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International Journal of

DEVELOPMENT RESEARCH International Journal of Development Research

ISSN: 2230-9926

Vol. 5, Issue, 12, pp. 6130-6134, December, 2015

Full Length Research Article KNOWLEDGE, ATTITUDE AND PRACTICES OF HEALTH CARE WORKERS TOWARDS BIOMEDICAL WASTE MANAGEMENT: NEEDS IMPROVEMENT Bhawna Sharma, *Dr. Dimple Kasana and Shipra Jain Department of Microbiology, VMMC & Safdarjung Hospital, New Delhi, India, 110029 ARTICLE INFO

ABSTRACT

Article History:

Apple Health care associated infections (HCAIs) are increasing among patients and drawing governments and regulatory bodies. Proper bio medical waste (BMW) management reduces cross infection in hospitals, but compliance to follow these rules and recommended instructions is commonly poor. A pilot study was conducted over a period of 3 months in a tertiary teaching care hospital in India included 100 randomly selected study subjects from 5 different wards like intensive care units (ICU’s), labour rooms, paediatrics, casualty and burns department , out of them 20 were doctors, nurses (20), undergraduate medical students (20), nursing attendants (20) and sweepers (20). The highest level of knowledge regarding BMW legislation was among the doctors (70%) and least among the sweepers (35%). By analysing the knowledge of BMW practices doctors had the maximum (100%) and sweepers had minimum (25%) knowledge. On analysing attitude towards BMW, all the categories of HCWs had a favourable attitude. Mean attitude score was 8.34, out of which the best was among doctors (8.75) and least favourable was among sweepers (7.8). The study subjects were observed for their waste management practices and precautions taken by them for safe management. Only 50% of the study subjects discard waste according to the colour coding. So, compliance of bio-medical waste management practices should be corrected finely to reduce HCAI among HCWs.

Received 11th September, 2015 Received in revised form 30th October, 2015 Accepted 19th November, 2015 Published online 30th December, 2015

Key Words: Knowledge, Attitude, Practice, Health care associated infections, Health care workers.

Copyright © 2015 Bhawna Sharma et al., This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

INTRODUCTION Health care associated infections (HCAIs) are increasing among patients and drawing the attention of the governments and regulatory bodies. With “Clean Care is Safer Care” as a prime agenda of the global initiative of World Health Organization (WHO) on patient safety programmes, it is time for developing countries to formulate and implement the much-needed policies for basic infection prevention practices in health care centres. The compliance rate is directly linked to management system design and easy accessibility of hygiene products. In the wake of the growing burden of HCAIs, increasing severity of illness, complexity of treatment and superimposed multi-drug resistant (MDR) pathogens, health care practitioners (HCPs) are reversing back to the basic principles of infection prevention by doing simple measures. Examples include the maintenance of hand hygiene, proper waste management, an organized system and healthcare worker’s motivation. *Corresponding author: Dr. Dimple Kasana Department of Microbiology, VMMC & Safdarjung Hospital, New Delhi, India, 110029.

Information on the (a) awareness of bio-medical waste management rules (b) training undertaken by HCWs (c) practices with respect to segregation of bio-medical waste (BMW), use of colour coding for waste disposal, sharps instrument management by shredders and cutters, access to common waste management facilities and disposal were improved. Despite advances in infection control, the proper message is not consistently formulated into clinical practice (Jarvis et al., 1994) (Rotter et al., 1998). Proper BMW management reduces cross infection in hospitals, but compliance to follow these rules and recommended instructions is commonly poor. Thus, the management of BMW should be a subject of considerable concern to public health administrators and infection control specialists, as well as for the benefit of general public. Waste management practice is team work and no single class of health care workers (HCW) is responsible for the safe management and full program application (Mathur et al., 2011). In view of the above problems due to improper BMW management and cross infections, it is essential for everyone to know the present scenario pertaining to Knowledge, Attitude & Practices (KAP) regarding BMW management

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among all categories of HCWs in the hospitals and to assess the risks posed by inadequate/ ineffective waste management in a hospital setting. Aims and Objectives To assess the Knowledge, Attitude and Practices related to compliance of BMW management among various categories of health care workers (doctors, nurses, undergraduate medical students, nursing attendants and sweepers).

MATERIAL AND METHODS A pilot study was carried out among the HCWs (both males and females) of a large 1650 bed tertiary care teaching hospital in India over a period of three months from June to August 2013. The participants were fully informed about the design and purpose of the study and a written informed consent was obtained. A sample size of 100 randomly selected HCWs consisting of doctors (20), nurses (20), undergraduate medical students (20), nursing attendants (20) and sweepers (20) working in the five departments participated in this study. Departments included were the intensive care units (ICU’s), labour rooms, paediatrics ward, casualty and the burn department. A prior observational study was conducted through interviews and questionnaires to assess the KAP regarding BMW of the study participants. Interviews were done on the health care persons, gives the idea about their knowledge regarding the waste management practices, policies, and their attitude to follow the instructions and their practice habits at working place.

RESULTS Analyzing Knowledge More than half of the study participants (53%) were not aware of the legislation applicable to BMW management. The highest level of knowledge regarding BMW legislation was among the doctors (70%). The sweepers (35%) had the lowest level of knowledge on this legislation. Slightly more than half (52%) of the participants reported that they were aware of the waste management plan in their health care settings. The knowledge of BMW management plan was found to be highest among doctors (95%) and lowest among sweepers (10%).

Waste management responsibilities were included in the employee job descriptions for 81% of the respondents. Awareness regarding the waste management policy was found to be 100% among nurses, but was lowest among students (55%). Half (50%) of the study population was not aware that the Central Board of Pollution Control (CBPC) had authorization to enforce safe practices for BMW management in hospitals Table I. Analyzing knowledge on the BMW practices, it was found that (63%) of the HCWs knew about the facilities available in the hospital for waste treatment. The doctors had the best knowledge (100%). The sweepers had the least knowledge (25%). When assessing the practice for segregation of waste into different categories, 64% of the study participants were able to respond correctly. In addition, (69%) of them knew about the colour coded bins and were able to match the colour codes correctly. When using the WHO categories of waste, only 15% of the study population knew the correct answer. None of the Sweepers were able to answer correctly, when they were asked about the types of wastes. 100% doctors had the knowledge of facilities available for waste management and only 25% of sweepers had knowledge of facilities available for waste management. Among knowledge of various methods of waste disposal, again doctors had the maximum (100%) knowledge and sweepers had 0% knowledge Table II. In analysing the knowledge of the study participants regarding the direct and indirect health hazards associated with improper waste management, it was found that only 55% of them were aware of the health hazards associated with improper waste management. They were as follows: doctors 95%, nurses 40%, nursing attendants 40%, and sweepers 35%. Knowledge about hand hygiene was 90% in the study population, though sweepers had the least knowledge (60%). Regarding vaccines available for preventing HCAI, doctors had the best knowledge (100%), followed by students (90%), nurses (75%), nursing attendants (60%) and sweepers (45%). Table III. The total knowledge was assessed on a scale of 15. Fifteen questions were asked and each correct answer was given one mark. The mean score of the knowledge was 10.39. The doctors had the highest score (13.15) and the sweepers had the least (7.35).

Table I. Knowledge of the study subjects regarding waste management policy Doctors nurses Knowledge regarding Legislation applicable to BMW management

Nursing attendants

students

sweepers

14(70%)

8(40%)

9(45%)

9(45%)

BMW management Plan in hospital

19(95%)

8(40%)

9(45%)

14 (70%)

2(10%) 52(52%)

BMW management responsibility in job description

18(90%

20(100%)

14(70%)

11(55%)

18(90%) 81(81%)

8(40%)

9(45%)

Authorization by Central board of Pollution control

15(75%)

11(55%)

7(35%)

Total

7(35%)

47(47%)

50(50%)

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Table II. Knowledge of the study subjects regarding waste management practices

Table III. Knowledge of the study subjects regarding Health Hazards Associated with improper waste management and their Prevention

Table IV. Mean score of the Knowledge of health care workers on the basis of questionnaires asked to them

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Table V. Mean attitude score of health care workers on the basis of 10 questionnaires asked to them

Table VI. Analysing practices of health care workers

The difference between the different categories was statistically significant, p0.05 for all the occupational groups. Table V. Analysing Practice The assessment of practices of HCWs was observational. The study participants were observed for their waste management practices and precautions taken by them for safe management by analysing their daily basis records maintained in the different wards for disposal of wastes. Total study population was 100 subjects. The study population included doctors (20), nurses (20), undergraduate medical students (20), nursing attendants (20) and sweepers (20). Fifty (50%) of them discarded waste according to the colour coding. When disposing of needles, only 40% of them put the sharp into a puncture proof blue container and that container was disposed into the blue bag. Although needle cutter is permitted in India

after that only 30% of the study participants would sometimes cut the needles prior to disposal Table VI.

DISCUSSION Poor management of healthcare waste exposes HCW and the general public to infections and toxic hazards (Sengodan et al., 2014). The Government of India (notification 1998) specifies hospital waste management to be an integral part of hospital hygiene and maintenance protocols. This involves management of a range of activities, such as collection, transportation, operation or treatment of processing systems, and disposal of waste. The initial segregation and storage activities are the direct responsibility of the occupier in the health care establishments. If the infectious component gets mixed with the general non-infectious waste, the entire mass becomes potentially infectious and hence adds to the cost of its handling (Patil et al., 2005). Proper management of healthcare waste must begin directly at the collection sites where hazardous and non-hazardous waste are segregated into specific colour-coded bins and sent to the final treatment sites (Yong et al., 2009). Effective means of BMW management involves adequate knowledge among the medical and paramedical staff. In assessing knowledge, the doctors had the best knowledge

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about hospital waste management, mean score 13.15 (out of 15) while sweepers had the lowest score (7.35). This affects the safe management of the hospital waste. These figures are similar to the result obtained from a study conducted by Qureshi Waseem et al., which revealed that the doctors had adequate knowledge about BMW and the health hazards spread, due to its improper management, in comparison to the nurses and paramedical staff (Qureshi et al., 2007). The poor knowledge of the sweepers related to BMW may be due to their lack of training. Thus, the staffs that actually handle the waste are at much higher risks and need to be educated on aspects of BMW. Safe and sustainable health care waste management is not possible without a favourable attitude among HCW. On analysing attitudes towards BMW, all the categories of HCWs had a favourable attitude. The mean attitude score was 8.34. The best score was for the doctors (8.75) and the lowest score was for the sweepers (7.8). The difference was not statistically significant, (ANOVA test), p>0.05 for all the occupational groups. A study conducted by Dipankar Chattopdhhyay et al., showed the attitude score of nurses and doctors as 21.5 and 25 respectively. This showed that the attitude of the HCWs towards BMW was good (Chattopdhhyay D et al., 2010). A study conducted to assess the knowledge and practices related to waste management among doctors, nurses, and housekeepers in the surgical departments at Al-Mansoura University Hospital, Egypt, also revealed only 27.4% of the nurses, 32.1% of the housekeepers, and 36.8% of the doctors had satisfactory knowledge of BMW and as for practice; 18.9% of the nurses, 7.1% of the housekeepers, and none of the doctors had adequate practice in BMW management. The nurses’ knowledge score had a statistically significant weak positive correlation with the attendance of training courses (r=0.23, p