Occupational biohazard exposure during patient waste management: PPE use, reporting practices, and systemic barriers...

Nurses face occupational exposure risks during patient waste management, yet this aspect of nursing practice remains understudied. This study examined personal protective equipment (PPE) use during patient waste management and explored the behavioural, organizational, and environmental factors influencing adherence to infection prevention practices.

A mixed-methods national survey of nurses (N = 683) was conducted. Quantitative data were analysed using Kruskal-Wallis and χ² tests, while open-ended responses underwent thematic analysis. Associations between PPE-related practices and demographic and organizational characteristics were examined to identify patterns in protection, reporting, and risk perception.

Glove use was nearly universal; however, face masks, gowns, eye protection, face shields, and respirators were used less consistently during waste-management activities. Quantitative and qualitative findings identified barriers, including limited PPE accessibility, time constraints, discomfort, and reliance on perceived rather than actual risk. Nurses frequently described splash exposures as routine, and many reported greater willingness to report needlestick injuries than splash or spill exposures. Infrastructure limitations, including poorly located utility rooms and limited mitigation devices, further contributed to inconsistent protective practices.

Patient waste management represents an underrecognized source of occupational biohazard exposure in nursing care. PPE adherence is influenced by interacting behavioural, cultural, organizational, and environmental factors. Findings highlight the importance of addressing exposure desensitization, improving reporting practices, strengthening access to PPE and mitigation technologies, and fostering a safety culture that supports consistent adherence to infection prevention protocols.