Occupational Injuries and Medical Waste Handling Practices Among Hospital Cleaning Workers In Shendi Locality, Sudan: A Cross-Sectional Analytical Study
This cross-sectional study of 143 hospital cleaners in Shendi, Sudan, reveals a high prevalence (47.6%) of occupational injuries over the past year, identifying age and PPE use as risk factors while longer working hours and pre-employment medical examinations were associated with reduced injury odds, underscoring the urgent need to strengthen occupational health systems and waste management practices.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In hospitals, the work of keeping spaces clean is often invisible until something goes wrong. Behind the scenes, a specific group of workers handles the most dangerous byproducts of medical care: the waste. This includes used needles, blood-stained bandages, and contaminated materials that can carry infectious diseases. For decades, health experts have known that managing this waste is not just about keeping a facility tidy; it is a critical safety issue. If the waste is not sorted, packed, and thrown away correctly, the people who handle it face a constant risk of cuts, stabs, and exposure to harmful germs. These risks are part of a broader field called occupational health, which studies how the conditions of a job affect a worker's body and safety. When safety systems are weak, the people doing the dirty work often pay the price with injuries that could have been prevented.
A team of researchers from Shendi University in Sudan decided to look closely at this problem in their own region. They focused on Shendi Locality, an area in the River Nile State that hosts several hospitals, including specialized centers for heart and kidney care. These facilities generate a significant amount of medical waste, putting the cleaning staff at the center of the risk. The researchers wanted to understand how often these workers got hurt and what factors in their daily routine might be making those injuries more or less likely. They did not just ask if injuries happened; they looked at the workers' ages, their training, the equipment they used, and the specific ways they handled the waste bags.
The study involved 143 hospital cleaning workers, almost all of whom were women, working across nine different hospitals in the area. The researchers asked each worker about their job history, whether they had ever been cut by a needle or a sharp object while working, and how they managed their daily tasks. They found that nearly half of the workers, about 48 percent, had experienced at least one occupational injury in the year before the study. This rate was high, suggesting that the danger is a common part of the job in this region. The risk was not the same everywhere, however. Some hospitals reported injuries for every single worker on their cleaning staff, while others, like a military hospital, reported very few. This difference pointed to the idea that the specific rules and culture of each hospital matter more than the individual habits of the workers.
When the researchers dug deeper into the numbers, they found some surprising patterns that challenged common assumptions. For instance, they looked at whether wearing protective gear, such as gloves and masks, made a difference. Intuitively, one might expect that workers who wore protection would be safer. However, the data showed the opposite: workers who reported using personal protective equipment were actually more likely to have been injured. The researchers explained that this does not mean the gear is useless. Instead, it likely means that the workers who faced the highest risks were the ones who were told to wear the gear. If a worker is handling a pile of unsorted waste full of sharp needles, they are more likely to be given gloves and more likely to get hurt. The gear was a sign of a dangerous job, not the cause of the injury.
Another finding seemed to go against the idea that longer hours lead to more accidents. Workers who reported working longer shifts actually had lower odds of being injured compared to those working shorter shifts. The researchers suggested this might be because the workers who could handle long hours were a specific group: perhaps they were more experienced, or perhaps they were simply healthier and more capable of doing the job safely. Similarly, older workers, who had been on the job longer, showed a slightly higher risk of injury, likely because they had spent more years exposed to the hazards of the job.
Training was another area where the results were nuanced. Many workers had received training on how to handle medical waste safely. Yet, the trained workers reported injuries at a higher rate than those who had not been trained. The researchers cautioned that this does not mean training causes harm. Instead, it suggests that hospitals tend to send the workers in the most dangerous departments to training after an accident has already happened, or as a way to manage a high-risk area. The training was a response to the danger, not the source of it.
One of the most clear protective factors the study identified was a medical check-up before a worker was hired. Workers who had undergone a medical examination before starting their jobs were much less likely to have been injured. This suggests that hospitals with better safety systems, which include screening workers for fitness, also tend to have better overall safety practices. Additionally, the physical nature of the work played a role. Workers who said they could easily carry and move the waste bags were more likely to be injured than those who found it difficult. The researchers interpreted this to mean that the workers who moved the bags easily were likely handling larger volumes of waste or working in areas with more hazardous materials, simply increasing their exposure.
The study did not find a strong link between injuries and other common safety measures like regular medical check-ups after hiring, vaccination, or having a supervisor watch over the work. This does not mean these things are unimportant, but rather that in this specific group of workers, they were either not different enough to show a statistical effect, or they were not the main drivers of safety. The most significant differences came from the hospital itself and the specific conditions of the job.
In the end, the research paints a picture of a workforce that is under constant threat, not because of a lack of individual effort, but because of the systems they work within. The high rate of injury is a result of how the waste is generated, how it is handled, and how the hospitals manage their safety protocols. The findings suggest that to protect these workers, hospitals need to look beyond just telling workers to be careful. They need to strengthen the entire system of waste management, ensure that safety checks happen before people start working, and recognize that the workers who face the most danger are often the ones who need the most support. The study confirms that in Shendi, and likely in many similar places, the safety of the people cleaning the hospitals is a complex issue that requires a strong, organized approach to solve.
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