Knowledge, Attitude and Practice (KAP) Study Regarding Bio-Medical Waste Management Am ong Staff in a Tertiary Care Hospital at Andhra Pradesh

 

Mondal Ramkrishna¹*, Satyanarayana P²

¹Deputy Medial Superintendent, AMRI Hospital Dhakuria, Gariahat Road, Kolkata, West Bengal, India

²Prof. & HOD, Dept of Medial Administration, Yashoda Hospital, Secunderabad, Telengana, India

 

ABSTRACT:

Background: In Bio Medical Waste (BMW) Management, three important steps are Segregation, Transportation and Disposal of the Waste as per the Rule. Yet, another most important aspect is the Knowledge, Attitude and Practice (KAP) of the human factors handling the waste.  Good knowledge of safe and effective way of Handlin will develop a good attitude, and with good attitude correct and safe practice will be developed. Objective: This study is to assess the Knowledge, Attitude and Practice (KAP) regarding BMW management among the different groups of staff in a tertiary care hospital through a cross sectional study during the period of June-August 2012. Methods: The questionnaire method was used and questionnaires were designed for the study. For each four group of study people, three different set of questionnaire has been made to reduce the bias. The sample comprises of a total of 163 Doctors, 40 Administrators, 149 Nursing.and 187 Housekeeping staff were selected using stratified random sampling technique.Results: It was found that, nursing staff scored highest (80.75%) and Doctors score lowest (76.25%) in knowledge.  In Attitude also the nursing staff scored highest (85%) and lowest (75.3%) Doctor.Administrator shows highest s (83.91%) in Practice and doctor least (79.25%).  Over all The Nursing staff and Administrators scored highest (81.75%) and Doctor was lowest (76.94%).Conclusions: The study concludes that healthcare waste management should go beyond data compilation, enforcement of regulations and acquisition of better equipment. Regular training is required vigorously.

 

 

 

INTRODUCTION:

To do any work in an efficient way three things are necessary namely, Full knowledge about the work, Positive attitude to do the work and Correct and safe Practice. In Bio Medical Waste (BMW) Management, three important steps are, - Segregation of the waste, Transportation of the waste and Disposal of the Waste as per the Rule. Yet, another most important aspect of the BMW Management is the Knowledge, Attitude and Practice (KAP) of the human factors handling the waste.  The improper management and disposal of BMW causes serious health and environmental problems in terms of air, water and land pollution.[1] The World Health Organization (WHO) states that the human element is more important than the technology and almost any system of treatment and disposal i.e. operated by well-trained and well-motivated staff can provide more protection for staff, patients and the community, than an expensive or sophisticated system i.e. managed by staff who do not understand the risks and the importance of their contribution.[2] Good knowledge of safe and effective way of handling BMW will develop a good attitude, and with good attitude correct and safe practice will be developed.

 

Though BMW constitutes a small fraction only 10- 20% of the municipal solid waste, must be segregated and identified and not be mixed with other wastes as it poses a threat to human health and the environment.  Since the infectious waste gets mixed with municipal solid waste, it has potential to make the whole lot infectious in adverse environmental conditions.[3] Implementation of environmental law and safe practices is not the responsibility of government alone, active participation of people is also essential.[4, 5] Training in health and safety should ensure that workers know of and understand the potential risks associated with health care waste.[6] The cleaning staff has poor knowledge of basic safety issue in general.The supervisor of the cleaning staff transfer the knowledge of what he understood from the Nursing Infection control officer to his cleaning staff including the newly joined.

 

The key aspect for the management of waste is to give appropriate education for all those who come into contact with waste and undergo training for all those who are responsible for handling waste. There were no distribution of booklets, guides, and leaflets describing the risks associated with medical waste management based on legislation or ministry recommendation in hospital, for those who directly handle medical waste in their daily work.[7] Good information is essential, particularly for cleaning contractors, or when employees change jobs or work routines, and for substitute or temporary workers. Knowledge must be constantly updated through ongoing discussion and continuing education.

 

Dravidians in 500 BC were the pioneers in scientific waste management, which were discovered in the excavations of Mohen-jo-Daro and Harappa.[8] Evidence of legal approach to hygiene and clean environment can be found in the Babylonian Law (early 2000 BC), which forbade sale of contaminated grains.[9] Since early recovery of patients and health of clinical staff directly depends on a clean and hygienic environment, it is essential that health care waste is managed properly, by practicing segregation, collection, storage and disposal in a proper and scientific manner. The hazardous waste is a potential reservoir of the infection and diseases in patients are transmitted through it. [10] Excellent hygiene practices in health care facilities are the prerequisite for good medical waste management. [5] Continuous monitoring and training is also an important aspect in hospital waste management system. Training capsule must be developed for doctors, nursing officers, paramedical staff and other waste handlers separately in the languages they understand and periodically the training programme should be implemented to refresh and update their knowledge and skills to ensure a sound waste management system.[11] Aim of the study to assess the Knowledge, Attitude and Practice (KAP) regarding BMW management among the different groups of staff in a tertiary care hospital.

 

METHODOLOGY:

All staffs of the Hospital were assessed about the BMW in terms of the Knowledge, Attitude and Practice (KAP). Hospital staffs were divided into four categories, namely

1.    Administrator including Medical Nursing and Operational.

2.    Doctors including Consultants, Registrar, Trainee and DMOs

3.    Nurses and allied staff  including Technicians

4.    Housekeeping staff (Ward Boys/Ayyammas)

 

The study is conducted in a tertiary care super specialty hospital in the major towns of the state of Andhra Pradesh.

 

This study is design as a cross sectional study during the period of June-August 2012. The questionnaire method was used and questionnaires were designed for the study mainly consists of different and relevant aspect of BMW Management. For each four group of study people, three different set of questionnaire has been made to reduce the bias. Each set consist of  12 questions and out of 12 questions four questions were framed for each area of knowledge, attitude and practice.

 

The sample comprises of a total of 163 Doctors, 40 Administrators, 149 Nursing and 187 Housekeeping staff were selected using stratified random sampling technique as shown below.

 

Figure 1: Different group of staff participation.

A pilot study was conducted at a different tertiary care super specialty hospital at Andhra Pradesh having bed strength 370, to check the reliability, validity and feasibility of the study. An interpreter’ help was taken for local language especially for Housekeeping and some Nursing and Allied Health staff. The data analysis of the pilot study was done with the help of simple statistics and the tool was found to be adequate and we decided to proceed to the actual collection of data for the study. The data was analysed on the objectives of the study using various Statistical methods like Percentage, Mean or Average etc

 

RESULTS:

Total 539 hospital staff was subjected to KAP study. Details data in different group wise given as below.

 

Table 1: KAP Study Detail data for different Group wise.

CATEGORY OF STAFF	Set of Questionnaire	NO. OF SUBJECT (N)	Average Percentage of Knowledge Score	Average Percentage of Attitude Score	Average Percentage of Practice Score	Over All Average KAP %
Doctor	SET  - I	58 (35%)	76.25	75	82	77.75
	SET - II	63(39%)	77	75.5	78.25	76.92
	SET - III	42 (26%)	75.5	75.5	77.5	76.17
	Total/Avg	163 (30%)	76.25	75.3	79.25	76.94
Administrator	SET  - I	13(32%)	86.5	82.75	88.5	85.92
	SET - II	15 (38%)	76.75	81.75	80.00	79.5
	SET - III	12 (30%)	75	81.25	83.25	79.83
	Total/Avg	40 (7%)	79.41	81.92	83.91	81.75
Nursing and Allied staff	SET  - I	45(30%)	80.00	86.75	80.50	82.42
	SET - II	48(32%)	79.8	86	80.75	82.17
	SET - III	56 (38%)	82.5	82.3	77.25	80.67
	Total/Avg	149 (28%)	80.75	85	79.5	81.75
Housekeeping staff	SET  - I	61(33%)	80.25	77.00	84.75	80.67
	SET – II	62 (33%)	72.5	81.5	74.5	76.17
	SET – III	64 (34%)	78.5	81.75	83.5	81.25
	Total/Avg	187 (35%)	77.08	80.1	80.91	79.36
Grand Total/Avg		539	78.38	80.6	80.89	79.95

 

Figure2: Comparison of KAP Score among different group of staff.

Below diagram shows comparison of KAP study of four categories of the staff

DISCUSSIONS:

This study was done on a predesigned and pre tested questionnaire and a cross sectional study design was selected as similar study design were adopted in other studies. [12, 13, 14, 15]

 

Category -Doctors: It was found doctors scored 76.25% in the knowledge about BMW and scored 75.33% in attitude and in practice 79.25%. Over all doctor group score around 76.94% in KAP study.

Category - Administrators: It was found that, Administrators have 79.42% in knowledge, 81.92% in attitude and 83.92% in practice regarding BMW. Overall Administrator group scored around 81.75% in KAP study.

 

Category - Nursing and Allied Staff: It was found that in this category of staff scored 80.75% in knowledge and 85% in attitude and 79.5% in practice in relation to BMW management. Over all these group scored 81.75% in KAP study.

 

Category - House keeping Staff: These category staff, in knowledge scored 77.08 %, and 80.08% in Attitude and in Practice 80.92%. Overall the group scored 79.36%.

 

It was found that, nursing staff scored highest score (80.75%) and Doctors score lowest score (76.25%) in knowledge. In Attitude also the nursing staff scored highest (85%) and lowest (75.3%) Doctor.Administrator shows highest score (83.91%) in Practice and doctor least (79.25%). Over all The Nursing staff and Administrators scored highest (81.75%) and Doctor were lowest (76.94%).

 

In this study, it was seen that doctors were having less score compare to other staff; which is contrary to the few studies [13, 16, 17], where qualified personals like doctors have more knowledge than other staff.  In Bijapur study [17] it was shown that teaching staff (97.4%) gives more correct response than nonteaching staff (80%). In a study at Allahaad city [18] shows doctor scoring as high as 85.1%, Nursing.as 81.6%, sanitary staff as 33.7%. In this study Nursing score (81.75%) is similar to the above study but doctor score (76.94%) is little less and House keeping staff score (79.36%) is much higher.

 

But in a very recent study in 2012 in a tertiary care hospital of West Bengal [19] shows a lack of knowledge among junior doctor as low as 29.5% in some aspects in spite of BMW inclusion in the MBBS curriculum, which is shows that doctor have much less knowledge than our study. It also shows the knowledge of doctors in some areas as high as 94.4% which are similar to other studies. [13, 16] A stud by Deo et al. shows intermediate results.[20] Another study at Andhra Pradesh also shows lower result where only 14.4% had knowledge about various methods of disposal among paramedical staff [21], however in our study it was high.

 

Another study at Puducherry by Joseph et. al. also shows that almost only half the healthcare professional including doctors, house staff and students were aware of the legislation.

 

The study concludes that healthcare waste management should go beyond data compilation, enforcement of regulations and acquisition of better equipment. It should be supported through appropriate education, training and the commitment of the healthcare staff, management and healthcare managers within an effective policy and legislative framework. Regular training is also required vigorously. BMW Management is not the sole responsibility of the persons handling BMW; rather it is the responsibility of each and every individual working at Hospital.

 

Health education for all hospital personnel in the form of multi language seminars, pamphlets on waste hazards; encourage studies on different aspects of medical waste. It shows that statutory guideline alone cannot achieve the desired goal of proper BMW management, if we are not motivating with the help of behavior change communication (BCC) of all strata of medical professionals specially doctors.[19]

 

Following suggestions and recommendations are proposed to improve the Knowledge, Attitude and Practice among different staff of the Hospital for better BMW management:

·        Intensive training program at regular time interval for all staff.

·        Inclusion of Bio-Medical Waste topic in induction training programme for all new staff.

·        A system of monitoring for information, education and communication (IEC) regarding BMW.

 

REFERENCES:

1.     Manyele S. V., (2004a). Effects of improper hospital waste management on occupational health and safety. Africal Newsletter on Occupational Health and Safety, 14, 30 – 35.

2.     WHO, (2001). Health care waste management. Rapid assessment tool for country level. 2nd draft.

3.     Info Nugget. (1996). Hospital Waste Management and Bio-degradable Waste. Government of India, Press Information Bureau.

4.     WHO (2005). Understanding and simplifying bio – medical waste management. A training manual for trainers. www.noharm.org/details.cfmID=1197andtype=documentwater_sanitation_health/medicalwaste/decisionmguid erev221105.pdf

5.     Khokhar AK, Principles of health care waste management, IGNOU; 2009.

6.     Pruss, A., Cirouit, E., and Rushbrook, P., Safe management of wastes from health-care activities, WHO, 1999. 230pp.

7.     http://www.epa.gov/osw/nonhaz/industrial/medical/index.htm

8.     Anand RC, and Satpathy S, Hospital Waste Management - a holistic approach, 2nd Ed. Jaypee brothers, ND, 2000, p 1, 19.

9.     Trivedi PR, International Encyclopedia of Ecology and Environment, 1994, Vol. 6, p. 12.

10.   Khokhar AK, Hospitals and Health Service management - Principles and Practices, New York: Oxford University press., 2001, 959pp.

11.   Chandra H, Guidelines for Waste Disposal in Hospital, IGNOU; 2009.

12.   Rao PH. Report: Hospitalwaste management – awareness and practice: a study of three states in India, Waste Manag Res. 2008 Jun; 26 (3):297-303.

13.   Pandit NB, Mehta HK, Kartha GP, Choudhary SK. Management of Biomedical waste: Awareness and practice in a district of Gujrat. Indian J Public Health. 2005; 49:245-7.

14.   Kishore J, Goel P, Sagar B, joshi TK. Awareness about biomedical waste management and infection control among dentists of a teaching hospital in New Delhi, India. Indian J Dent Res. 2000; 11:157-61.

15.   Verma LK, Mani S, Sinha N, Rana S. Biomedical waste management in nursing homes and smaller hospitals in Delhi. Waste Manage Res.2008; 28:2723-34.

16.   Saini S, Nagarajan SS, Sarma RK. Knowledge; attitude and Practice of biomedical waste management amongst staff of a tertiary level hospital in India. J Acad Hosp Adm.2005; 17:2.

17.   MC Yadavannavar, Aditya S Berad, PB Jagirdar. Biomedical Waste management: A study of Knowledge, Attitude, and Practices in a tertiary health care institution in bijapur. Indian J community Med. 2010 January; 35(1): 170-171.

18.   Vanesh mathur, S Dwivedi, MA Hassan, RP Misra. Knowledge, Attitude and Practice about Biomedical Waste Mangement among Healthcare Personnel: A cross-sectional study. Indian J community med. 2011 Apr-Jun; 36(2):143-145.

19.   Mausumi Basu, Palash Das, Ranabir Pal. Assessment of future physicians on biomedical waste management in a tertiary care hospital of West Bengal. J Nat Sci Biol Med. 2012 an-Jun; 3(1):38-42.

20.    Deo D, Tak SR, Mnde SS. A study of knowledge regarding biomedical waste management among Employee of a tertiary hospital in rural area. J Indian Soc Hosp Waste Manage. 2006; 5:12-6.

21.   Shafee Mohd, asturwar N, Niruama N. Study of Knowledge, attitude and practices regarding biomedical waste amng Paramedical workers. Indian J community Med. 2010; 35:369-70.

 

 

 

 

Received on 03.03.2017                Modified on 07.08.2017

Accepted on 16.11.2017           ©A&V Publications All right reserved