“EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE AND PRACTICE REGARDING BIO MEDICAL WASTE MANAGEMENT AMONG LABTECHNICIANS OF SELECTED LABORATORIES AT BIJAPUR”.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MR. GURURAJ. GUGGARI
COMMUNITY HEALTH NURSING
FIRST YEAR M.Sc NURSING
YEAR 2011 -2013
BLDEA’S SHRI B M PATIL
INSTITUTE OF NURSING SCIENCES
SOLAPUR ROAD, BIJAPUR - 586103
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / MR. GURURAJ GUGGARI.I YEAR M. SC. NURSING
BLDEA’S SHRI B.M.PATIL INSTITUTE OF NURSING SCIENCES, BIJAPUR-586103
2 / NAME OF THE INSTITUTION / BLDEA’S SHRI B.M.PATIL INSTITUTE OF NURSING SCIENCES, BIJAPUR -586103
3 / COURSE OF THE STUDY AND SUBJECT / I YEAR M. Sc. NURSING
COMMUNITY HEALTH NURSING
4 / DATE OF ADMISSION TO THE COURSE / 04.07.2011
5 / TITLE OF THE STUDY
“EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE AND PRACTICE REGARDING BIO MEDICAL WASTE MANAGEMENT AMONG LABTECHNICIANS OF SELECTED LABORATORIES AT BIJAPUR.”
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8 / BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Let the wastes of the sick not contaminate the lives of the healthy”.
Biomedical waste is any waste (solid or liquid) that is generated in the diagnosis, treatment or immunization of human beings or animals. Which carries a higher potential for infection and injury than any other type of infection The important waste generating sources are government and private hospitals, nursing homes, clinics, blood bank, laboratories and research organizations etc.1
Inadequate and inappropriate handling of health care wastes have serious public health consequences and significant impact on the environment.8 Approximately 75-90% of biomedical waste is nonhazardous and as harmless, the remaining 10-25% is hazardous and can be injurious to human, animals and deleterious to environment. If both these types are mixed together then the whole waste is going to become harmful.11 It is estimated that annually about 0.33 million tons of hospital waste is generated in India and waste generation rate ranges from 0.5 to 2.0 kg / bed / day.8
The World Health Organization has classified waste in 8 categories and as per Government of India (1998) the Biomedical waste has classified into 6 categories those are human anatomical waste, blood and body fluids, animal, slaughters house waste, microbiology, biotechnology waste, waste sharps, discarded medicines and solid waste.5
As per the rule of Bio medical waste – 1998 explains that who generate, dispose biomedical waste in any manner is expected to have proper knowledge, practice and capacity to guide others for waste collection, management and proper handling technique.1Effective management of biomedical waste is not only a legal necessity but also a social responsibility.8 The Biomedical waste should be segregated in to containers/bags at the point of generation of the waste. The colour coding and type of containers used for disposal of waste are mainly yellow colour, red colour, blue colour and black colour. Treatment and disposal technology for health care waste are incineration, chemical disinfection, wet and dry thermal treatment, microwave irradiation, land disposal and inertization.1
The risk from the health care waste are to staff including medical, paramedical and house maintenance personnel, patients and their attendees, visitors, workers in the laundry, recycling plants transportation, landfills, scavengers and public.4 Although there is an increased global awareness among health professionals about the hazards and also appropriate management techniques but the level of awareness in India is found to be unsatisfactory. Adequate knowledge about the health hazards of hospital waste as well as laboratory waste, proper techniques and methods of handling the waste and practice of safety measures are needed.8
6.1 NEED FOR THE STUDY
“Effort: effect and impact”
Threats to health know no boundaries. In an age of wide spread global trade and technical development, new and existing diseases can cross national borders and threaten our collective security. Along with those factors hospital waste also has become threat to health.14
The quantity of hospital waste generated will varies depending upon the hospital policies and practices and the type of care being provided. The fact available from developed countries ranges from 1.5 kg/pt./day and developing countries it ranges from 1-2 kg/pt./day. According to World Health Organization report around 85% of the waste is domestic waste and non-hazardous, 10% is infectious and the remaining 5% is non-infection but hazardous.13
According to the survey by National Environmental Engineering Research Institute 1997. The middle and low income countries health care waste generated is lower than in high income countries. Among the health care waste 80% is general care waste. 15% pathological and infections waste, 1% sharp waste, 3% chemical and pharmacological waste.1 In India, the rate of generation of hospital waste is estimated to be 1.59 to 2.2 kg/day/bed and out of which 10-15% is found to be biomedical waste.9 In Karnataka quantity of waste is ½ -4kg/bed/day, the total quantity of hospital waste, i e about 40 tons/day. The problem of bio medical waste disposal in the hospitals and other health care establishments has become an issue of increasing concern, prompting hospital administration to seek, a new ways of scientific, safe and cost effective management of waste.16
The characters of the health care waste that make it a health risk are , infectious agents ,toxic chemicals, sharps ,which renders it as highly infectious, flammable, genotoxic , cytotoxic and radioactive. Every year worldwide of total 1200 million infections. 8 – 10 million hepatitis B, 2.3 to 4 -7 million hepatitis C and 80.000 to 1, 60,000 HIV infection are estimated it occur from re-use of syringes needles without sterilization4. Bijapur is one of the district in Karnataka with the population of approximately 3.26 lacks and with a number of hospitals, nursing homes, polyclinics, laboratories which are producing large quantities of infection and noninfectious waste. Paramedical workers are also getting some of the hazards due to improper waste management and lack of practice about biomedical waste management.15
One of the study conducted in Bangalore city to assess the occupational health and safety measure in some selected health care institutions ,total 88 HCI (health care institution) are selected relevant information collected by head of the institution regarding PPE (Personal protective equipment) through direct observation, interaction and discussion with health care workers. This study reveals that PPE namely gown, gloves and masks were practiced only 1/3 rd of HCI’s and among that doctors wear gown about 35%, gloves 48% and mask about 4%, nurses wear 0% gown, 43% gloves and 2% mask and technician wear the 15% gown 6% mask and 5% gloves. This revels that the practice of using gown or gloves among lab technician was found very low.4
Inadequate waste management will cause environmental pollution, unpleasant smell, growth and multiplication of vectors like insects, rodents, worms and may lead to typhoid cholera, hepatitis and even AIDS.13 The concept and principles constitute the core for management of health care waste are polluter pays, precautionary, duty of care, waste reduction, recycling and reuse, environmentally sound treatment and disposal of waste and proximity principle.4
A study was conducted in Ludhiana tertiary care hospital to assess the knowledge and practice among the medical and paramedical staff. Only 10% sample was selected randomly which includes 476 doctors 378 nurses and 142 paramedical staff. A semi structured questionnaire was used to collect the information. This study reveals that use of color coding system (93.7%) in doctors, (94.7%) in nurses and were paramedical staff having knowledge (94.7%) and coding (92.7%) about biomedical waste management. Certain deficiencies, like the doctors were observed to be sounder in theoretical than the practical aspect and also found that paramedical staff had better practical knowledge rather than the theoretical knowledge about Biomedical waste management.6
Based on the review of literature and the observation the investigator concluded that the lab technicians had inadequate knowledge and practice regarding biomedical waste management. The investigator felt that there is a need to give the information on biomedical waste management to the lab technicians.
6.2 REVIEW OF LITERATURE
Review of literature is an important source of development of research project. It helps to gain deep insight into research problem and provide information of what has been done previously. It helped the researchers to be familiar with the existing studies and provide basis for methodology, tool for data collection and research design.
A cross sectional study was conducted in Allahabad city to assess the knowledge, attitude and practice among the doctors, nurses, lab technicians and sanitary staff regarding the Biomedical waste .The participants were doctors (75) nurses(60), lab technicians(78) and sanitary staff(70). This study reveals that doctors, nurses and lab technicians had better knowledge than the sanitary staff regarding Biomedical waste. Knowledge regarding colourcoding and waste segregation, nurses and lab technicians had better knowledge than the doctors. Regarding practice related to Biomedical waste, sanitary staff were ignorant on all the counts. Study concludes that importance of training regarding waste management needs emphasis, lack of proper and complete knowledge about Biomedical waste management impact and practice of appropriate waste disposal.8
The hospital based cross sectional study was conducted in Karimnagar (A.P) to assess the knowledge, attitude and practice of hospital staff regarding biomedical waste Management especially on paramedical worker. Out of 267 private nursing homes and clinics, 47 were selected by systematic random sampling. A total of 500 study subjects were selected from those hospitals by informed consent. The study reveals that totally 266 (53.2%) study subjects know about Biomedical waste management correctly out of which 138(51.8%) were nurses, 114(42.85%) were technicians, 14(5.26) were house keepers. Only 8(1.6%) study subjects know about categories of Biomedical waste among that 5 (62.5%) were technicians .Total 353(70.6%) study subjects having idea about segregation of Biomedical waste. only 72(14.4%) subjects had knowledge about method of disposal. Majority of the study subjects i e 479(95.8%) had knowledge about various health problems caused by Biomedical waste of which 234(48.8%) were nurses. This study determine that positive attitude was found to improve the current situation in Biomedical waste management , the nurses were having better knowledge , attitude and practice about Biomedical waste management better than the house keeping and technical staff.7
A survey based study was conducted at health care environment setting in Kerala state to determine awareness about biomedical waste management policy, practice and to assess attitude towards it. Data was collected by questionnaire, informal interview and site visits by an investigator. During the site visited, photo documentation was done on various aspects of biomedical waste management methods followed by health care institutions. These photographs revealed that unscientific biomedical waste management techniques are followed at various levels of segregation, treatment, transport and disposal. The study concludes that the biomedical waste management practices followed in majority of health care institutions in Kerala is unscientific.10
A cross sectional study was conducted to assess the knowledge, attitude and practice in a tertiary health care institute in Bijapur on biomedical waste management. Total 334 employees were interviewed with self-administered questionnaire out of which 180 were non-teaching staff and 154 were teaching staff. The study reveals, that comparing, teaching staff having [97.4%] knowledge, than non-teaching staff [80%] gave the correct response. Similar difference were observed between teaching and non-teaching staff with respect to attitude and practice regarding biomedical waste management [p<0.01].2
A study was conducted on tertiary level hospital staff in India to know the present knowledge, attitude and practice on Biomedical waste management. subjects were taken from 1600 bedded hospital 800 doctors, 1600 nurses and 6000 other supportive staff were interviewed by questionnaire design, This study reveals that knowledge score among nurses (60%), sanitary staff (14%), OT staff (14%) and laboratory staff (12%). Attitude score among nurses is (100%), sanitary staff (81%), OT staff (90%) and laboratory staff (56%). Practice score among nurses is (100%), sanitary staff (67%), OT staff (90%) and laboratory staff (44%). By this we can understand that there is a significant gap between knowledge, attitude and practice among the participants/subjects.9
6.2 STATEMENT OF PROBLEM
“Effectiveness Of Self-instructional Module On Knowledge And Practice Regarding Biomedical Waste Management Among Lab Technicians Of Selected Laboratories At Bijapur”
6.3 OBJECTIVES OF THE STUDY
1. To assess the knowledge regarding biomedical waste management among
Lab technicians as measured by structured knowledge questionnaire.
2. To assess the practice regarding biomedical waste management among
Lab technicians as measured by structured practice check list.
3. To find out relationship between knowledge and practice of lab technicians
regarding biomedical waste management.
4. To evaluate the effectiveness of self-instructional module on biomedical waste
Management among lab technicians.
5. To find the association between the pretest knowledge and practice score with
selected demographic variables.
6.5 OPERATIONAL DEFINITION
· Effectiveness: In this study it refers to significant gain in the difference between pretest and posttest knowledge score.
· Self-Instructional module: In this study it refers to written material regarding the introduction, definition ,types, procedure and importance about biomedical waste management.
· Knowledge: In this study it refers to the understanding and awareness of the lab technicians regarding the biomedical waste management.
· Practice: In this study it refers to activity performed by lab technicians for the biomedical waste management.
· Biomedical waste management: In this study it refers to systematic and scientific way of managing the healthcare waste through a step-by-step process such as segregation, storage, transportation, and disposal.
· Lab technicians: The technical person who have undergone a training of DMLTC or BSMLT.
· Laboratory: In this study it refers to functional unit designed to carry out the medical investigations.
6.6 ASSUMPTIONS
1. The lab technicians may have inadequate knowledge regarding
biomedical waste management.
2. Provision of the Self-instructional module may promote the knowledge and practice about the Biomedical Waste management among the lab technicians.