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ORIGINAL ARTICLE
Year : 2019  |  Volume : 12  |  Issue : 6  |  Page : 508-510  

Knowledge, attitude and practices of health care workers in biomedical waste management in a newly opened tertiary care hospital


Department of Microbiology, Shri Lal Bahadur Shashtri Government Medical College, Ner Chowk, Mandi, Himachal Pradesh, India

Date of Submission13-Nov-2018
Date of Decision03-Sep-2019
Date of Acceptance23-May-2019
Date of Web Publication17-Oct-2019

Correspondence Address:
Lata R Chandel
Department of Microbiology, Shri Lal Bahadur Shashtri Government Medical College, Ner Chowk, Mandi - 175 008, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_233_18

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  Abstract 


Background: Biomedical waste management (BMWM) and adoption of standard work precautions are core strategies in infection control. For effective implementation of infection control practices, capacity building of various stakeholders in BMWM is essential. This study evaluates the impact of training on BMWM and infection control practices in cleaning personnel and technical staff. Methods: Two categories of health-care workers were trained on infection control management and BMWM. A pre- and posttest was administered in both groups. Results: On posttest evaluation, the knowledge showed significant improvement. This could be assessed as a modification of attitude and practices during handling of BMW shown on audit done on routine rounds of hospital conducted by the infection control committee. Conclusion: We recommend that evaluation of training is critical for effective implementation of trainings.

Keywords: Biomedical waste management, evaluation of training, pre- and post-test


How to cite this article:
Ganju SA, Chandel LR, Sharma A, Singh R, Kumari N, Bhatia A. Knowledge, attitude and practices of health care workers in biomedical waste management in a newly opened tertiary care hospital. Med J DY Patil Vidyapeeth 2019;12:508-10

How to cite this URL:
Ganju SA, Chandel LR, Sharma A, Singh R, Kumari N, Bhatia A. Knowledge, attitude and practices of health care workers in biomedical waste management in a newly opened tertiary care hospital. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2019 Nov 20];12:508-10. Available from: http://www.mjdrdypv.org/text.asp?2019/12/6/508/269423




  Introduction Top


Infectious waste is produced during the patient care at hospitals, clinics, maternity homes, and research institutes. The quantity of infectious waste ranges from 0.5 to 2 kg/day.[1] Of the total hospital wastes, 80% is general waste, 15% is pathological and infectious waste, 3% is chemical and pharmaceutical wastes, and 1% is radioactive and cytotoxic waste.[2] If proper disposal methods and precautions are not taken, accidents to health-care workers (HCWs) in medical institutions generating medical waste can occur, posing a public health threat.[3]

Significant risk of getting exposed to blood and other body fluids while imparting health-care services compounds the situation. This may lead to infection due to blood-borne viruses including hepatitis B virus, hepatitis C virus, and human immunodeficiency virus or other infections such as typhoid, cholera, tuberculosis, skin infections, and respiratory infections.[4]

Tertiary care hospitals, especially the newly opening, have an enormous challenge to ensure the safety of health-care personnel, and infection-free environment for their clients and to meet the standards of latest biomedical waste management (BMWM) rules and amendments thereof. The BMW needs to be handled properly by the trained HCW within an organization for which they ought to have the requisite knowledge, attitude, and behavior.[5] This can be achieved by regular in-house training in hospitals instructed by sufficiently knowledgeable managers, especially microbiologist, who are continuously involved in formulating and implementing BMWM and infection control practices guidelines.


  Materials and Methods Top


It was a real challenge to start proper BMW handling and infection control practices in our newly opened medical college and hospital. To begin with, it was decided by the Department of Microbiology, in consultation with Principal cum dean and Medical superintendent to take up the training of all the newly appointed cleaning personnel and laboratory technicians, who are at abundant risk of catching hospital-acquired infections due to improper knowledge of BMW handling and standard work precautions. This study was done in the Department of Microbiology in our tertiary care hospital. All the newly appointed HCWs in the two categories, i.e., cleaning personnel and laboratory assistants were imparted training in three batches comprising 40 participants each on recent guidelines of BMW Handling Rules, 2018 and standard work precautions. These HCWs had been working in the hospital for more than 6 months. The training methodology included: short lectures, group discussions, videos clips, demonstrations, and Powerpoint presentations. A selfmade pretest and posttest questionnaire was administered to the participants. The questionnaire was prepared in Hindi for cleaning personnel, while it was prepared in English for the laboratory technical staff.

Each correct answer received a score “1,” total scores in both pre- and posttest were calculated ranging from 0 to 10 points and expressed as percentages. The knowledge was assessed on three parameters: good (7–10 points) ≥70%, fair (5–6 points) 50% to <70%, and poor (0–4 points) <50%. The analysis was done by calculating percentage improvement after the training session.

The approval to conduct the training and assessment was taken duly from the Principal cum Dean and hospital administrator. Informed consent was obtained from all HCWs undergoing the training.


  Results Top


The results showed that the majority of cleaning personnel (50.7%) had relatively a good knowledge regarding BMWM and standard work precautions. Fair knowledge was seen in 18.6%, while 28% had poor knowledge. In case of laboratory technical staff, majority, i.e., 53.3% had fair level of knowledge, 20% had good knowledge, while 26.6% with poor knowledge. However, after implementation of the training program, majority of them improved their knowledge. Among the cleaning personnel, 85.3% demonstrated good knowledge. Among the laboratory assistants, 96.6% showed good knowledge, and there was no poor performer [Table 1] and [Table 2]. The gain index is shown in [Table 3].
Table 1: Level of knowledge of cleaning personnel

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Table 2: Level of knowledge of laboratory technical staff

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Table 3: Knowledge gain index

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Further on audit on rounds of hospital done by infection control committee of the tertiary care hospital for attitude and practices, it was observed that there was a drastic change in awareness of both cleaning personnel and laboratory technicians toward handling of BMW. They were well aware of the precautions while handling BMW, the respective colored bins to be used for specific type of waste, importance of handwashing, and reporting of incidence of any injury while handling waste. Use of personnel protective equipment and soap for handwashing was found to be increased on scrutiny of indent registers. Reporting of needlestick injuries was found to be increased on observation of the related records. Intramural collection of BMW was done at appropriate times, when patient load in hospital was less. Overall significant change could be observed in BMW management and general sanitary condition of the hospital.


  Discussion Top


Knowledge, attitude, and behavior are major components of hospital waste management and infection control practices.[6] Periodic training leads to learning and then transcends into application leading to the desired results.[7] Training given to the employee is directly related to the performance of the organization. In a study, it was found that training of the service provider in terms of management and disposal of health-care waste lead to improvement in practices.[8] Continuous education of professionals as well, can lead to overall improvement in their approach toward infectious waste management and are important to improve the waste handling by staff in hospital setup.[9] Regular information and reinforcing messages on the management of infectious waste can further add to improvement.[10] To minimize improper waste handling, intensive and periodic trainings form an integral part of BMWM.[11],[12] Thus, there is a need of regular trainings for hospital workers in BMWM and standard work precautions to improve the practices of health workers as recommended by other authors and confirmed by our study.[13],[14]

Therefore, it is being planned to project the results of this study in the forthcoming training sessions to other categories of hospital staff to motivate HCWs for enthusiastic participation. The study will be extended to assess whether what is taught is being implemented to achieve desired results.


  Conclusion Top


We conclude that trainings and workshops on BMWM and standard work precautions of cleaning personnel and laboratory technical staff have shown promising results. Evaluation of any training methodology is imperative for assessments and maintenance of quality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ferreira V, Teixeira MR. Healthcare waste management practices and risk perceptions: Findings from hospitals in the Algarve region, Portugal. Waste Manag 2010;30:2657-63.  Back to cited text no. 1
    
2.
Ege H. Management of Medical Wastes in Province of Adana; Problems and Solution Offers. Adana, Turkey: University of Cukurova, Institute of Science, Department of Environmental Engineering Publication; 2009.  Back to cited text no. 2
    
3.
Kumar R, Samrongthong R, Shaikh BT. Knowledge, attitude and practices of health staff regarding infectious waste handling of tertiary care health facilities at metropolitan city of Pakistan. J Ayub Med Coll Abbottabad 2013;25:109-12.  Back to cited text no. 3
    
4.
Shiao J, Guo L, McLaws ML. Estimation of the risk of bloodborne pathogens to health care workers after a needlestick injury in Taiwan. Am J Infect Control 2002;30:15-20.  Back to cited text no. 4
    
5.
Akbolat M, Işık O, Dede C, Çimen M. Evaluation of level of knowledge of healthcare professionals about medical wastes. Univ Acibadem Health Sci J 2011;2:131-40.  Back to cited text no. 5
    
6.
Rasheed S, Iqbal S, Baig LA, Mufti K. Hospital waste management in the teaching hospitals of Karachi. J Pak Med Assoc 2005;55:192-5.  Back to cited text no. 6
    
7.
Kirkpatrick DL. Evaluating Training Programs. San Francisco: Berrett-Koehler Publishers, Inc.; 1994.  Back to cited text no. 7
    
8.
Kumar R, Khan EA, Ahmed J, Khan Z, Magan M, Nousheen, et al. Healthcare Waste Management (HCWM) in Pakistan: Current situation and training options. J Ayub Med Coll Abbottabad 2010;22:101-5.  Back to cited text no. 8
    
9.
Ferdowsi A, Ferdosi M, Mehrani Z, Narenjkar P. Certain hospital waste management practices in Isfahan, Iran. Int J Prev Med 2012;3:S176-85.  Back to cited text no. 9
    
10.
Brunot A, Thompson C. Health care waste management of potentially infectious medical waste by healthcare professionals in a private medical practice: A study of practices. Sante Publique 2010;22:605-15.  Back to cited text no. 10
    
11.
Qaiser S. Survey of sharp waste disposal system in clinics of new Karachi. J Pak Med Assoc 2012;62:163-4.  Back to cited text no. 11
    
12.
Freedman AM, Simmons S, Lloyd LM, Redd TR, Alperin MM, Salek SS, et al. Public health training center evaluation: A framework for using logic models to improve practice and educate the public health workforce. Health Promot Pract 2014;15:80S-8S.  Back to cited text no. 12
    
13.
Yong Z, Gang X, Guanxing W, Tao Z, Dawei J. Medical waste management in China: A case study of Nanjing. Waste Manag 2009;29:1376-82.  Back to cited text no. 13
    
14.
Pruss A, Giroult E, Rushbrook P. Safe management of wastes from health-care activities. Geneva: World Health Organization; 1999.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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