G.N.M.

Internship Group-A Chapter I

Topic Biomedical Waste Management Introduction
Background of the study When the earth is sick and polluted. Human Health is impossible to Heal ourselves we must heal our plant and to heal our planet we must heal ourselves Hospital is one of the complex institutions frequented by people from every walk of life in the society without any distinction between age, sex, race and religion. This is over and above the normal inhabitants of the hospital i.e. patients and staff. All of them produce waste which is increasing in its amount and type due to advances in scientific knowledge and creating its impact. Biomedical waste is defined as any solid or liquid waste including its containers and any intermediate products generated during diagnosis, treatment or immunization of Human beings or animals. The Biomedical waste by definition includes wide variety of items like drugs, containers, sharp instruments, cotton bandages etc. Biomedical waste is specially dangerous as along with causing environmental pollution if contains large quantity of hazardous materials. According to WHO report, around 85% of hospitals waste is actually non hazardous (chemical, pharmaceutical & radioactive)2 careless and indiscriminate disposal of this waste by healthcare establishments and research institution can contributes to spread of hepatitis and HIV (AIDS) and a number of treatable and untreatable conditions among those who hand it carelessly including general public. The quantity of biomedical waste generated will very depending upon hospital policies and type of care being provided. The data available from developed countries indicates a range from 1-15 kg / bed / day. Wit substantial inter country and inter specialty differences. Data from developing countries indicates that the range is essentially similar but the figures are lower i.e. 1-2 kg / bed/ day. Accidental contact with this waste of infected patients and body fluids may lead to transmission of infection and if not properly destroyed many of these items such as

disposables, needles, syringes may get unlawfully recycled to hazardous situation for population.

Sources of Biomedical Waste Hospital

Clinics

Veternary Hospitals

Dispensaries

Animal Houses Research Institutions

Nursing Homs

Blood Banks

Increase in Population

Increse in Diseases

Biomedical Waste Management

Increase in Population

Increase in Hospital

Relation to Human population

The management of biomedical waste was till recently, a neglected issue. Though the first draft rule for horpitals waste management were laid down in 1995, Health care waste management in india started receiving its true attention only after The biomedical waste rules came into existence in July 1998. In accordance with these rule (Rule 4) it is the duty of every occupier that is a person who has the control over the institution and or its premises, to take all steps to ensure that waste generated is handled without any adverse effects to human health and environment.

Colour Coding Yellow

Type of Container

Waste Categories CAT 1. Human Anatomical Waste CAT 2. Animal Waste

Plastic Bag

CAT 3. Microbiology CAT 6. Soiled waste

Red Disinfected Container Plastic Bag

CAT 3. Microbiology CAT 6. Soiled Waste CAT 7. Solid Waste (Waste IV, Tubing, catheterets)

White / Blue Plastic Bag / Puncture proof of container

CAT 4. Waste Sharp CAT 7. Plastic Disposable Tubing etc.

Black Plastic Bag / Puncture proof container

CAT 5. Discarded Medicine & cytotoxec drugs CAT 9. Incineration Ash CAT 10. Chemical Waste

Green

Plastic Bag

General Waste

Colour coding of Biomedical waste management & handling.

Action plan for waste management

Origin/Source of waste Generation

Waste Minimisation Separation

Waste Handling (Schedule for collection within the process)

Waste Identification Category Colour Coding/Labeling

Waste Treatment

Mis for Medical Disposal

* Action plan for waste management Segregation of waste is of utmost importance .. The present study is carried out to assess the knowledge regarding biomedical waste management among the nursing staff in Civil Hospital. This assessment will help the authorities to develop a strategy to improve biomedical waste management effectively.

NEED FOR STUDY Poor management of health care waste can cause serious disease to health care personnels, to the waste weekers, the patient and to the general public. The greater risk posed by infectious waste are accidental needlestick injuries, which can cause hepatitis B and HIV infections. There are however numerous other disease which can be transmitted by contact with infectious health care waste.

During the handling of waste, injuries occur when syringes needles in rigid puncture proof containers and more over unprotected pits increase risk exposure of health care workers of waste handlers and of community at large, to needle stick injury. The reuse of infectious syringes represents major threat to public health. WHO estimated that in 2000 worldwide infectious undertaken with contaminated syringe caused about 2-3 million infectious of Hepatitis B, Hepatitis C and HIV. Such situations are very likely to happen when health care waste is dumped on an uncontrolled site which is easily assessable by the public. Children are particularly at risk to come in contact with infectious waste. The contact with toxic chemicals such as disinfectants may caused accidents when they are assessable to public. In 2002, the results of WHO assessment conducted in 22 developing countries showed that proportion of health care facilities that do not use proper waste disposal methods are 18-64%. STATEMENT A descriptive study to assess the knowledge regarding Biomedical waste management among the staff nurses of civil hospital Bathinda. OBJECTIVES 1. To assess the level of knowledge on Biomedical waste management among the nursing staff. 2. To find the association of the level of knowledge with selected Sociodemographic variables. VARIABLES Knowledge on Bio-medical waste management. OPERATIONAL DEFINITIONS: Knowledge:- Level of information of nurse on structured questionnaire regarding biomedical waste management as evident from knowledge scores.

Bio-medical waste: Bio-medical waste means any waste which is generated during the diagnosis, treatment and immunization of the human beings in the production of biological waste.

Bio-medical waste management: It is the planning and managing the activities in an organization to achieve disposal of biomedical waste effectively in safe & sound manner. Nurse:- Nurse is trained diploma/degree holder in nursing & registered with the state nursing council and working in the hospital setting of shif duties (regular basis). ASSUMPTIONS OF THE STUDY The assumptions underlying study are:The nurses have some knowledge regarding Biomedical waste management. Nurses provide correct response according to their knowledge. Nurses willingly participate in the study. DELIMITATIONS OF STUDY:The knowledge level is based on only structured questionnaire. The results are reflecting the knowledge of nurses working in Civil Hospital, Bathinda INCLUSION CRITIERIA:The Nurses who are registered under state nursing council. The Nurses who will be present at the time of data collection, working in civil hospital Bathinda. EXCLUSION CRITERIA:The Nurses who are sick at time of duty on work. The Nurses who are unwilling to participate in study. Summary:This chapter has dealt with the introduction of study, need for study, statement of Problem, objectives of study, operational definitions, assumptions of study, delimitation of study.

Chapter II REVIEW OF LITERATURE THOSE WHO FAIL TO READ THE HISTORY ARE DESIGNED TO SUFFER THE REPITITION OF MISTAKES. Review of literature is an essential step in research. Scientific research cannot add to human knowledge if it is conducted in isolation from other scientific efforts. The review of literature helped the investigator to develop in depth knowledge of the study undertaken. It also helped the investigator to develop the tool for the study as well as to analyse the data. Biomedical waste means any waste which is generated during diagnosis, treatment or immunization of human beings and animals or in the research activities pertaining thereto or in the production or testing of biological, and including categories as mentioned in schedule.

Review of Study A cross sectional study was conducted on tertiary level hospitals of kurumnagear (Andhra Pradesh) to assess knowledge, attitude and practices of staff regarding waste management statistical analysis of result done by chi-squre test of percentage which revealed that nurses have better knowledge towards separation of waste 236 (99.3%). Proper disposal 234 (98.7%) implementation of rules 233 (98.3%) and co-operation in Programmes 149 (62.8%). Study concluded that nurses had a statistically significantly better knowledge than the technical and housekeeper staff. A study was conducted on tertiary level hospital in India, 2004, about biomedical waste management to assess the knowledge, attitude and practices of health care works and study revealed that the knowledge among nurses is 60% and that of sanitary staff 14% OT staff 14% and lab staff is 90% and nurses 100% and study concluded that nurses had a better knowledge than technical and housekeeping staff. A study of awareness on biomedical waste management in nurses and paramedical staff at military hospital Khadkhi, analysis was done by using questionnaires, analysis was

done by using questionnaires, which revealed that nursing staff having excellent knowledge (82.35%) about biomedical waste management and the study concluded that there is an urgent need for raising awareness and education of medical waste issue need for the staff. A cross sectional study was conducted among paramedical workers of Appolo Hospital, Jubillee Hills of Hyderabad to assess their attitude, Practices and knowledge regarding biomedical waste management. Analysis was done by using questionnaires and study was revealed that nurses have better knowledge regarding biomedical waste management than sanitary staff. The study concluded that the awareness and proper practices about biomedical waste management is very satisfactory. A cross sectional study was conducted on Hospital staff in PGIMER Chandigarh to assess their knowledge, attitude, Practice regarding Biomedical waste management. Analysis was done by using questionnaires which revealed that nurses were having better knowledge, attitude, practice than technical staff. The study concluded that regular training to nurses technical and housekeeping staff should be done and system of monitoring should be evolved. A study was conducted in New Delhi among nursing personnels to assess their knowledge, attitude, practice on Biomedical waste management. Analysis was done by using questionnaires. The study revealed that there is a marked improvement in the segregation practices among nursing personnels in nursing homes and smaller hospitals in Delhi and the study concluded that proper and timely observation of nursing personnel is necessary to evaluate the knowledge of Hospital personnels. A study was conducted in Govt. Hospital in Agra City (India) to assess the KAP of Hospital staff regarding Biomedical waste management. Analysis as done by using questionnaires which revealed that knowledge regarding Biomedical wate practices about generation and colour coding of bags was 41% & 30% respectively as compare to 34% and 36% who did not attend health care training and this study concluded that there is an urgent need for training and raising awareness of all nursing personnels regarding Biomedical waste practice.

A cross sectional study was conducted on health care workers of medical college and hospital of Allahabad (India) to assess their knowledge, attitude practices regarding biomedical waste management. Analysis of result done by questionnaires which revealed that doctors nursing have better knowledge sanitary staff. The study was concluded that important of training regarding waste management needs emphasis lack of Proper knowledge about waste management impacts appropriate waste disposal.

CHAPTER III METHODOLOGY

Research methodology defines that what the activity of research is, how to proceed, how to measure progress. It indicates general pattern of regaining the procedure to gather valid and reliable data for problem under study. This chapter deals with methodology adopted to conduct a research study on A study to assess the knowledge on biomedical waste management among nursing staff in Civil Hospital, Bathinda.

This chapter Include:1) Research Approach & design 2) Research setting (Selection & description of setting) 3) Population 4) Sample and sampling technique 5) Data collection techniques. 6) Selection, development & description of the tool. 7) Content validity of tool. 8) Reliability 9) Tryout of the tool/Pilot study. 10) Ethical consideration 11) Plan & procedure for data collection 12) Plan for data analysis

Research Approach (Non-Experimental)

Research Design (Descriptive Survey)

Research Setting Civil Hospital Bathinda

Population (Staff Nurses Working in Civil Hospital Bathinda)

Sample (20) (Using Convenient Sampling )

Data Collection

Analysis and Interpretation of Data

SCHEMATIC REPRESENTATION OF RESEARCH METHODOLOGY

1.

RESEARCH APPROACH AND RESEARCH DESIGN:-

The approach to research is an umbrella that cover the basic procedures for conductive research. Design refers to a plan of collecting and utilizing data so that desired information can be obtained with sufficient precision or so that and hypotheses can be tested properly. A non experimental descriptive study design was considered to be appropriate for the Present study to assess the knowledge of nurses relationship between knowledge of nurses and selected variables. 2. SETTING OF STUDY:-

The study was conducted in Civil Hospital, Bathinda. The criteria for the setting were accessibility of nurses, familiarity of researchers with setting so it is easy to contact and obtain co-operation from nurses and administration or authorities for collection of data. 3. POPULATION OF THE STUDY:-

The target population for study was nurses in Civil Hospital Bathinda. The group includes only those study subjects who were present at the time of data collection and were willing to participate in the study. 4. SAMPLE AND SAMPLING TECHNIQUE:-

Purposive non random sampling technique was used fro selection of subjects. Total 20 staff nurses were selected from Civil Hospital Bathinda purposively on the basis of availability in study. 5. DATA COLLECTION TECHNIQUE:-

The structured questionnaire was developed for data collection from subjects to meet the objectives of study. 6. SELECTION, DEVELOPMENT & DESCRIPTION OF TOOL:-

On the basis of objectives of study, the structured questionnaire was developed for knowledge assessment of nurses related to biomedical waste management. After considering the suggestion of experts, necessary medication were done.

The tool consist 3 Parts:Part 1:- Questions related to demographic data of respondent. It includes age, gender, religion, residence, education, Professional experience ward where posted and any work shop attended on Bio-medical waste management. Part 2:- Questionnaire for the collection of data. The question were related to biomedical waste management. Total 20 question were there out of which 11 question were on the basis general knowledge on biomedical waste management. 6 question were on the basis of category of biomedical waste management. 3 question were on the basis of Hospital Policy regarding Biomedical management. Part 3:- Scoring Pattern: Total no. of question 20 Each question carried 1 marks So, total score is 20 Above mean - adequate knowledge Below mean inadequate knowledge. 7. VALIDITY TOOL:The tool after developing was submitted to experts in field of nursing and medical. The experts include are Mrs Navjot Kaur (M.Sc Nursing). A letter requesting for validation of tool was sent, which also include problem statement and objectives of study. Experts were requested to judge the items for their clarity appropriateness validity and relevance of the content. Appropriate corrections were made according to the expert opinion. 8 RELIABILITY :Reliability is concerned with consistency of the measurement tools. A tool only can be considered reliable if it measures an attribute with similar results on repeated use. Reliability of the tool was obtained by using test retest. The value of coefficient of corelation was 0.987 which was considered very good for tool.

9 PILOT STUDY The Pilot study was conducted in Civil Hospital Bathinda which does not including the study subjects. The pilot study was done to assess the effectiveness of criterion measures, retest the tools, to find the clarity of items a the feasibility for conducting study to obtain information for information the project & to decide on the plan of statistical analysis. Pilot study was conducted on the structured tools of ten samples to check the problem faced in collection of data & applicability of the research tool. 10. ETHICAL CONSIDERATION:The ethical committee of Guru Gobind Singh College of nursing Talwandi Sabo approved the study protocol. Consent forms and information sheet was prepared and provided to study subjects in English. Informed written consent was obtained from the participants. 11. PLAN AND PROCEDURE FOR DATA COLLECTION:Sample were selected by convenient sampling technique. Formal permission was obtained from authorities. Subjects were explained the purpose of study and confidentiality of response was assessed. To assess knowledge questionnaire was used. 12. PLAN FOR DATA ANALYSIS:The data analysis was obtained as per the objectives of study. The data obtained was entered in the master sheet, analyzed inferential statistical methods. The following plan of analysis will be used: 1. Descriptive statistical method: Calculation of percentage, mean, frequency, standard deviation. and interpreted using descriptive and

2. Inferential statistical method: T-Test was used to computed the relationship of knowledge score related to age, sex, educational status and occupational status.