RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / Name of the candidate and address {in block letters} / SAMITH M.TSAHYADRI COLLEGE OF NURSING
SAHYADRI CAMPUS,ADYAR, MANGALORE- 575007
2 / Name of the institution / SAHYADRI COLLEGE OF NURSING, SAHYADRI CAMPUS,ADYAR, MANGALORE – 575007
3 / Course of study and subject / M. Sc NURSING,
COMMUNITY HEALTH NURSING
4 / Date of admission to the course / 30-06-2012
5 / Title of the topic
‘’EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING PREVENTION OF OCCUPATIONAL DISEASES AMONG CORPORATION SANITARY WORKERS AT SELECTED AREAS IN MANGALORE’’
6 / BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
“STUDY OF DISEASE IS REALLY THE STUDY OF MAN AND HIS ENVIRONMENT’’
A rising quality of life and high rates of resource consumption patterns have had a unintended and negative impact on the urban environment - generation of wastes far beyond the handling capacities of urban governments and agencies. Cities are now grappling with the problems of high volumes of waste, the costs involved, the disposal technologies and methodologies, and the impact of wastes on the local and global environment.1
All activities in solid waste management involve risk, either to the worker directly involved, or to the nearby resident. Risks occur at every step in the process, from the point where residents handle wastes in the home for collection or recycling, to the point of ultimate disposal. Health risks from waste are caused by many factors, such as the nature of raw waste like toxic, allergenic and infectious substances and its components like gases, dusts , sharps, the nature of waste as it decomposes and their change in ability to cause a toxic, allergenic or infectious health response, the handling of waste (e.g., working in traffic, shoveling, lifting, equipment vibrations, accidents),the processing of wastes (e.g., odour, noise, vibration, accidents, air and water emissions, residuals, explosions, fires),the disposal of wastes (e.g., odour, noise, vibration, stability of waste piles, air and water emissions, explosions, fires).2
Workers and waste pickers handling solid waste throughout the world are exposed to occupational health and accident risks related to the content of the materials they are handling, emissions from those materials, and the equipment being used. Denmark, has reported results from in-depth, long-term, country-wide studies of solid waste workers, compared with data on the overall national labour force, that are could be considered statistically valid for determining risk. The Indian study of parasitic infection among solid waste workers was obtained from conducting stool samples from 1500 workers from 33 Indian cities which show the risk of waste picking.2
Apart from the social atrocities that these workers face, they are also exposed to certain health problems by virtue of their occupation. These health hazards include musculoskeletal problems, infections, skin problems and respiratory system problems.3
There is no internationally accepted definition for the term “occupational disease" However, occupational diseases are usually defined as diseases arising out of or in the course of employment.4
The modes of exposure for the various infections among sanitary workers are as follows:
· The most common way is by hand-to-mouth contact during eating, drinking and smoking, or by wiping the face with contaminated hands or gloves.
· By skin contact, through cuts, scratches or penetrating wounds, i.e., from discarded hypodermic needles. Certain organisms can enter the body through the surfaces of the eyes, nose and mouth.
· By breathing as dust, aerosol or mist.3
The infections commonly studied among sanitary workers include leptospirosis and infection.
Leptospirosis is an important occupational disease affecting people coming in contact with animals and their discharges. The occurrence of infection in ones workplaces is linked to the environment to which the worker is exposed and the adaptability of the organism in that working environment. Rodents usually abound in underground sewers and are carriers of leptospira. The urine of rodents and other animals present in that area is likely to contaminate these sewers. Leptospira are excreted in the urine of the infected animals. Thus, sewer workers are at a potential risk of leptospirosis.3
Mostly, the dermatitis is a non-infective one. An outbreak of cases of airborne irritant contact dermatitis has been reported among incinerator workers employed in a sanitary treatment facility.3
Thus, to summarize, the sanitary workers suffer mainly from chemical and biological hazards. This can be prevented through engineering, medical and legislative measures. The engineering measure should focus on making the process more mechanistic. These workers should also be benefited from occupational health services, which should include pre-placement and periodic health monitoring. Also, regular awareness programs should be conducted to impart education regarding safer work procedures and use of personal protective devices.3
6.1 NEED FOR THE STUDY
“PREVENTION IS BETTER THAN CURE”
Solid wastes are produced since the beginning of civilization. During early period solid waste was conveniently disposed off as the population was very low with large open land spaces. However, with the advent of industrialization followed by urbanization the problem of waste disposal increased. The quality of municipal solid waste generated in India has been consistently rising over the year. This can be attributed to the rapid population growth, mass migration of population from rural to urban areas, increase in economic activities in general in the city and the change in lifestyle of the people.5
Population growth and economic development have brought increasing amounts of solid waste to urban areas. In most developing countries, the ever-increasing quantities have overwhelmed local governments' capabilities to cope efficiently. Infectious medical wastes and toxic industrial wastes in the solid waste mixture expose waste handlers to a wide array of risks. In many of these countries, waste pickers commonly find their livelihood through sorting and recycling of secondary materials. Exhaust fumes of waste collection trucks traveling to and from disposal sites, dust from disposal operations, and open burning of waste all contribute to occupational health problems. More removed environmental impacts, such as downwind air pollution and down gradient water pollution from solid waste disposal facilities, can affect the surrounding population as well as the families of waste pickers.5
A global relationship appears to exist between solid waste handling and increasing health risk. The risk is greatest in developing countries, where the contact between the solid waste worker and waste is greatest and the level of protection is least. From the information available, most occupational health and injury problems could be minimized by simple safety procedures that cost little, and most adverse environmental effects could be minimized by closing open dumps and implementing sanitary landfills. The relative risk for solid waste workers and waste pickers in developing countries is undoubtedly much higher.5
Some of the commonly reported occupational health & injury issues related to waste handlers:
I. Back & joint injuries from lifting heavy waste filled containers.
II. Respiratory illness from ingesting particulates, bio aerosols & volatile organics during waste collection and from working in Smokey and dusty conditions at open dumps.
III. Infections from direct contact with contaminated materials.
IV. Skin problems like dermatitis.
V. Puncture wound leading to tetanus, hepatitis & HIV infection.
VI. Headache and nausea from anoxic conditions where disposal sites have high methane, carbon dioxide & carbon monoxide concentration.
VII. Lead poisoning from burning of materials with lead containing batteries, paints etc.6
According to a survey, conducted among 4 to 5 million people working as waste handlers and were employed by the local civil bodies to clean excrement in public places. These workers are commonly exposed to gases like hydrogen sulphide, methane, ammonia resulting in health problems like skin problems, respiratory problems, and gastro intestinal problems.3
Respiratory disorders are among the most common occupational diseases. In order to assess the respiratory status of the Construction and Sanitary workers a study was conducted. The construction and sanitary workers are exposed to harmful dust particles as well as pathogens regularly which affect their respiratory system. A standardized questionnaire designed, covering all the required data was served to 249 workers. After considering the exclusion criteria, 101 construction workers and 56 sanitary workers in the study group were compared with 92 controls in terms of their respiratory status. Respiratory complaints were significantly higher in the study group compared to controls. Frequencies of abnormal spirometric findings were significantly higher in the study group. The study results demonstrated that occupational exposure to cement, road dust and unwanted wastes created severe harm to the workers respiratory system. Therefore, it is recommended to diminish workers exposure to environmental dust by proper implementation of respiratory protection programs. Also, filling out the standard respiratory questionnaire and performing the pulmonary function tests are advised for workers in their periodic examination programs.7
The investigator found that these problems are more among the people involved in waste management. The lack of knowledge and practice about the various preventive measures is one of the major causes for the occupational related diseases. So the training in the prevention of occupational related disease will help to reduce the incidence among them. It has been envisaged that training will help in gaining necessary knowledge and practice in preventing the occupational diseases among corporation sanitary workers.
6.2. REVIEW OF LITERATURE
A cross sectional study was conducted among sanitary workers with total number of 93 employed in sanitary and housekeeping activities. Among them are 66 male and 10 female sanitary workers and 17 Ayas (female housekeepers).The study revealed that 46% of workers were illiterate and 49% had attended primary school. Mean age of subjects was 31.8 + 8.4 years. They were not provided with protective equipment and were never vaccinated against hepatitis B. majority (56%) of them collected and carried the two Kinds of wastes in the same vehicle. 48% of them reported of sustaining one or more injuries at work. Frequently reported injuries were: cuts (47%), pricks (34%), falls (15%) and burns (4%). 26% of them reported of contracting skin diseases from wastes, while 12% caught ENT disorders, 9% gastro-intestinal disorders, 6% respiratory diseases and 8% hepatitis. It is concluded from this study that sanitary workers of CMH, Rawalpindi are unaware of the risks and hazards associated with handling of hospital wastes. They are exposed to biological, physical and toxic substances routinely. But they lacked the required knowledge, skills and protections to safeguard their health. There is a need to improve the training and education of all hospital housekeeping staff in the principles of management of hospital waste.8
A Comparative study was conducted to assess the prevalence of Hepatitis B, Hepatitis C, and HIV (human immune deficiency Virus) among medical waste handlers and Non- medical waste handlers in selected hospitals at Libya. The data was collected for the period of one year. The sample size was 300 medical waste handlers and 300 non medical waste handlers. The information was collected by blood examination. The findings revealed that Hepatitis B Virus was detected in 7 (2.3%) and 1(0.3%) and Hepatitis C Virus in 8(2.7%) and 0(0.0%) among medical waste handlers and non medical waste handlers respectively. It is also found that significant differences were observed in the detection rates of Hepatitis B Virus (or: 7.14; p<0.04) and Hepatitis C virus (or: unified; p<0.05) in medical waste handlers when compared with non medical waste handlers. Out of total samples (medical waste handlers) studied, only (21%) were immunized against Hepatitis B virus and (7%) were trained to handle medical waste. The study concluded that prevalence rates of Hepatitis B Virus and Hepatitis C Virus were significantly higher in medical waste handlers than those in non medical waste handlers.9
A cross sectional study was conducted to investigate 217 male workers from the hongkong with varied levels of manual lifting experiences , A structured questionnaire were administered to each worker by the same investigator. Multivariate analysis indicated that the effects of perceived risk were significant for three of them, lower back pain symptoms (85%) were the most frequent among manual handling workers followed by the shoulders, upper back, hips, upper legs and neck. Musculoskeletal symptoms for multiple body parts were more prevalent (64%) of all workers than those for single body regions (19%) Approximately 85% of lower back symptoms were associated with disorders in other body regions. Multivariate analyses indicated that the effects of perceived risk were significant for eight body regions, and that age was significant for three of them. Perceived risk of lifting injury also was significant for multiple body regions. Musculoskeletal symptoms are prevalent in single and multiple body regions among manual handling workers.10
A quasi experimental study was conducted in Thailand to assess the effectiveness of comprehensive health risk protection behaviors, knowledge, attitudes, and practices among scavengers in open dump sites. A control group of 44 scavengers and an intervention group of 44 scavengers participated in the study. A standard questionnaire was administered to the samples. The information was obtained via face-to-face interviews and the scavengers were asked about their demographic characteristics, occupational information, socioeconomic conditions, work shifts, health status, general health impairments (accidents, injuries, complaints, and diseases), and knowledge, attitudes, and practices regarding self-protective behaviors. An observation form was used to record the conditions of scavengers’ work in relation to environmental health risk and self-protective behaviors. The analysis showed significant differences before and after the intervention program and also between the control and intervention groups. After follow-up, knowledge, attitudes, and practices improved significantly in the intervention group (P < 0.001), but there was no significant difference in the control group.11
A comparative study was conducted in India to assess the respiratory and general health of rag pickers who rummage through the garbage through bumps and land fill. To correct and sell recyclable materials for living the samples were 98 rag pickers and 60 controls match for age, sex, socio economic conditions. The data were obtained from a questionnaire, clinical examinations and laboratory investigations and the result shows that a higher prevalence of low hemoglobin, high circulating eosinophil and monocyte count, unhealthy gums, frequent diarrhoea and dermatitis when compared with controls after controlling for smoking as a confounder respiratory symptoms and lung function decrement where recorded in 94% and 52% of the rag pickers compared with 54% and 34% of control group.The study concludes that the rag pickers suffer from multitude health problem which seem related to their occupation.12