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Background <p>Biomedical waste management (BMW) is critical for public health and environmental protection. Training programs often assess knowledge but rarely evaluate translation to workplace practice. The study assessed knowledge, attitudes, and practices of BMW and explore perceived barriers to compliance using Kirkpatrick framework.</p> Methods <p>A sequential explanatory study was conducted at a tertiary hospital in North India. Phase-I surveyed 250 healthcare workers via structured questionnaire to assess KAP corresponding to Kirkpatrick Levels 1–2, response rate 87.7%. Level 1 was inferred from questions on perceived usefulness and relevance of training. Phase-II conducted 12 face-to-face semi-structured interviews with purposively sampled staff from high BMW-generating departments until thematic saturation. Interviews explored self-reported behaviour and perceived organizational outcomes corresponding to Levels 3–4. Quantitative data were analyzed descriptively. Qualitative data were analyzed by content analysis in QDA Miner Lite v3.0.7 with independent coding by two researchers. Integration was achieved at interpretation stage via joint display, and meta-inference per GRAMMS guidelines.</p> Results <p>Participants were predominantly female (75.2%). 58% were nursing staff/trainees/BMW handlers. High awareness was observed for BMW rules 97.2% and color-coding 98.0%, but practice gaps persisted: only 68.4% used full PPE, 71.1% used hub-cutters, and 66.8% knew 1% sodium-hypochlorite preparation. Qualitative analysis identified four domains: Level 1-Reaction: training perceived useful but short; Level 2-Learning: high knowledge but skill gaps; Level 3-Behavior: self-reported compliance undermined by understaffing, turnover, lack of supervision; Level 4-Results (perceived): vaccination achieved but audits and injury reduction absent per participant perception. Integration showed positive reaction and learning were associated with, but did not consistently translate to, self-reported behaviour due to systemic barriers.</p> Conclusion <p>Despite high awareness, self-reported compliance was suboptimal. Perceived gaps in training, enforcement, staffing, and accountability were associated with limited knowledge-to-practice translation. Participants perceived organizational outcomes remained limited. Refresher training, workforce stabilization, and supervisory audits may be needed for safety outcomes.</p>

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A sequential explanatory study on knowledge, attitudes, and practices of biomedical waste management among healthcare workers using a Kirkpatrick framework

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月9日

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  • Poonam Kushwaha,
  • Nilanjan Dam,
  • Saket Shekhar,
  • Satya Prakash Singh

摘要

Background

Biomedical waste management (BMW) is critical for public health and environmental protection. Training programs often assess knowledge but rarely evaluate translation to workplace practice. The study assessed knowledge, attitudes, and practices of BMW and explore perceived barriers to compliance using Kirkpatrick framework.

Methods

A sequential explanatory study was conducted at a tertiary hospital in North India. Phase-I surveyed 250 healthcare workers via structured questionnaire to assess KAP corresponding to Kirkpatrick Levels 1–2, response rate 87.7%. Level 1 was inferred from questions on perceived usefulness and relevance of training. Phase-II conducted 12 face-to-face semi-structured interviews with purposively sampled staff from high BMW-generating departments until thematic saturation. Interviews explored self-reported behaviour and perceived organizational outcomes corresponding to Levels 3–4. Quantitative data were analyzed descriptively. Qualitative data were analyzed by content analysis in QDA Miner Lite v3.0.7 with independent coding by two researchers. Integration was achieved at interpretation stage via joint display, and meta-inference per GRAMMS guidelines.

Results

Participants were predominantly female (75.2%). 58% were nursing staff/trainees/BMW handlers. High awareness was observed for BMW rules 97.2% and color-coding 98.0%, but practice gaps persisted: only 68.4% used full PPE, 71.1% used hub-cutters, and 66.8% knew 1% sodium-hypochlorite preparation. Qualitative analysis identified four domains: Level 1-Reaction: training perceived useful but short; Level 2-Learning: high knowledge but skill gaps; Level 3-Behavior: self-reported compliance undermined by understaffing, turnover, lack of supervision; Level 4-Results (perceived): vaccination achieved but audits and injury reduction absent per participant perception. Integration showed positive reaction and learning were associated with, but did not consistently translate to, self-reported behaviour due to systemic barriers.

Conclusion

Despite high awareness, self-reported compliance was suboptimal. Perceived gaps in training, enforcement, staffing, and accountability were associated with limited knowledge-to-practice translation. Participants perceived organizational outcomes remained limited. Refresher training, workforce stabilization, and supervisory audits may be needed for safety outcomes.