Ahmed Mohammed Elnour, Mayada Mohamed Reda Moussa, Mohamed Darwish El-Borgy,

Transcription

1 International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o:05 11 Impacts of an Educational Interntion Program on the Attitude of Kosti, Rabak, and Eduiem Hospitals ursing and Sanitation Staff with regard to Healthcare Waste Management Ahmed Mohammed Elnour, Mayada Mohamed Reda Moussa, Mohamed Darwish El-Borgy, ur Eldin Eltahir Fadelella, Aleya Hanafy Mahmoud High Institute of Public Health, Alexandria Unirsity, Egypt Faculty of Medicine and Health Sciences, Unirsity of El Imam El Mahdi, Sudan Corresponding author: Tel.: ; Abstract-- Health education and supervision is necessary for better Healthcare waste (HCW) management. All the employees of various designations in a healthcare facility are required to be aware of proper collection, segregation, and transport HCW to the final disposal point. Attitude of health professionals plays a significant role in successful management of HCW. Health education programs are important to raise awareness and delop skills of healthcare workers. It is important to highlight the role(s) to be played by each individual staff member. In order to facilitate communication amongst the healthcare workers, training should target a multidisciplinary group and be provided at hospitals. The present study aims at assessing nursing and sanitation staff attitude regarding before and after the implementation an educational interntion program in the three hospitals under study (Kosti, Rabak, and Eduiem) which represent the main hospitals in the White ile State in Sudan. The study main results showed that attitude of nursing and sanitation staff is generally positi regarding HCW management, and it significantly improd after the implementation of the educational interntion program. The study recommended continuous educational programs for hospitals staff with enough information and training relevant to. ITRODUCTIO In deloping countries, the risk perceptions of health care providers on healthcare waste (HCW) are much lower when compared to deloped countries. (1) Staff health education leads to a more informed workforce, which is the foundation for achieving higher standards of infection control and patient safety. Knowledge of staff can also help patients and visitors understand their role in maintaining good hygiene, and to become more responsible for the wastes they produce. (2) Health education and capacity building of healthcare staff are essential in the efforts to minimize the transmission of secondary infections. (4) Health education is therefore linked to healthcare quality improments, institutional policies and procedures, human resource delopment including staff performance evaluations, and facility organization to ensure that someone takes responsibility for the health education program. The costs of health education should be incorporated into the healthcare facilities annual budget. (2) Attitudes are relatily constant feelings, predispositions or set of beliefs directed towards an object, person or situation. They are evaluati feelings and reflect our likes and dislikes. They often come from our experiences or from those of people close to us. They either attract us to things, or make us wary of them. (3) Attitude of the healthcare personnel is of prime importance in proper HCW management. (4) The aim of current study was to assess nursing and sanitation staff s attitude before and after an educational program regarding in the White ile State main hospitals in Sudan. MATERIAL AD METHODS This study was carried out at the three main hospitals in White ile State, Sudan: Kosti hospital, Rabak hospital and Eduiem hospital. A quasi-experimental study design was applied to assess the impact of an interntion program on attitude regarding. For the interntion program, 200 nurses and sanitation staff from the three hospitals were chosen randomly; 50% of participants (100) was subjected to the pre-deloped educational program (Interntion group) while the other 50% (100) was not and remained as (Control group). Both groups were subjected to a pre-test and a post-test. A predesigned and pre-coded self-administered questionnaire was filled by nursing and sanitation staff to assess their attitude at the three hospitals under study (5, 6) regarding.

2 International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o:05 12 The attitude statements were scored as follows Score "3" for agree answer Score "2" for not sure answer Score "1" for disagree answer The total mean attitude score was calculated by summing up all scores for all questions and dividing by number of questions (18). The total achievable score was 18x3=54. Total scores ranged from ( points) and were adjusted out of 100 into 0.0%-100%, and then graded as follows:- Positi attitude (41-54 points) 75% eutral attitude (27-40 points) 50% - < 75% egati attitude ( points) < 50% Interntion program An interntion program was designed according to the results of the pre-test and was tailored according to the needs of the nursing and sanitation staff at the three hospitals under study. Educational materials were prepared, reviewed and tested before using them. The affecti objecti was to delop a positi attitude towards. The educational sessions were held at the hospitals as follows:- Kosti hospital: in the unirsity hall, which was prepared for medical students Rabak hospital: in the common meeting hall Ed-duiem hospital: in the health collage lecture hall Six educational sessions were delired or two weeks. The participants were divided to groups, and some attended sessions in the morning from 10:00 am to 11:30 am, others in the afternoon from 12:00 pm to 1:30 pm, while others in the ening from 5:00 pm to 6:30 pm. The following educational methods were used in the interntion program:- Lectures Group discussion Videos Demonstration Health talk Power point presentations The six sessions cored the following:- Session1: Definition, sources and categories of HCW Session2: The public health impacts of improper HCW management Session3: Regulations of healthcare waste management Session4: Operation of Session5: Case studies Session6: Planning for Post interntion phase (s) The pretest questionnaire was introduced to the nursing and sanitation staff immediately at the end of the program and three months later to reassess the interntion program impacts on their attitude regarding. Ethical considerations Approval of hospitals administrators was taken. Informed consent was taken from all participants in the study. Statistical analysis: Data were collected, revised, coded and fed to statistical software (Statistical Package for the Social Sciences) SPSS rsion 21. Descripti statistics were done including frequency distribution, mean and standard deviation. Tests for normal distribution were done to select the suitable statistical analysis methods For interntion and group samples in interntion program the percent columns were ignored due to equality of the sample size number and percent. (sample size=100) The non-parametric Mann-Whitney test was used to assess the difference between interntion and control group, while Wilcoxon test was used to compare interntion group's improment before and after the educational program, immediately and three month after the end of the program. The tests were two tailed, alpha error of 0.05 was chosen, and a p- less than or equal 0.05 was considered significant Study limitations In the night shift, there was no way for nurses to lea their patients because there is only one nurse to ser the ward, so some of them joined the education program when they switched to the morning shift. One of the hospital halls was not well prepared for educational program and not comfortable. Some participants did not attend all the educational sessions due to personal reasons. RESULTS AD DISCUSSIO The following tables and figures explain the results of nursing and sanitation attitude regarding in the three phases: before interntion, immediately after interntion, and three months after the educational interntion program.

3 International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o:05 13 Table I Distribution of nursing and sanitation staff with regard to their pre and post-test attitude scores regarding at the selected hospitals in White ile State, Sudan, 2013 Attitude statements Control group n=100 Interntion group n=100 Pre-test Pre-test -Immediate - After three months Ag.S D.Ag Ag.S D.Ag Ag.S D.Ag Ag.S D.Ag Ag.S D.Ag is important to hospitals sanitation Properly managed HCW may cause infection Legislation is important to is one of my duties HCW cannot transmit diseases training is important othing is wrong with putting HCW in incorrect containers The sanitation authority must know immediately if HCW is managed in a wrong way The proper is not important for the safety of patients from infection

4 International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o:05 14 should not ha priority because the hospital s role is patient treatment Hospital s integrated HCW management is useful Wearing personal protecti measures is not important when dealing with HCW Improper in the hospital may contaminate air, soil and water Improper in the hospital may cause cancer There is no worry from HCW in transmitting AIDS or Hepatitis B I am interested in HCW management I am satisfied with current HCW management in the hospital I am willing to apply proper methods in Ag = Agree.S = ot Sure D.Ag = Disagree Continued table I

5 International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o:05 15 Table II Comparison of pre and post-test attitude of nursing and sanitation staff regarding at the selected hospitals in White ile State, Sudan, 2013 Interntion group n=100 Attitude statements Control group n=100 Relation test (Wilcoxon) is important to hospitals sanitation Properly managed HCW may cause infection Legislation is important to HCW management is one of my duties HCW cannot transmit diseases Pre-test Z- P- Pre-test - Immediate P eu P eu P P eu P eu P After three months eu Pre-test& Immediate Z- P- Relation test(wilcoxon) Pre-test& Three months Z- P- Immediate& Three months Z- P

6 International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o:05 16 training is important othing is wrong with putting HCW in incorrect containers The sanitation authority must know immediately if HCW is managed in a wrong way The proper HCW management is not important for the safety of patients from infection should not ha priority because the hospital s role is patient treatment Hospital s integrated is useful Wearing personal protecti measures is not important when dealing with HCW Continued table II

7 International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o:05 17 Improper HCW management in the hospital may contaminate air, soil and water Improper HCW management may cause cancer There is no worry from HCW in transmitting AIDS or Hepatitis B I am interested in HCW management I am satisfied with current HCW management in the hospital I am willing to apply proper methods in HCW management Continued table II P = Positi eu =eutral =egati egati= (<50%) eutral = (50% - <75%) Positi ( 75%) Significant (P<0.05)

8 Percent International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o: is importance to hospitals sanitation Properly HCW managed may cause infection Legislation is importance to one of my duty HCW cannot transmitted diseases Pre-test Immediate Three months Fig. 1. Pre and post-test (immediate and three months later) attitude of nursing and sanitation staff in the interntion group regarding at the selected hospitals in White ile State, Sudan, 2013

9 Percent International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o: training is importance othing wrong when putting HCW in incorrect position 95 The sanitation authority must know immediately if HCW put in wrong way 27 The proper HCW management not important for the safety of patients from infection Pre-test Immediate Three months must not ha priority because the hospital role is patient treatment Fig. 1. (continued): Pre and post-test (immediate and three months later) attitude of nursing and sanitation staff in the interntion group regarding HCW management at the selected hospitals in White ile State, Sudan, 2013

10 Percent International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o: Hospitals integrated is useful Wearing protecti equipment is not important when dealing with HCW Improper HCW management in the hospital may contaminate air, soil and water Improper HCW management in the hospital may cause cancer Pre-test Immediate Three months Fig. 1. (continued): Pre and post-test (immediate and three months later) attitude of nursing and sanitation staff in the interntion group regarding HCW management at the selected hospitals in White ile State, Sudan, 2013

11 Percent International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o: o worry about HCW for transmition of AIDS or Hepatitis B virus Iam interested in HCW management Iam satisfied about the current HCW management in the hospital Iam willing to apply the proper methods in Pre-test Immediate Three months Fig. 1. (continued): Pre and post-test (immediate and three months later) attitude of nursing and sanitation staff in the interntion group regarding HCW management at the selected hospitals in White ile State, Sudan, 2013

12 International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o: % Pre-test Immediate 10 Three months 10 76% Positi eutral Fig. 2. Comparison between the total attitude scores in the interntion group before and after interntion with regard to at White ile State main hospitals, Sudan, 2013

13 International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o:05 23 Table III Pre-test and post-test total attitude scores regarding at White ile State main hospitals, Sudan, Total attitude scores Control group n=100 Interntion group n=100 Pre-test Three months Pre-test Immediate Three months Positi eutral egati egati (<50%) eutral (50% - <75%) Positi ( 75%) Table IV Relations between total attitude scores (Wilcoxon test) regarding at White ile State main hospitals, Sudan, Control group n=100 Interntion group n=100 Pre-test& Three months Pre-test& Immediate Pre-test& Three months Immediate& Three months Z- P- Z- P- Z- P- Z- P Significant (P<0.05) Regarding pre and post-test of nursing and sanitation staff attitude, the results of the present study indicated that 76% of the study sample had a positi attitude regarding (pre-interntion). This percent was increased to % after the implementation of an educational interntion program (table 3, figure 2). Concerning the attitude statement " is important to hospitals sanitation", the responses showed that 95% had positi attitude, 3% were neutral, and 2% had negati attitude. As for the attitude statement "HCW management is one of my duties", the responses demonstrated that only 65% had positi attitude, 23% were neutral, and 12% had negati attitude (table 1, figure 2). Similarly, a study done in Bangalore in India in 2012 (4) reported that 9.9% of study subjects felt was an unnecessary extra burden on healthcare staff. The findings of the present study also agree with the study conducted in Elmansora in Egypt in 2012 (8), which realed that nurses do not think was an important prerequisite for a good patient care service, and some also felt that it was not their duty, but the responsibility of the administration and sanitary staff. The majority of nursing and sanitation staff in the interntion group in the present study (85%) agreed with the attitude statement " training is important" (table 5, figure 3). This result was consistent with a study in igeria in 2011 (9) and the previous study done in Elmansora in Egypt in 2012 (8). Both studies reported a general positi attitude towards training programs on. Regarding the attitude statement "There is no worry from HCW in transmitting AIDS or Hepatitis B virus", the current results realed that 61% of nursing and sanitation staff in the interntion group disagreed with that statement showing a positi attitude, 27% agreed showing a negati attitude, and 12% were neutral (table 1, figure 2). The results show similarities to those of studies in Ethiopia in 2012 (10), South Africa in 2009 (11), and in India in 2005 (12). These studies also reported that the majority of participants were aware about the dangers of HIV and Hepatitis B transmission through improper. Hower, concerning the attitude statement "Properly managed HCW may cause infection", more than half of the interntion group (54%) agreed with the statement showing negati attitude, (29%) had positi attitude and (17%) were neutral (table 1, figure 1). This result was inconsistent with the study done in Ethiopia in 2012 (10) and the study in South Africa in 2009 (11), in which most of the participants agreed that only improperly managed HCW could transmit infection for healthcare providers and patients. The findings of the present study also showed that 60% of the participants in the interntion group had a negati attitude, 14% were neutral, and only 26% had a positi attitude towards the attitude statement "Improper HCW management in the hospital may contaminate air, soil and water" (table 1, figure 1). This finding was not in agreement with a study conducted in India in 2013 (5), which realed that the majority of nursing staff (84.9%) had a positi attitude regarding the statement "Inappropriate disposal of HCW results in environmental degradation". After the implementation of the health educational interntion program, there were significant improments in ten attitude statements amounting to 55.6% of the eighteen attitude statements (table 2), whether in the immediate post-test and/or in the post-test after three months. Attitudes total scores in the pretest demonstrated that, in general, 76% of the participants in the interntion group had positi attitudes and 24% were neutral (table 3). In the immediate post-test and after three months after the educational interntion program implementation, the total

14 International Journal of Basic & Applied Sciences IJBAS-IJES Vol:15 o:05 24 attitude scores were positi in % and neutral in 10% of the interntion group (table 3). There is a significant difference in the total attitude scores between the pretest and the post-test after three months (Z =3.104, P =0.002), while no significant difference was detected between the pretest and the post-test immediately after the end of the educational interntion program (Z =1.917, P =0.055) (table 4). This result indicates that a long time might be needed for the healthcare personnel to change their attitudes. [10] HS Estates. Revised Guidance on Contracting for Cleaning. Leeds, UK: HS Estates, Department of Health; [11] Ramokate T, Basu D. Healthcare waste management at an academic hospital: knowledge and practices of doctors and nurse. South African Medical Journal. 2009; 99(6): [12] Pandit B, Mehta HK, Kartha PK, Choudhary SK. Management of Bio-medical Waste: Awareness and Practices in a district of Gujarat. Indian Journal of Public Health. 2005; 49(4): RECOMMEDATIOS The change in the attitude of the health care personnel is of prime importance in proper. It is therefore imperati that is included in the curricula of healthcare education. It is also necessary to keep the health care personnel informed about the risks associated with poor waste management systems and also about the scientific, safe and cost effecti ways of handling HCW. This necessitates the administration of regular training to impro their knowledge and change their attitude and practices. The Ministry of Health should plan for continuous training programs for all the healthcare facilities employees according to their different roles, and to enhance the infection control measures in the hospitals. Sharing the expenses of infrastructure requirements for hospital waste handling and training of healthcare personnel by gornment, public bodies and voluntary associations will also help implement updated procedures and practices of. The commitment and support of the health care establishments will ensure that there are no adrse health risks and environmental pollution from HCW management activities. REFERECES [1] Muluken AY, Haimanot GM, Solomon MW. A cross sectional study on factors associated with risk perception of healthcare workers toward healthcare waste management in health care facilities of Gondar Town, orthwest Ethiopia. Int J Infect Control. 2012; 8(3): 1-9. [2] Municipal waste education council. Waste management education policy statement. Western Australian gornment association [3] Yazachew M, Alen Y. Introduction to health education. Ethiopia public health training initiati [4] Mathur V, Dwidi S, Hassan MA, Mishra RP. Knowledge, Attitude and Practices about Biomedical Waste Management among Healthcare Personnel: A Cross-sectional Study. Indian Journal of Community Medicine. 2011; 36(2): [5] Asadullah GK, Dharmappa BA. Study on knowledge, attitude and practice regarding biomedical waste among private staff in private hospitals in Udupi city,karnataka, India. International Journal of Geology, Earth and Environmental Sciences.2013; 3(11): [6] Yenesew MA, Moges HG, Woldeyohannes SM. A cross sectional study on factors associated with risk perception of healthcare workers toward healthcare waste management in health care facilities of Gondar Town, orthwest Ethiopia. International Journal of Infection Control. Int J Infect Control. 2012; 8(3): [7] BhaskarB,idugala H, Avadhani R. Biomedical waste management knowledge and Practices among healthcare providers in Mangalore. Unirsity Journal of Health Science. 2012; 2(1): [8] El-Sayed SH, Zakaria AM, Gheith A. Interntion Program for urses about Health Care Waste Management. Research Journal of Medicine and Medical Sciences.2012; 7(1): [9] World Health Organization. Wastes from healthcare activities. Fact sheets no 231. Geneva: World Health Organization; 2006.