Introduction

Due to the disposal of surgical masks, face shields, gloves, shoe covers, and PPE, waste production has increased since the coronavirus epidemic started (PPE). According to Chandrappa and Das (2012), these wastes are known as biomedical waste (BMW) and fall into four main categories: infectious, hazardous, radioactive, and general biomedical waste. Gloves, masks, and PPE kits were used more frequently during the COVID-19 disaster and were afterwards thrown as waste (Vijay et al. 2022). However, these items could be contagious and require proper disposal and treatment. The amount of biological waste produced during the Corona virus outbreak and afterward differed significantly. In 2016, approximately 16,000 kg of biomedical waste was generated per day, which increased dramatically to 20,400 kg per day by 2020 and has now reached 23,500 kg per day in 2021 (https://timesofindia.indiatimes.com/city/hyderabad/t-stares-at-biomedical-waste-crisis-amid-covid/articleshow/84533758.cms).

Because it is highly contagious, biomedical waste produced at blood banks, research labs, hospitals, clinics, and nursing homes are disposed of by incineration in accordance with the biomedical waste management guidelines. Contrarily, when biomedical waste is dumped with domestic waste by the public without being separated, it poses intriguing issues. Home-quarantined COVID-19 positive patients who were asymptomatic, disposed off their gloves and masks in dustbins, resulting in the contamination of household garbage with hazardous biomedical waste (Reddy 2020; Sangkham 2020). Improper disposal of masks and gloves by healthy and asymptomatic people after usage, which left them lying all over the street and infected nearby water bodies (Xiang et al. 2020). According to earlier surveys, 70% of participants disposed of their used masks and gloves in the trash after using them (Mejjad et al. 2021). Untreated and incorrectly disposed biomedical waste from the public can be dangerous and transmit disease across society (Healthcare waste (who.int)). In addition to increasing microbial burden, this could also impact the environment by introducing additional plastic and microplastic debris into terrestrial and aquatic ecosystems in the form of discarded masks and gloves. The issue of safety and the long-term effects on the environment are also brought up by this activity (Xiang et al. 2020).

BMW is dealt by skilled staff in health care facilities, hospitals, and research facilities and disposed of at its source by incineration, chemical disinfection, wet and dry thermal treatment, microwave irradiation, land disposal, and conversion into inert material (Datta et al. 2018). However, there is no strategy in place to handle BMW emanating from residences that produce household garbage.

BMW is often burned in incinerators that were operating at full capacity when COVID was in place for the disposal of BMW. Mixing garbage presented further challenges because incinerators were overloaded beyond capacity. Such situation was reported in Delhi, Vijaywada, and West Bengal, where these ran out of their capacities (Reddy 2020).

In addition to the rise in disease burden, improper waste management exacerbated BMW's burden (Datta et al. 2018; Reddy 2020). The proper disposal of gloves and masks seems to be another problem. Due to the rapid increase in BMW, several nations have failed to properly handle and dispose of it, posing a risk to front-line employees engaged in handling and treatment as well as to the environment (Datta et al. 2018). In many developing countries, the proper disposal of discarded masks and gloves has been neglected, and no guidance has been given to the public (Poudel 2021).

Waste can be recovered rather than disposed off based on the 3Rs idea, which stands for reduce, recycle, and reuse (ref 2). Reusability options were suggested, such as use of cloth masks repetitively after washing, employing dry heat pasteurization to disinfect N95 respirators and surgical facemasks, to reduce the amount of BMW (Kalina et al. 2022). Additionally, in order to decrease the amount of masks that have been discarded, these were hydrothermally liquefied into renewable fuel oil while ethanol was also being produced (Xiang et al. 2020). These were discarded in the pit latrine disposal system in Morocco (Kalina et al. 2022). Many nations have strict guidelines and systems in place for properly disposing of waste, such as sorting and disinfecting it first, then leaving it for nine days before sorting to reduce the risk of exposing first-line employees to viruses (Das et al. 2021). Only a small number of developed nations, though, were able to hit this goal.

The way people in the community used and disposed of their gloves and masks has an influence on the production of BMW and other environmental effects (Xiang et al. 2020; Mejjad et al. 2021). The management of BMW must take into consideration in human behaviour. By raising awareness about the need for appropriate disposal of masks and gloves, individuals can inspire others to follow the same path (Poudel 2021).

The current study was designed to determine the level of public awareness of the COVID-19 pandemic, biomedical waste, and methods for its disposal. This was a questionnaire-based survey carried out in February 2022. A total of 105 non-experts were selected to fill out the questionnaire about bio-medical waste management. The purpose of this study was to determine the extent of awareness of people about infection caused by COVID-19 and its variant, and biomedical waste management. Despite of their awareness, the precautions they follow to dispose off their used masks and gloves were recorded. Further, the views of the people about the amendment in waste transportation vehicle and installation of small incinerators in the society to overcome the problem of biomedical waste at societal level were listed. These suggestions of the people will help the government in improving their policies to control the release of biomedical waste at its source.

Methodology

Study design/questionnaire preparation

The questionnaire was developed according to the other surveys conducted by many scientists (Opalinski 2008), (Hone and El Said 2016) (Krithiga et al. 2021). However, the survey included several questions to test various hypotheses that are being tested in this study, which were related to the COVID-19 pandemic and biomedical waste and its disposal practices. The study was cross-sectional and used anonymous online feedback.

The questions of this survey were categorised into three categories: (i) based on their knowledge about COVID-19; (ii) based on their knowledge about biomedical wastes; and (iii) based on the disposal of biomedical waste like gloves and masks.

Data collection

An online survey was conducted using Google Forms in February 2022. It was circulated among the people of Jaipur with a request to fill them. Prior to administering the questionnaire, the purpose of the study was explained to all participating respondents, and their consent were taken. The filled-up responses were divided into three age groups: 14–25 years old (young people), 26–40 years old (middle-aged people), and 40–60 years old (old people). A cross-tabulation was performed to determine the relationship between their knowledge of biomedical waste and its disposal practices.

Data analysis

All statistical tests were performed and found to be adequate to assess the significance of differences. The sample included a random subset of non-expert individuals, and thus, the survey can be considered a representation of a larger population. There were three categories of the questionnaire and respondents were asked to fill out the form for all categories. In this questionnaire-based survey, the different choice-based questions were used to enable the participants to respond based on their agreement with a particular choice. To assess the level of awareness, all responses were clubbed in to one variable. The respondents, who have responded for all the three categories has been put as “1” otherwise “0” (Golandaj and Kallihal 2021).

As the resulting dataset would be coded, collated, and analysed in SPSS 17 at a 0.05% significance level, the Chi-square test was performed. The p-values of < 0.01 and < 0.05 were considered to observe statistically significant association between a dependent variable and predictor variables. Cross-tabulation was also used to tabulate some specific questions to find out the corelation of two questions.

Results and discussion

Awareness to COVID-19

The results of the COVID-19 awareness related questionnaire are presented in Fig. 1. To answer the first question, "What precaution do you use frequently to avoid COVID-19 infection?", maximum of 60–80% of people in all three age groups accepted that they were using masks. Many participants (20%) preferred hand sanitizers to soap, whereas the elderly (40%) preferred soap. In response to the second question, which was related to the use of sanitizer, when COVID-19 cases are reducing, 83–100% of participants of all age groups accepted the use of sanitizers and disinfectants. About 36.4–40% of all age groups were also found to be aware of the harmful effects of sanitizer, as they mentioned in response to question 3 (Fig. 1).

Fig. 1
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Responses of questionnaire to analyse the awareness to COVID-19 and precautions to avoid infection among the people

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In response to question 4, which was related to awareness, 80% of people from all age groups were found to be aware of the fact that they could acquire infection even after vaccination. When were they asked (question 5): "What precautions do you take after being vaccinated?" 80% of the young and old age groups and 100% of adults responded that they used to wear masks despite being vaccinated. About 9.1% of youth and 20% of older people used sanitizer to clean their hands. This demonstrates the level of awareness among all age groups regarding prevention from COVID-19 infection. Everyone was aware of the precautions, such as wearing masks and using sanitizer and soap to clean and wash hands. They were aware of the spread of COVID-19 and therefore followed all precautions even after vaccination.

Awareness about biomedical waste and its disposal

The questionnaire used in the study contains some questions on biomedical waste and its disposal methods to find out the level of awareness of biomedical waste and its disposal. These are presented in Fig. 2. "Are you aware of biomedical waste?" asked question 6; 89.8% of young people, 90% of adults, and 60% of the elderly were aware of biomedical waste. Every day, 18.2% of participants discard masks. However, 39.8% of participants used cloth masks, which were washed and reused (Question 7, Fig. 2). However, only 71.6% of young people, 100% of adults, and 40% of the elderly sanitise their masks and gloves before throwing them away (question 8, Fig. 2). It is pertinent to note that 31.8% of the young participants never sanitized their mask before disposal (Question 9, Fig. 2).

Fig. 2
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Questions asked to the participants related to biomedical waste i.e., masks/gloves disposal

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A cross-tabulation (Fig. 3) of people's awareness of biomedical waste (Question 6, Fig. 2) and the frequency of washing or sanitising masks before disposal (Question 9, Fig. 2) revealed that 6.81% of the young are unaware and, as a result, do not sanitise their masks before disposal (Fig. 3). Despite their awareness of biomedical waste, 25% of young people never sanitised their waste before disposal, and 26.13% only rarely sanitised it. Such types of cases were not observed in adults or older age groups (Question 9, Fig. 2). Similarly, 2.3% of the young did not sanitise PPE kits prior to disposal (Question 10, Fig. 2). This shows the casual behaviour of young people towards the disposal of gloves and masks, despite their awareness about biomedical waste.

Fig. 3
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Cross-tabulation between the questions to show the relationship of participant’s awareness and their action to wash or sanitize their masks (* reveals significant result i.e. p < 0.05)

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Despite of their awareness on biomedical waste, 31.8% of young people, 40% of adults, and 60% of the elderly did not use separate bags for waste disposal (Question 11; Fig. 4). To determine their level of awareness regarding the use of separate waste bags, 5.68% of adults and 20% of the elderly were found to be unaware and, as a result, did not use separate waste bags (p 0.05) (Fig. 4). In order to avoid the risks posed by any person infected with COVID-19, they were kept in isolation and provided with appropriate medical care (Question 12, Fig. 5). The result of the cross-tabulation of question 6 with question 11 revealed that participants didn’t used separate bags for waste disposal (Question 11, Fig. 6), despite their awareness. This is a matter of concern, as improper disposal may lead to the spread of infection through infected materials and may give rise to mutants. Only 2% of young people used personal protective equipment (PPE) kits and disposed of them in separate bags (p < 0.05) (Fig. 6). This depicted the lack of awareness about the use of separate bags for disposing of infected material, i.e., biomedical waste. These findings are in contrast to the study conducted in Tamil Nadu about biomedical waste, which reported the use of separate containers by 72.8% of health care workers (Krithiga et al. 2021) (Dalui et al. 2021).

Fig. 4
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Questions asked to the participants related to biomedical waste and their way of avoidance to risk

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Fig. 5
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Cross-tabulation to know the relationship between the participants’ awareness about the medical waste and use of separate bags for different types of wastes (* reveals significant result i.e. p < 0.05)

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Fig. 6
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Cross-tabulation to know the relationship between the participants’ awareness about the way of avaoiding the risk of COVID-19 and use of separate bags for the disposal of waste (* reveals significant result, p < 0.05)

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People were aware of biodegradable masks, and thus, they would purchase them regardless of their price (Question 14, Fig. 4). This reveals the need of training the public about biomedical waste and the disposal of masks after use.

Suggestions to Government

The people were asked about their views on including a separate section in a waste transportation vehicle for biomedical waste, 87.5% of youth, 100% of adults, and 100% of old age persons agreed, and 5.7% of youth remained unanswered (Question 14, Fig. 7). When asked, "Should the government include a section of a medical waste transportation vehicle?" 100% of adults and seniors agreed that a separate section in a waste transportation vehicle should be included. However, 90.99% of people agreed that the government should incorporate a separate section in waste transportation vehicles (Question 15, Fig. 7).

Fig. 7
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Questions related to their suggestion to control the exposure of waste to the workers dealing with it

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A cross-tabulation of these two questions revealed that 100% of adults and older people desired a separate section for biomedical waste disposal in waste transportation vehicles. Only 2.27% people were unaware of this and not recommended it to the government (p < 0.05) (Fig. 8). This data showed that people were aware of the segregation of waste in waste transportation vehicles. There has been no report published on the public's demand for a separate section for biomedical waste, as well as the need for training and awareness in this area.

Fig. 8
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Cross-tabulation of two questions i.e., should a separate section or container be included in waste transportation vehicle with should government include a separate section in waste transportation vehicle

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In addition to this, 90% of youth, and 100% of adults and older people preferred the installation of incinerators in colonies for masks and gloves to prevent the spread of infection (Question 16, Fig. 7). This reveals the status of disposing masks and gloves among them by incineration.

Conclusion

Biomedical waste, generated by the public during the COVID-19 pandemic, is an important problem that needs to be addressed properly, and the public must be aware of it. Improper disposal and ignorance of the waste accumulation may give rise to several problems, including the spread of infection. Awareness among the people can be a major tool to combat issues related to the disposal of masks and gloves during the COVID-19 pandemic. Regardless of the person's symptoms, waste disposal requirements must be properly observed. This study reveals that people are aware of the pandemic and biomedical wastes, their consequences, and the precautions that need to be taken to cope with the situation. A broad public awareness campaign may be beneficial in making people aware of the importance of strictly adhering to biomedical waste guidelines.