INTRODUCTION:

The term “Biomedical Waste” has been defined as “any waste that is generated during diagnosis, treatment or immunization of human beings or animals or in the research activities pertaining to or in the production or testing of biological and includes categories mentioned in Schedule I of Govt. of India’s biomedical waste (management and handling) rules 1998”^1,2.

Enormous amounts of hazardous and infectious waste are produced in hospitals across the world in the course of various biomedical procedures. India produces approximately 2kg/bed/day.³This biomedical waste comprises of: sharps, which (if improperly segregated) could become agents for spread of deadly diseases like HIV-AIDS, hepatitis B and C infections⁴; human and animal tissues, which also harbor many pathogenic microorganism in addition to those mentioned above; cytotoxic waste as well as recyclable waste like soiled or unsoiled plastic and rubber items which (if improperly disposed) would have an adverse impact on ecological balance.^5,6

Evaluation is an essential and integral component of all system as without evaluation we can't know the success or failure. It is only through evaluation one can know the real impact i.e., achievement against the set objectives. What were the problems faced, what were the changes and modifications with reasons there of? The most important principle is that good performance must be rewarded and the poor must be corrected.⁷

Good quality biomedical waste management entails not only proper adherence to protocol at health care facility level but also, investment in and implementation of disinfection of, recycling and disposal at the terminal site.⁸ However, success of the later steps depends on initial processing that is the one done at the point of generation in health care facilities in the first place, the quality of which, we believe, depends on the knowledge, attitude and practices of the various health care professionals working therein. India has well established protocols for handling and management of biomedical waste, namely, the BMW (Management and Handling) Amendment Rules, 2000. These rules mandate healthcare facilities to segregate disinfect and dispose biomedical wastes in a manner which protects the safety of healthcare professionals as well as that of the environment.⁶Training of the various healthcare professionals with respect to biomedical waste management is incorporated in curricula as well as job orientation programs. However, evidence from various parts of India suggests that, gaps in knowledge and lacunae in attitudes and practices are still prevalent to a worrying extent among the various categories of healthcare professionals^8-12. This being a matter of concern, a study was warranted to assess their knowledge, attitudes and practices with respect to biomedical wastes in this part of the country. It was hoped that such a study would elucidate upon the magnitude and distribution of gaps and/or disconnects in and between theory and practice.

RESEARCH QUESTION:

Will an education programme using seminars and presentations to hospital staff involved in hospital waste management can enhance their knowledge as evidenced by pre and post interventional surveys?

AIMS AND OBJECTIVES:

1. To find out the levels of knowledge, attitudes and practices towards BMW management among Senior doctors and Medical Officers, PGs (Jr Doctors), nursing staffs and sanitary staffs working in J.A.H. group of hospitals (A Tertiary hospital of G. R. Medical College Gwalior Madhya Pradesh).

2. To inculcate in them the safe and healthy practices of BMW management through an educational intervention.

3. To determine their awareness regarding Biomedical Waste Management policy and practice

4. To find out the areas of gaps in knowledge, attitude and practices regarding BMW management

MATERIALS AND METHODS:

The same group of participants, i.e., people engaged in its management.

Sample and sampling technique:

150 participants from J.A.H. group of Hospitals, Gwalior were included in the study which fulfilled the sampling criteria. A written informed consent was taken from all the willing workers. Enrollment of all biomedical waste handlers in the study was undertaken during the study and intervention period of 1^st July 2021 to 25^th Sep 2021.

Subjects:

The participants of the present study comprised of 150 participants, who were engaged in its management in one way or the other.

Variables: Independent variables:

Independent variable was Educational Intervention, that is, planned teaching and audio-visual presentation regarding biomedical waste management.

Dependent variables:

The dependent variables of this study were knowledge and practice, educational status, work place and experience of the participants.

Data collection:

A pre-tested structured questionnaire was prepared and used for data collection. A Planned teaching and audiovisual presentation for the biomedical waste management was prepared based on guidelines from Govt. of India.

Structured Questionnaire:

Consisted of 18 multiple choice questions to assess the knowledge of participants regarding biomedical waste management. A maximum score of 18 and minimum sore 0 was given. One mark was given for each correct response and 0 mark was given for each wrong response. No negative marking was done.

The knowledge score was arbitrarily graded as follows:

Poor: <10 correct answers

Good: 10-13 correct answers

Excellent: >13 correct answers

Statistical Analysis:

Data has been composed in Microsoft spreadsheet. After compilation of data has been analyzed and review statistically by appropriate test like Chi Square test by Epi Calc 2000 statistical software. Significance level will be 95% confidence level (p<0.05). Data has been described as a frequency (Percentage) distribution. Data will be presented through suitable statistical graphs.

CONCEPTUAL FRAMEWORK:

RESULT:

Out of 150 participants, 40 were Sr Doctors and Medical Officers (MOs), 40 Post graduates (Jr doctors), 40 nursing staffs and 30 sanitary staffs. of the total Sr doctors and MO and post graduates 70% and 65% had excellent knowledge about biomedical waste management respectively, while nursing staff and sanitary staff has only 37,5% and 13.3% excellent knowledge respectively and had significant (p=0.001) more poor knowledge in comparison to sr and jr doctors (Table1).

Table 1: Level of knowledge about BMW management among different groups before providing feedback

Health care personnel	Scoring of correct answer
	Excellent No (%)	Good No (%)	Poor No (%)
Sr doctors and MO (n=40)	28(70.0)	12(30.0)	0.0(0)
Post Graduates(n=40)	26(65.0)	13(32.5)	1(2.5)
3. Nursing Staff(n=40)	15(37.5)	14(35.0)	11(27.5)
4. Sanitary staff(n=30)	4(13.3)	9(30.0)	17(56.7)

P= 0.001 (Highly Significant)

Table 2 revealed that before the educational intervention the level of knowledge about bio medical waste management among sr doctors and Mo was most 73.33% in comparison to other groups. After educational intervention in all groups there had been significant increase in knowledge about BW management (P=0.001).

Table 2: Comparative study of different groups before and after intervention

Health care personnel	Result of correct answer (Mean)			P value
Health care personnel	Pre-exposure results Mean (SD)	Post-exposure results Mean (SD)	% Increase	P value
1. Sr Doctors and MO	73.33(4.4)	93.80(5.6)	20.47	0.001*
2. Post Graduates	57.95(3.7)	68.7(4.2)	10.75	0.001*
3. Nursing Staff	60.93(4.6)	69.07(5.3)	8.14	0.001*
4. Sanitary staff	50.8(5.9)	60.52(6.3)	9.72	0.008*

*Statistical Significance

Table3 showed the result of follow color coding during BW management. Sr doctors and Mo had the significant (P<0.05) most knowledge about color follow during BW management in comparison to other groups.

Table 3: Practices among health care personnel of follow colour coding system during biomedical waste management

Health care personnel	Yes No. (%)	No No. (%)	Sometimes No (%)
1. Sr doctors and MO(n=40)	30(75.0)	0(0)	10(25.0)
2. Post Graduates(n=40)	24(60.0)	1(2.5)	15(37.5)
3. Nursing Staff(n=40)	25(62.5)	2(5.0)	13(32.5)
4. Sanitary staff(n=30)	17(56.7)	9(30.0)	4(13.3)

x²= 28.4, df=6, P=0.007 Statistically significant

In our study safe needle disposing practice was just significantly (P<0.04) good in doctors and nursing staff in comparison to sanitary staff (Table-4). 90% of the post graduates, 83% undergraduates, 93% nursing staff and 65% class IV follow the proper safe needle practices. Among them nursing staff has more knowledge then others but overall comparison was not statistically significant (p>0.05).

Table 4: Knowledge regarding safe needle practices among health care personnel

Health care personnel	Yes No. (%)	No No. (%)	Sometimes No. (%)
1. Sr doctors and MO(n=40)	36(90.0)	1(2.5)	3(7.5)
2. Post Graduates [Jr Doctors(n=40)	32(80.0)	2(5.0)	6(15.0)
3. Nursing Staff(n=40)	34(85.0)	1(2.5)	5(12.5)
4. Sanitary staff(n=30)	18(60.0)	5(16.7)	7(23.3)

x²= 12.6, df=6, P=0.048 Statistically significant

DISCUSSION:

Whenever an individual visit a hospital with any quite illness, he/she expects the doctors, nurses and even the support staff to indicate care and concern towards him/her or rather empathize with him/her. Especially the biomedical waste management is invariably considered a stressful occupation within the healthcare system, these may negatively affect the health status of patients, which could then hinder their professional performance and affect the standard of healthcare provided.¹⁴

The present study was conducted in J.A. group of Hospitals, Gwalior, India. The assessment of knowledge of biomedical waste handler’s pre and post intervention on the same group i.e. senior doctors and medical officers (MO) and post graduates (MD/MS Students), nursing staffs and sanitary employees was conducted. The sample was selected using purposive sampling technique. The biomedical waste handlers were grouped into three categories according to their knowledge and practice scores as poor, good and excellent scores. It was found that 67.0% of the senior doctors and Medical officers and 65% post graduate (Jr doctors) had excellent knowledge about bio-medical waste management, while only 37.5% of the nursing staff had excellent. Majority of the sanitary staffs (56.7%) fell in the poor knowledge category. These findings are in accordance with other studies undertaken on assessment knowledge, attitude and practice of health care workers which have uniformly indicated that the knowledge, attitude and practices to be very good among consultants and medical doctors and being very poor among the laboratory workers and Biomedical Waste Handlers.^(15-19) Most of the nurses however, lie in between the doctors and the IV class waste handlers in terms of their knowledge and practice. A study carried out in AIIMS has observed excellent knowledge and practice among nursing staff¹⁶.

The pre and post intervention results were evaluated. And it was found that there has been highly significant improvement in grades in both the knowledge and practice after training thus highlighting the importance of training and seminars. Maximum increment in knowledge was noted among sr doctors and MO i.e. 20.47% while minimum increment in knowledge was noted among nursing staff i.e. 8.14%. The postgraduates and sanitary staff lie in between being 10.75% and 9.72% respectively. The poor improvement among sanitary staff can be attributed to lack of proper communication medium as well as lack of basic education. Sagoe-Moses C, et al(2001)⁽²⁰⁾conducted a study on risks to the health care workers in the developing countries which has revealed that protecting health care workers in developing countries is a challenge as even the basics of medical care are difficult to provide and where the protection of health care workers does not appear in any health care priorities. Clearly, health care workers in developing countries are at serious risk of infection from blood borne pathogens particularly HBV, HCV and HIV because of the high prevalence of such pathogens in many poorer regions of the world. Although the prevalence of blood borne pathogens in many developing countries is high, documentation of infections caused by occupational exposure is poor. It is unlikely that surveillance and reporting of occupational exposure to infected blood will be undertaken in places where post exposure prophylaxis, treatment, and workers’ compensation are lacking. The risk to the health care workers in developing countries is due to a lack of gloves, masks, and goggles to protect them from contaminated blood and body fluids.

PROBLEM FACED:

1. Gather every group member at one place on time.

2. Lack of basic education among key health personnel (e.g., nursing and sanitary staff) responsible for BM waste management.

CONCLUSION:

· Overall, the knowledge, attitude and practices among the participants were fair.

· Knowledge, Attitude and Practices were far better among Sr Doctors and MO and Postgraduates doctors (Jr doctors) than among the nursing staffs and sanitary employees.

Thus, it could be concluded from the present study that the knowledge among various key health care personnel (e.g., nursing and sanitary staff) about BM waste generation, legislation and management is not adequate. Regular monitoring and training are required at all levels.

RECOMMENDATIONS:

In dealing with BMW management, following points are important:

· Knowledge

· Attitude and,

· Practices.

Thus, keeping above three basic points in mind, the following steps can lead to effective management and practices in our hospitals.

· Providing basic education to all those involved in waste disposal and management.

· Organizing seminars, workshops, voluntary programmes that enhance and upgrade the knowledge of all those involved in its management.

· Facilitating them with adequate waste disposal measures during waste collection and disposal.

· Pre-employment selection and training should be made mandatory.

Accountability may be ensured by random “surprise” checks by trained staff equipped with checklists.

REFERENCES:

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2. Government of India, Ministry of Health and Family Welfare (MoHFW). National Guidelines on Hospital Waste Management Based upon the Bio-Medical Waste (Management and Handling) Rules, 1998. New Delhi: MoHFW; 2002.

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Received on 09.11.2021 Modified on 24.03.2022

Asian Journal of Management. 2022;13(3):171-175.

DOI: 10.52711/2321-5763.2022.00031