INTRODUCTION:

Until fairly recently, medical waste management was not generally considered an issue. In the 1980s and 1990s, concerns about exposure to human immunodeficiency virus (HIV) and hepatitis B virus (HBV) led to questions about potential risks inherent in biomedical waste. Thus hospital bio medical waste generation has become a prime concern due to its multidimensional ramifications as a risk factor to the health of patients, hospital staff and extending beyond the boundaries of the medical establishment to the general population.¹

Keeping in view inappropriate Bio-Medical waste management, the Ministry of Environment and Forests notified the “Bio-Medical Waste (management and handling) Rules, 1998” in July 1998. In accordance with these Rules (Rule 4), it is the duty of every “occupier” i.e. a person who has the control over the institution and or its premises, to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment. Handling, segregation, disinfection, storage, transportation and final disposal are vital steps for safe and scientific management of Bio-Medical Waste in any establishment. ¹

Biomedical waste, (BMW), consists of solids, liquids, sharps, and laboratory waste that are potentially infectious or dangerous and are considered biowaste. It must be properly managed to protect the general public, specifically healthcare and sanitation workers who are regularly exposed to biomedical waste as an occupational hazard. ²

Proper disposal of biomedical waste is of paramount importance because of its infectious and hazardous characteristics. Overall it poses for occupational hazard for the healthcare workers and as well as to the waste handlers.³The Bio-Medical Waste Management is performed by all the people involved in the health care setting which includes doctors, nurses, technicians, laboratory personnel and sanitary staffs.^{4, 5.6}

This study focuses on the Safai Karmachari (Sanitary Staff) as they are designated especially for the final handling of the Bio-Medical Waste. In addition to that they are not aware of the proper Bio-Medical Waste Management making them the most vulnerable group in the health care setting for occupational hazard related to Bio-Medical Waste.⁷

Shalini Sharma and S.V.S Chauhan⁸ conducted a study to assess the awareness of BMW Management among the health workers in three apex Government Hospitals, Agra. The three hospitals were Sarojini Naidu Medical College, Lady Lyall Maternity Hospital and District Hospital. The total number of sample was 1227, out of which 145 were sanitary staffs. A questionnaire was distributed to assess the study and the result showed that only 70 sanitary staffs were aware of BMW Management.⁸

Previous studies reveal that the Sanitary Staff (Safai Karmachari) have a very little knowledge regarding Bio-Medical Waste Management and as well as very few of them practice proper Bio-Medical Waste Management.⁹

PROBLEM STATEMENT:

“Knowledge and practice of bio - medical waste management among safai karmachari working at central referral hospital, Gangtok, Sikkim”

OBJECTIVES:

The objectives of the study were to 1) Assess the knowledge and practice of Safai Karmachari regarding Bio-Medical Waste Management in a selected hospital, Gangtok. 2) Identify correlation between knowledge and practice of Safai Karmachari regarding Bio-Medical Waste Management. 3) Find out the association between selected demographic variables with knowledge and practice of Safai Karmachari 4) Provide information for improving the practice of Safai Karmachari regarding Bio-Medical Waste Management

OPERATIONAL DEFINITION:

· Knowledge: It refers to understanding of Safai Karmachari with regard to handling, segregation, disinfection, storage, transportation, and final disposal of Bio-medical waste by using structured knowledge questionnaires on Bio-Medical Waste Management during interview schedule.

· Practice: It refers to the activities of the Safai Karmachari regarding Bio-Medical Waste Management, assessed using observational checklist.

· Bio-Medical Waste management: It refers to the handling, segregation, disinfection, storage, transportation and final disposal of Bio-Medical Waste by Safai Karmachari.

· Safai Karmachari: It refers to the individuals who are employed in C.R.H and perform the final handling of Bio-Medical Waste.

· Selected demographic variables: It refers to the Safai Karmachari’s educational qualification, total years of experience and experience of attending any previous teaching/seminar/workshop on Bio-Medical Waste Management

Hypothesis:

All the hypotheses are measured at 0.05 level of significance

· H₁: There is a correlation between knowledge and practice of the Safai Karmachari.

· H₂: There is a significant association between the knowledge of the Safai Karmachari on bio medical waste management with selected variables.

· H_{3 :}There is a significant association between the practice of the Safai Karmachari on bio medical waste management with selected variables.

MATERIALS AND METHODS:

A non experimental survey research approach was considered to be the most appropriate for the present study as it aimed at to quantify the knowledge and practice of Safai Karmachari regarding Bio-Medical Waste Management. The research design selected for the study is Non-Experimental Descriptive co-relational Survey Design as it is mainly focused on assessing and describing the knowledge and practice of Safai Karmachari regarding Bio-Medical Management as shown in Figure 1.

The study was conducted in Central Referral Hospital, 5^th Mile Tadong, Gangtok, East Sikkim The population under study consisted of 30 Safai Karmachari within15 to 65 years of age belonging to different wards of Central Referral Hospital, Tadong, Sikkim having working experience of less than 3 years to more than 12 years, who available during the study and willing to participate in the study. Researcher adopted convenience sampling technique for the selection of the Safai Karmachari. She took the name list of Safai Karmachari from the human resources department and the registers maintained by the Safai Karmachari Supervisors, which was used as the sampling frame, then selected the Safai Karmachari who were fulfilled the sample criteria for this study.

Data collection tools and technique

The instrument used for data collection was Structured Knowledge Questionnaire on Bio-Medical waste Management and observation checklist on practice of Safai Karmachari regarding Bio-Medical Waste Management which was validated by five experts in the field. In this study a structured knowledge questionnaire, was a questionnaire that was filled up by the respondents. The structured knowledge questionnaire had two sections. Section I consisted of demographic variables. Demographic variables comprised of 10 items to collect the information regarding personal information. Section II comprised of 20 multiples choice questions to collect the information from the Safai Karmachari regarding their knowledge on Bio-Medical Waste Management. Observational checklist comprised of 12 activities which were observed by the interviewers in the participants in order to assess their practice which handling Bio-Medical Waste. Each correct response was given a score of 1. The maximum score for Questionnaire was 30 and Observation Checklist was 12.

RESULT AND DISCUSSIONS:

Findings related to Demographic Variables:

Table 1:Distribution of Safai Karmachari by their Demographic Characteristics N=30

Sr. No	Demographic Variables	f	%
1.	Age
	15 – 25 years	4	13.4
	26 – 35 years	15	50
	36 – 45 years	10	33.3
	46 – 55 years	1	3.3
	56 – 65 years	0	0
2.	Gender
	2.1 Male	6	20
	2.2 Female	24	80
3.	Educational Qualification
	3.1 No formal education	6	20
	3.2 Upto class V	9	30
	3.3 Upto class VIII	12	40
	3.4 Upto class X	2	6.7
	3.5 Above class X	1	3.3

The data given in table 1 indicate that 4 participants(13.4%) belonged to the age group of 15 – 25 years and 15(50%) belonged to age group of 26 – 35 years and 10(33.3%) belonged to age group of 36 - 45 years and 1(3.3%) belonged to the age group of 46 – 55years. Among them 24(80%) were females and 6(20%) were male. 6(20%) had no formal education 9(30%) had educational qualification upto Class V, 12(40%) Upto Class VIII, 2(6.7%) upto class X and 1(3.3%) had educational qualification above class X.

Figure 2: Distribution of samples according to the type of employment

The data given figure 2 shows that among 30 participants, 3 participants (10%) were regular employees of the hospital and rest 27(90%) were on contract basis.

Table 2: Distribution of samples according to their Clinical Area N=30

Sl. No	Clinical area	Frequency	Percentage
1	Male Medicine ward	3	10
2	Female Medicine Ward	3	10
3	Male Surgical Ward	3	10
4	Female Surgical Ward	3	10
5	MICU	3	10
6	SICU	3	10
7	NICU	3	10
8	OT	3	10
9	OBG	3	10
10	Private ward	3	10

Table 2 shows that out of 30 participants, 3(10%) were from Male Medicine Ward, 3(10%) were from Female Medicine Ward, 3(10%) were from Male Surgical Ward, 3(10%) were from Female Surgical Ward, 3 (10%) were from OBG Ward, 3(10%) were from Operation Theater, 3 (10%) were from Surgical Intensive Care Unit, 3(10%) were from Medical Intensive Care Unit, 3 (10%) were from Neonatal Intensive Care Unit and 3(10%) were from Private Ward.

Figure 3 shows that among 30 participants 10(33.3%) has work experience upto 3 years, 5(16.7%) has work experience of 3-6 yrs, 10(33.3%) has 6-9 years, 2(6.7%) has 9-12 years and 3(10%) has >12 yrs of work experience.

Figure 4: Distribution sample according to previous experience of teaching/workshop/seminar on Bio-Medical Waste Management.

Figure 4 show that 17 Safai Karmachari (56.7%) had experience of attending any previous teaching/seminar/ workshop, whereas 13 Safai Karmachari (43.3%) did not have any experience.

Figure 5: Distribution of samples according to their Vaccination against Hepatitis B

Table 3: Distribution of samples according to the place, years and number of experiences in attending previous teaching/seminar/workshop. (n=17)

Sample No	Place	Years	Times
2	CRH	2009-2011	3
3	CRH	2010-2011	2
4	CRH	0	1
9	CRH	2010-2011	2
10	CRH	2010-2011	2
12	CRH	2011	1
13	CRH	2009-2010	2
18	CRH	2008-2011	6
19	CRH	2011	1
20	CRH	2007-2010	6
22	CRH	2009	1
23	CRH	2008	1
24	CRH	2011	1
25	CRH	2009-2011	3
27	CRH	2007-2011	4
28	CRH	2011	1
30	CRH	2009	1

Figure 5 shows that 46.7% of the participants were vaccinated against Hepatitis B Virus whereas remaining 53.3% was not.

Table 4: Frequency and percentage distribution of participants according to Vaccination against Hepatitis B Virus n=14

Vaccination	Frequency	Percentage (%)
Upto Dose I	14	46.7
Upto Dose II	10	33.3
Upto Dose III	5	16.6
Upto Booster Dose	3	10

Table 4 shows that among 14 Safai Karmachari(46.7%) all had received dose I of Hepatitis B vaccine then after 10(33.3%) had upto dose II, 5(16.6%) had upto dose III and only 3(10%) had received vaccination upto booster dose. N=30

Figure 6: Distribution of samples according to their Vaccination against Tetanus Toxoid.

Figure 6 shows that 19 Safai Karmachari (63.3%) had been vaccinated against Tetanus toxoid and 11(36.7%) had not been vaccinated.

Findings related to knowledge and practice of Safai Karmachari regarding Bio-Medical Waste Management

Table 5:Findings related to knowledge assessment regarding Bio-Medical Waste Management N=30

Category of score	Score	Frequency	Percentage (%)
Excellent Knowledge	16 to 20	8	26.7
Good Knowledge	11 to 15	19	63.3
Average Knowledge	6 to 10	3	10
Poor Knowledge	≤5	0	0

The findings in table 5 show that majority of the subjects (63.3%) possessed good knowledge, (26.7%) possessed excellent knowledge and only (10%) possessed average knowledge.

Table 6: Area wise mean percentage score of Knowledge level on Bio-Medical Waste Management N=30

Sr. No:	Area	Maximum Score	Mean % Score
1.	Meaning	29	96.6
2.	Handling	58	64.4
3.	Segregation	91	75.8
4.	Storage	27	45
5.	Disinfection	61	67.7
6.	Transportation	74	82.2
7.	Disposal	43	71.6
8.	Universal Precaution	44	73.3

The above table 6 depicts that the Knowledge of Safai Karmachari regarding various areas of Bio-Medical Waste Management are meaning (96.6%), handling (64.4%), segregation (75.8%), storage (45%), disinfectant (67.7%), transportation (82.2%), disposal (71.6%) and universal precaution (73.3%).

Table 7: Findings related to practice assessment regarding Bio-Medical Waste Management among the Safai Karmachari N=30

Category of score	Score	Frequency	Percentage (%)
Good	8 to 11	0	0
Average	4 to 7	19	63.3
Poor	<4	11	36.7

The data presented in the Table 7 shows that majority of the subject (63.3%) had average practice and (36.7%) had poor practice.

Table 8: Area wise mean percentage score of Practice level on Bio-Medical Waste Management N=30

Sr. no:	Area	Maximum Score	Mean % Score
1.	Handling	46	51.11
2.	Segregation	10	16.67
3.	Storage	5	16.67
4.	Disinfection	19	63.33
5.	Transportation	28	93.33
6.	Disposal	6	10

The above table 8 depicts that the Knowledge of Safai Karmachari regarding various areas of Bio-Medical Waste Management are handling(66.67%), segregation(20%), storage(80%), disinfectant(80%), transportation(90%) and disposal (80%).

Table 9 Maximum score, Range of score, Mean and Standard Deviation of knowledge and practice among Safai Karmachari regarding Bio-Medical Waste Management N=30

Sl. No.	Variables	Maximum score	Range of score	Mean	Standard deviation
1	Knowledge	20	8-17	14.04	2.059
2	Practice	11	1-6	7.4	2.42

The data presented in Table 9 shows:

· The mean score for knowledge and practice were 14.04 and 7.4 respectively.

· The standard deviation for knowledge and practice were 2.059 and 2.42 respectively.

· The range of score for knowledge was 8 – 17 and range of score for practice was 1 – 6

· The maximum score for knowledge was 20 and for practice were 11.

Findings related to the Correlation between knowledge and practice of Safai Karmachari regarding Bio-Medical Waste Management.

Table 10: Correlation between Knowledge and Practice of the samples regarding Bio-Medical Waste Management: N=30

Sample no.	Knowledge	Practice	Correlation
1	9	2	0.31
2	14	6
3	15	5
4	13	5
5	14	2
6	16	3
7	13	4
8	13	3
9	15	2
10	16	5
11	15	4
12	16	3
13	13	4
14	17	4
15	17	5
16	12	1
17	16	6
18	16	2
19	14	4
20	14	4
21	8	2
22	14	5
23	14	6
24	13	3
25	15	5
26	10	2
27	15	6
28	15	6
29	15	4
30	17	4

The data presented in table 10 reveals that knowledge score with a mean score (14.04) and the practice score with a mean score (7.4) had a correlation coefficient (r) value of 0.31, which were lying between 00 and +1 (0 < 0.31< 1) .This showed a poorly positive correlation between knowledge and practice score of biomedical waste management among the Safai Karmachari.

Findings related to the association of knowledge Score and practice level with selected demographic variables

The association between knowledge and practice of Safai Karmachari regarding Bio Medical Waste Management with selected factors:

1. Educational qualification

2. Year of experience in clinical area

3. Previous experience of any teaching/workshop/ seminar on Bio-Medical Waste Management.

The table 11 depicts that there is no association between the knowledge score of Safai Karmachari regarding Bio Medical Waste Management with educational qualification (x²=13.02)_,years of experience in clinical area (x²=18.43) and with Experience of attending any previous teaching/seminar/workshop on Bio-Medical Waste Management (x²=4.35).

Data presented in table 12 shows the obtained chi value for educational qualification (5.01) at df (8) and experience of attending any previous teaching /seminar /workshop on Bio-Medical Waste Management (4.04) at df (3) was not significant at 0.05 level of significance whereas years of experience(24.43) at df (8) was significant at 0.05 level of significance .

Table 11: Chi square value for association between knowledge score and selected demographic variables N=30

Demographic variables

Knowledge level

χ2

p-value

Excellent

Good

Average

Poor

Educational qualification

No formal

Upto class V

Upto class VIII

Upto Class X

Above X

13.02

21.03

Years of experience in clinical area.

Upto 3 years

3-6 years

6-9 years

9-12 years

> 12 years

18.43

21.03

Experience of attending any previous teaching/seminar/workshop on Bio-Medical Waste Management

Yes

4.35

5.99

p>0.05

Table 12: Chi square value for association between Practice level and selected demographic variables N=30

Demographic variables

Practice level

χ2

p-value

Good

Average

Poor

Educational qualification

No formal

Upto class V

Upto class VIII

Upto Class X

Above X

5.01

15.51

Years of experience in clinical area.

Upto 3 years

3-6 years

6-9 years

9-12 years

> 12 years

24.43^*

15.51

Experience of attending any previous teaching/seminar/workshop on Bio-Medical Waste Management:

Yes

4.04

5.99

p* < 0.05

Discussion Related to other studies

The findings of the present study shows that 96.6% had knowledge on meaning, 45% on storage and 71.6% on disposal/treatment of Bio-Medical waste Management. The findings of the study is consistent with the findings of the study of S Sreegiri ,G Krishna Babu¹⁰ and, Yadavannavar¹¹ where the level of knowledge among the Safai Karmachari were meaning (53%), storage (25%) and disposal/treatment (73%) regarding Bio-Medical Waste Management.

The finding of the present study shows that 63.3% has average practice on Bio-Medical Waste Management whereas, 36.6% has poor practice. The findings of the study is consistent with the findings of the study of Ugen Dophu¹² where out of 53 Sanitary staff, 36 (76.9%) practiced good Bio-Medical Waste Management and 17(32.1%) practiced poor Bio-Medical Waste Management.

IMPLICATIONS:

Nursing Education

1. Inclusion of Bio-medical Waste management in B. Sc. Nursing, ANM and GNM Curriculum

2. In-service Education on Bio-Medical Waste Management

3. Health Education Programme in Urban setting as well as hospital and institutional settings

Nursing Administration

1. Standard protocol of the Bio-Medical Waste Management must be developed in the ward

2. Ensure supply of the necessary items in the ward

3. Create awareness and reinforce the practice among health care workers

4. Development of module in respect of prevention of needle sticks injury among the health care workers and hands on training programme on the same.

Nursing Practice

1. Strict following of the Bio-medical Waste management protocol in all the wards

2. Continuous monitoring of the Safai Karmachari and other waste handler during collection, segregation, storage and transportation of Bio-Medical Waste.

3. Infection control nurse should be appointed in each area to check the practice of health care workers regarding

4. Case studies can be done to generate more evidence to support this protocol

Nursing research

1. The Evidence based Practice and nursing researches co-exist and support each other to strengthen the Nursing Field. Therefore, practice of Bio-Medical Waste management must be incorporated in nursing care.

2. Dissemination of research knowledge through journals.

CONCLUSION:

1. About 63.3% of Safai Karmachari had good knowledge on Bio-Medical Waste Management whereas the remaining 26.6% had excellent knowledge and 10% had average knowledge.

2. Regarding the practice of Safai Karmachari on Bio Medical Waste Management, 63.3% had average practice and 36.6% had poor practice.

3. Most of the Safai Karmachari (96.6%) had knowledge on the meaning of Bio-Medical Waste Management, whereas only 45% had knowledge on storage.

4. Similarly, most of the Safai Karmachari (93.33%) practiced good transportation techniques, whereas only 16.67% practiced proper methods of segregation of Bio-Medical Waste

5. As per the various areas of Bio-Medical Waste Management, 75.8% and 82.2%of Safai Karmachari had knowledge regarding segregation and transportation but when it came to practice, segregation was practiced by 16.67% whereas most of them (93.33%) practiced transportation.

6. Most of them had knowledge (71.6%) on disposal of waste management but it has been seen that only 10% practiced it.

7. There is a no correlation between the knowledge and practice of Safai Karmachari regarding Bio-Medical Waste Management which has been seen in various areas such as segregation, disposal and storage.

8. There is no significant association between knowledge of Safai Karmachari with educational qualification, total years of experience and previous experience of attending teaching/seminar/workshop on Bio-Medical Waste Management.

9. There is a significant association between practice of Safai Karmachari with the total years of experience where as it has no association with educational qualification and previous experience of attending teaching/seminar /workshop on Bio-Medical Waste Management.

ACKNOWLEDGEMENT:

We are thankful to Prof. Mridula Das, Principal, Sikkim Manipal College of Nursing for providing us with the opportunity to conduct this project and complete it with support and guidance.

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Received on 02.12.2014 Modified on 07.01.2015

Asian J. Nur. Edu. and Research 5(2): April-June 2015; Page234-241

DOI: 10.5958/2349-2996.2015.00046.4