste management documents. Descriptive statistics were used to summarize infectious healthcare waste management practices, and bivariable and multivariable binary logistic regression analyses were performed to identify factors associated with proper infectious healthcare waste management practices. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, and statistical significance was declared at p < 0.05.

Overall, 218 of 379 waste handlers (57.5%; 95% CI: 52.4%-63.1%) demonstrated proper infectious healthcare waste management (IHCWM) practices. Most facilities had designated waste storage areas (349/379, 92.1%) and separate containers for hazardous and non-hazardous waste (350/379, 92.3%). However, gaps were observed in waste labeling, the appropriate placement of waste containers, and the use of protective footwear among waste handlers. In multivariable logistic regression analysis, work experience of 3-5 years (AOR = 0.56; 95% CI: 0.33-0.97), awareness of healthcare waste management guidelines (AOR = 2.35; 95% CI: 1.21-4.57), availability of adequate personal protective equipment (PPE) (AOR = 0.59; 95% CI: 0.35-0.97), and reporting occupational injuries to management (AOR = 0.50; 95% CI: 0.28-0.92) were significantly associated with proper IHCWM practices.

Although more than half of the waste handlers practiced proper IHCW management, critical gaps remain in training, guideline implementation, and PPE provision. Strengthening institutional policies, providing targeted training, and ensuring consistent availability of PPE are essential for improving occupational safety and promoting effective healthcare waste management in Addis Ababa.