Assessment of Knowledge, Attitude and Practices related to Biomedical Waste Management among Undergraduate Students: A Questionnaire-based study

Assessment of Knowledge, Attitude and Practices related to Biomedical Waste Management among Undergraduate Students: A Questionnaire-based study Dr. Aditi Tiwari 1, Dr. Madhu Sweta Jain 2 , Dr. Ananya C. Tripathi 3 Ritika Tiwari 4 [email protected] 1 ,[email protected] 2 , [email protected] 3 , [email protected] 4 Abstract— Background: To ascertain Knowledge, Attitude and Practices of Orthodontic Undergraduate students (I/II/III) regarding biomedical waste management protocol and to compare Knowledge, Attitude and Practices of Undergraduate Dental Students Aim of Study: To assess Knowledge, Attitude and Practices related to Biomedical Waste Management among Undergraduate Dental Students. Methods and Materials: ▪ A self-designed English language questionnaire were used for this study. 20 questions were formulated to assess the knowledge, attitude & practice of Biomedical Waste Management among Undergraduate Dental Students. The questions were validated for content by senior faculty of Institute. Suggestions were incorporated & questionnaire was modified accordingly. ▪ The questionnaire were sent via google forms to for collection of responses. A consent form was attached along with the questionnaire containing brief description of the study. ▪ Data sheet was prepared for all the responses received to ascertain the results. Result: There were in total 207 responds. Two respondents (1.0%) scored 0, while 12 respondents (5.8%) scored 1. The scores were distributed as follows: 25 respondents (12.1%) scored 2, 47 respondents (22.7%) scored 3, 59 respondents (28.5%) scored 4, 34 respondents (16.4%) scored 5, and 28 respondents (13.5%) scored 6.Red,Yellow,Blue and White dustbins were used as main criteria under which waste segregation was done. Keywords: Biomedical waste, infection control, dental students, interns. I. Introduction Biomedical waste management affects public health and environmental safety, particularly within healthcare sectors. Orthodontic practices generate diverse types of biomedical waste, including sharp objects such as ligature ties and wires, which, if improperly handled, can pose serious health risks[7]. Effective disposal and segregation practices are essential to prevent the spread of infectious agents and ensure compliance with regulatory standards. Despite the existence of well-defined protocols, the lack of awareness and adherence to the proposed guideline, especially among undergraduate dental students highlights a pressing need for educational initiatives in this context and necessitate strict enforcement measures. This study aims to explore the knowledge, attitudes, and practices of dental students toward biomedical waste management while identifying common challenges and proposing actionable solutions. By addressing issues such related to inadequate training, improper segregation, and non-compliance with guidelines, we can foster responsible waste management practices that protect both human health and the environment[1]. The emphasis is on raising awareness through educational tools, enforcing regulations, and enhancing infrastructural support to mitigate risks associated with biomedical waste in orthodontic settings. Management of Regulated Medical Waste in Dental HealthCare Facilities are done by use of color coded or labeled container[2]. Orthodontic armamentarium encompasses a wide range of materials and wires and sharp materials that require to be disposed off in appropriate bags to prevent accidental/occupational hazard. Handling, segregation, mutilation, disinfection, storage, transportation and final disposal are vital steps for safe and scientific management of biomedical waste management dental and orthodontic setup[5]. II. Methods and Materials This study was a cross-sectional survey done on undergraduate dental students of a renowned dental college of Navi Mumbai region. A detailed questionnaire was developed with questions designed to gauge the knowledge, attitude, and practice about the biomedical waste disposal in clinical setup. The questionnaire consisted of four sections. First was designated to collect basic demographic details such as age, gender and year of study. Second section was attitude section consisting of 5 multiple choice questions (MCQs) followed by knowledge section consisting of 14 MCQs which terminated with 6 practice based questions in MCQ format. Inclusion criteria consisted of consenting individuals belonging to third year, final year BDS and/or internship period and those who do not give consent for the study were excluded from the study. III. Questionnaire A self-designed, structured, pre-validated English language questionnaire was used for the study. The questionnaire comprised of Knowledge, Attitude and Practice related to Biomedical Waste Management of armamentarium used routinely in Orthodontics. A self-designed English language questionnaire was used for the study. The questionnaire content validity was done by 10 subject experts. Ambiguous questions if any were modified and the essential items were retained. The questionnaire was pilot tested on 10 individuals. Biomedical Waste Management for Orthodontic armamentarium could be considered as an unexplored niche often paid less attention from an academic and clinical perspective at times. Appropriate training is of utmost importance to foster an environment conducive for efficient handling of Biomedical Waste of dental operatory in practice. Orthodontic armamentarium comprising of sharps and wide array of wire materials and framework that could cause potential health hazard if not addressed in a proper manner as per the proposed guidelines[3]. Orthodontic armamentarium usually is less familiar to most general dentists and associate staff. It requires more awareness and educational program for efficient implementation IV. Participant Characteristics Between 26 November 2024 and 17 December 2024, 207 undergraduate dental students completed the online questionnaire. All records included an electronic consent statement and were 100 % complete, with no item-level omissions. The Google-Form template used for data collection did not request age, gender, academic-year, or geographic information, so demographic stratification could not be undertaken; this constraint is acknowledged as a methodological limitation for subsequent analyses. A single duplicated personal identifier was detected, but examination of time-stamps and response patterns confirmed that it represented two distinct submissions; therefore, all 207 records were retained for analysis in accordance with the a-priori plan (complete-case approach). The survey collected a total of 207 responses, with all questionnaires being fully completed. Only one instance of a duplicate identifier was detected, accounting for 0.5% of the responses. There was no item-level missing data reported in the survey. However, demographic variables such as age, gender, academic year, city, and state were not captured in the survey due to their exclusion from the Google Form used for data collection. As a result, demographic distribution could not be reported. Overall, the survey demonstrated a high completion rate and minimal data quality issues. Key point: Although the sample size is robust for a single-centre KAP survey, the absence of demographic data limits subgroup comparisons (e.g., year-wise or gender-wise differences). All subsequent statistical tests therefore treat the cohort as a single analytic group unless otherwise stated. Knowledge Domain Results A total of 14 knowledge items (Q 6 – Q 19) were scored for every respondent (maximum = 14). Composite score: mean ± SD = 9.17 ± 1.74 (median = 9; IQR = 8–10; range = 5–13).Only 9.7 % (n = 20) achieved ≥12/14, while 6.3 % (n = 13) scored ≤6/14, indicating substantial heterogeneity in factual mastery. Table 2: Item-wise performance Correct responses for each knowledge item (N = 207) Item Correct n Correct % 95 % CI Wax bag colour 157 75.8 70.0–81.7 Applicator-tip bag 138 66.7 60.2–73.1 Debonded-bracket bag 160 77.3 71.6–83.0 Cotton-salivation bag 171 82.6 77.4–87.8 Yellow-bag treatment 185 89.4 85.2–93.6 Bag symbol 27 13.0 9.0–17.9 BMWM disinfectant (1 % NaOCl) 175 84.5 79.4–89.0 Working-model disposal 117 56.5 49.7–63.2 Hawley-appliance bag 4 1.9 0.5–4.8 E-chain bag 144 69.6 63.2–75.5 Fixed-appliance disposal 183 88.4 83.8–92.4 LA syringe & needle protocol 135 65.2 58.6–71.4 Mini-implant disposal 133 64.3 57.6–70.6 Yellow-bag thickness 170 82.1 76.8–87.3 Results: Highest accuracy (≥80 %): yellow-bag treatment, BMWM disinfectant concentration, cotton-salivation bag selection, fixed-appliance disposal procedure, and minimum bag thickness.Lowest accuracy (<60 %): biohazard symbol identification (13 %), working-model disposal (56 %), and Hawley-appliance bag choice (1.9 %). Interpretation: While foundational concepts such as bag colour coding and chemical disinfection were well-understood, critical gaps persist in recognizing regulatory symbols and the specific disposal route for acrylic appliances—areas that warrant targeted instructional reinforcement. Attitude Domain A total of 207 completed records were analyzed for the five attitude items (Q 1 – Q 5). Response distributions are detailed in Table 3 and summarized below. Awareness of colour-coded disposal protocol (Q 1). Only 7.7 % of students felt completely aware of the colour-bag system, while the dominant category was partially aware (76.3 %), underscoring a sizeable knowledge gap in a fundamental safety requirement. Knowledge of the local