A Feasibility Survey to Develop check list on the Practices Regarding Biomedical Waste Management in Community Health Institutions in a District of Haryana, India

Pramod Kumar¹, Dr. Indarjit Walia²

¹Faculty, College of Nursing, Pt BDS PGIMS, Rohtak and PhD Scholar National Consortium for PhD in Nursing, New Delhi

²Former Principal, NINE, PGIMER Chandigarh

*Corresponding Author Email:

ABSTRACT:

Everything is made for a defined purpose “anything which is not intended for further use is termed as waste”. In the scientific and industrial era combined with increasing population and their demand, the turnover of products has gone very high resulting into increase in quantum of urban solid waste. With increasing need of Health Care in fast changing society the role of hospitals/nursing homes comes to the forefront. A case study design supplemented by naturalistic observation was employed. Judgmental sampling was used for the in depth and holistic analysis of the practice of biomedical waste management in PHCs (n=3) and sub centres (n=12) at Rohtak District, Haryana. Biomedical waste management check list related to the practice and facilities of biomedical waste management as per standards (BMW Rule, 1998) was developed under expert guidance. The data were collected with the help biomedical waste management check list Part-1 consisted of 2 items related to the basic information and practices as per various settings, part-2: consisted of 8 items related to the basic requirements, Part 3 consisted of 4 items related to the transportation protocols, part 4 consisted of 6 items related to collection and storage, part 5 consisted of 7 items related to treatment and disposal, part 6 consisted of 5 items related to generation and segregation, part 7 consisted of 14 items related to Storage and treatment protocols. The principal investigator observed the practices and recorded the same as per the checklist, Photo and records. Quantitative approaches are used for the data analysis.

KEYWORDS: Practice, Biomedical waste management, community health institution, Haryana.

INTRODUCTION:

“Let the waste of “sick’ not contaminate the “lives” of healthy “

With increasing need of Health Care in fast changing society the role of hospitals/nursing homes comes to the forefront. Hospital is a residential establishment which provides short term and long term medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for a person suffering or suspected to be suffering from disease or injury and parturient. It may or may not also provide services for ambulatory patients on an outpatient ¹ Biomedical waste are defined as waste that are generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining there to, or in the production or testing of biological², studies have shown that 85% of the waste generated in health care establishments is non-hazardous, about 10% is infectious and hazardous and the remaining 5% is non –infectious but hazardous waste³. In India, approximately 0.33 million tons of hospital waste is generated yearly and in hospital settings, 0.5 to 2.0kg of biomedical waste is being generated per bed every day⁴

OBJECTIVES:

To test the feasibility of main study and check list on practices regarding biomedical waste management in community health Institutions in a District of Haryana.

MATERIAL AND METHODS:

A study was conducted to determine the practices regarding biomedical waste management in community health Institutions in a District of Haryana. The major aims of the study was to assess the feasibility of tools in various perspectives in terms of its acceptability, time needed for administration and to refine the methodology and data collection methods. A case study design supplemented by naturalistic observation was employed. Judgmental sampling was used for the in depth and holistic analysis of the practice of biomedical waste management in PHCs (n=3) and sub centres (n=12) at Rohtak District, Haryana.

Domain 1: consisted of 2 items related to the basic information, the present study found that basic guidelines for bio – medical waste management was fully available in labour room and general ward (100%), while in procedure room and laboratory guidelines were available only in few settings (67%). On the other hand situation was worst in OPD where there was no availability of basic guidelines (0%).However regarding appropriateness of charts as per content and readability was well maintained in labour room and general ward (100%).

Domain 2: consisted of 8 items related to the basic requirements Colour coded bags was adequately available in procedure room (100%) while the same was comparability less (67%) in labour room, laboratory and general wards..Needle destroyers were available in most of settings (67%) but the laboratory settings were less equipped with the same (33%). Findings of study shows that utilization of needle destroyers by health care providers was adequate in procedure room and laboratory (100%), while in labour room and general ward its utilization was somewhat less (67%). Moreover its utilization in OPD is nil as compared to other settings.OPD was lacking the all basic requirements of biomedical waste management such as the availability of colour coded bags, needle destroyer etc.

Domain 3: consisted of 4 items related to the transportation protocols designated waste route in the health institution was satisfactory in procedure room, OPD, laboratory and general ward (67%) on the other it was comparatibly less labour room for some settings (33%). It was found that waste was transported in close containers adequately in labour room, laboratory, procedure room and general ward (100%), on the other hand waste transportation was not satisfactory in OPD for some settings (33%). Waste was transported in bins/ trolleys/Wheel borrows in properly in labour room and general ward (100%). While it was less satisfactory in procedure room and OPD for some settings (67%).

Domain: 4 consisted of 6 items related to collection and storage

Sl no

Domain

Procedure Room

OPD

Labour room

Laboratory

General Wards

Frequency

Collection of waste in covered bins

Yes

100

Is the bins filled more then ¾ level

Yes

100

Is the bins cleaned

Yes

100

Is the infectious and non infectious waste filled in same bins

Yes

100

Storage of waste beyond 48 hrs

Yes

100

Domain 5: consisted of 7 items related to treatment and disposal

Sl no

Domain

Frequency

Percentage

Disinfection of plastic or sharp at the point of generation

Yes

Biomedical waste disinfected and mutilated before final disposal

Yes

100

Cut and chemically disinfection of syringe before final disposal

Yes

100

Is the infectious and non infectious waste mixed at any point

Yes

Domain 6: consisted of 14 items related to Storage and treatment protocols.

The findings of the study shows that waste was segregated properly at the site of generation in procedure room, OPD, labour room and general ward with the exception of labour room where it was less practiced. It was found that sharps infectious waste was disposed in white puncture proof containers in labour room and general ward while it was less practiced in procedure room, OPD and laboratory.

Segregation of used needles and other sharps was satisfactorily coordinated in white puncture proof containers labour room, laboratory and general ward. However it was not satisfactory in procedure room for many settings on the other hand it was very poorly coordinated in OPD.

It was found that practice of disinfection of plastic and sharp at the point of generation was well practiced in procedure room, labour room and general ward. However for many settings it was less practiced in OPD and laboratory. In all settings log book are maintained for quantity of waste (100%).

DISCUSSION:

Medical science is no exception, modern medical institutions have succeeded in developing new technologies to save life, but in the very process they overlooked and failed to develop technologies that take care of the removal of biomedical waste⁶. Current waste management practices are characterized by poor quality collection services and improper disposal at open dumpsites^.16

Present study used the Bio-Medical Waste (Management and Handling) Rules, 1998 to develop check list for to assess the practice on biomedical waste management the different domain of the check list is affective to assess the biomedical waste management practice. The six domain of the checklist is also helpful to assess the facilities available at the health centre. The proper biomedical waste management is essential for the environment as well for the health professional, WHO guideline also used to develop the check list.

BMW management is currently a burning issue more so with the increasing health care facilities and increasing waste generation.²¹ Therefore knowledge regarding the segregation and disposal of BMW is essential for the health care workers (HCW). Government of India has notified the Biomedical Waste (Management and Handling) rules 1998 with subsequent amendments (June 2nd 2000, September 2003 and 2011). India generates around three million tonnes of medical wastes every year and the amount is expected to grow at eight per cent annually.¹²

Rao P 2008 shows that awareness of Bio-medical Waste Management Rules was better among hospital staff in comparison with private medical practitioners and awareness was marginally higher among those in urban areas in comparison with those in rural areas. Training gained momentum only after the deadline for compliance was over. Segregation and use of colour codes revealed gaps, which need correction. About 70% of the healthcare facilities used a needle cutter/destroyer for sharps management.¹³

LIMITATIONS:

1. It is just to check feasibility to main study

2. Sample size was small

3. Only rural health centre included.

ACKNOWLEDGEMENTS:

I owe my immense and long standing gratitude to all the participants of the study, without their co-operation and participation it would have been impossible to conduct the study. My sincere thanks to all those who assisted me, directly or indirectly in the successful completion of this study.

CONFLICT OF INTEREST:

The study entitled A feasibility survey to develop check list on the practices regarding biomedical waste management in community health Institutions in a District of Haryana, India, Pramod kumar Faculty, College of Nursing, Pt BDS PGIMS, Rohtak and PhD Scholar National Consortium for PhD in Nursing, New Delhi. Authors do not have any relationships/ condition/ circumstances that present a potential conflict of interest.

SOURCE OF FUNDING:

The study entitled a feasibility survey to develop check list on the practices regarding biomedical waste management in community health Institutions in a District of Haryana, India is the self funded research work of Mr. Pramod kumar.

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Received on 15.02.2017 Modified on 18.03.2017

Asian J. Nur. Edu. and Research.2017; 7(3): 295-298.

DOI: 10.5958/2349-2996.2017.00061.1