Determinants of improper healthcare waste segregation in a Tertiary Referral Hospital in Southern Rwanda: a cross-sectional study

Healthcare services generate both infectious and non-infectious waste, which must be separated at the source to ensure proper disposal. When the segregation is not well done, the mixed waste may spread infections to people and to the environment. This study aimed to assess the determinants of improper healthcare waste (HCW) segregation at a Tertiary Referral Hospital in Southern Rwanda. From October to December 2023, a cross-sectional study was conducted using direct observations and a structured checklist. Waste segregation was classified as proper or improper, with independent variables including hospital departments and segregation facilities. Logistic regression was used to identify factors influencing improper segregation, with significance set at 0.05. Healthcare waste segregation performance varied by department, with the Intensive Care Unit achieving the highest rate (69%), and Internal Medicine having the lowest (55%). Internal Medicine had a significantly higher probability of inappropriate segregation (AOR: 1.887, 95% CI: 1.011-3.588, p = 0.048). The lack of infectious waste bins (AOR: 2.273, 95% CI: 1.656-3.118, p = 0.001) and non-infectious waste bins (AOR: 1.476, 95% CI: 1.045-2.086, p = 0.027) increased the likelihood of improper segregation. The presence or absence of red or black plastic bags in waste bins had no significant effect on HCW segregation performance. Inadequate healthcare waste segregation was common, particularly in Internal Medicine. Designated waste bins increased segregation, whereas color-coded bags had little effect. Improving infrastructure and ensuring the consistent availability of appropriate waste bins are essential to enhance waste segregation and reduce associated health hazards.