Factors Associated with Adherence to Safety-Protocols in Handling Medical Wastes Among Healthcare Workers in a Selected Tertiary Healthcare Facility in Lagos State, Nigeria.

Abstract:

Background: The safe handling of medical waste is critical to preventing occupational exposures and reducing public health risks, particularly in resource constrained settings like Nigeria. Despite institutional policies and global guidelines, adherence to safety protocols among healthcare workers appears inconsistent. Similarly, studies to determine the reasons for this inconsistency remain unsolved. Therefore, this risk behavior diagnostic study guided by behavior theories assessed predictors of adherence to safety protocols among healthcare workers (HCWs) at Lagos University Teaching Hospital (LUTH). Methods: A cross-sectional survey study design was employed, involving 403 consenting healthcare practitioners selected by stratified sampling technique. A validated structured 55- item questionnaire was used for data collection and analysis was performed by the computer-assisted statistical software IBM SPSS version 23. Descriptive statistics were used to summarize measures of variables in the study, while inferential statistics including ANOVA and logistic regression analyses were used to assess relationships between independent variables and adherence behavior, and to determine variables with significant predictive value at 5% level of significance. Results: Findings revealed that respondents scored (26.1 ± 2.3) on a 33-point scale for self- reported adherence behavior representing a prevalence of 79.1% with above average knowledge of 63.6%, and mean score of (8.9 ± 2.1), strong motivation of 83.6%, and mean score of (27.6 ± 1.8), and good behavioral skills of 78.2% and mean score of (25.8 ± 1.9). Tetanus vaccination was below expectation (34.7%) and disposal of contaminated PPE was equally unacceptably low (29.8%). Logistic regression revealed motivation as the strongest predictor of adherence (β = 0.61, p = 0.004), followed by behavioral skills (β = 0.57, p= 0.002) and knowledge (β = 0.48, p = 0.008). ANOVA indicated a significant difference in adherence across job roles with Nurses and HCWs with 6–10 years of experience showing significantly higher adherence (p = 0.001 and p = 0.002, respectively). Conclusions and recommendations: The study concludes that multiple factors are involved in the dynamics of adherence to safety protocols in medical waste handling. While HCWs demonstrate foundational knowledge, skills and generally high levels of motivation, intrinsic motivation was the most significant determinant of adherence. Interventions should therefore emphasize motivational reinforcement, continuous training, and supportive workplace environments to sustain high adherence. Strengthening institutional policies and promoting a safety-oriented culture can further safeguard healthcare workers. These measures align with global occupational health goals and can reduce infections and environmental risks associated with medical waste.