Among the Iii Year Bsc( N) Students in a Selected

“STUDY TO ASSESS THE EFFECTIVENESS OF STP ON KNOWLEDGE AND PRACTICE REGARDING BIOMEDICAL WASTE MANAGEMENT

AMONG THE III YEAR BSC( N) STUDENTS IN A SELECTED

NURSING COLLEGE AT TUMKUR.”

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

Mrs. PROMILA PANDEY

MEDICAL SURGICAL NURSING

Akshaya College of Nursing,

Tumkur, Karnataka.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. Name of the Candidate : Mrs.PROMILAPANDEY

And address M.Sc Nursing, 1st Year

Akshaya College of Nursing,

Tumkur, Karnataka.

2. Name of the Institution : Akshaya College of Nursing

3. Course of Study : M.Sc. Nursing 1st year,

And Subject MEDICAL SURGICAL NURSING

4. Date of Admission to : 28-6-2008

Course

5. Title of the Topic : “STUDY TO ASSESS THE EFFECTIVENESS OF STP ON KNOWLEDGE AND PRACTICE REGARDING BIOMEDICAL WASTE MANAGEMENT AMONG THE III YEAR BSC ( N) STUDENTS IN A SELECTED NURSING COLLEGE AT TUMKUR”

6. INTRODUCTION

Bio-medical waste is defined as waste that is generated during the diagnosis, treatment or immunisation of human beings or animals, or in research activities pertaining thereto, or in the production or testing of biological products1.

The different location or points of waste generation are:

§  Operation theaters/wards/labour room/OPD

§  Dressing rooms

§  Injection rooms

§  Intensive Care Units, ITU, CCU

§  Dialysis room

§  Laboratory

§  Corridor

§  Compound of hospital or nursing home

Biomedical waste consists of solids, liquids, sharps, and laboratory waste that are potentially infectious or dangerous. 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

Biomedical waste differs from other types of hazardous waste, such as industrial waste, in that it comes from biological sources or is used in the diagnosis, prevention, or treatment of diseases. Common producers of biomedical waste include hospitals, health clinics, nursing homes, medical research laboratories, offices of physicians, dentists, and veterinarians, home health care, and funeral homes.2

The following is a list of materials that are generally considered biomedical waste:

Solids

·  Catheters and tubes

·  Disposable gowns, masks, and scrubs

·  Disposable tools, such as some scalpels and surgical staplers

·  Medical gloves

·  Surgical sutures and staples

·  Wound dressings

Liquids

·  Blood

·  Body fluids and tissues

·  Cell, organ, and tissue cultures

Sharps

·  Blades, such as razor or scalpel blades

·  Lancets

·  Materials made of glass, such as cuvettes and slides

·  Metal stylets

·  Needles

·  Plastic pipettes and tips

·  Syringes

Laboratory waste

·  Animal carcasses

·  Hazardous chemicals with biological components

·  Media

·  Medicinal plants

·  Radioactive material with biological components

·  Supernatants

Exceptions

Cadavers, urine, feces, and cytotoxic drugs are not considered biomedical waste.2

The Bio-Medical Rules have recommended different colour codes for waste containers in which different types of wastes needs to be stored. Clinical and general wastes should be segregated at source and placed in colour coded plastic bags and containers of definite specifications prior to collection and disposal.1
The container should comprise of an inner plastic bag of varied colour depending on the type of waste. It should be of a minimum gauge of 55 micron (if of low density) or 25 micron (if of high density), leakproof and puncture proof, and should match the chosen outer container. the outer container is a plastic bin with handles, and of a size which will depend on the amount of waste generated. The inner polythene bag should fit into the container with one-fourth of the polythene bag turned over the rim.
Labeling has been recommended to indicate the type of waste, site of generation, name of generating hospital or facility. This will allow the waste to be traced from the point of generation to the disposal area.
The containers are then to be transported in closed trolleys or wheeled containers which should be designed for easy cleaning and draining.
Categories and color coding recommended for segregation in health-care establishment, including the categories mentioned in the Bio-Medical Waste Regulations of the Ministry of Environment and Forests, Government of India.

CATEGORIES OF BIO-MEDICAL WASTE.1

6.1NEED FOR THE STUDY

Risk to healthcare workers and waste handlers

Improperly contained contaminated sharps pose greatest infectious risk associated with hospital waste. There is also theoretical health risk to medical waste handlers from pathogens that may be aerosolized during the compacting, grinding or shredding process that is associated with certain medical waste management or treatment practices. Physical (injury) and health hazards are also associated with the high operating temperatures of incinerators and steam sterilizers and with toxic gases vented into the atmosphere after waste treatment3.
Risk to the public
Public impacts are confined to esthetic degradation of the environment from careless disposal and the environmental impact of improperly operated incinerators or other medical waste treatment equipment.3
There may be increased risk of nosocomial infections in patients due to poor waste management. Improper waste management can lead to change in microbial ecology and spread of antibiotic resistance.3

Hazardous waste
A) Potentially infectious waste

These include infectious, infective, medical, biomedical, hazardous, red bag, contaminated, medical infectious, regulated and regulated medical waste. All these terms indicate basically the same type of waste, although the terms used in regulations are usually defined more specifically. It constitutes 10% of the total waste which includes:

1. Dressings and swabs contaminated with blood, pus and body fluids.
2. Laboratory waste including laboratory culture stocks of infectious agents
3. Potentially infected material: Excised tumours and organs, placenta removed during surgery, extracted teeth etc.
4. Potentially infected animals used in diagnostic and research studies.
5. Sharps, which include needle, syringes, blades etc.
6. Blood and blood products.

B) Potentially toxic waste

1. Radioactive waste: It includes waste contaminated with radionuclide; it may be solid, liquid or gaseous waste. These are generated from in vitro analysis of body fluids and tissue, in vitro imaging and therapeutic procedures.
2. Chemical waste: It includes disinfectants (hypochlorite, gluteraldehyde, iodophors, phenolic derivatives and alcohol based preparations), X-ray processing solutions, monomers and associated reagents, base metal debris (dental amalgam in extracted teeth).
3. Pharmaceutical waste: It includes anesthetics, sedatives, antibiotics, analgesics etc.

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 medical waste. Thus hospital 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 population3.
Although very little disease transmission from medical waste has been documented, both the American Dental Association (ADA) and Center for Disease Control recommend that medical waste disposal must be carried out in accordance with regulation3.
Hospital waste management has been brought into focus in India recently, particularly with the notification of the BMW (Management and Handling) Rules, 1998. The rule makes it mandatory for the health care establishments to segregate, disinfect and

dispose their waste in an eco-friendly manner3.

The nurses spend maximum time with patients in the ward than any other member of the health team, increases their exposure and risk to the hazards present in hospital environment, mainly biomedical waste. They need to be well equipped with latest information, skills and practices in managing this waste besides reducing hospital-acquired infections to protect their own health. They are also responsible for preventing risk due to waste to the other members of health team and community at large3.

Health and safety of the nursing staff is cardinal feature of biomedical waste mangaement.. Although biomedical waste management can't be achieved without the cooperation of each and every worker and patient, however, nursing personnel play a significant role in this whole process. They need to be informed about current available technology to deal biomedical waste. The sound knowledge and safe practices among all health care staff need to be strengthened3.

The investigator during her clinical experience noticed students of under graduate nursing being unaware of biomedical waste management.. Hence the researcher had decided to design a structured teaching programmme and test its effectiveness on knowledge and practice of students of II year BSc (N).

6.2Review of literature

A study was conducted to assess the knowledge and practices of the nurses in biomedical waste management, before and after administration of information booklet at the medical, surgical and orthopaedic wards of Guru Teg Bahadur Hospital, Shahdara, Delhi.. The research approach adopted for the study was evaluative,. with one group pre-test post-test design. The independent variable in the study was the information booklet on "Bio-medical waste management" for nursing personnel. The dependent variables were knowledge and practices of staff nurses regarding nursing management of Bio medical waste generated in different units of hospitals. Total enumeration sampling technique was used to obtain an adequate size sample. After assessing knowledge and practice of staff nurses through a structured questionnaire and observation checklist, the booklet was administered to 32 nursing personnel. The post - test was administered after a week on same group of nurses (only 30 nurses responded and two nurses declined to respond)4.

The cross-sectional study was carried out in the eight surgical departments at Al-Mansoura University Hospital. All health care personnel and their assistants were included: 38 doctors, 106 nurses, and 56 housekeepers. Two groups of jury were included for experts’ opinions validation of the developed protocol, one from academia (30 members) and the other from service providers (30 members). Data were collected using a self-administered knowledge questionnaire for nurses and doctors, and an interview questionnaire for housekeepers. Observation checklists were used for assessment of performance. Only 27.4% of the nurses, 32.1% of the housekeepers, and 36.8% of the doctors had satisfactory knowledge. Concerning practice, 18.9% of the nurses, 7.1% of the housekeepers, and none of the doctors had adequate practice. Nurses’ knowledge score had a statistically significant weak positive correlation with the attendance of training courses (r=0.23, p0.05). Validation of the developed protocol was done, and the percent of agreement ranged between 60.0% and 96.7% for the service group, and 60.0% and 90.0% for the academia group5.

A survey was conducted to study the existing medical waste management (MWM) systems in Tanzanian hospitals during a nationwide health-care waste management-training programme conducted from 2003 to 2005. The aim of the programme was to enable health workers to establish MWM systems in their health facilities aimed at improving infection prevention and control and occupational health aspects. During the training sessions, a questionnaire was prepared and circulated to collect information on the MWM practices existing in hospitals in eight regions of the Tanzania. The analysis showed that increased population and poor MWM systems as well as expanded use of disposables were the main reasons for increased medical wastes in hospitals. The main disposal methods comprised of open pit burning (50%) and burying (30%) of the waste. A large proportion (71%) of the hospitals used dust bins for transporting waste from generation points to incinerator without plastic bags. Most hospitals had low incineration capacity, with few of them having fire brick incinerators. Most of the respondents preferred on-site versus off-site waste incineration. Some hospitals were using untrained casual labourers in medical waste management and general cleanliness. The knowledge level in MWM issues was low among the health workers. It is concluded that hospital waste management in Tanzania is poor. There is need for proper training and management regarding awareness and practices of medical waste management to cover all carders of health workers in the country6.