الفهرس 
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Abstract
Medical waste Workers (MWWs) play a key role in proper waste disposal as they are involved in the entire waste management processes. (Sorting, handling and transportation, storage, treatment and final disposal). Medical waste workers are working in a very poor and unsafe working environment and mostly they are victims of occupational health hazards from inadequate waste management practice and unsatisfactory knowledge (Deress et al., 2019).
The hazardous nature of medical wastes is due to infectious agents, toxic or hazardous chemicals, pharmaceuticals, sharps, genotoxic and radioactive. Prevention of occupational exposure to medical waste involve strict adherence to universal precautions and standard methods of segregation and disposal of health care waste. Universal precautions involves proper hand washing, use of face masks, protective eye shield, hand gloves, aprons and/or gowns, safety booths and other use of others personal protective equipment’s or devices during services delivery. Others measures include care with handling of medical devices/instrument, proper segregation and disposal of medical waste, immunization of workers against preventable occupational diseases and post exposure prophylaxis where applicable (Junaid et al., 2017).
The Aim of the study:
The aim of the study is to assess occupational health hazards among workers dealing with medical waste disposal in outpatient clinics through:
1- Assessing occupational health hazards among workers dealing with medical waste.
2- Assessing knowledge of workers dealing with medical waste about occupational health hazards and medical waste disposal.
3- Assessing practices of workers dealing with medical waste toward prevention of occupational health hazards related medical waste disposal.
4- Assessing workplace environment (temporary storage room) for medical waste management.
Research questions:
1- What are the occupational health hazards among worker dealing with medical waste disposal?
2- What are the medical waste workers knowledge about occupational health hazards and medical waste management?
3- What are the medical waste workers practices toward medical waste management?
4- Is the relation between Socio-demographic characteristics of medical waste workers and their knowledge?
5- Is the relation between medical waste disposal workers knowledge and their practice?
Research Design:
A descriptive explanatory research design was employed to fulfill the aim of the study and answer the research question.
Research Setting:
The study was conducted at outpatient clinics at Family Medicine Centers affiliated to Directorate of health Affairs in Cairo Governorate, which included 136 centers. Chosen 50% of them. Which are largest places with a verity of services that serve a large segment of people.
Subject of study:
A convenient study sample of 250 medical waste workers was chosen to conduct the study. The total number of workers dealing with medical waste in the previously mentioned settings was 714 medical waste workers who working at the previous mentioned setting, 35% from total sample size, at confidence level 95% was used in this study. (Thompson, 2012).
Tools of Data Collection:
Two tools were used for data collection:
First Tool: Interview Questionnaire Sheet
It was designed by the investigators in Arabic language after reviewing the recent and relevant literature, and consisted of four parts:
Part I:
This part was concerned with demographic and work characteristics of medical waste workers which include 8 questions; age, gender, marital status, educational level, years of experiences, department and attendance and types of training course. (Q 1- 8)
Part II:
Medical history of workers dealing with medical waste this part was designed by investigator to assess medical history of study sample; which include 7 questions; chronic disease, before joining or after joining work, take medication, surgical history, vaccination for hepatitis B virus, doses of vaccination, and place. (Q 9 - 15).
Part III:
This part was adopted from WHO, (2019) to assess data regarding previous exposure to occupational health hazards related medical waste disposal included 17 questions; have you been exposed to any types of biological hazards, causes of needle stick injuries and post exposure action, have you been exposed to chemical hazards, cause and immediate action after exposure, have you been exposed to physical hazards, suffering from back pain, causes and immediate action after exposure, have you been exposed to psychological hazards, suffering from depression and anxiety, causes. (Q16-32)
Part IV:
This part was designed by investigator to assess workers level of knowledge about occupational health hazards and medical waste management included 21 questions; meaning of occupational hazards, types of biological, chemical, psychological and physical health hazards, meaning of medical waste, types of medical waste, segregation and color-coding of medical waste, handling of medical waste, storage of medical waste, final disposal of medical waste, measures taken to reduce hazards. (Q 33- 53)
Tool II: An observational checklist
Adopted from CDC, (2020) and national infection prevention and control manual, ministry of health and population, 2020 and after reviewing the recent literature and it will include the following two parts:
Part A:
Designed to assess workers practice accordingly, the national infection prevention and control manual, ministry of health and population, 2020 and Centers for Disease Control and Prevention, 2020 to evaluate the Medical waste workers practice. Include 35 items; Apply Universal precautions when dealing with medical waste, Apply hand washing technique before and after dealing with medical waste, separation of medical waste according its types, handling of medical waste, interim storage, treatment and final disposal, safe methods of sharp and liquid medical waste disposal.
Part B:
Designed to assess workplace environment accordingly, the national infection prevention and control manual, ministry of health and population, 2020 and Centers for Disease Control and Prevention, 2020. Include; 12 items to assess the work environment (temporary storage room) for medical waste in outpatient clinics at family health medicine centers.
Results:
The result of this study can be summarized in:
The mean age of the studied medical waste workers was 42.05±8.31, regarding gender and marital status, 80.8% and 90.0% of the studied sample are male and married, regarding educational level 58% of them have preparatory education, regarding Years of experience 45.2% of the studied sample has ≥ 15 years of experience the Mean SD of years of experience is 13.7±6.97 years, regarding attending training programs 4.8% of the studied sample attending training programs on the safe handling of medical waste, 50% of them attending course about handling and transporting of medical waste and 83.3% of them attending one course, regarding their work place 34% of them working at surgical clinic. Also, 28% of them working at medicine clinic.
The study sample hade chronic disease 39.2% of the studied sample has history of chronic diseases, 80.6% and 67.6% of them suffered from hypertension and hepatitis C, and 90.7% and 77.8% of them suffer from a chronic disease after joining work and take medication regularly, regarding surgical history 18.4% of the them had surgical history, regarding vaccinated against hepatitis B virus 20.8% of the studied sample were vaccinated 84.6% of them take three doses and 100% of them were vaccinated through the infection control program at their center.
For biological hazards 88.4% of the studied sample were exposed to biological hazards. Also, 52% of them were exposed to chemical hazards 95.2% of them were exposed to physical hazards. Furthermore, 71.2% of them were exposed to psychological hazards.
For knowledge about occupational health hazards and medical waste management 92.0% and 84.8% of the studied sample has unsatisfactory level of total knowledge, regarding post-exposure actions 89.6% of them have unsatisfactory level of total knowledge.
Regarding practice for apply universal precautions and hand washing technique 92.0% and 91.4% of the studied sample has inadequate level of total practice. Regarding sorting and handling and transporting 87.2% and 84.0% of them has inadequate level of total practice, regarding internal storage and final disposal 55.2% and 68.8% of them has inadequate level of total practice.
There was highly statistically significant relation between the studied sample’ knowledge about medical waste management and occupational health hazards and their education level, years of experience and Attendance of previous seminars/training programs at P= <0.01. Also, there was statistically significant relation with their age at P= <0.05. While, there were no statistically significant relation with their sex and marital status at P= > 0.05.
There was highly significant positive correlation between total knowledge and total practice regarding medical waste management among studied sample at P= < 0.01.