INTRODUCTION:

The health care sector includes a diverse range of health care facilities which have a size assortment from large general and specialist hospitals to small municipal dispensaries and D-type centers. All these facilities are an integral part of our society with an endeavor to reduce health problems and to eliminate jeopardy to people’s health.

In the course of curing health problems the health care sector produce huge amount of bio-medical waste which may be hazardous to all those who come in contact with this waste. Hazardous waste management is a concern for every health care organization.¹

Biomedical waste (BMW) is a waste generated during diagnosis, treatment or immunization of human beings or animals, or in research activities or in the production and testing of biological and is contaminated human fluids. The waste produced in the course of health care activities carries a higher potential for infection and injury than any other type of waste. Approximately 70-90% of the biomedical waste is non-hazardous and as harmless as any other municipal waste. The remaining 10-25% is hazardous and can be injuries to humans or animals and deleterious to environment. It is estimated that annually about 0.33 million tons of hospital waste is generated in India and, the waste generation rate ranges from 0.5 to 2.0 kg bed per day.²

The biomedical waste management and handling rules have been notified in 1998. These rules are meant to improve the overall waste management of health care facilities in India. Schedule I of which describes the categories of biomedical waste, their treatment and disposal methods, schedule II of which describes the color coding and type of container for disposal of biomedical waste. Bio-medical waste if not handled properly and within the stipulated time period could strike in the form of fatal infection. Additional hazard includes pilferage during transport and recycling of disposables without even being washed.³

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.⁴

A study to assess the awareness of BMW management among the health workers in three apex government hospitals, agra. The total number of samples were 1227, out of which 145 were sanitary staffs. A questionnaire was distributed to assess the study and the results showed that only 70 sanitary staffs were aware of BMW management.⁵

A study was conducted to assess the knowledge, attitude and practice of paramedical staff regarding health care waste management practices. A pre-tested questionnaire was used among the paramedical staff of four PHCs. The result showed that 33 (91.7%) staff knew that impact of health care waste on the community and the environment. knowledge regarding appropriate waste management ranged from 33% to 86%. Twenty one (58%) felt that there was need for training. Attitude regarding segregation, containment and storage was average (51%-59%) practices regarding the use of gloves, disinfection of syringes and recapping the needles ranged from 20%-40%. The study concluded that all the paramedical staff should undergo training in health care waste and certain wrong practices should be corrected.⁶

The present study tries to find out the real state of affairs of the knowledge and attitude of class IV employees regarding biomedical waste management and also help the authorities to develop the strategy for improving the situation in future.

OBJECTIVES OF THE STUDY:

The objectives of the study were:

1. To assess the level of knowledge regarding biomedical waste management among class IV employees in general hospital, Thiruvananthapuram.

2. To determine the attitude towards biomedical waste management among class IV employees in general hospital, Thiruvananthapuram.

3. To determine the association between knowledge score with the socio demographic variables

4. To determine the association between attitude score with the socio demographic variables

MATERIALS AND METHODS:

Research approach:

Quantitative approach was adopted for this study

Research design:

A descriptive design was used for the study.

Setting of the study:

General hospital, Thiruvananthapuram was selected as the setting of the study.

Population:

The study population constitute class IV employees working in General hospital, Thiruvananthapuram.

Sampling technique and sample size:

The purposive sampling technique was used for the study. Sample size was 100.

Research Tool:

Tool used for data collection in the present study were:

Tool 1: Questionnaire to assess knowledge regarding biomedical waste management among class IV employees

Section A:

Questionnaire to assess the socio-demographic data.

This is structured questionnaire which consists of 6 questions to gather socio demographic data like age, gender, Education, Year of experience, Presence of health workers in the family, prior exposure to educational programmes regarding Biomedical Waste Management.

Section B:

Questionnaire to assess knowledge regarding biomedical waste management among class IV employees

This is a structured questionnaire which consists of 20 questions. Each question has five options and the right option carries one mark. Total score is 20. The grading for knowledge score is as follows.

Grade Score

Poor <5

Average 6 – 10

Good 11 – 15

Excellent 16-20

Tool: 2 – Rating scale to assess attitude regarding biomedical waste management among class IV employees

It consists of 10 statements with 5 options as strongly agree, agree, uncertain, disagree, strongly disagree. The minimum score is 10 and the maximum score is 50. The grading for attitude score is as follows.

Grade Score

Unfavourable attitude ≤25

Favourable attitude >26

Data collection process:

Data collection was done after obtaining permission from the medical officer, General Hospital, Thiruvananthapuram. Data collection was done during Dec 2016 to Jan 2017. After getting informed consent from the participants, self administered structured questionnaire for assessing knowledge regarding biomedical waste management and rating scale for assessing attitude regarding biomedical waste management were distributed to each subjects.

RESULTS:

Section: A

Demographic characteristics of class IV Employees

· 24% of the subjects were males and 76% were females.

· 67 % of them completed secondary education, 26% of the subjects completed primary education and 7% of them completed their college education

· 97% have prior work experience in biomedical waste management.

· Majority of the staff (86%) of the staff doesn’t have health workers in the family.

· 82% of subjects have attended classes on biomedical waste management.

Section: B

Distribution of subjects according to their level of knowledge regarding Biomedical waste management

Figure– 1 Distribution of subjects according to the knowledge score

The above figure shows that majority (73%) of subjects had average knowledge regarding biomedical waste management.

Section: C

Figure – 2 Distribution of subjects according to their attitude towards Biomedical waste management

The above figure shows that majority (99%) of subjects had favourable attitude towards biomedical waste management.

Section D: Association of knowledge score with the socio demographic variables

Table-1

SL NO

Demographic variables

X²

P value

Gender

a) Male

b) Female

0.077

0.508

Education

a) Primary

b) Secondary

c) College

4.315

0.365

Work experience

a) Yes

b) No

1.144

0.564

Presence of health worker in the family

a) Yes

b) No

4.492

0.106

No : of persons who attended the class previously

a) Yes

b) No

1.577

0.045

The above table shows that there is a statistically significant (p<0.05) association between knowledge score and number of person who attended the class previously.

Section-E: Association of attitude score with the socio demographic variables

Table-2

Sl No

Demographic variables

X²

P value

Gender

c) Male

d) Female

0.319

0.760

Education

d) Primary

e) Secondary

f) College

2.287

0.232

Work experience

c) Yes

d) No

0.031

0.970

Presence of health worker in the family

c) Yes

d) No

6.205

0.140

No : of persons who attended the class previously

c) Yes

d) No

0.222

0.820

The above table shows that there is no significant association between the attitudes of the class IV employees towards BMW management with sociodemographic variables.

DISCUSSION:

Findings of the study are discussed in terms of objectives and theoretical bases.

Demographic variables showed that:

· 24% of the subjects were males and 76% were females.

· 67 % of them completed secondary, 26% of the subjects completed primary and 7% of them completed their college education

· 97% have prior work experience in biomedical waste management.

· Majority of the staff (86%) of the staff doesn’t have health workers in the family.

· 82% of subjects have attended classes on biomedical waste management.

The results showed that majority (73%) of subjects had average knowledge and majority (99%) of subjects had favourable attitude towards biomedical waste management. The study findings are also similar to the study conducted 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 management⁷

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 annually⁸

RECOMMENDATIONS:

1. All class IV employees and health Care professionals should be given proper training about biomedical waste management

2. Regular in-service educational programmes on biomedical waste management by infection control department of the hospital

3. Regular health check up of all staff at least every 6 months to detect early signs of hospital acquired infection.

4. Vaccination of all hospital staff against Hepatitis B infection, at the time of employment itself.

CONCLUSION:

The healthcare personnel need to be good in theoretical knowledge as well as practices. The need of comprehensive training programs regarding BMW management is highly recommended to all hospital staff. Wherever, generated, a safe and reliable method for handling of BMW is essential. Effective management of BMW is not only a legal necessity but also a social responsibility. A step forward has been made in India in the field of medical waste management but there remains much scope for improvement in the field.

This study revealed that although the attitude about biomedical waste management was high among the class IV employees, the knowledge was comparatively low. There is a great need for continuing education and training programmes to be conducted for health workers.

REFERENCES:

1. Saini S.S. Nagrajan RK Sarma Vol 17 No.2 2005-01 2005-12 Journal of the Academy of Hospital Administration KAP of Bio-Medical Waste Management amongst staff of territory level Hospital in India.

2. K Park. Park’s Textbook of Preventive and Social Medicine, 21st ed. Jabalpur: Bhanot Publishers; 2011. p730.

3. Government of India. Biomedical waste (Management and Handling) Rules, 1998. Extraordinary, Part II, Section 3, Subsection (ii). The Gazette of India 1998, 27 Jul; No.460.

4. Biomedical waste. Wikipedia, the free encyclopedia. 2011.available at URL:en.wikipedia.org

5. T Maheswari. Knowledge and practice of bio medical wast management. Asian Journal of Nursing Education and Research 5(2): April- June 2015

6. Rao DJ, Shaline S, Hemanth. A study on knowledge attitude and practice of paramedical staff regarding healthcare waste management. Unpublished Dissertation submitted to RGUHS; 2009.

7. S Gurasangeeth, K Amandeep. Knowledge and attitude of students regarding Bio Medical Waste management. Asian Journal of Nursing Education and Research 6(1): January-March2016

8. Massrouje H T, Medical waste and health workers in GAZA Governorates, East Mediterranean Health Journal, 2001, November; 7(6);1017-1024

Received on 24.07.2018 Modified on 22.09.2018

Asian J. Nursing Education and Research. 2019; 9(1):117-120.

DOI: 10.5958/2349-2996.2019.00023.5