INTRODUCTION:

Great strides have been made in the field of health care system over the years. The health of public, patients and professionals alike are affected by poor waste management practices and also contributes to environmental degradation.

The term “biomedical waste” has been defined as “any waste that is generated during diagnosis, treatment or immunization of human beings or animals, or in the research activities pertaining to or in the production or testing of biologicals and includes categories mentioned in schedule I of the Government of India’s Biomedical Waste (Management and Handling) Rules 1998” ^1,2.

In India, the Ministry of Environment and Forests has promulgated the Biomedical Waste (Management and Handling) Rules 1998 for proper management of BM waste. These rules are meant to improve the overall waste management of health care facilities in India^1,2. The absence of proper waste management, lack of awareness about the health hazards from BM waste, insufficient financial and human resources, and poor control of waste disposal are the most critical problems connected with health care waste.

Although there is increased global awareness among health care professionals about hazards and also appropriate management techniques, the level of awareness in India has been found to be unsatisfactory^3-4. Therefore, the present study was conducted to assess the level of knowledge and attitude among students of SKSS group of Colleges, Sarabha, Ludhiana, India.

PROBLEM STATEMENT:

A descriptive study to assess the knowledge and attitude regarding bio-medical waste management among the students in selected colleges of SKSS Group of Institutes, Sarabha, Ludhiana, Punjab.

OBJECTIVES:

1. To assess the knowledge regarding bio-medical waste management among the students.

2 To assess the attitude regarding bio-medical waste management among the students.

3 To find out the correlation between knowledge and attitude regarding bio-medical waste management among the students.

4 To find the association of knowledge and attitude regarding bio-medical waste management among the students with selected variables such as age, gender, type of course, area of practice and year of study.

STUDY SETTING:

The study was carried out among the students studying in Shaheed Kartar Singh Sarabha, College of Nursing and Shaheed Kartar Singh Sarabha Ayurvedic Medical College Ludhiana, Punjab. The College of Nursing is offering a variety of nursing courses i.e. MSc Nursing (Mental Health Psychiatric Nursing, Community Health Nursing and Obstretical and Gynaecological Nursing), Post Basic BSc Nursing, BSc Nursing, General Nursing and Midwifery, Auxillary Nursing and Midwifery. The Ayurvedic Medical College offers BAMS course to the aspiring students

REVIEW OF LITERATURE:

S Alok, S Varsha, S Swati, S Prabhat (2013) conducted a cross-sectional study to determine the following among the workforce of the Jaipur Dental College, India: their awareness regarding biomedical (BM) waste management policy and practices, their attitude towards biomedical waste management, and their awareness regarding needle-stick injury and its prevalence among different categories of health care providers. A questionnaire was distributed to 144 dentists, nurses, laboratory technicians and Class IV employees (cleaners and maintenance personnel). It was surprising that 36% of the nurses had an extremely poor knowledge of biomedical waste generation and legislation and just 15% of the Class IV employees had an excellent awareness of biomedical waste management practice. It concluded from the study that there are poor levels of knowledge and awareness about BM waste generation hazards, legislation and management among health care personnel in Jaipur Dental College. Regular monitoring and training are required at all levels.

Vanesh Mathur, S Dwivedi, MA Hassan, RP Misra (2011) conducted a cross-sectional study to assess knowledge, attitude, and practices about biomedical waste management among healthcare personnel. The study was conducted among hospitals (bed capacity >100) of Allahabad city. Medical personnel included were doctors (75), nurses (60), laboratory technicians (78), and sanitary staff (70). The results revealed that doctors, nurses, and laboratory technicians have better knowledge than sanitary staff regarding biomedical waste management. The study concluded that the importance of training regarding biomedical waste management needs emphasis; lack of proper and complete knowledge about biomedical waste management impacts practices of appropriate waste disposal.

DEFINITION OF TERMS:

“Knowledge” refers to awareness and understanding on bio-medical waste managements as expressed by the students. “Attitude” refers to the ideas and views of students regarding bio-medical waste management. “Bio-medical waste management” refers to any waste generated during diagnosis, treatment or immunization of human beings or animals. “Students” refers to the females and males undertaking nursing or Ayurvedic course in Shaheed Kartar Singh Sarabha Group of Colleges.

METHODOLOGY:

A descriptive study design was used to carry out this study. The students were administered structured questionnaire and three point Likert scale to assess the knowledge and attitude of students regarding bio-medical waste management. A total of 380 students were selected. The students who fulfilled the inclusion criteria were selected by convenience sampling method.

Inclusion criteria:

(a) The students who were willing to participate and present at the time of data collection.

(b) Students studying in the Nursing and Ayurvedic college.

The tool was peer reviewed and was prepared in English language. The tool consisted of three parts:

Part A: Socio-demographic data

Part B: Knowledge questionnaire consisting of 28 questions. Each correct response was given a score of one and the wrong responses zero. The total score was 28.

Part C: Attitude Scale: The attitude scale consisted of 12 items, both positively and negatively phrased in a 3 point Likert scale. The total score was 36.

The data collection was started on 27-28 April 2015 for a period of two days. The tool was administered at the same time to all the students in the nursing college and next day it was administered to those studying in Ayurvedic college.

The students were administered the questionnaire by the investigators. The data was analyzed using the descriptive and inferential statistics. The data analyzed was presented using tables and diagrams.

Validity and reliability:

Expert opinion was sought from the faculty of College of Nursing Research Committee.

Ethical considerations:

The study was carried out with the permission from the authorities of the Shaheed Kartar Singh Sarabha College of Nursing and Shaheed Kartar Singh Sarabha Ayurvedic Medical College, Ludhiana, India. An informed written consent was obtained from the students participating in the study. Measures were taken to maintain the confidentiality of the data and the participants.

Table1:Frequency and Percentage Distribution of sample characteristics: N=380

Sample Characteristics

Frequency (%)

Age

18 - 22

23 - 27

28 - 32

314 (82.6)

64 (16.8)

02 (0.5)

Gender

Male

Female

22 (6)

358 (94)

Undergraduate

BSc (N)

Post Basic BSc (N)

General Nursing and Midwifery

Bachelor Of Ayurvedic Medicine and Surgery

171 (45.0)

60 (25.8)

123 (32.4)

26 (6.8)

Area of clinical experience

Private

Government

Both

120 (31.6)

50 (13.2)

210 (55.3)

Table 2: Frequency and percentage distribution of subjects according to knowledge score N=380

Level of knowledge	Score	Frequency (%)
Excellent	≥ 21	07 (1.8)
Good	17-20	105 (27.6)
Average	14-16	117 (30.8)
Below average	<14	151 (39.7)

Maximum score: 28 Minimum score: 0

Table 3: Frequency and percentage distribution of subjects according to attitude score: N=380

Level of attitud	Score	Frequency (%)
Positive attitude	≥ 29	364 (95.8)
Negative attitude	<28	16 (4.2)

Maximum score: 36

Minimum score: 0

Table 4: Relationship between knowledge score and attitude score regarding biomedical waste management among undergraduate.

Variables	Mean ±SD	r value	p value
Knowledge	14.49 ± 3.30	1	0.05
Attitude	8.42 ± 1.65	1	0.05

Table : 5 Association of knowledge and attitude score regarding biomedical waste management among undergraduate with selected socio demographic variables.

Variables

Knowledge score

Attitude score

Mean ± SD

F/tp value

Mean ± SD

F/t p value

Age

18 -22

23 -27

28 -32

314

14.74±3.31

13.34±3.00

11.50±2.12

F= 5.74

p 0.004

8.59±1.48

7.64±2.15

7.00±0.00

F = 10.02

p = 0.00

Gender

Male

Female

358

15.50±2.70

14.43±3.33

F = 2.42

p =0.12

8.77±1.47

8.40±1.66

F = 0.08

p = 0.7

Undergraduate

BSc (N)

Post Basic BSc (N)

General Nursing and Midwifery

Bachelor Of Dental Surgery

Bachelor Of Ayurvedic Medicine and Surgery

171

123

15.85±2.85

13.23±2.33

13.73±3.59

12.00±2.91

F = 23.21

p =0.000

8.57±1.35

7.68±2.00

8.47±1.76

8.84±1.56

F = 5.30

p = 0.001

Area of clinic

Private

Government

Both

120

210

14.66±2.79

12.28±2.64

14.91±3.51

F = 14.00

p = 0.00

8.41±1.45

8.06±1.44

8.51±1.79

F =1.53

p = 0.21

Data collection was arranged and tabulated to process the findings. Descriptive and inferential statistics such as frequency, mean, standard deviation, percentage, ANOVA were used to analyze the data.

Table 1. shows that the majority of the students were from the age group 18-22 years and were females. Maximum number of the students were pursuing BSc Nursing course and their area of clinical practice was both government and private.

Table 2. shows that 39.7% had below average knowledge, 30.8% of students had average, 27.6% had good, only 1.8% had excellent knowledge regarding biomedical waste management.

Table 3. shows that majority (95.8%) had positive attitude regarding biomedical waste management.

Table 4 shows that there is a positive correlation between knowledge and attitude of the students regarding biomedical waste management. The knowledge regarding biomedical waste management has impact on the attitude of the students.

Table 5 shows a significant relationship of knowledge regarding bio medical waste management was found with age of the student, undergraduate course at p≤ 0.5. A significant relationship of attitude regarding bio medical waste management was found with age of the student, undergraduate course and area of clinical experience at p ≤ 0.5

DISCUSSION:

The study found that 39.7% of the students have below average knowledge regarding biomedical waste management which is similar to the findings of study conducted by Hashemi M, Khanjani N, Saber M, Fard NK (2010) in Iran which showed that the students of the School of Public Health still need more education in health literacy as they are supposed to be the promoters of public health in the society in the near future⁵.

The study findings are also similar to the study conducted by Mohd Shafee, NB Kasturwar, and N Nirupama⁶ in Karimnagar town, Andhra Pradesh among 500 paramedical staff working in various private nursing homes and clinics that revealed that the staff lacked the required knowledge about BMW management but a positive attitude was found to improve the current situation in BMW management.

RECOMMENDATIONS:

Periodic research on bio-medical waste management and role of nurses should be undertaken.

The study was confined to one major group of colleges, further studies are required on a larger population to generalize the results, in the formulation and implementation of BMW guidelines.

IMPLICATIONS:

The topic of biomedical waste management should compulsorily be made a part of the undergraduate curriculums of both nursing and Ayurvedic medicine and periodical continuing education should be provided.

CONCLUSION:

Our study revealed that although the attitude about biomedical waste management was positive among the students, the knowledge was comparatively below average .This study indicated that there is a need for creating awareness among students regarding biomedical waste management. If we need to protect our environment and health of community we must sensitize ourselves, motivate ourselves to this important issue not only in the interest of health care workers but also in the interest of community.

ACKNOWLEDGEMENT

We acknowledge and thank the Principals of College of Nursing and College of Ayurvedic medicine for giving us permission to conduct the study. We also thank the students for their cooperation and participation.

REFERENCES:

1. Government of India, Ministry of Environment and Forests. Bio-Medical Waste (Management and Handling) Rules. Gazette of India. 1998 (27 Jul). Available from: http://envfor.nic.in/legis/hsm/biomed.html

2. Government of India, Ministry of Health and Family Welfare (MoHFW). National Guidelines on Hospital Waste Management Based upon the Bio-Medical Waste (Management and Handling) Rules, 1998. New Delhi: MoHFW; 2002.

3. Pandit NB, Mehta HK, Kartha GP, Choudhary SK. Management of bio-medical waste; Awareness and practices in a district of Gujarat. Indian Journal of Public Health. 2005; 49: 245-247.

4. Kishore J, Goel P, Sagar B, Joshi TK. Awareness about biomedical waste management and infection control among dentists of a teaching hospital in New Delhi. Indian Journal of Dental Research. 2000; 11: 157-161.

5. Hashemi M1, Khanjani N, Saber M, Fard NK. Evaluating health literacy of Kerman Medical University, School of Public Health students about recycling solid waste. J Ayub Med Coll Abbottabad. 2010 Oct-Dec; 22(4):101-5.

6. Mohd Shafee, NB Kasturwar, and N Nirupama. Study of Knowledge, Attitude and Practices Regarding Biomedical Waste among Paramedical Workers. Available from :http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2940212/

Received on 10.09.2015 Modified on 21.09.2015

Asian J. Nur. Edu. and Research 6(1): Jan.- Mar.2016; Page 123-126

DOI: 10.5958/2349-2996.2016.00024.0