When Medical Waste Handling Goes Wrong

Infection Control TodayInfection Control Today, Nov 2019 (Vol. 23 No. 9)
Volume 23
Issue 9

Healthcare workers face unique occupational hazards. In what other field can an employee so readily experience burnout, chemical exposure, and sharps injuries that introduce pathogens to the body? Now, a new study has further bolstered the list of healthcare workers’ concerns, suggesting that medical waste handlers are at increased risk of hepatitis B virus (HBV).

Recently published in the American Journal of Infection Control, the meta-analysis of 9 cross-sectional studies found that although just 3 of the papers revealed statistically significant relationships between HBV and medical waste handling, the pooled odds ratios for all studies showed a significant association overall. The chances of a medical waste handler contracting HBV were higher in Africa than elsewhere, likely due to insufficient infection control knowledge, according to the study.

“This meta-analysis documented an urgent problem, especially in African healthcare settings. This problem is potentially preventable if the right precautions are taken,” study co-author Ahmed Arafa, MBBCh, MS, a PhD student at Osaka University in Japan, told Infection Control Today via email. “Of note, we detected a weaker association between medical waste collection and HBV in studies conducted in non-African health settings- with better infection control programs-than studies conducted in African ones.”

Why Infection Control and Prevention Must Prevent HBV

Public health officials take great issue with HBV for several reasons. For one, according to the study, the virus affects 240 million patients globally each year, particularly in sub-Saharan Africa and Southeast Asia. With high morbidity and mortality rates, acute HBV infection stole more than 165,000 years to disability and resulted in 111,000 deaths, according to the World Health Organization. The virus also raises
economic costs, touching everything from outpatient expenses to hospital admissions for related disease.

Because HBV infects people primarily through infected blood and bodily fluids and requires only limited exposure to wreak havoc, healthcare workers are at risk of contracting the virus. What’s more, as many as 66,000 HBV cases per year stem from lapses in sharps safety, according to the meta-analysis.

How Hospitals Can Take Action

The problem is especially pronounced for medical waste handlers, Arafa said. As a physician in Egypt, he saw many of these individuals, who typically work on temporary hospital contracts, neglect to don personal protective equipment.

In a prior study, Arafa analyzed the knowledge, attitude, and practice of healthcare workers, including medical waste handlers, and came to concerning conclusions.

“I found that medical waste collectors had suboptimal knowledge, negative attitude, and careless practice,” he said. “Therefore, it was, somehow, predicted that medical waste handlers may carry the heaviest burden of blood-borne hospital-acquired infections.”

In Africa, where the risk of HBV to medical waste handlers is higher, it’s clear that leaders throughout the hospital should place more importance on infection control, Arafa noted. The sense of responsibility must extend into the C-suite.

But in countries where infection control is more advanced, infection preventionists and health system administrators can also do more to protect medical waste handlers-and thus patients-from the scourge of HBV.

“I think that the first step is to emphasize... the fact that medical waste handlers are part of the medical staff, and therefore they should receive protective equipment, free vaccines, and awareness programs, just like physicians, nurses, and lab technicians,” Arafa said.


Arafa A, Eshak ES. Medical waste handling and hepatitis B virus infection: A meta-analysis. Am J Infect Control. 2019 Sep 11. doi: 10.1016/j.ajic.2019.08.011.

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