JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES Nayak S, Nayak V, Somu G, Shankar B. Knowledge And Attitude of Nurses on Biomedical Waste Management: A Cross Sectional Study. J Pharm Biomed Sci 2014;04(08):733-736. The online version of this article, along with updated information and services, is located on the World Wide Web at: www.jpbms.info Journal of Pharmaceutical and Biomedical Sciences (J Pharm Biomed Sci.), Member journal. Committee of Publication ethics (COPE) and Journal donation project (JDP).
Original article Knowledge And Attitude of Nurses on Biomedical Waste Management: A Cross Sectional Study SmithaNayak 1,*, VinodNayak 2, G. Somu 3, Shankar B 2 Affiliation:- 1 Assistant Professor, School of Management, Manipal University, Manipal, Karnataka, India 2 Associate Professor, Department of Forensic Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India 3 Professor, Department of Hospital Administration, Kasturba Medical College, Manipal University, Manipal, Karnataka,India The name of the department(s) and institution(s) to which the work should be attributed: Kasturba Medical College, Manipal University, Manipal, Karnataka, India Address reprint requests to Dr.SmithaNayak. Assistant Professor, School of Management, Manipal University, Manipal, Karnataka or at smithanayak.v@manipal.edu Article citation: Nayak S, Nayak V, Somu G, Shankar B. Knowledge and attitude of nurses to biomedical waste management: A cross sectional study. J Pharm Biomed Sci 2014; 04(08):733-736. Available at www.jpbms.info ABSTRACT Introduction: The hospital sector has gone through a revolutionary change in the process of health care delivery and has emerged into a complex multidisciplinary system. This sector utilizes an array of items in the process of delivering health care and leaves behind unusable waste which is has to be handled and disposed with utmost care. Among all the stakeholders in the healthcare industry, the nurses spend most of their time with the patients than any other employee segment. This increases their risk exposure to the hazards present in hospital INTRODUCTION T he hospital sector has gone through a revolutionary change in the process of health care delivery and has emerged into a environment. Hence there is a need for the nurses to be well equipped with latest information, skills and practices in managing biomedical waste management. Methodology: We surveyed 128 nurses at Kasturba Hospital, Manipal to explore their knowledge and attitude towards biomedical waste management. This research also explored the biomedical waste management practices adopted by the nursing staff at the hospital. The research instrument used is a structured questionnaire that has been statistically validated. Results: Among 128 respondents who participated in the survey, most of the respondents had less than five years of experience in the healthcare sector. Most of the nurses were knowledgeable on issues pertaining to biomedical waste management. 87 percent of the respondents were knowledgeable about the practices and procedures and 76 percent displayed a positive attitude towards biomedical waste management. KEYWORDS: Biomedical waste; Knowledge; attitude; nurses. Competing interest / Conflict of interest The author(s) have no competing interests for financial support, publication of this research, patients and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript. Disclosure forms provided by the authors are available with the full text of this article at jpbms.info complex multidisciplinary system. This sector utilizes an array of items in the process of delivering health care and leaves behind unusable 733
waste which is labelled as hospital waste. Biomedical waste (BMW) is defined as the waste generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biological products. Hospitals generate various kinds of wastes from wards, operation theatres and outpatient areas. Around seventy to eighty percent of the hospital waste is general waste that is equivalent to domestic waste. The rest thirty to forty percent of the waste is hazardous in nature and may create a variety of health risks. These wastes include bandages, cotton, soiled linen, body parts, sharps (needle, syringes, etc.), medicines (discarded or expired), laboratory wastes, etc. which carries infection and should be properly collected, segregated, stored, transported, treated and disposed to prevent contamination and nosocomial infection. According a report published by the Ministry of Environment and Forests (MoEF) in 2012, India produces huge quantum of biomedical waste annually. In India, 4,05,702 kg of biomedical waste is produced every year out of which only 2,91,983 kg/day is disposed. This implies that 28 per cent of the waste is not disposed appropriately and is left untreated. At a national level, Karnataka produces the highest quantity (62,241 kg) of biomedical waste per day followed by Uttar Pradesh (44,392 kg), Maharashtra (44,392 kg) and Kerala (32,884 kg). Improper handling of biomedical waste has risks associated with it. It is risky for hospitals, doc nursing staff, patients and the environment at a macro level. Glance at Bio-medical Toxics link Fact sheet (2001) indicates that improperly contained contaminated sharps pose greatest infectious risk associated with hospital waste. Healthcare workers are also exposed to a theoretical health risk 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 treatment. Patients are also exposed to risks of poor BMW management can lead to changes in microbial ecology and spread of antibiotic resistance. Among all the stakeholders in the healthcare industry, the nurses spend most of their time with the patients than any other employee segment. This increases their risk exposure to the hazards present in a hospital environment. Hence there is a need for the nurses to be well equipped with latest information, skills and practices in managing BMW. By adopting healthy, safe practices they can reduce incidence of hospital acquired infections to themselves and patients. Hence brings in a need to educate and orient the nursing staff regarding effective management of biomedical waste. There is a need to assess the knowledge, attitude and practices of the nurses for implementing educational training program or refresher training program on proper management and disposal of waste, to ensure that they follow the guidelines of the hospital and to ensure that they are aware of potentially serious implications of the mismanagement of waste in the hospital. MATERIALS AND METHODS The study design was descriptive and it was conducted in Kasturba Medical College (KMC), Manipal, South Karnataka. The Study period was 3 months, March to June, 2013. Minimum sample size was calculated to be 128 taking into consideration N=2019 and population standard deviation as 0.67. Study participants were nurses working in KMC Hospital. Sampling technique was purposive, a non-probability method. Instrument used to collect data was a structured questionnaire which was designed to assess the knowledge, attitude and practices of nurses with reference to bio-medical waste management. The research instrument also contained an observational checklist that contains items to assess the practices regarding biomedical waste management. Each item is observed by the Investigator and scored. The research instrument was validated through a pilot study and necessary changes were incorporated in cases where the cronbach s alpha was less than 0.7. Data was compiled and analyzed using SPSS 18. RESULTS The sample size consisted of 128 nurses, among whom 91 percent of the respondents were less than 30 years of age. 84 per cent of them had less than 5 years of experience and a minor 8 percent had experience of more than five years. 82 per cent of the respondents had undergone an orientation program on biomedical waste management. Awareness of nurses on issues like constituents of BMW, segregation of waste and color coding system adopted in BMW waste 734
management was assessed. It is observed that, 87 percent of the nurses were aware of the constituents of biomedical waste, 5 percent were of the view that it was inclusive of industrial waste and the rest opined that it included municipality and domestic waste. The definition of segregation of wastes is known to 62 percent of the nurses who stated segregation as those wastes stored as per color code while 27 percent of them has stated segregation as those wastes which are transported & destroyed while 6 percent stated that the infectious waste was mixed with non-infectious waste and the rest opined that waste are stored in plastic container. Most of the respondents were aware of the color coding system adopted (Table 1.1) Table 1. Knowledge of nurses on BMW management. Question Correct answer Frequency (Total=128) Percentage (%) BMW waste refers to? Biological waste 111 87 Wet tissues & bones from operation theatre & labor can be classified under? The most essential step performed before hospital waste disposal is? The maximum storage time (in hours) for waste from waste area is within? The specific immunization which should be taken by the health professional who are involved in BMW waste is? The first step a nurse should perform after sustaining a sharp injury is? Solid waste 101 79 Segregation 74 58 24 109 85 Hepatitis B 114 89 Squeeze & clean the area under running water 89 70 What is the symbol for biohazard? 114 89 Most of the nurses were knowledgeable on issues pertaining to BMW management. 79 percent were of the view that wet tissues & bones from operation theatre & labor could be classified as solid waste. It is also observed that only 70 per cent of the nurses knew the first step to perform on sustaining an injury. Attitude of nurses towards BMW management was gauged by obtaining their views of ten statements using a five point likert scale, having a maximum score of 5 and a minimum score of 1. The extent of agreement and disagreement is recorded on a scale of 1-5, where 5 indicating strongly agree and 1 indicating strongly disagrees. A maximum score of 50 and a minimum score of 5 could be obtained by of the respondents. The total score thus obtained is divided equally into two categories, namely 5 33 and 34-50. The first category (5-33) is labelled as negative attitude towards bio medical waste management and the second category (34-50) is labelled as positive attitude. Two binary measures were created from this output to indicate positive (1) and negative (2). It is observed that 76 per cent of the respondents displayed a positive attitude and 24 percent of the respondents displayed a negative attitude towards BMW management process. The research instrument also contained an observation checklist that was used by the researcher to record the observations made. On observation, it is revealed that the majority (96 percent) of the nurses identify and label the infectious and non- infectious waste while the rest did not follow this practice. Sgerwal et al. 4 (2004) opine that only 70 per cent of the health professionals properly identified and disposed infectious and non-infectious waste. The color coding system was adopted as per the standard guideline by all the participants majority (96 per cent) of the nurses practiced the usage of gloves, gown, mask while handling waste. A similar study concluded that only 75 percent of the nursing staff was observed using gloves while handling wastes. It is concluded that the majority of the nursing staff followed most of the procedures and systems of BMW management. Explore the association between the variables of the study. Table 1.2 displays the output of the analysis. It is concluded 735
that the knowledge level of the nursing staff is not significantly associated to the number of years of experience. It is also observed that there is no significant association between the attitude of the nursing staff towards BMW management and the practice adopted by them (Table 1.2). Table 1.2 Association between study variables. Variable 1 Variable 2 Chi square value p Value Knowledge Experience 15.689 0.959 Attitude Practice 87.236 0.815 DISCUSSION Nurses are the largest occupational group in any health care agency. By virtue of their job responsibilities they are frequently exposed to BMW. The nurses risk of exposure to health hazard and infection to the patients are equally challenging issues to the nurses all over the world. Only nurses are aware of the risks and proper management techniques they can effectively handle the same challenge. The present study explores knowledge and attitude among nurses in BMW waste management, in one of the leading hospitals in South India. The working area of a majority of the nurses included wards and ICU, 47 per cent and 35 per cent respectively. These areas are the most prone areas where there is maximum nursing circulation and an encounter with the wastes. The remaining working areas included OT (12 per cent) and casualty (7per cent). Most (82 per cent) of the nurses had attended orientation training on BMWwaste management from Kasturba Hospital as well as from the previous institute they worked. Training received by them was either through professional education (56 per cent) or in-service education (27 per cent), mass media (2 per cent) and other means (13 percent).in Kasturba Hospital there is induction program once in a month or 6 months as per the requirement of the hospital, solely for the nurses so that they are aware of the BMW management practices. Most of the nurses interviewed are aware of BMW management practices and display a positive attitude towards the process. In terms of practices followed by the nurses in Kasturba hospital, the majority (96 per cent) has sincerely followed the practice of identifying and labelling infectious and noninfectious waste which is an important aspect. It can be concluded that knowledge, attitude and practices of the nurses regarding BMW management were not strongly associated with the demographic variables like age, years of experience and professional qualification. Neither there was strong association found between knowledge level and attitude level, knowledge and practices and also between attitude and practice of nurses regarding BMW management. Overall, it is evident that the nursing staff at the hospital is aware of the BMW practices and procedures and opines that it is essential to adopt these practices to ensure their safety and the safety of the patients. As 24 percent of the respondents still have a negative attitude towards BMW management practices, training and refresher programs can be designed for enhancing their attitude rather than only focusing on imparting awareness. REFERENCES 1.Saraj Badgujar, Sanskriti Menon, Anil Kumar, Shyamala Mani.Biomedical Waste Management Scenario in Pune. Savonier and Abstract book in National Workshop. 2002-2003; 30. 2.Shakharkar B.M. Principals of Hospital Administration 1st Ed. New Delhi: Jaypee Publishers 1998. 3.Sahar et al Intervention program for nurses about health care waste management Research journal of Medicine and medical sciences,egypt. 2012;7(1):25-37. 4.Sgerwal B.C, Lakshmy. A, ManojJais, GeetaMenta. Theoretical awareness and Practical Compliance of BMW Waste Management among Health Care Personnel in a tertiary Care Hospital in New Delhi. Souvenir and Abstract Book in National Work Shop.Indore: 2004. Copyright 2014 Nayak S, Nayak V, Somu G,Shankar B.This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 736