I

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON

KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS

BIO-MEDICAL WASTE MANAGEMENT AMONG

NURSING PERSONNEL IN SELECTED PRIMARY

HEALTH CENTERS OF KARIMNAGAR (DIST.)

ANDHRA PRADESH.

Thesis submitted for the award of

Doctor of Philosophy in Nursing

BY

Mrs. DEVI BUELA JANET

GUIDE

Prof. Dr. (Mrs) INDRANI DASARATHAN

VINAYAKA MISSIONS UNIVERSITY

SALEM, TAMILNADU, INDIA.

2016

II

VINAYAKA MISSIONS UNIVERSITY

CERTIFICATE BY THE GUIDE

I, Prof. Dr. Indrani Dasarathan, Principal Ashram college of Nursing

Eluru, certify that the thesis entitled “A Study To Assess The Effectiveness

Of Structured Teaching Programme On Knowledge, Attitude And

Practice Towards Bio-Medical Waste Management Among Nursing

Personnel In Selected Primary Health Centers Of Karimnagar (Dist.)

Andhra Pradesh” submitted for the degree of Doctor of Philosophy by Mrs. D.

BEULA JANET is the record of work carried out by her during the period 2005

– 2016 under my guidance and supervision and this work has not formed the

basis for the award of any degree, diploma associate-ship, fellowship or other

titles in this University or any other University or Institutions of higher learning.

__________________________

Prof. Dr. Indrani Dasarathan

M.Sc M.Phil Ph.D

Principal

Ashram College of nursing

Eluru, Andhra Pradesh

Place :

Date :

III

VINAYAKA MISSIONS UNIVERSITY

DECLARATION

I, MRS. DEVI BEULA JANET declare that the thesis entitled

“A Study To Assess The Effectiveness Of Structured Teaching

Programme On Knowledge, Attitude And Practice Towards Bio-Medical

Waste Management Among Nursing Personnel In Selected Primary

Health Centers Of Karimnagar (Dist.) Andhra Pradesh” submitted by me

for the degree of Doctor of Philosophy is the record of work carried out by me

during the period 2005 – 2016 under the guidance of Prof. Dr. Indrani

Dasarathan Principal Ashram College of Nursing, Eluru, A.P and this has not

formed the basis for the award of any degree, diploma associate-ship,

fellowship or other titles in this University or any other Universities or

Institutions of higher learning.

Place: Salem, Tamil Nadu Signature of the Candidate

Date:

IV

ACKNOWLEDGEMENTS

I am greatly and sincerely indebted to GOD almighty, for showering upon

me His loving mercies, kindness, blessings and abundant grace.

The authorship of doctoral dissertation of this magnitude is only one aspect

of a complex process. In this monumental work I have been greatly aided by many

individuals to whom I owe a debt of gratitude.

The present study would not have been possible without the persistent effort

and sustained interest evinced by my research guide Prof. Dr. Indrani Dasarathan

M.Sc., M.Phil, Ph.D, Principal, Ashram college of nursing, Rajahmundry, A.P. It has

been a gratifying experience for me working with her and I would like to

acknowledge her commitment to the vision of producing a quality work.

I express my heartfelt thanks to Mrs. Dr. Subadra, District medical and

health officer for granting permission to undertake their doctoral study this

encouragement will be gratefully remembered.

I extend my earnest gratitude to Late Dr. T.N Krishnaveni for an

unconditional encouragement and valuable guidance.

My deepest and sincere thanks to Dr. K. Lalitha, Professor Dept of

Mental Health Nursing NIMHANS for her enlightening ideas and elegant

direction throughout the study.

V

I express my warmest thanks to Prof. Dr. K. Rajendran, Dean

(Research) Vinayaka missions university, Salem for his unstinted cooperation

in every phase of my research study.

I wish to express my profound thanks to Prof. Dr. Porselvan, HOD. Dept

of Statistics, Sri. Ramachandra Medical College, Chennai, for his guidance.

My heartfelt thanks to all the experts who had taken time to go through

my research tool and module and for giving valuable suggestions for the

validation of the tool and module.

I would like to thank Prof. P. Jyotsna M.A English Literature for editing

the thesis.

My sincere thanks to Mrs. S. Hymavathi, Principal, Mediciti college of

Nursing for her unconditional endurance.

I dedicate the dissertation with immense gratitude to my staff

Mrs. P.M Thamarai selvi, Mrs. Jissa Melvin, Mr. Ravindra Raju, c,

Ms. Ravi. Christy Roja for their timely assistance and support throughout the

study.

My heartful thanks to Mr. G. K. Venkataraman, Elite Computers for his

untiring effort in deciphering the manuscript into a legible piece of work.

VI

I am indeed thankful to all Nursing Personnel who participated in the

study.

I am indebted to my parents and my family members, who stood beside

me throughout my study.

Finally, I thank all who have directly or indirectly helped me in

completing this work in time.

Devi Beula Janet

VII

TABLE OF CONTENTS

CHAPTER CONTENTS PAGE NO.

1 INTRODUCTION 1-7 1.1 Background of the Study 7-13 1.2Need for the Study 13-20 1.3Statement of the Problem 21 1.4Objectives of the Study 21 1.5 Operational Definition 22-24 1.6 Hypotheses of the Study 24

1.7 Variables of the study 25

1.8 Delimitation of the Study 25 1.9 Conceptual Framework 26-28 2 REVIEW OF LITERATURE 29-69

2.1 General information regarding bio-medical waste management

30-33

2.2 Studies and related literature on Bio-medical Waste Management.

33-69

1. Studies related to knowledge, attitude

and practices on Bio-Medical Waste Management

33-58

2. Studies and literature related to effects of

improper Bio-Medical Waste Management

58-62

3. Studies and literature related to proper

management Bio-Medical Waste Management

62-69

3 METHODOLOGY 70-88 3.1 Research Approach 70-71 3.2 Research Design 71-72 3.3 Study variables 72-73 3.4 Setting of the Study 73-74 3.5 Population 74-75 3.6 Sample 76 3.7 Sampling Technique 76 3.8 Sample Size 76-77 3.9 Criteria for Sample Selection 77 3.10 Development of the Tool 78 3.11 Description of the Tool 78-80 3.12 Scoring procedure 80-82 3.13 Content Validity 83

VIII

CHAPTER CONTENTS PAGE NO.

3.14 Reliability of the Tool 83-84 3.15 Pilot Study 84-85 3.16 Ethical Consideration 85 3.17 Data Collection Procedure 85-87 3.18 Plan for Data Analysis 88 4 ANALYSIS AND INTERPRETATION 89-121

5 DISCUSSION, SUMMARY, CONCLUSION, IMPLICATIONS LIMITATIONS AND RECOMMENDATIONS

122-147

BIBLIOGRAPHY 148-157

ANNEXURES 158-234

IX

LIST OF TABLES

TABLE TABLES PAGE.

NO

1 Interpretation of the score. 82

4.1a Frequency and percentage distribution of demographic variables on biomedical waste management. 93

4.1b Frequency and percentage distribution of demographic variables on biomedical waste management. 94

4.2 Frequency and percentage distribution of subjects according to before and after STP level of knowledge. 98

4.3 Frequency and percentage distribution of subjects according to before and after STP level of practice. 100

4.4 Frequency and percentage distribution of subjects according to before and after STP level of attitude. 101

4.5a Mean difference of structured teaching programme on level of knowledge regarding bio medical waste management among nursing personnel.

103

4.5b Mean difference of structured teaching programme on level of practice regarding bio medical waste management among nursing personnel.

105

4.5c Mean difference of structured teaching programme on level of attitude regarding bio medical waste management among nursing personnel.

107

5a Association between knowledge and their selected demographic variable after STP. 109-110

5b Association between practice and their selected demographic variables after STP. 112-113

5c Association between attitude and their selected demographic variables before STP. 115-116

6a Before and after STP mean, standard deviation and correlation of overall levels of knowledge, and practice of nursing personnel on bio medical waste management.

118

6b Before and after STP mean, standard deviation and correlation of overall levels of knowledge and attitude of nursing personnel on bio medical waste management.

120

6c Before and after STP mean, standard deviation and correlation of overall levels of practice and attitude of nursing personnel on bio medical waste management.

121

X

LIST OF FIGURES/ GRAPHS

FIGURE CONTENT Page.

No

1 Conceptual framework based on Pender’s Health Promotion Model.

28

2 Schematic diagram of research design. 72 3 Schematic diagram of research process. 75

4 Percentage distribution of nursing personnel according to their professional qualification. 96

5 Percentage distribution of nursing personnel according to their present designation. 96

6 Percentage distribution of nursing personnel according to their year of experience. 97

7 Percentage distribution of level of knowledge on before- STP among nursing personnel regarding biomedical waste management.

99

8 Percentage distribution of level of knowledge on after STP among nursing personnel regarding biomedical waste management.

99

9 Percentage distribution of nursing personnel according to before and after STP level of attitude regarding biomedical waste management.

102

XI

LIST OF ANNEXURES

ANNEXURE NO.

TITLE PAGE

NO

I Letter seeking permission to conduct study in Karimnagar District, Andhra Pradesh.

158

II Letter granting permission to conduct study in Karimnagar District, Andhra Pradesh.

159

III District Medical and Health office, ethical committee approval letter.

160-161

IV Letter requesting expert for their opinion and content validity.

162-163

V List of experts consulted for content validation of tool. 164-166 VI Description of items 167 VII Data collection schedule 168-170 VIII Evaluation criteria checklist for content validity of tool. 171-173

IX Subjects informed consent form for participation in research study.

174-175

X Certificate for English editing. 176

XI Tool for data collection. 177-186

XII Scoring Key. 187 XIII Content validity certificate. 188

XIV Structured teaching program on Biomedical waste management.

189-233

XV Map 234

XII

LIST OF ABBREVIATIONS USED

Sl. No ABBREVATION EXPANSION

1 WHO World Health Organisation

2 M Mean

3 N Sample Size

4 F Frequency

5 MD Mean Difference

6 NS Not significant

7 X 2 Chi square

8 S Significant

9 % Percentage

10 < Less than

11 > More than

12 = Equal to

13 Df Degree of freedom

14 SD Standard deviation

15 P Probability

16 AIDS Acquired immuno deficiency

syndrome

17 BMW Bio Medical Waste

18 BMWM Bio Medical Waste Management

19 ROL Review Of Literature

20 UN United Nation

21 MWTA Medical Waste Tracking Act

22 ISHWM Indian Society of

Hospital Waste Management

23 HCW Health care wastes

24 STP Structured teaching program

25 PHC Primary Health centre

26 USA United states of America

XIII

Sl. No ABBREVATION EXPANSION

27 HIV Human immuno virus

28 GNP Gross National Product

29 HCW Health care waste

30 IGNOU Indira Gandhi National Open

University

31 NGO Non Governmental Organization

32 OT Operation Theatre

33 HCTs Health care facilities

34 CHC Community health centre

35 PNC Post natal clinic

36 ANC Ante natal clinic

37 RCH Reproductive child health

38 STD’s Sexually transmitted Diseases

39 ISE In service education

XIV

ABSTRACT

A study to assess the effectiveness of structured teaching

program on knowledge, practice and attitude towards Bio-Medical Waste

Management among nursing personnel in selected primary health

centers of Karimnagar (Dist), Andhra Pradesh was undertaken for the

award of doctor of philosophy in nursing at Vinayaka Mission University,

Salem. OBJECTIVE : To find out the effectiveness of structured

teaching programme by comparing the levels of knowledge, attitude and

practice towards biomedical waste management among nursing

personnel before and after structured teaching programme. DESIGN :

Pre experimental research design (one group pre test and post design)

was used for the study. SETTING: Out of 76 Primary Health Centers,

only 60 PHC’S were selected from Karimnagar district. SAMPLING

TECHNIQUE: Simple random sampling technique PARTICIPANTS: 300

nursing personnel’s were selected as sample. MEASUREMENT: The

instrument used for data collection was structured questionnaire, five

point attitude scale (Likert), observational rating scale for practice. KEY

FINDINGS: The outcome of the study revealed that Before Structure

Teaching Programme 130(43.33 %) of nurses had moderately adequate

knowledge, it is interesting to know that none of them had inadequate

knowledge after STP. Before STP 212(70.67%) of nurses were having

fair practice level. After STP none of them were having poor practice

level. Before STP 224 (74.67%) of nurses had favourable attitude. After

XV

STP 300 (100%) of nursing personnel had favourable attitude and none

of them had unfavourable attitude. Paired ‘t’ test findings revealed that

nursing personnel improved their knowledge, practice and attitude After

structured teaching programme. In terms of the relationship the obtained

coefficient correlation value r=0.388 at *P<0.01 level shows there was

statistically significant correlation of the nursing personnel’s knowledge

and practice after STP. The obtained co-efficient of correlation value is

r=0.509 and r=0.3 significant at *P<0.01 and *p< 0.05 before and after

STP respectively. This confirmed that an increase in the levels of

knowledge has shown increase in the levels of attitude statistically. The

obtained co-efficient of correlation value is r=0.726 and r=0.786

significant at *P<0.01 and *p< 0.05 before and after STP respectively,

commends a positive co- relation both before and after STP levels of

practice and attitude which confirms an increase in the levels of practice

have increased the levels of attitude. The association between socio-

demographic variables with knowledge, practice and attitude regarding

biomedical waste management were significant at 0.05 level.

CONCLUSION: The study findings concluded that majority of the

nursing personnel improved their knowledge, practice and attitude on

bio-medical waste management after structure teaching programme.

IMPLICATIONS: Community health nurse should be equipped with the

knowledge on Bio medical waste management, inform, educate,

communicate and motivate on first level health care providers on Bio

XVI

medical waste management to bring about a change.

RECOMMENDATIONS: A study can be conducted to identify the

problems faced while practicing bio medical waste management.

CHAPTER - 1

INTRODUCTION

1

CHAPTER - I

INTRODUCTION

The concern for bio-medical waste management has been felt

globally with the rise in deadly infections such as AIDS, Hepatitis and

improper disposal of Health care waste. The United National

environmental programme (UNEP) through UN Basel Convention (JAN,

2013) on the control of trans boundary movements of hazardous wastes

and their disposal has classified health care waste as most hazardous

waste, after radioactive waste.

Jina Mccarthy (JUNE, 2015) over the years there have been

tremendous advancements in the health care system. However it is

ironic that the health care settings, which restore and maintain

community health, are also threatening their well-being. Poor waste

management practices pose a huge risk to the health of the public,

patients, professionals and contribute to environmental degradation. It is

reported that for the first time the Biomedical waste management issue

was discussed at a meeting convened by the World Health Organization

regional office for Europe at Bergen, Norway in 1983. Investigation

carried out by the Environment Protection Agency (EPA) of USA in this

regard culminated in the passing of Medical Waste Tracking Act

2

(MWTA), Nov 1988. With the passage of time the problem has evolved

as a global humanitarian issue.

K. Park (2015) the Bio-medical waste (Management and handling)

Rules 1998 lay down clear methods for disposal of bio-medical waste,

defined as “any waste generated during the diagnosis, treatment or

immunization of human beings or animals or in research activities used

in the production or testing of biologicals.” Pollution control boards of

every state have been given the task of authorizing and implementing

the rules.

According to WHO, (2006) the eleven South-East Asia countries

together produce some 3,50,000 tons of health care waste per year,

close to 1000 tons a day. As it is not segregated at source, all of it is to

be considered hazardous despite the fact that only 10-20 per cent is

infectious in nature. The main bottleneck to sound health care waste

management programme is lack of training and appropriate skills,

insufficient resource allocation and lack of adequate equipment.

The Composition of average domestic dustbin can be broken

down as follows:

10% Glass

30% Paper/Cardboard

9% Metals

3

3% Textiles

4% Plastics

23% Vegetable Waste

21% Dust, Cinders, Miscellaneous

Some of the waste on the other hand may also contain poisonous

substances like Mercury, lead, cadmium from batteries, old medicines,

household cleaning & Decorating chemicals and garden chemicals.

Large Governmental hospitals work differently from smaller private

nursing homes, district hospitals from primary health care centres. The

large quantities of waste generated reflect the rapid changes in

individual life style and priorities. In proportion the hazardous and

infectious portion of the waste is only 10% of the whole waste generated

in a health care facility. However, when this small portion is mixed with

the other types of waste a problem arises.

Increasing population, increasing number of hospitals and related

health care settings, increased use of consumables in health care have

increased quantum of waste day after day, especially in developing

countries. Added to this, general waste and health care waste posing a

major challenge in disaster situations Eg. Earth Quakes, Floods,

Tsunami

4

WHO (2016) the major changes proposed in BMWM rules 2016& its

implications:

a) The ambit of the rules has been expanded to include vaccination

camps, blood donation camps, surgical camps or any other

healthcare activity;

b) Phase-out the use of chlorinated plastic bags, gloves and blood bags

within two years;

c) Pre-treatment of the laboratory waste, microbiological waste, blood

samples and blood bags through disinfection or sterilization on-site in

the manner as prescribed by WHO or NACO;

d) Provide training to all its health care workers and immunize all health

workers regularly;

e) Establish a Bar-Code System for bags or containers containing bio-

medical waste for disposal;

f) Report major accidents;

g) Existing incinerators to achieve the standards for retention time in

secondary chamber and Dioxin and Furans within two years;

h) Bio-medical waste has been classified in to 4 categories instead 10

to improve the segregation of waste at source;

i) Procedure to get authorization simplified. Automatic authorization for

bedded hospitals. The validity of authorization synchronized with

validity of consent orders for Bedded HCFs. One time authorization

for Non-bedded HCFs;

5

j) The new rules prescribe more stringent standards for incinerator

to reduce the emission of pollutants in environment;

k) Inclusion of emissions limits for Dioxin and furans;

l) State Government to provide land for setting up common bio-medical

waste treatment and disposal facility;

m) No occupier shall establish on-site treatment and disposal facility, if a

service of `common bio-medical waste treatment facility is available

at a distance of seventy-five kilometer.

Ref: WHO guidelines & CDC guidelines

6

The awareness regarding biomedical waste management is very

less among health care personnel. Thus all the hospital care personnel

are at risk to get many fatal infections like HIV, HBV, HCV and injuries

by these infectious materials7. The health care personnel are not aware

of the process of biomedical waste management which includes

collection, segregation, transportation and disposal of waste. They are

not aware of the colour coding used in the biomedical waste

management also. Many of the health care personnel are not aware of

the legal issues because they are not aware of the Bio-medical Waste

(Management and Handling) law 1998.

India has the experience of Orissa Cyclone, Gujarat Earth Quake

(2003) and Floods on and off in Andhra Pradesh and West Bengal

Districts adjacent to Bangladesh. Lessons from these situations as well

as from Indonesia call for recognition of Waste Management as an

important intervention in disaster intervention package; clinical waste

(health care waste management) is an inseparable part of this.

7

1. 1 BACKGROUND OF THE STUDY

Health services have become complex. There has been a

growing concern about their functioning both in the developed and

developing countries. Questions are about the quality of medical care,

utilization and coverage of health service benefit to communities.

How ever there are many pushes for understanding the dynamics

of rural health care delivery urgently, including the waste management --

both in terms of infrastructure availability and types of solutions needed

for the management and handling of the Bio Medical waste in health

care industry.

8

According to WHO Report (1998), Medical Waste has been

growing concern because of recent incidents of public exposure to

discarded blood vials, needles, empty Prescription bottles and syringes,

particularly from the municipal garbage bins and disposal sites.

Hazardous hospital waste are unique forms of solid and liquid waste

generated in the diagnosis, treatment and Prevention of human disease.

Each year large amount of hazardous wastes are produced by various

health care settings.

K. Park (2015) Hospital Waste Management has been brought

into focus, recently particularly with the ruling by Honourable Supreme

Court of India and notification of the Biomedical Waste (Management

and Handling) Rules 1998, which makes it mandatory for the health care

establishments to segregate, disinfect and dispose their waste in an

eco-friendly, manner. No effort needs to be spared to ensure

implementing strategies for safe and sound management of Bio-Medical

waste.

Bio Medical waste management include waste segregation,

waste collection, waste transportation waste storage, waste disposal &

waste minimization & reuses. In other words “Hospital Waste” includes

both risk waste and non-risk waste.

9

Adrain(1998) Waste produced by the health care settings about

75-90% constitutes the general health care waste. It comes mostly from

administrative and housekeeping functions of the health care

establishments and may also include waste generated during

maintenance of health care Premises. The remaining 10-25% of health

care waste is regarded as hazardous and may create variety of health

risk.

Hazardous wastes when ineffectively managed may compromise

the quality of client care, additionally they present occupational health

risks to those who generate, handle package store, transport treat and

dispose of them. They also present environmental and contribute to

infections such as AIDS, Hepatitis, Tuberculosis, Cholera, Enteric

Infections and many others.

Indian Society of Hospital Waste Management (ISHWM)’ (2000)

and the Society came into existence on 10th April 2000 and registered

under Societies registration Act XXI of 1860 with Registration Number

36939. The subject of Environmental Protection and Hospital Waste

Management involves multidisciplinary approach and involves active

participation by specialists of various disciplines such as pathology,

Microbiology, Hospital Administration, preventive & Social Medicine.

Therefore, it will function to bring together specialists from various

10

disciplines under a roof with a common personal goal and environmental

protection.

Bio Medical Waste Management uses four colours namely Green,

Black, Yellow and Red (coding colours) used for bags to collect and

dispose of hospital waste. Hands: The two figures over the top and

bottom denote the hands in light brown outlined with black to denote the

hands, which stand for the control and management of waste. Syringe:

The syringe has been used as a symbol to represent hospital waste due

to its extensive use in clinical practice. Biohazard; hence the universally

accepted logo for biohazard appears in the backdrop. Tree & the Blue

background: denote the eco friendliness, which is very important while

disposing of hazardous waste. Summary: the Logo depicts the hospital

waste (syringe), which is a biohazard to the community being efficiently

managed (by hands) in an environmental friendly (tree and blue

background) manner.

Concept of environmental hygiene and sanitation has been there

in India since the time Rigveda. With the increasing burden of population

explosion, urbanization and industrialization, it is beyond the resources

and limitations of governmental agencies to take care of all aspects of

environmental health. Individuals and communities have their own role

to play in the maintenance of safe environment.

11

Waste generated depends on numerous factors such as

established waste management methods, type of hospital

establishment, proportion of patients treated on a day care basis. This

(2001) study surveyed the waste from hospital and clinics in Phitsamulok

and the average daily waste generated as general, medical and

hazardous waste from all hospitals in Phitsamulok Province at 1.751,

0.284 and 0.013 kg / bed respectively.

A survey done in Bangalore (2002) reveals that the quantity of

hospital waste generated is about 40 tonnes / day, out of that nearly

45- 50% is infectious Segregation of infectious waste from non-

infectious waste is done only in about 30% of hospitals.

Health care setting must realize that an effective programme of Bio

Waste Management as an integral part of the infection control

programme and therefore critically linked to the quality of patient care

and work healthy and safely. In many instances waste handling is left to

the poorly educated and lowest category of workers operating without

any training, guidance and supervision. Additionally when properly

implemented and enforced, effective waste management can have

distinct economic benefits, such as cost savings linked of life of health

care providers and community.

12

According to WHO [2002] The reuse of infectious syringes

represents a major threat to public health. WHO estimated that, in 2000,

worldwide, injections undertaken with contaminated syringes caused

about 23 million infections of Hepatitis B and Hepatitis C and HIV (Safe

Health Care Management Policy Paper). Such situations are very likely

to happen when health-care waste is dumped on uncontrolled sites

where it can be easily accessed by the public: Children are particularly

at risk to come in contact with infectious wastes. The contact with toxic

chemicals, such as disinfectants may cause accidents when they are

accessible to the public.

Indian society of hospital waste management [2006], have

evolved a protocol based on own experience to address this pernicious

problem. Biomedical waste is essentially a management issue and not a

technology one. Technology interventions have failed and have been

unable to protect either health care workers or the larger community

from the risk it poses. The installation of polluting incinerators makes the

problem worse, by instilling a false feeling of well-being. Health care

workers as well as poor unsuspecting rag pickers/waste handlers still

suffer from deadly needle stick injuries exposing them to HIV and

hepatitis viruses amongst others, while incinerator workers and the

community are exposed to the deadly emissions of noxious gases viz.

dioxins, furans and also the mercury. Hence, falling into the trap of a

13

sophisticated technology by hawking industries, we would only end up

throwing valuable resources down the drain, and miss a vital opportunity

to put our combined good sense to better use.

Increasing population, increasing number of hospitals and related

health care settings, increased use of consumables in health care have

increased quantum of waste day after day, especially in developing

countries. Added to this, general waste and health care waste posing a

major challenge in disaster situations e.g. Earth Quakes, Floods,

Tsunami

India has the experience of Orissa Cyclone, Gujarat Earth Quake

and Floods on and off in Andhra Pradesh and West Bengal Districts

adjacent to Bangladesh. Lessons from these situations as well as from

Indonesia call for recognition of Waste Management as an important

intervention in disaster intervention package; clinical waste (health care

waste management) is an inseparable part of this.

1. 2 NEED FOR THE STUDY

The functional unit of health care delivery system in India is the

primary health centre. The country has around 21,854 primary health

centres. The country invests around 1.5 to 2% of its gross national

product (GNP) on health. Thus health centres can no longer ignore

14

health safety & Environmental concern country arising out of in

appropriate disposal of Bio-waste generated in the health centres.

The common and regular practice of disposing human placenta

was to hand it over to the relatives who would then throw it in the river

(or) bury it at their river bed.

None of the primary health centers in India had the needle

centers (or) needle burner, needles were capped and thrown in the

garbage or were collected in a carton box and handed over to the scrap

dealer and the ultimate end of it is not known. Chemical disinfection

were not available. There was no incinerator to treat the Bio-Medical

Waste so it was burnt in the back yard of the primary Health centers.

When question was raised the gram panchayat says that they are not

responsible for disposing the waste. The other reason for not complying

with the laid norms was in adequate infrastructure and lack of regulatory

authority.

Bio-Medical Waste generated by the private practitioners and

the primary health centers was disposed carelessly in the open field (or)

in the garbage bin. It would then find its way into the hands of children

(or) local scrap dealers. The Bio-Medical Waste that is generated in the

urban area is under the vigilance of the governing authority but much of

15

the waste that is generated in the rural settings is not considered (or)

then ignored causing a major health problem to the rural population.

Lack of knowledge, ignorance and lack of regulatory authority body adds

to the problem.

A survey approach used by Usha prabakar (2000) in New Delhi,

India found that only 50% of nursing personnel had knowledge on Bio-

Medical waste generation & 40% had knowledge on waste disposal

there the investigator felt the importance of an ongoing training

programmes on the waste management to the nursing personnel

working in primary health center.

16

According to world health organization life threatening virus

infections such as HIV/ AIDS and Hepatitis B & C, health care workers,

particularly nurses, are at greater risk of infection through injuries from

contaminated sharps.

Bio-Medical Waste Management is an important subject that

needs urgent action. In most circumstances it is appropriate to consider

an incremental approach realizing that an improvement is of greater

value even if resources do not allow achievements of highest standards

immediately. It is recognized that the management of hazardous waste

is not only a technical problem but is ultimately influenced by cultural

social and economic circumstances. At the local level health care setting

are encouraged to work together to address the economic, public health

and environmental impact concerns Bio-Medical Waste Management.

Global alliance for vaccine immunization demonstrated the need

to formulate the policy specific to immunization waste as this category is

considered as a part of the Bio-Medical waste formulated policy will

ensure immunization campus and routine immunization, not to have

unmanaged waste is hospital and at primary health centre.

A survey conducted by the National Service Scheme in Mumbai,

the results shows that 85 clinics reports that 97% of them continued to

17

dump their infectious waste into Brihanmumbai Municipal Corporation

(BMC) bins and one of the pathological lab even threw their Bio- waste

into the sea.

The speakers Mohammed Ali and Mohammed Khallel on

International symposium in Karachi (2001) criticized the Pakistan

government for its neglect of Bio waste. If the activities of Bio-Medical

waste management, middlemen and scavengers and other who

contributed to the reuse of syringes and other medical items were not

checked, this practice would continue to pose a grave hazard to the

health of the people, both directly and by polluting the environment.

Arif Zubair (2001) identifies Bio-Medical waste as an important

component of the overall environmental system as it posed a grave

health hazard. According to his recent study, about 20% of Bio-Medical

waste generated was hazardous and it was 8 tons/day in Karachi.

Sham Sundar (2003) conducted study on knowledge, attitude, and

practice of universal precautions and occupational safety among 60

nursing professionals who were selected by Random sampling

technique in tertiary center’s at Bangalore. The study revealed that

appropriate practice of universal precautions during the procedure were

Intramuscular/ subcutaneous injection; 20 (33%) Intravenous

Cannulation; 56 (93%) Wound Dressing and 43 (72%) waste

18

management. However, there was no significant association was found

between Knowledge, Attitude and Practices of Universal precautions

The investigator concluded that inappropriate Practice of Universal

precautions increases the risk of occupational exposure to Blood. The

rate of Needle Stick Injuries proper disposal of needles should be

practiced by all Health care providers in order to minimize needle stick

injuries.

World health organization (2004) formulated the importance of

health care waste management as Bio waste; it is of paramount

important because of its infections and hazardous characters.

WHO (2005) introduced “a decision making guide” for

management of social health care waste at primary health centres, to

handle the waste management in urban and rural health settings, thus

the community can become zero waste target.

Hemanth .T [2005], submitted the report on developing a training

programme on Sound Health Care Waste Management. It emphasizes

the need for developing and implementing a sound system for the

management of health care wastes (HCW) in all health facilities has

been a neglected issue. Despite the fact that there is an increasing

generalized awareness for its urgency among health professionals and

19

the general public, HCW still remains a low priority . It is an area

requiring radical attitudinal change from all concerned stake holders.

Techno economic feasibility options for final treatment and disposal

methods of biomedical waste were discussed as requested by the

participants and the Government of Maldives.

Park K (2015), reports that the average composition of hospital

waste in India is as follows: Paper – (15%), Plastic –(10%), Rag (15%),

Metal Sharps (1%), Infectious Waste (1.5%), Glass (4%) and General

waste (53.5%). The need to educate different health care professionals/

workers, NGOs and other stake holders was thus identified as a priority.

To cater the needs of these health care professionals, Indira Gandhi

National Open University (IGNOU) had decided to develop and launch

Certificate Programme in Health Care Waste Management in the South-

East Asia Region Countries.

Ministry of health / Riyadh (2005) submitted its Bulletin report on

survey conducted on Knowledge of health workers at a Riyadh hospital

regarding health care waste management. The study participants

(67.5%) knew the different colour coding. 54.7% of study participants did

not know about the means of transportation of waste inside the hospital.

The low knowledge group included 139 (43.3%), the high knowledge

group included 182 (56.7%). On examining the association between

20

knowledge and other related variables, the proportion of high levels of

knowledge was greater among females, nurses, non-Saudis, and those

with previous training. It is clear from the study findings that knowledge

of participated health care worker of health care waste management has

still not achieved the desired standards. Improving the awareness of

health care workers about the health care waste management rules

implemented in Saudi Arabia in general, is urgently required. Extensive

training and retraining programmes bring about change in attitudes and

risk behaviour of health care workers for the effective implementation of

waste management. Teaching and demonstration sessions with both the

nursing and paramedical staff are also required.

The investigator personal experience in various field posting

stimulated to conduct the study on Bio-Medical waste management

which contribute to adequate knowledge, favourable attitude better

practice to nursing professional this will aid in appropriate management

of waste in health care settings.

21

1.3 Statement of the Problem

A study to assess the effectiveness of structured teaching

program on knowledge, attitude and practice towards Bio-Medical waste

management among nursing personnel in selected primary health

centers of Karimnagar (Dist), Andhra Pradesh.

1.4 Objectives of the Study

1. To assess the level of knowledge, attitude and practice towards

biomedical waste management among nursing personnel before

structured teaching programme

2. To assess the level of knowledge, attitude and practice towards

biomedical waste management among nursing personnel after

structured teaching programme.

3. To find out the effectiveness of structured teaching programme by

comparing the levels of knowledge, attitude and practice towards

biomedical waste management among nursing personnel before

and after structured teaching programme.

4. To find out the association between knowledge, attitude and

practice of nursing personnel on biomedical waste management

and their selected demographic variables

5. To find out the relationship among knowledge, attitude and

practice of nursing personnel on biomedical waste management.

22

1.5 Operational Definitions

Assess:

It refers to the process of the critical analysis and evaluation of the

Bio-Medical waste management based on the scores obtained before

and after structured teaching programme among Nursing Personnel.

Effectiveness:

It refers to the gain of female nursing personnel’s level of

knowledge attitude and practice in terms of types of waste segregation,

waste collection, waste transportation, waste storage, waste disposal,

minimization and reuse following structured teaching programme

designed and administered by the investigator.

Knowledge:

It refers to the ability of the nursing personnel to answer questions

related to Bio-Medical Waste Management such as types of waste

segregation, waste collection, waste transportation, waste storage,

waste disposal, minimization and reuse as elicited by the structured

questionnaire devised by the Investigator.

Attitude:

It refers to the response given by health care workers related to

Bio-Medical Waste Management as elicited by 5 point attitude scale in

the area of types of waste segregation, waste collection, waste

23

transportation, waste storage, waste disposal, minimization and reuse as

devised by the Investigator.

Practice:

It refers to a set of acts / actions implemented in handling and

disposing of the Bio-Medical Waste Management in the areas of types of

waste segregation, waste collection, waste transportation, waste

storage, waste disposal, minimization and reuse as elicited by a 5 point

observation rating scale devised by the Investigator.

Bio-Medical Waste Management:

It refers to the management of biological and non biological waste

generated in the health care settings that includes waste segregation,

waste collection, waste transportation, waste storage, waste disposal,

minimization and reuse.

Nursing Personnel:

It refers to female manpower employed in Primary Health Centres

of Karimnagar (dist) such as Multipurpose health assistant, health

visitors, staff nurses, public health nurses, community health officers,

employed in Primary Health Centre to render comprehensive health

services.

24

Primary Health Centres:

It refers to functional unit of health care delivery system in India

providing health Services to the community. It refers to Primary Health

Centres of Karimnagar District.

Structured Teaching Programme:

Structured teaching programme refers to organised teaching

stratergy regarding Bio medical waste management which includes

types of waste segregation, waste collection, transportation, hazards of

improper waste management, treatment of waste and reuse with the

help of Flash cards, Black Board, Leaflet, transparency’s, Posters and

Liquid Crystal Display.

1.6 Hypothesis of the Study:

H1: There will be significant difference in the levels of knowledge of

nursing personnel before and after structured teaching programme.

H2: There will be significant difference in the levels of attitude of

nursing before and after structured teaching programme.

H3: There will be significant difference in the levels of practice of

nursing personnel before and after structured teaching programme.

H4: There will be significant association between the knowledge,

attitude and Practice of nursing personnel with their selected

demographic variables

H5: There will be a significant correlation between the knowledge,

attitude and practice of nursing personnel.

25

1.7 variables

Independent variable

In this study independent variable is “Structured teaching

programme on Bio Medical Waste management” as developed by the

researcher.

Dependent Variable

In this study the dependent variable is Knowledge attitude and

practice of Nursing personnel on Bio Medical Waste Management.

Extraneous Variable

There are demographical variables like age, marital status,

religion, professional qualification, present designation, monthly income,

years of experience, participation in In-service education on Bio-Medical

Waste Management, awareness about Bio-Medical Waste Management

through mass media, adoption of BMWMP by PHC.

1.8 Delimitation of the Study:

This study is delimited to,

1. Primary Health Centers of Karimnagar Dist A.P.

2. Female Nursing personals working in the selected PHC’s

3. Female Nursing personals who can understand English and Telugu.

26

1.9 Conceptual framework:

This section deals with theoretical frame work adopted for the

study. A conceptual frame work provides the investigator the guide lines

to proceed in attaining the objectives of the study based on theoretical

back ground. It is a systematic representation of the steps, activities and

outcome of the study.

Investigator has adopted PENDERS HEALTH PROMOTION

MODEL (1980) for this study .This model seeks to increase the

individual and community well being, The model focuses on modifying

factors, cognitive perceptual factors and likely hood of participants in

health promoting behavior.

This model is used to predict the likelihood of an individual

engaging in health promotion behavior .The cognitive factors reflect on

the individual belief. Additional modifying factors influence the

perception of the individual on benefits and barriers of health actions

influencing likelihood of actions.

Investigator aimed at assessing the knowledge, attitude and

practice of nursing personnel on Bio-Medical Waste Management the

PENDERS HEALTH PROMOTION MODEL was found suitable to elicit

the health promotion behavior of the nursing personnel.

27

The cognitive components of the study are knowledge attitude and

practice. The modifying factors of the study are structured teaching

programme. The intervention of the study and socio demographic factors

such as Age in years, Marital status, Religion, Educational qualification,

Professional qualification, present designation, Monthly income in

Rupees, Number of years of experience Work experience in foreign

countries, participated in service education programme on biomedical

waste management, Awareness about biomedical waste management

through mass media, adopting BMWMP in PHC . The cognitive factors

and the demographic factors are interrelated with each other and result

in the resultant level of knowledge, attitude and practice. The resultant

behaviour could either be a positive outcome (adequate knowledge,

favourable attitude and fair practice) or negative (inadequate knowledge,

unfavourable attitude and poor practice).

The positive outcome facilitates compliance to changes in the

healthcare industry and ultimately a provision of optimal healthcare

services.

The negative outcome on the other hand results ineffective

compliance of health care system, necessitating promotion of suitable

intervention, so as to change the negative out come to the positive one.

The positive and negative loops culminate respectively so that the cycle

continues.

26

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CHAPTER – 2

REVIEW OF

LITERATURE

29

CHAPTER – II

REVIEW OF LITERATURE

This chapter deals with review of literature related to Bio-medical

Waste Management. A review of related literature is an essential aspect

of scientific research. It involves the systematic identification, location,

scrutiny and survey of written materials that contain information on

research problems (Polit & Hungler, 1998). Keeping this in mind the

investigator probed into the accessible sources and gain an in-depth

understanding from the related studies.

2.1] General Information regarding Bio-medical waste Management.

2.2] Studies and Related literature on Bio-medical Waste

management.

1. Studies related to knowledge, attitude and practices on bio-

medical waste management among nursing personnel.

2. Studies and literature related to effects of improper Bio-medical

waste management.

3. Studies and literature related to proper management of Bio- waste

30

2.1] General information regarding bio-medical waste management.

According to Biomedical Waste Management and Handling Rules

(1998) hospital waste can be classified into hazardous waste (10-25%),

non-hazardous waste (75-90%). The hazardous waste can be classified

as infectious (15-18%) which includes, non-sharps, plastic disposables

and liquid waste and other hazardous waste includes radioactive waste,

discarded glass, pressurized containers, chemical waste, cytotoxic

waste and incinerator ash. The non-hazardous waste (75-90%) is

municipal dump.

Routes of transmission of disease by biomedical waste such as

inhalation (breathing), ingestion, contamination of wounds, absorption

from cutaneous and mucous membranes, injury causing breach in

continuity of surface followed by infection.

Bio-Medical Waste Management

Diseases associated with Bio Medical waste are AIDS, Hepatitis,

Gastroenteritis, Typhoid fever, Skin infections, Septicaemia,

Tuberculosis, Tetanus, Cancer and Genetic/ Foetus Abnormality.

The Biomedical waste can adversely affect several categories of

people. As such, anyone (including general public) can be affected.

However, those associated with a health care establishment (hospital,

31

nursing home, etc) are at a greater risk. Categories of individuals are

medical doctors, nurses, compounders, dressers, OT assistants, lab

assistants, ward boys, ayah, sweepers, biomedical waste handlers, etc,

patients in health care establishments or those receiving home care,

visitors / attendants to health care establishments or attendants at home,

workers in support services allied to health care establishments, such as

laundries, waste handling and transportation, rag-pickers.

Impact of Bio-Medical Infectious Waste is:

Clifton R D (1985-2004) In 1992, eight cases of HIV were

recognized as occupational infections in France. Transmission took

place through wounds in waste handlers. In June 1994, out of 39 cases

of HIV infection in USA. 34 reportedly occurred from an injury through

the sharp biomedical waste. Four resulted from exposure of skin or

mucous membrane to infected blood. By June 1996, the number of

cumulative recognized cases of occupational HIV infection had arisen to

51 in USA and all of them were nurses, doctors or laboratory assistants.

It is estimated that in USA, approximately 86,000 to 160,000 health care

workers are injured annually by sharp biomedical waste. Out of these

about 163 to 323 persons develop Hepatitis B infection subsequently. A

hospital housekeeper in the USA developed staphylococcal bacteraemia

and endocarditis after a needle injury. It is estimated that in Japan the

risk of HIV and Hepatitis B infection after hypodermic needle puncture is

32

0.3 and 3 percent respectively. Nearly 66 percent of the rag pickers in

India suffer from an injury (or wound) because of biomedical waste. Most

of the data given above is from developed countries. Unfortunately we

do not have an effective system of reporting such episodes in India.

Protective Measures

All employees of the hospital, including biomedical waste

handlers, must be vaccinated against Tetanus and Hepatitis B. Extreme

care must be taken while handling needles and other sharps, since most

sharp injuries occur between the points of their use and disposal.

Sharps should not be left casually on counter tops, food trays, beds, etc.

as the grievous injury can result. Clipping, bending or breaking the glass

and needles with hands must not be practiced as this can cause

accidental injuries.

Sharps should be segregated at the site of generation and

thereafter placed in a puncture proof container. All disposable items

must be dipped in 1 percent hypochloride solution for atleast half an

hour to ensure disinfection. Exposure to radiation should be avoided as

much as possible. All universal precautions are to be taken while dealing

with HIV positive or Hepatitis B positive cases. In operation theatre,

goggles / glasses must be worn.

33

The transfer of instruments in the OT should not be from hand to

hand between a nurse and doctor or vice versa. Instead, a tray or bowl

should be used during transfer of instruments. Do not hold the

instrument from pointed / sharp end. First Aid Box and emergency

medicines should be available.

2.2] Studies and Related literature on Bio-medical Waste Management.

1. Studies related to knowledge, attitude and practices on

Bio-medical waste management among Health care providers.

Anna Abraham (2016) conducted a cross-sectional study on

Awareness, Knowledge and Practices on Bio-Medical Waste

Management Among Health Care Professionals in Mangalore. The study

is conducted using a pre-tested questionnaire to assess the awareness,

knowledge and practices on medical waste management among health

care personnel in different health care settings in Mangalore city,

Doctors, nurses, and laboratory technicians have better knowledge than

sanitary staff regarding biomedical waste management. Knowledge

regarding the color coding and waste segregation was found to be better

among nurses and laboratory staff as compared to doctors. The

management of hospital waste requires its segregation and removal

from the health care establishments in such a way that it will not be a

source of health hazards to those who are directly or indirectly related to

the hospital environment. The segregation of waste in almost all

hospitals is not satisfactory. Proper and judicious handling of Bio-

34

medical waste continues to be a matter of serious concern for health

authorities in India.

Manish Jain (2016) conducted a cross-sectional study on

“Assessment of the knowledge, attitude and practices regarding

Biomedical Waste Management amongst Paramedical Staff in a Tertiary

Level Health Care Facility” Using multistage random sampling, 147

nurses working in various departments in the hospital and 34 lab

technicians working in central lab, blood bank, pathology, and

microbiology departments were selected for this study. Only 79 (44.88%)

knew of biomedical waste legislation and only 57 (32.38%) had correct

knowledge of percentage of hazardous waste. Only one-third (54,

30.68%) knew of the categories of biomedical waste and only about half

of the respondents (103, 58.52%) knew about disinfection of sharps

before disposal. Seventy (39.77%) respondents were in favor of

discarding used needles immediately. The practice score of Lab

Technicians was significantly less than the nurses. Knowledge regarding

color coding and risks of handling biomedical waste was not adequate

among the participants. Compulsory continuous intensive training

programs should be conducted at regular time interval for all the

paramedical personnel with special importance to the new comers.

35

Shantanu Tyagi (2016) conducted a Cross-Sectional study on

Knowledge, attitude and practices of biomedical waste management

among health care personnel in selected primary health care centres in

Lucknow among health care personnel working at the Primary Health

Centres. A total of 89 health care personnel comprising of doctors,

nurses, health workers, laboratory technicians, pharmacists and class IV

workers were interviewed with a pre-designed and pretested semi-

structured questionnaire. About 35.0% of the staff nurses, 56.2% of

paramedical staff and none of the class IV workers had complete

knowledge about colour coding and segregation of bio medical waste.

As compared to other health care personnel, only 18.8% of class IV

workers are aware about universal precautions, while 45.4% were

concerned about needle stick injury. None of the class IV workers had

ever attended training for BMW management. Proportion of staff nurses,

paramedical staff and class IV immunized for Hep B Vaccine was 50%,

21.8% and 9.1% respectively. The study revealed lack of knowledge and

awareness about bio-medical waste management amongst primary

healthcare workers which results in inadequate handling and

management, thereby exposing them as well as the general public to

health and environmental hazards.

36

Leela Manju (2016) conducted a cross-sectional study on

knowledge, attitude and practice regarding biomedical waste

management among health care personnel in a medical college,

Trivandrum, among 320 Health care Personnel. A pretested structured

questionnaire was used for data collection. A self made scoring system

was devised to categorize KAP as good, average and poor. Results:

Doctors had good knowledge and attitude, nurses had the same in

practice while cleaning staff had majority of those with poor KAP as

compared to all other categories. An average level of KAP was most

prevalent in each category. Knowledge and Practice were found to have

significant positive correlation with professional category (p-value= 0.002

and p-value.

Madhurima Basu (2016) conducted A descriptive cross- sectional

survey assessment of knowledge, attitude and practices of dental waste

management among undergraduate dental students of Bapuji Dental

College and Hospital in Davangere city The study sample were the

dental students (140 students) in Davangere city. Knowledge, attitude

and practice towards dental waste management was assessed using a

structured questionnaire containing 29 items. Descriptive statistics was

applied to check the knowledge, attitude and practice of dental students.

Out of 140 participants 41(29.3%) were males and 99 (70.6%) were

females. Majority (97.9 %) of dental students were aware of the term

37

biomedical waste and almost 72.8 % agreed to the need for disinfection

of biomedical waste before disposal. Only 48.6% agreed that infectious

waste to be put in yellow plastic bag with bio-hazard symbol. Only few

(13.6%) of them use needle burner to destroy it which is the ideal

method. Though dental students have good knowledge but they were

not aware of color coding in disposing the infectious waste and not

practicing appropriate method of handling the dental waste.

Vasantha Kalyani (2016) conducted descriptive study to assess

the knowledge of Bio-medical waste management among B.Sc. (Hons.)

Nursing students of AIIMS, Rishikesh. Total 159 students of B.Sc.

(Hons.) Nursing; 51 students of first year, 58 students of second year

and 50 students of third year was selected. It was found that the 89% of

the students had the average knowledge, 8% had the good knowledge

and 4% had the poor knowledge about the bio medical waste

management. Study concluded that although most of the students had

the knowledge of Bio Medical Waste and its management but regular

training reinforcement on bio medical waste management practices is

required for the students.

Gaurav Sharma (2016) conducted A cross sectional study

amongst paramedical workers and nursing students regarding

awareness of various aspects of biomedical waste (management and

38

handling) rules. The study was conducted amongst paramedical workers

and nursing students posted at Prince Bijay Singh Memorial and

Associated Group of Hospitals Attached to Sardar Patel Medical

College, Bikaner. Out of 607 respondents, maximum (57%) were

Paramedical workers followed by General Nursing and Midwifery (G. N.

M) students (24.7%), and B.Sc. nursing students (18.3%). Majority

(70.6%) of the participants didn’t have any training on Biomedical Waste

management. 20.6% of study population had poor awareness regarding

various aspects of Biomedical Waste Management. Highly significant

difference was seen when awareness of various professional group

regarding different aspects of Biomedical Waste Management was

compared. The lack of proper and complete awareness about

Biomedical Waste Handling and management rules impacts practice of

appropriate waste disposal leading to serious health consequences,

thus there is a need to reinforce and update knowledge of health care

workers on the subject.

Shalini Sunderam (2015) conducted a descriptive study on

knowledge and practice regarding biomedical waste management

among staff nurses and nursing students of Rajendra Institute of Medical

Sciences, Ranchi. A total of 240 nurses participated in the present

study, randomly chosen from various departments A pre-designed, pre-

tested, structured proforma was used for data collection after getting

39

their informed consent. The knowledge regarding general information

about Bio Medical Waste management was assessed(with scores 0-8),it

was found that level of knowledge was better in student nurses than

staff nurses as student nurses scored good(6-8correct answers) in more

than half of the questions (65%).Whereas staff nurses scored good in

only 33.33% questions. When the practical information regarding the

BMW management is assessed (with scores 0-8), it was found that staff

nurses had relatively better practice regarding BMW management than

students as they scored good(6-8correct answers) in 40% and 30%

respectively. Though overall knowledge of study participants was good

but still they need good quality training to improve their current

knowledge about Bio Medical Waste.

Kumar v (2015) conducted “A study to assess the knowledge,

attitude and practices of biomedical waste management among health

care personnel at tertiary care hospital.”. Study participants included,

interns and house officers doctors, nursing staff, laboratory technicians,

sanitary workers (ward boys and sweepers) working in the institute and

dealing with bio medical waste. Knowledge score as satisfactory was

highest among doctors (86%), followed by nursing staff (70%) and lab

technicians (46%). The practice score of Bio Medical Waste

Management was satisfactory in most doctors (90%), nursing staff (78%)

and lab technician (68%) and it was poor in 62% of sanitary workers. To

40

tame this shortfalls induction training of newer health care personnel and

continuous in-service training programs and periodically evolution of the

health care personnel is required.

Parul Singhal (2015) conducted a cross sectional study on

knowledge, attitude, and practices regarding biomedical waste

management among the health-care workers in a multispecialty teaching

hospital at Delhi., It consisted of 120 Health Care Workers as

participants, which included 30 doctors, 30 nurses, 30 laboratory staffs,

and 30 sanitary staffs. A predesigned structured questionnaire was

administered to the participants after obtaining their consent and briefing

them about the study. Data collected were analyzed, correct colour

coding for waste disposal was known to 84.2% of respondents, and

awareness about transmission of important diseases such as HIV

infection and hepatitis B through Bio Medical Waste was known to

66.7% of the participants. The practice of recapping of used needles,

which is one of the important risk factors for needle-stick injuries was

found among 25.8% of respondents and was the highest among the

sanitary staffs (83.3%). Awareness about the practice of initiating

accident reporting Performa on contact with blood/body fluids of HIV-

infected patients was found to be 77.5% overall and only 10% among

the sanitary staffs. Similarly, the awareness about the practice of post

exposure prophylaxis for the prevention of HIV infection was found to be

41

71.7% overall and only 10% among the sanitary staffs, which could be

owing to their poor literacy status. Training of the sanitary staff on all

aspects of Bio Medical Waste management will lead to a further

improvement in Bio Medical Waste disposal in the hospital.

Anish Khanna (2014) conducted study on An Assessment of

Knowledge, Attitude and Practices about Biomedical Waste

Management among Owners of Nursing Homes/Private Hospitals in the

Central Area of Uttar Pradesh, India. This was a descriptive cross-

sectional study design conducted in the city of Lucknow. The owners of

the private nursing homes/ private hospitals (having bed>50) of Lucknow

city were interviewed. A total of 40 subjects were included in the study.

Majority (80%) of the subjects were MD/MS in different disciplines of

medicine and surgery. The duration of running of hospital was ≥10

among 57.5% of the subjects. About half (55%) of the subjects received

any training BMW management. There was a significant difference in the

BMW knowledge and attitude scores for age greater than 40 years and

less than 40 years of age (p<0.001). The knowledge and attitude score

was higher who had any training on BMW management compared with

those who did not had any training. Higher percentages of subjects

(77.5%) were aware about HIV might transmit through Bio Medical

Waste. Majority (90%) felt that safe management of health care waste

was an extra burden on work. The importance of training regarding

42

biomedical waste management cannot be overemphasized; lack of

proper and complete knowledge about biomedical waste management

impacts practices of appropriate waste disposal among medicos as well

as paramedical staff.

KH Amruth (2014) conducted a study on Knowledge attitude and

practice study on biomedical waste management among health care

professionals and paramedical students in a Tertiary Care Government

Hospital in South India. Study was conducted among 400 health care

professionals including doctors, nurses, nursing students, and laboratory

technician course students. The results were evaluated. It was found

that the doctors had the maximum knowledge and practice among

health care professionals. The results also indicated that knowledge is

not uniform among individual group, and there exists considerable

variation within the group. The results of our study revealed that the

project for upgrading safety in health care initiative taken by the

Government of Tamil Nadu to create awareness of biomedical waste

management among health-care professionals have certainly improved

the Knowledge Attitude Practice on biomedical waste management.

Hence, such a program is mandatory to improve the biomedical waste

management in health-care centers.

43

Meera Gopalakrishnan (2014) conducted Across-sectional study

on Knowledge, attitude, and practices about biomedical waste

management among dental healthcare personnel in dental colleges in

Kothamangalam, questionnaire based survey containing 24 questions to

assess the knowledge, attitude and practice on biomedical waste

management. The samples were the teaching faculty members and

students of 3 dental colleges in Kothamangalam, Kerala. The mean

knowledge, attitude and practice scores were 4.35±1.63, 4.69±1.97,

4.43±0.78 respectively with maximum scores of 9, 5 and 10. Significant

differences existed in relation to educational qualification of respondents

in knowledge and practice scores. The study revealed that although the

attitude regarding biomedical waste management among faculty

members and students of the institution was high, knowledge and

practice remained low.

A. Mohsen (2014) conducted a cross-sectional study on the

knowledge, attitudes and practices of health-care providers towards

waste management at Shams University Hospitals, Cairo, Egypt. In the

study 110 physicians, 151 nurses and 89 housekeepers were

interviewed using a pre-designed questionnaire. Housekeepers were

significantly more knowledgeable than physicians or nurses about

hospital policies and systems for waste disposal, but less so about

specific details of disposal. Housekeepers also had the highest overall

44

scores for attitudes to waste disposal among the 3 groups. Significantly

more nurses had satisfactory practice scores (84.0%) than did

physicians (67.3%) (housekeepers were not assessed). Training and

duration of work experience were not significantly associated with

knowledge, attitude and practice scores, except for nurses with longer

work experience, who were more likely to have satisfactory knowledge

about waste disposal than less experienced nurses.

Puranik DS (2013) conducted A study to assess the knowledge

and practice on bio-medical waste management among the health care

providers working in PHCs of Bagepalli Taluk with the view to prepare

informational booklet. In the present study, health care providers are

categorized into four; Senior Health Workers (SHW), Junior Health

Workers (JHW), Laboratory Technicians and Pharmacists. Periodical

visits were made to analyse knowledge and practice about biomedical

waste management among health care providers of all PHCs in

Bagepalli Taluk using questionnaires. Results: 29% were between the

age of 21-30 years and 41-50 years, 26% were between the age group

of 31- 40 years and 16% were ≥ 51 years. 77 (64%) were females. 85%

of were multi-purpose branch health worker/auxiliary nurse midwives 8%

were laboratory technicians, and 7% were pharmacists. 39 (33%) had 0-

5 years of experience, 28 (23%) had 6-10 years of experience, 18 (15%)

had 11-15 years of experience, and 35 (29%) had ≥ 16 years of

45

experience. 99 (83%) did not have any in-service education and 21

(17%) had attended in-service education regarding biomedical waste

management. Conclusion: Findings from this study revealed the lack of

knowledge and awareness of bio-medical waste management even

among health workers. This has led to the poor practice of biomedical

waste handling and management.

Dharmappa b (2013) conducted a cross sectional study study on

knowledge, attitude and practices regarding biomedical waste

management among nursing staff in private hospitals at Udupi city,

Karnataka, The study listed 17 hospitals as clusters and 4 hospitals

were randomly selected for the study. A pre-structured questionnaire

was used for data collection. Data was collected from 166 nursing staff

of four selected hospitals after getting oral consent from hospital

managing director and participants. The result revealed that the majority

160(96.4%) of participants were female and mean age of respondents

were found to be 28.6 (±9.04) years. Majority 159(95.8%) of nursing staff

had considered the biomedical waste as different from general wastes

and 150(90.4%) of respondent were agreed for the segregation of Bio

Medical Waste at point of generations. The study showed that 77.51% of

study participants had knowledge about various diseases transmission

through Bio Medical Waste. The overall knowledge 95.8% regarding Bio

Medical Waste among nursing staff of hospital no.1 was significantly (p

46

<0.001) higher than other hospitals. The study concluded that regular

training and supervision is necessary for better healthcare waste

management and implementation.

Sagar Borker (2013) conducted a cross sectional study on

“Knowledge, attitude and practice about bio-medical waste management

among personnel of a tertiary health care institute in Dakshina

Kannada,” Study was done using convenient sampling method, a total of

120 health care personnel were selected which consisted of 4 groups

with 30 each of doctors, nurses, lab-technicians and class-IV waste

handlers. Data was collected using a pre-tested, semi-structured

questionnaire. The study revealed that knowledge regarding colour

coding and risks of handling bio-medical waste was poor across all the 4

groups especially among class-IV waste handlers. Majority of the study

participants had never undergone any training on bio-medical waste

management and there was a felt need for the same. A meagre 36%

doctors, 43% nurses, 30% lab-technicians and 13% class-IV waste

handlers were discarding the bio-medical waste according to colour

code. Among the class-IV waste handlers 67% reported needle stick

injury. As the knowledge and practice regarding bio-medical waste

management was poor there is a need to conduct periodic training and

retraining workshops with special focus on proper use of personal

protective gear.

47

Athavale Arvind V (2012) conducted a study on assessment of the

knowledge regarding Bio Medical Waste management. In this study 10%

sample of each of the 4 categories of staff on roll was randomly selected

for the study, the sample consisted of 110 respondents: 38 doctors, 44

nurses, 21 Lab technicians and 7 waste handlers/supporting staff. The

knowledge of doctors about Bio Medical Waste management & handling

rule was much better (92.1%) as compared to nurses (54.5%) and Lab-

technicians (47.6%) and it was statistically significant (p-value < 0.05).

Conclusion: The doctors where observed to be good in theoretical

knowledge. While in case of nurses and lab-technicians the reverse was

true. Recommendation: The need of comprehensive training programs

regarding Bio-Medical waste management is highly recommended to all

hospital staff.

Mathur V (2011) conducted a cross-sectional study among the

health care personnel to assess knowledge, attitude, and practices

about biomedical waste management at MLN Medical College,

Allahabad, India. The participants included were doctors (75), nurses

(60), laboratory technicians (78), and sanitary staff (70). Doctors, nurses,

and laboratory technicians have better knowledge than sanitary staff

regarding biomedical waste management. Knowledge regarding the

colour coding and waste segregation at source was found to be better

among nurses and laboratory staff as compared to doctors. The study

48

showed the importance of training programme on bio-medical waste

management.

Mohd Shafee.et.al.,(2010) conducted a pre-experimental one

group pre-test and post-test research design was used to evaluate the

effectiveness of planned teaching programme on biomedical waste

management among nursing students in selected colleges of nursing at

Mangalore. Reliability of the tool was tested by split half method [r=0.80].

Multistage random sampling technique was used to select 120 nursing

students. Data collected from the sample were analyzed by descriptive

and inferential statistics. The analysis of the level of knowledge of the

students shows that majority [90.83%] of the sample have average

knowledge 8.4% of the subjects had poor knowledge and only 0.83% of

the respondents have good knowledge on biomedical waste

management. Pre-test mean score was only 49.05% whereas post-test

mean knowledge score was 86.06%. The effectiveness of PTP was

45.44% in the area of biomedical waste management and 52.7% in the

area of safety practices of nurses. Significant difference between pre-

test and post-test knowledge scores was tested using paired ‘t’ test

findings revealed that there was a significant differences between pre-

test and post-test knowledge scores in all the areas as well as overall

knowledge on biomedical waste management [p<0.001]. Hence it was

49

observed that PTP was effective in improving the knowledge of nursing

students.

Kiran Bhat et al [2008] conducted a study to find the efficacy of

chemical treatment by hypochlorite solution of Biomedical waste like

sharps and tubings in Jammu. In absence of autoclave and microwave,

these biomedical wastes are a source of infection to the society. It

becomes imperative to disinfect these before mixing them with general

waste. In this study, 80 samples were taken from different sources of

discarded tubing and sharps and were tested for presence of

microorganisms. It was found that hypochlorite solution if used correctly

is an excellent disinfectant and thus tubings, sharps and disposables

should be dipped in I% hypochlorite solution for a minimum period of 30

minutes before being disposed off.

Deepali Deo (2006) conducted a Study on Knowledge and attitude

regarding Biomedical Waste Management among 331 health care

providers of Teaching Hospital in Rural Area at Beed. The study

analyzed that the knowledge regarding general information of

Biomedical Waste was assessed, the average score was highest in

medical staff (4.46), followed by paramedical staff (4.02) and least in non

medical staff (3.45). However when the practical knowledge was

assessed the average score was maximum in paramedical staff (3.46)

50

followed by medical staff (2.97) and least in non medical staff (2.35). The

attitude of medical employees about biomedical waste management was

more positive than paramedical employees. The investigator Concluded

that the medical staff should be more involved in waste management

system and secondly importance of this subject should be emphasized

on everyone concerned. This would be by creating awareness about

biomedical waste management amongst public, patients and hospital

staff.

Swathi A wale (2006) conducted a study to assess the knowledge

and practice of the health team members regarding Bio-Medical Waste

segregation and disposal at Pune. The study outlined that 9 (75%) of

health care professionals did not know about colour coding system and

segregation. 2 (22.22%) of health care professionals practice the

shedding and throwing of tubing’s, catheters and sharps in general

garbage without segregating the waste as per colour coding The study

recommended the need for in service programme on bio medical waste

management for health professionals who are working in the village.

Saini S [2005] conducted a study to assess the knowledge,

attitude and practice of biomedical waste Management among hospital

staff of Karimnagar Andhra pradesh. Out of 267 private nursing homes

and clinics, 47 were selected by systematic random sampling. A total of

51

500 study subjects were selected from those hospitals by informed

consent. The study reveals that totally 266 (53.2%) study subjects know

about Biomedical waste management correctly out of which 138(51.8%)

were nurses, 114(42.85%) were technicians, 14(5.26) were house

keepers. Only 8(1.6%) study subjects know about categories of

Biomedical waste among that 5 (62.5%) were technicians .Total

353(70.6%) study subjects having idea about segregation of Biomedical

waste. only 72(14.4%) subjects had knowledge about method of

disposal. Majority of the study subjects i e 479(95.8%) had knowledge

about various health problems caused by Biomedical waste of which

234(48.8%) were nurses. This study determine that positive attitude was

found to improve the current situation in Biomedical waste management,

the nurses were having better knowledge, attitude and practice about

Biomedical waste management better than the housekeeping and

technical staff.

Joe Joseph, C.G. Ajith Krishnan (2004), conducted survey on

awareness about waste management policy practices. Attitude among

health care providers at Pondicherry. Data was collected from all

sections of employees in health care settings. To document the

practices, photographs were also taken Overall response rate was

(82%). More than half (52%) of the respondents were not aware of the

existence of a legislation and majority (72%) were not aware of

52

authorisation. Burning was most widely followed (42%), practice followed

by incineration (39%), burial (28%), segregation (24%), autoclave (24%)

and deep burial (23%). Vast majority (74%) did not use any colour

coding and only a very small percentage (15%) used the bio-hazard

symbol. Maintaining a register and auditing virtually did not exist.

Majority (80%) regarded this as an issue that needs to be tackled. No

appropriate strategy exists and it is time to act, to prevent an epidemic

waiting to happen. The survey concludes a grim picture staying that no

appropriate strategy exists for proper management of bio-medical waste.

There is an urgent need to increase awareness about rules, regulations

and procedures regarding this vital issue. Bio-medical waste programme

cannot be successfully implemented without the willingness, self-

motivation, and co- operation from all sections of employees of any

health care setting. By sensitising the employees to this issue coupled

with effective implementation of rules by surprise visits from monitoring

authorities will facilitate successful implementation of the programme.

Ritu Singh etal (2002), conducted a study regarding the role of an

information booklet on BMW management for 32 staff working in the

different wards of the selected hospitals. The results of the study

observed that less than half of the staff nurses were aware of various

risks and methods of treatment and disposal of biomedical waste. After

STP knowledge scores were significantly higher than before STP

53

knowledge scores. The maximum percentage gain was in the area of

handling, storage and transportation of waste and lowest percentage

gain was in the area of health and safety precautions. The study

concluded that the information booklet is found to be effective in

improving knowledge and skills among nursing staff.

Jugal Kishore, T.K.Joshi (2000), suggested biomedical waste

management for nursing professionals. The author outlined the

measures to be taken for health and safety nurses, observing universal

precautions, use protective equipment and wearing glove, mask etc,

don’t recap needles: if there are frequent needle stick injuries, report to

the hospital authority, don’t pipette with mouth any blood or chemicals,

avoid skin contact and inhalation of cytotoxic and other chemicals

splashes of eyes should be washed with ample amount of water for 10 –

15 minutes, receiving full vaccination for hepatitis ‘B’ and tetanus,

training is must for nurses. It should emphasize safe work practice

proper handling of needles and other sharps. Chemicals and cytotoxic

drugs besides providing practical aspects of biomedical waste

management.

Matsumoto. S (2000), conducted a study in nine health care

facilities (HCFs) including four hospitals, two health centres, and three

higher clinics, in two phrases, “to assess the waste management aspect

and to determine daily waste generation rate”. The result showed that

54

the median quantity of waste generated at the facilities was

3.46kg/day/bed. The quantity of waste per day generated at health care

facilities increased as occupancy increased (p<0.001). The proportion of

hazardous waste (20-63.1%) generated at the different HCFs was much

higher than the WHO recommendation (10-25%). There was no waste

segregation in most HCFs and only one used a complete colour coding

system. Solid waste and waste water were stored, transported, treated

and disposal inappropriately at all HCFs. Needle stick injuries were

prevalent in (25%) among all the waste handlers employed at these

HCFs. Additionally , low levels of training and awareness of waste

legislation was prevalent among staff. The study showed that

management practices of health care waste at HCFs is poor.

Moritz J.M (2000), conducted a cross- sectional study on

“knowledge, attitude and practices regarding biomedical waste” among

500 paramedical workers at Karimnagar town (Andhra Pradesh). The

data were collected by one to one interview using pre and post test

design proforma. Totally 266 (53.2%) study subjects knew about BMW

correctly, of which 138 (51.8%) were nurses, 114 (42.85%) were

technicians and 14 (5.26%) were housekeepers. Only 8 (1.6%) study

subjects knew about categories of BMW of which 5 (62.5%) were

technicians. Total 353 (70.6%) study subjects were having idea about

segregation of BMW. Only 72 (14.4%) subjects had knowledge about

55

various methods of disposal of BMW. Majority of the study subjects i.e.

479 (95.8%) had knowledge about various health problems caused by

BMW, of which 234 (48.8%) were nurses. 278 (55.6%) study subjects

committed that they will cooperate in BMW management. The nurses

had a better attitude toward separation of wastes 236 (99.5%), proper

disposal 234 (98.7%), implementation of rules 233 (98.3%) and

cooperation in programs 149 (62.8%). 482 (96.4%) study subjects

minimized waste, 227 (47%) were nurses, 129 (26.76%) were

technicians and 126 (26.14%) were housekeepers. Totally 335 (67%)

study subjects segregated BMW, of which majority were nurses, 169

(50.44%). 297 (59.4%) subjects collected waste into colour coded bags.

Segregation and separation of plastic waste was done better by the

nurses.

Studmicki J (2000), conducted a survey method among 40 nurses

and paramedical staff and housekeeping staff on biomedical waste

management at Military hospital, Khadkhi (Town), Pune, Maharastra,

India. A structured Interview Schedule was conducted. Housekeeping

staff wear protective devices such as gloves, face masks, gown etc,

while handling the waste. The nursing staff and housekeeping staff have

excellent knowledge about categories of hospital wastes. All the nursing

and housekeeping staff have excellent knowledge about colour coding

of waste carry bags. About (80%) of the housekeeping staff has

knowledge about routes of disease transmission. About (70%) of the

56

nursing staff has knowledge and (30%) housekeeping have very poor

knowledge about methods used for disinfection of non-incinerable

wastes. About (80%) of the nursing and all the other paramedical and

housekeeping staff have very poor knowledge about biohazard symbols

and its meaning. About 70%of nursing staff and only 23.5% of

housekeeping staff the knowledge about the time within which the waste

has to be treated. Proper and scheduled training has to be given for the

staffs. Special training has to be given for the personnel who are

handling the waste directly on regular basis.

Koska MT (1998), conducted a Case study on Rules and

management of biomedical waste at Vivekananda Polyclinic,

Department of Geology, University of Luck now, India. Hospitals and

other care establishments have “duty of care for the Environment and for

public health, and have particular responsibilities In relation to the waste

they produce (i.e., biomedical waste).Negligence in terms of biomedical

waste management, significantly Contributes to polluting the

environment, affects the health of human beings, and depletes natural

and financial resources. The present paper provides a brief description

of the Biomedical waste (Management and Handling) Rules 1998. The

objective in undertaking this study analyzed the biomedical waste

management system, including policy practice (i.e., storage, Collection,

transportation and disposal). There is a need to create awareness

among all other stake holders about the importance of biomedical waste

57

management and related regulations. Furthermore, 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

health care staff and management and health care managers within an

effective policy and legislative framework.

Lawrence JM (1997), conducted a case study on Bio-medical

waste management. Biomedical waste is an issue of growing concern

since it is a source for contamination & pollution, capable of causing

diseases& illness either through direct contact or indirectly through

contamination of soil, ground water surface water and air. the health

care establishments are integral part of life support system .improper

disposal of waste generated from such establishments can have direct

and indirect health impact as well as pose potential threat to the

surrounding environment, persons handling it and the public in general.

There is an urgent need to improve the medical waste management

practices in our country based on systematic and scientific planning of

medical waste disposal. The Govt .of India has enacted bio medical

waste [management & handling] Rules, 1998 making it mandatory for

disposal of medical waste in the prescribed manner. There are various

technologies available for treatment of medical waste thermal processes

of treatment such as auto- calving, microwaving & incineration are

58

effective for treatment of most types of waste. However, those treatment

technologies should be operated as per guide lines to achieve the

standards prescribed .The present report seeks to collect information on

status of medical waste management and , in particular, methodology of

testing autoclaves/ thermoclaves using bacillus stearothermophilus

spores.

2. Studies and literature related to effects of improper Bio-medical

waste management.

Akarian M, Vakili M (2004), conducted a Bio-medical waste survey

in 45 private hospitals in Fars Province, Iran. The survey found that Bio-

medical waste is considered dangerous because it may possess

pathogenic agents and can cause undesirable effects on human health

and environment. The survey was carried out in all 45 private hospitals

of Fars Province (Iran) from the total number of 50 governmental and

private hospitals located in this province. In order to determine the

amount of different kinds of waste produced and the present situation of

waste management. The results indicated that the waste generation

rate is 4.45Kg/bed/day, which includes 1830 Kg (71.44%) of domestic

waste, 712 Kg (27.8%) of infectious waste, and 19.6 Kg (0.76%) of

sharps. Segregation of the different types of waste is not carried out

perfectly. Two (13.3%) of the hospitals use containers without lids for on

site transport of wastes. Nine (60%) of the hospitals are equipped with

59

an incineration and 6 of them (4%) have operational problems with the

incinerates. In the hospitals under study there aren’t any training

courses about Bio-medical and the hazards associated with them.

Performing extensive studies all over the country compiling and enacting

rules, establishing standards and providing effective personnel training

are the main challenges for the concerned authorities and specialists in

the field.

Karthik Subramanian (2004), reported that hospitals dumping

body parts in dustbin. The article reported that a portion of a severed

limb found its way into a Chennai Corporation lorry (registration number

TN04E 2589) which cleared garbage from the Royapettah Government

Hospital on June 8th 2004. A hospital official admitted that a severed

limb found its way into the garbage bin, but denied that body parts were

being dumped regularly. Sanitary workers are trying to blow it out of

proportion. A government official, on condition anonymously said a

comprehensive solution to treating biomedical waste continued to be

elusive for city hospitals. A common facility for treating biomedical

waste at a site near Chengalpattu remained only on paper.

Karthik Subramanian (2004), reported that in Kodungaiyur ground

/ biomedical waste where stray dogs devour human flesh. The article

revealed that it has been a regular occurrence at the Kodungaiyur

60

dumping ground, where hospital waste has been dumped in the open by

Corporation garbage lorries. The rag pickers said that they are quite

used to the sight of dogs running across the dumping ground, eating

human flesh.

Nidhi Jisadal (2004), conducted seroprevalence of Hepatits C

Virus (HCV) among 100 health care workers employed in Critical care

units at New Delhi. The study revealed that 75% of health care workers

are exposed to HCV by infected blood / blood products of the HCV

infected patients. Investigators concluded that the health care workers

must be sensitized about universal precautions and safe disposal of the

Bio-Medical Waste.

Chetan B. Bhat (2003), conducted evaluative community based

study on Health care waste management and its practices at Bangalore

on 22 health care settings. The study revealed that 14 (64%) Institutions

segregated infectious waste from non-infectious waste. The Institutions

with appropriate segregation of: Sharps-73%, Gloves-50%, Bandage-

50%, Plastic-27%, Liquid-10%, Surgery-89% and Placenta-89%.

Common Treatment Facility was utilized by (73%) Institutions to dispose

of the Health Care Waste. The investigator concluded that there is a

need for fine-tuning of colour-coding practice. There is intimate link

between the quality of Health Care Waste Management and extent of

fulfilment of the Rules.

61

Akter N. Hussain Z, (2002), conducted a study to evaluate the

current status of hospital waste management in Bangladesh and its

probable health effect. The aim is to recognize the health effect of the

existing practice, to determine the awareness level of doctors and

nurses about hospital waste, to identify the weakness, and to provide

suggestions for improvement. Hospital staff, waste pickers, and local

residents were interviewed while in depth field observation, which

included sample collection and laboratory analysis was also conducted.

The study revealed that it has been quite evident that a satisfactory Bio-

medical system in Govt. Hospitals and several private clinics is severely

lacking. Some staff members interviewed were suffering from various

kinds of infectious diseases such as viral hepatitis B, typhoid, skin

disease/allergy, diarrhea, dysentery, TB, Malaria. The study indicates

that there is a need to improve the handling and disposal methods of

hospital waste in almost all the available medical facilities. Based on the

analysis of the situation, several suggestions and recommendations

have been made to aid in the development of a waste management

system.

Matsumoto (2000), reports the present status of nosocomial

infections and biohazards of medical waste. The article reveals that

nosocomial infections are already major problems and are a growing

concern to all medical staff and among the general public. Therefore, an

62

effective infection control program especially against transmission mode

of infection, is essential for the well-being of the patients and the safety

of health care personnel. Various categories of medical waste should

be segregated adequately and appropriate management is necessary.

Adequate handling techniques can protect personnel from injury and the

biosafety manual should be available to prevent injury.

3. Studies and literature related to proper management of Bio-

medical waste.

Chitnis V, Chitnis S (2003), conducted a study about solar

disinfection of infectious biomedical waste: a new approach for that

developing countries. The study revealed that solar heating as an

alternative technology. The immersed simulated infectious waste with

added challenge bacteria in water in a box-type solar cooker, which was

left in a box-type solar cooker, which was left in the sun for 5 hr. In 24

sets of observations, the amount of viable bacteria was reduced by

about 7 log. They also tested infectious medical waste with a heavy

load of bacteria [10(8) – 10(9)/g] from their hospital’s burn unit for solar

heat disinfection in 20 experiments. The results showed a similar 7log

reduction in the amount of viable bacteria. Solar heating thus seems to

be a cheap method to disinfect infectious medical waste in less

economically developed countries.

63

Grimmond T, Rings (2003), conducted a study regarding sharps

injury reduction using sharp smart–a reusable sharps management

system. The author outlined that sharp containers are associated with 11

– 13% of total sharps injuries yet have received little attention as a

means of sharp injury reduction. A newly developed reusable sharps

containment system (sharp smart) was trailed in eight hospital in 3

countries. The system was associated with an (86.8%) reduction of

container – related sharp injury (CRSI) (p = 0.012), a 25.7% reduction in

non – CRSI (p = 0.003) and a 32.6% reduction in total sharp injury (p =

0.002) compared with historical data. The study concludes that the

sharp smart system is an effective engineered control in reducing sharp

injury.

Delpech A (2000), suggested waste management as part of

selfcare, the author disclosed as health care professional he feel

concerned by the gap existing between urban and hospital practice

concerning the management of waste even when it is the same objects

which are disposed. The aims of this research were to assess the

quality of the education given by the hospital care giving staff on the

management of self-care waste and the impact of this training on the

patients. The drawing up of a systems of reference should enable the

improvement of the present situations. The small size of the sample

used for the pilot study showed the bad quality of the learning given by

64

the hospital staff and the inadequacy of the patients procedure. This

professional project is based on an updating of the knowledge of the

hospital caregivers for the management of the self-care material in order

to improve the quality of the care given by a hospital team .

Hayashi Y, Shigemitsu M (2000), conducted a project regarding

proper disposal of Bio-medical waste infection prevention and waste

management at Hiroshima city. The project outlined that in order to

prevent pollution and infection within and near the hospital, since its

establishment, Hiroshima city, as a hospital has been implementing a

“clean hospital project”, which has two goals: infection prevention and

waste management. The nosocomial infection prevention committee and

medical waste treatment and disposal examination committee lead these

efforts.

Llorente Alvare Z (1997), conducted a study on the evaluation of

Bio-medical management of sanitary waste in the principality of Asturias.

The study conducted with the object of evaluating the management of

sanitary waste of 12 publicly found Austrian Hospitals. The method

involves interviews with personnel from 91 different services were

undertaken always by the same interviewer and according to the rules of

Joint Commission of Health Care organizations. The study concluded

the level of incorrect classification of sanitary waste which has been

65

discovered suggests that, in order to improve the intra hospital

management of hospital. It is necessary to increase the amount of

information, modify certain attitudes of the hospital staff and reinforce

the level of supervision executed by the services of preventive medicine.

Escaf M. Shurtteff (1996), suggested a program for reducing

biomedical waste, which included redefining biomedical waste, reviewing

waste practices throughout the hospitals, educating staff and monitoring

outcomes, resulted in biomedical waste levels decreasing to (7.9%) of

total waste within 18 months. Savings realized were approximately

$67,000. This program is easily reproducible.

Moritz JM (1995), stipulated current legislation governing clinical

waste disposal. The author outlined that the legal definition of clinical

waste is distinguished from both “health care waste and infectious

waste” waste can be pre-treated so as to enable it to be disposed of

through the normal waste stream. The legislation is looked at by

reference to (1) production & storage (2) handling and transportation (3)

disposal. It is vitally important to draw up a waste management strategy.

effective segregation at source as a key factor in the waste management

strategy and will enable hospital authorities to make economic savings in

waste disposal costs. The new waste management licensing regulations

1994 require applications for waste management licenses to

66

demonstrate technical and financial competence as “fit and proper

person’s”.

Halbwachs H (1994), reported about solid waste disposal on

district health facilities of developing countries. The author describes that

Bio-medical waste is not necessarily difficult to dispose of. In most

cases it can be safely dumped in a properly designed waste pit. Waste

management problems at district hospitals in developing countries are

usually caused more by lack of information than by financial or technical

difficulties.

Hooper DM (1994) reported one hospitals and health care centres

road to waste minimization in New Jersey. This article outlined that there

are many new and exciting waste minimization programs being offered

to health care facilities. Companies are now making reusable operating

packs and gowns that are more efficient than disposables. The reusable

programs to save disposal costs for an institution. The hospital will also

be evaluating an IV bottle and bag recycling program. The New Jersey

Department of Environmental protection agency has given approval to

proceed with this type of recycling program. Waste reduction and

recycling in health care settings will continue to be challenging because

of the diversity of the waste stream and the changing environment facing

health care. Shore memorial believes it is moving in the right direction

67

with its waste minimization program to make a positive environmental

impact.

Kirby G (1993), suggested 3R’s (reduce, reuse, recycle) reduce

waste, save money for waste management. This article outlines the

problems of waste disposal in health care facilitated and offers practical

ways to reduce, reuse, recycle and compost waste in the health care

setting. The author presents data on medical waste, gives alternative to

incineration, and describes recycling practices at various hospitals.

Sharma V. Sharma A (1993), conducted a study of disposal of

Bio-medical wastes in a 500 bedded rural teaching hospital, Gujarat.

The study was carried out in order to observe and analyse the waste

disposal patterns. Data were collected by means of pre structured

interviews and on the spot observations of the various steps in the waste

disposal chain. It was observed that the hospital does not have a

documented waste management and disposal policy. The disposal of

wastes is not properly supervised and is exclusively entrusted to the

junior most staff from the house keeping department. Both the internal

as well as external transportation of Bio-medical wastes were found to

be far from satisfactory.

68

Koska MT, (1992), outlined the operating costs ever rising and

reimbursements over tightening, hospitals are looking for ways to cut

costs at every turn. The good news is that every area of hospital

operations – approaches that don’t require massive financial investment,

organizational restructuring, or teams of outside consultants. The

examples they have found through talking with hospitals across the

county are a fair sample of the types of opportunities out there. They

range across the entire hospital, from the laboratory to the pharmacy, to

nursing to waste management to the medical staff to the operating suite.

Studnicki J (1992), reports about the management of Bio-medical

medical waste. The article outlined that medical waste is a nightmare for

hospital administrators, cutting across department boundaries and

incorporating, legal, financial, and community concerns. In this two part

article the author provides a stepwise approach to effective waste

management. The first part gives background information on waste

generation, storage and disposal and delineates the framework of a

medical waste audit. This audit is put to the test in the second part,

where data from a pilot trial at an actual hospital are presented and

discussed.

69

Hylton H (1991), reported about sorting out medical waste, by

describing medical waste is part of the larger issue of solid waste

disposal facing America today. Its management often elicits deep fears

and concerns among the public. The reality is that medical waste poses

few health risks and many hospitals may be using more caution than

actually necessary to protect the public. For a variety of reasons,

however, waste disposal is presenting hospital managers with an

unprecedented challenge.

CHAPTER – 3

RESEARCH

METHODOLOGY

70

CHAPTER - III

RESEARCH METHODOLOGY

Research methodology involves the systematic, scientific

procedure to solve the research problem by which the investigator starts

from the initial identification of the problem to its final conclusion

[Abdellah Sep(2014)]. Methodology is a significant part of research

under which the investigator is able to project a blue print of the

research taken.

This chapter describes the methodology followed to assess the

effectiveness of structured teaching programme on knowledge, attitude

and practice towards bio-medical waste management among nursing

personnel.

This phase of the study includes research approach, design,

setting, population, sample, sample size and the sampling technique,

inclusive and exclusive criteria for selection of sample, variables,

development and description of tools, pilot study, data collection and

plan for data analysis.

3.1 Research Approach

Research approach is the most significant part of research. The

entire study is based on it. The appropriate choice of the research

71

approach depends upon the purpose of the study which was under

taken. According to Treece and Treece (2014), the approach to research

is the umbrella which covers the basic procedure for conducting the

research

Since the present study was proposed with the purpose to find the

effectiveness of structured teaching programme on knowledge, attitude

and practice towards bio-medical waste management among nursing

personnel. The research approach used in the study is quantitative

approach.

3.2 Research Design

Research design depicts the overall plan for organization. It helps

the researcher in the selection of subject’s manipulation of independent

variables application of suitable statistical method to be used to interpret

the data.

The selection of design depends upon the purpose of the study

i.e. research approach and variables to be studied. In the present study

pre experimental that is one group pre and post test design was

selected to evaluate the effectiveness of structured teaching programme

on knowledge, attitude and practice towards bio-medical waste

management among nursing personnel.

72

Fig.2 Schematic representation of research design

Key:

O1 - Assessment of knowledge, attitude and practice before STP.

X - STP

O2 -Assessment of knowledge, attitude and practice after STP.

3.3 Variables

Independent variable

In this study the independent variable is “Structured teaching

programme on Bio Medical Waste management” as developed by the

investigator.

Dependent Variable

In this study the dependent variable is Knowledge attitude and

practice of nursing personnel on Bio Medical Waste Management.

Before STP

AFTER STP

73

Extraneous Variable

There are socio demographic variables like age, marital status,

religion, professional qualification, present designation, monthly income,

years of experience, participation in in-service education programme on

Bio- Medical waste management, awareness about Bio- Medical waste

management through mass media, adoption of Bio- Medical Waste

Management policy by PHC.

3.4 Setting of the study

As per the presidential order in the year 1976 (Govt order :GoMs

No 797 Medical and health department dated 23 August 1976), Andhra

Pradesh government has been divided into 6 zones with 24 districts .

I ST ZONE-VIZAG

II ND ZONE-RAJAMUNDRY

IIIRD ZONE-GUNTUR

IV TH ZONE-CUDDAPAH

V TH ZONE-WARANGAL

VI TH ZONE-HYDERABAD

Karimnagar District which fall under fifth zone was selected by

simple random technique for the study. Karimnagar district comprised

of four divisions which include Pedapally [North] – 17 PHC’s; Siricilla

[South] – 15 PHC’s; Jagithyal [West] – 18 PHC’s; Huzurabad [East] –

26 PHC’s totalling to 76 PHC’s. Out of 76 PHC’s, 60 PHC’s which fall

within the radius of 50kms from Karimnagar were included in the study.

74

15 PHC’s which fall beyond 50kms radius from the Karimnagar (dist)

were eliminated and 1 PHC was selected for pilot study.

3.5 Population

The term population refers to the aggregate or totality of all the

objects, subjects or members that confirm to a set of specification (Polit

2014). The study population comprised of Multipurpose health

assistance (F) (520), Health visitors (68), public health nurses (34),

community health officer (5), staff nurses (70) working in primary health

centers (76) of Karimnagar district totaling to 696.

75

Figure: 3 - SCHEMATIC DIAGRAM OF RESEARCH PROCESS

RESEARCH PROCESS

Socio demographic Variables � Age � Marital status � Religion � Professional

Qualification � Present designation � Monthly Income � Year of experience � Participation in-service

Education programme on Bio-Medical Waste � Adoption of biomedical

waste management Policy at primary

health centers

Sampling & Sample Size

300 Nursing personnel who

were employed in selected

PHC of Karimnagar Dist.

Target Population All

nursing personnel who

are employed in 76 PHC

of Karimnagar Dist (696).

Accessible Population

Nursing personnel who were having 1 year of

work experience at 60 PHC

Simple random

sampling technique

Intervention,

Structured

teaching program

Data Collection and

data analysis

Dependent Variables

,Knowledge ,practice,

attitude of Nursing

personnel

AFTER STP

Inferential

Statistics

Descriptive

Statistics

BEFORE STP

Structured

Knowledge

Questionnaire

Attitude scale

Practice scale

Report Writing

76

3.6 Sample

A sample is a subset of a population selected to participate in

research study. The study sample comprised of female nursing

personnel who fulfilled the inclusive criteria.

3.7 Sampling Technique

Sampling is the process of selecting the portion of population to

represent the entire population. (Basavanthappa BT 2002)

Out of 24 districts of Andhra Pradesh, Karimnagar district was

chosen by using simple random sampling technique (Lottery Method).

Simple random sampling is the most basic type of probability sampling,

where in a sample frame is created by enumerating all members of a

population of interest and then selecting a sample from the sample

frame through completely random procedures. Out of 76 PHC’s 60

Primary health centers were included in the study. complete

enumeration method was used in selection of the sample, 300 nursing

personnel were selected as a sample for present study through simple

random sampling technique.

3.8 Sample size

The sample size of the study was a total of 300 nursing personnel

who are working in 60 selected primary health centers of Karimnagar

77

district of AP which includes multipurpose health assistance (F) (89),

Health visitors (83), public health nurses (39), community health officer

(5), staff nurses -84. (http://www.raosoft.com/samplesize.html)

3.9 Criteria for Sample selection

The following are the sampling criteria adopted for the study

Inclusion criteria

1. Female Nursing personnel who have more than one year of work

experience in primary health centers which are functioning under

district medical and health department of karimnagar district.

2. Female Nursing Personnel who are willing to participate in the

study.

3. Female Nursing Personnel who can read and write in English.

Exclusion criteria

1. Nursing personnel who have under gone a formal training/

continued educational programme on Bio-Medical Waste

Management

2. Nursing Personnel who were on long leave for a period of 3

months during the study period.

78

Data collection, Instrument and Technique

The most important and crucial aspect of the investigation is the

collection of appropriate information which would provide necessary data

to answer the question raised in the study. The instrument selected in a

research should be as for as possible the vehicle that would best obtain

data for drawing conclusions pertinent to the study. (Polit 2014)

3.10 Development of the Tool

Tool was constructed following an extensive review literature,

discussion with professional experts who are working in health industry.

3.11 Description of the Tool

Three tools were constructed

TOOL I- Structured questionnaire to assess the knowledge of nursing

personnel

TOOL II- A five point attitude scale (Likert) to assess the attitude of

nursing personnel

TOOL III- Observation rating scale to assess practice of nursing

personnel

Format of the Tool

TOOL I- Structured questionnaire

The structured questionnaire consists of 2 parts

79

PART I – The socio demographic variables of the study are age, marital

status, religion, professional qualification, present designation, monthly

income, years of experience, participation in in-service education

programme on Bio-Medical waste management, awareness about Bio-

Medical waste management through mass media, adoption of Bio-

Medical Waste Management policy by PHC. They were collected by

interviewing the nursing personnel and based upon their answers a tick

mark (√) was put for the appropriate response of each item.

PART II-Consist of structured questionnaire on Bio-Medical Waste

Management in terms of type, hazards, segregation and treatment of

Bio-Medical Waste Management

Section A: Questionnaire on Bio Medical waste management.

Section B: Questionnaire to elicit Knowledge on Hazards of improper

waste management.

Section C: Questionnaire to elicit Knowledge on waste segregation.

Section D: Questionnaire to elicit Knowledge on treatment of Bio Medical

Waste.

Assessment of knowledge was done by using multiple choice

questions devised by the investigator, It consists of 40 questions and it

is divided into four sub sections. Under each sub section there are 10

questions. The total score allotted was 40. The content validity of the

instrument was established with the guidance of experts.

80

TOOL II- 5 Point Attitude Scale.

The second tool 5 point attitude scale to assess the attitude of

nursing personnel on Bio-Medical Waste Management. The scale has

20 statements, 10 positive and 10 negative statements which had been

arranged as alternate positive and negative.

TOOL III- Observation rating scale (5 point) to assess practice of nursing

personnel. This scale has 20 statements.

3.12 Scoring Procedure

TOOL I- The structured questionnaire consists of 40 multiple choice

questions with three alternatives choices, where in one choice is right.

The correct response was given the score of one, No mark (0) was

awarded for the wrong response; totalling to maximum of 40 marks.

To interpret the level of knowledge the score was classified as

inadequate knowledge ≤ 50%, moderately adequate knowledge 51-75%,

adequate knowledge > 75%.

TOOL II- With respect to the rating scale the scoring was designed as

follows, the total points allotted was 100 for 20 items, the scoring for the

positive items has 5 points for Strongly agree (SA), 4 points for agree

(A), 3 points for Undecided (UD), 2 points for disagree (DA) and 1 point

81

for strongly Disagree (SD). The scoring key for the negative item has 5

points for strongly Disagree (SD), 4 points for disagree (DA), 3 points for

Undecided (UD), 2 points for agree (A), 1 point for Strongly agree (SA).

To interpret the level of attitude the score was classified as ≥ 50% for

unfavourable attitude, 51-75% for moderately favourable attitude and

≥ 75 for highly favourable attitude.

TOOL III- Nursing personnel were observed for collecting information

regarding practice on Bio medical waste management. It consists of 20

check list statements. The following criteria was followed

5 4 3 2 1

Consistently Most of

the time occasionally Less time Never

SCORE INTERPRETATION

The instrument of part I consist of 40 multiple choice questions

regarding bio medical waste management. The maximum score was 40

and the minimum score was 0. Based on the scoring, the percentage of

knowledge was calculated using the following formulae.

Obtained score _____________ X 100

Total score

Part II The instrument consists of 20 items of positive and negative

statements about Bio medical waste management the maximum score

82

was 100 and the minimum score was 20. Based on the scoring, the

percentage of attitude was calculated using the following formulae.

Obtained score _____________ X 100

Total score

PART III The instrument consists of 20 statements regarding practice of

Bio medical waste management the maximum score was 100 and the

minimum score was 20. Based on the scoring, the percentage of

practice was calculated using the following formulae.

Obtained score _____________ X 100

Total score

Interpretation of the Score: To interpret the level of knowledge,

attitude, and practice scores were distributed as follows:

Score in % Knowledge

Interpretation

Attitude

Interpretation

Practice

Interpretation

≤ 50 % In adequate

knowledge

Un favourable

Attitude Poor Practice

50-75 %

Moderately

adequate

knowledge

Moderately

favourable

Attitude

Good Practice

≥ 75 % Adequate

Knowledge

Highly

favourable

Attitude

Fair Practice

83

3.13 Content Validity

Validity refers to the degree to which an instrument measures and

what it is supposed to measure. To ensure content validity of the tool,

the tool was submitted to four medical experts and 7 nursing experts

along with the blue print, objectives, checklist and content validation

certificate. The content validity of the tools was established on the basis

of opinion of medical experts and nursing experts. Experts were

requested to give their opinion on the adequacy, relevance and

appropriateness of the tool.

3.14 Reliability

According to polite and Hungler reliability of an instrument is the

degree of consistency with which it measures the attribute it supposed to

measure.

� Reliability of the Knowledge tool was established by using test- retest

method. the instrument was found to be reliable as the reliability co-

efficient was r = 0.84

� Reliability of the attitude scale was established by using Chronbach

alpha method. The instrument was found to be reliable as the

reliability co-efficient was r = 0.83 [After Structure Teaching

Programme]

84

� Reliability of the practice scale was established by using inter-rater

method. The instrument was found to be reliable as the reliability co-

efficient was r = 0.86 [After Structure Teaching Programme]

Preparation of Structure Teaching Programme

Structure Teaching Programme is a guide for the investigator

because it helps to cover the topic, comprehensively with proper

sequence of points. Structure Teaching Programme was developed by

the investigator using the steps given below.

1. Framing the outline of Structure Teaching Programme

2. Preparing the outline of the content.

3. Deciding the method of instruction and audiovisual aids.

3.15 Pilot Study

The pilot study was conducted from September 2009 to November

2009 with the aim to assess the feasibility to conduct the main study, to

assess the effectiveness of data collection plan with referral to the

availability of sample following a formal permission from the heads of the

District Medical & Heath Office department, the pilot study was

conducted among 30 nursing personals working at Choppadhandi

Mandal PHC which fall under the fifth zone of Karimnagar dist. Data was

collected at Choppadhandi Mandal PHC. Before administration of

Structure Teaching Programme test was conducted by distributing the

tool to the female nursing personnel who fulfilled the selection criteria

85

considered for the main study. The time taken by the nursing personnel

to complete the tool was 30mins respectively. The Structure Teaching

Programme was administered. After administration of Structure

Teaching Programme, test was conducted after a week, the tool was

found to be valid and reliable. The result showed a positive correlation

between knowledge, attitude and practice on Biomedical waste

management among nursing personnel. Hence the investigator

proceeded with the main study.

3.16 Ethical Consideration

A formal written permission was obtained from the District medical

and health officer, Karimnagar dist (Annexure –I). The research protocol

with copies of research instrument and formal consent was submitted to

the organization, Ethical committee for approval and ethical clearance

for the study was obtained (Annexure – II). All the selected nursing

personnel were given the informed written consent form and adequate

explanation was given and the purpose of the study was explained

(Annexure – VI). Confidentiality of the information was assured along

with the choice of dropping out of the study as and when they wished.

3.17 Data Collection Procedure

The main study was conducted from Dec 2009 - Feb. 2010 at

selected primary health centres which fall under district medical and

health department of Karimnagar.

86

The nurses who met the inclusive criteria were selected by using

simple random sampling technique. The time of data collection was from

8am – 4pm. Each interview took about 40 minutes.

Data collection plan for each subject

ITEMS DURATION

1ST SESSION

To develop rapport with the nurse

Brief explanation about topic

5 minutes

Socio- Demographic Profile 5 minutes

2ND SESSION

Knowledge related Questions 10 minutes

3rd SESSION

Attitude related rating scale 10 minutes

4th SESSION

Practice related checklist 10 minutes

Self introduction was done by the investigator to establish rapport

with the nursing personnel and gained the confidence. Later the

investigator explained the purpose of instruments to the nursing

personnel.

87

The data was collected regarding the socio demographic variable

such as age, marital status, religion, professional qualification, present

designation, monthly income, years of experience, participated in-

service education programme on Bio-Medical waste management,

awareness about Bio-Medical waste management through mass media,

adoption of Bio-Medical Waste Management policy by PHC.

Structured knowledge questionnaire, 5 point likert scale to assess

the attitude and observation rating scale to assess the practice through

one to one teaching by Lecture cum demonstration with the help of

Liquid Crystal Display. Data collection was done in English by using

structured questionnaire. At the end of the STP, doubts were clarified

and then 10 minutes time was given for discussion.

All the nursing personnel participated in the teaching programme

with great interest and the same procedure was adopted for 10 weeks.

They were co operative and attentive. Each week 30 nursing personal

were selected. After seven days, after test with the same questionnaire

for the same group of nurses was conducted. The subjects were divided

into 60 groups within 300 samples. Teaching programme was done and

placed in separate spacious auditorium without any discussions data

collected without contamination.

88

3.18 Plan for data analysis:

Data analysis is the systematic organisation and synthesis of

research data and testing of research hypothesis by using the

collected data.

� The data will be analyzed by using descriptive and inferential

statistics method.

� Descriptive statistics like percentage and frequencies were used to

describe the sample characteristics [socio demographic Variables]

and area wise analysis.

� Paired ‘t’ test will be used to test the significant difference in the

knowledge, attitude, practice scores between before and after test

score.

� Correlation co-efficient, ‘r’ test will be used to correlate the nursing

personnel knowledge, attitude and practice.

� Chi-square test will be used to associate socio demographic

variables with knowledge, attitude and practice scores of nursing

personnel.

� The data analyzed will be presented in the form of table, diagrams

and graphs based findings.

CHAPTER – IV

ANALYSIS AND

INTERPRETATION

89

CHAPTER – IV

ANALYSIS AND INTERPRETATION

Analyses in the sense categorize order, manipulate and

summarize the data to obtain answer to research questions. The

purpose to analyse the relations of a research problem in a precise way

is to make the data intelligible and interpretable format to the reader.

Research data need to be processed and analyzed in a

systematic method, so that pattern of relationship can be detected. The

analysis is a process of organizing and synthesizing data in such a way

that research questions can be answered and hypothesis tested. (Polit &

Hungler) (2006).

In this chapter data was collected from 300 nursing personnel

who were working in selected PHC’s. The data analysis was done

through an integrated system of computer programme known as

Statistical package for social sciences, version 16.0. All the data was

entered and master sheet was prepared.

90

Objectives of the Study were:

1. To assess the level of knowledge, attitude and practice towards

biomedical waste management among nursing personnel before

structured teaching programme

2. To assess the level of knowledge, attitude and practice towards

biomedical waste management among nursing personnel after

structured teaching programme.

3. To find out the effectiveness of structured teaching programme

by comparing the levels of knowledge, attitude and practice

towards biomedical waste management among nursing personnel

before and after structured teaching programme.

4. To find out the association between knowledge, attitude and

practice of nursing personnel on biomedical waste management

and their selected demographic variables

5. To find out the relationship among knowledge, attitude and

practice of nursing personnel on biomedical waste management.

91

Organization of the study findings

The data was grouped, organized, analyzed and presented under

the following headings:

SECTION I

� Frequency and Percentage distribution of the nursing personnel

according to socio-demographic Variables.

SECTION II

� Comparison between before and after STP score on knowledge,

practice, attitude on Biomedical waste management among nursing

personnel

� Computing the mean and standard deviation to assess the before

and After STP scores on knowledge, practice and attitude.

� Comparison between before and After STP scores were done by

using paired ‘t’ test

SECTION III

� Correlation of knowledge, practice, attitude on Bio medical waste

management among nursing personnel before and after STP.

� Analyze the significant correlation in knowledge, practice, attitude on

Bio medical waste management among nursing personnel by using

Pearson’s correlation co-efficient.

92

SECTION IV

� Association between level of knowledge, practice, attitude with

demographic variables on Biomedical waste management among

nursing personnel

� Analyzing the significant association between level of knowledge,

practice, attitude with demographic variables on Bio medical waste

management among nursing personnel by using chi square test.

93

SECTION I

Socio - Demographic Variables on Biomedical waste management

among nursing personnel.

Table No.4.1 (a) Frequency and Percentage distribution of Socio

demographic Variables on Biomedical waste management among

nursing personnel.

N=300

Demographic Data Frequency (f) Percentage (%)

Age in years ≤20 24 8 21-30 60 20 31-40 102 34 41-50 62 20.67 > 50 52 17.33 Marital status Married 196 65.33 Unmarried 19 6.33 Widow 62 20.67 Divorce 23 7.67 Religion

Hindu 121 40.33 Christian 173 57.67 Muslim 6 2 Professional qualification

ANM 216 72 GNM 57 19

B.Sc(N) 23 7.67

PC B.SC (N) 4 1.33 Present designation

Multi Purpose health Assistant( F)

89 29.67

Health visitor 83 27.67 Staff nurse 84 28

Public health nurse 39 13

Community health officer

5 1.66

94

Table No.4.1 (b) Frequency and Percentage distribution of Socio -

demographic variables on biomedical waste management among

nursing personnel.

N=300

Demographic Data Frequency (f) Percentage (%)

Monthly income in Rupees

Less than or equal to 10000

31 10.33

10001-20000 79 26.33 20001-30000 103 34.34 >30000 87 29 Years of experience

1-5 years 41 13.67 6-10 years 77 25.67 11-15 years 36 12 >16 years 146 48.66 Participation in in-service education programme on biomedical waste management.

Yes 28 9.33 No 272 90.67 Awareness about biomedical waste management through mass media.

Mass media 143 47.67 Peer group 117 39 Family members 40 13.33 Adoption of bio medical waste management policy in PHC

Yes 61 20.33 No 239 79.67

95

The above tables 4.1(a) & (b) shows Frequency and percentage

distribution of demographic variables among nursing personnel in

selected primary health centers.

Data presented in Table 4.1a shows that 34% of the nursing

personnel were between the age group of 31-40years, 65.33% were

married, 57.67% were Christians and 72% had only ANM qualification.

Data presented in Table 4.1(b) shows that monthly income

indicate that majority of 34.34%(103) nursing personnel monthly income

ranged 20001-30000 Rupees. Considering the years of experience

majority of 48.66%(146) nursing personnel had more than 15 years of

experience. 90.67% (272) nursing personnel participation in service

education programme on biomedical waste. Regarding the awareness

about biomedical waste management majority of 39%(117) had

awareness through peer group, remaining 13.33%(40) had awareness

through family members. Adoption of Bio medical waste management

policy by primary health centre indicate that majority of 79.67%(239)

PHCs were not following bio medical waste management policy.

Fig.No 4: Percentage

to th

Fig.No. 5: Percentag

to

0%

10%

20%

30%

40%

50%

60%

70%

80%

ANM

72%

Pe

rcen

tag

e

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%

29.67%

Pe

rcen

tag

e

96

ntage distribution of nursing personnel ac

to their professional Qualification

entage distribution of nursing personnel ac

to their present designation

ANM GNM B.Sc(N) PC B.SC (N)

72%

19%

7.67%

1.33%

27.67% 28%

13%

1.66%

el according

l according

Series1

Fig.No.6: Percentage

to Participation in in

97

ntage distribution of nursing personnel ac

in- service education programme on bio

waste management

9%

91%

Yes

No

nel according

biomedical

Yes

No

98

SECTION II

Assessment of knowledge, practice, attitude of nursing personnel

regarding biomedical waste management before and after STP.

TABLE 4.2: Frequency and percentage distribution of nursing

personnel according to before and after STP level of knowledge

N=300

Level of Knowledge

BEFORE STP AFTER STP

Frequency (f)

Percent %

Frequency (f)

Percent %

Adequate (>75%) 88 29.34 246 82

Moderately adequate (50-75%)

130 43.33 54 18

Inadequate (<50%)

82 27.33 0 0

Total 300 100 300 100

Table no.4.2 shows the nursing personnel’s before and after

Structure Teaching Programme level of knowledge on biomedical waste

management. Before Structure Teaching Programme 130(43.33 %) of

nurses had moderately adequate knowledge, it is interesting to know

that none of them had inadequate knowledge after STP.

Fig.No.7: Percentage

biomedical waste ma

Fig.No.8: Percentage

biomedical waste m

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

Adequat

29

0%

20%

40%

60%

80%

100%

Adequate

99

ntage distribution of nursing personnel re

te management on level of knowledge bef

ntage distribution of nursing personnel re

ste management on level of knowledge a

uate (>75%) Moderate (50-75%) Inadequate (<50%)

29.34%

43.33%

27.33%

Before STP

uate (>75%) Moderate (50-

75%)

Inadequate (<50%)

82%

18%0%

After STP

nel regarding

efore STP

nel regarding

after STP

100

TABLE No 4.3: Frequency and percentage distribution of nursing

personnel according to before and after STP level of practice

N=300

Level of Practice

BEFORE STP AFTER STP

Frequency (f) Percent % Frequency (f) Percent %

Good (>75%)

15 5 274 91.33

Fair (50-75%)

212 70.67 26 8.67

Poor (<50%)

73 24.33 0 0

Total 300 100 300 100

Table no.4.3 shows the nursing personnel’s, before and after STP

level of practice on biomedical waste management. Before STP

212(70.67%) of nurses were having fair practice level. After STP none

of them were having poor practice level.

101

Table No.4.4: Frequency and percentage distribution of nursing

personnel according to before and after STP level of attitude

N=300

Level of Attitude

BEFORE STP AFTER STP

Frequency

(f)

Percent

%

Frequency

(f)

Percent

%

Favourable (>50) 224 74.67 300 100

Unfavourable (<50) 76 25.33 0 0

Total 300 100 300 100

Table no.4.4 shows the nursing personnel’s before and after STP

level of attitude on biomedical waste management. Before STP 224

(74.67%) of nurses had favourable attitude. After STP 300 (100%) of

nursing personnel had favourable attitude and none of them had

unfavourable attitude.

Fig.No.9: Percentage

to before and after ST

0%

20%

40%

60%

80%

100%

FAVOURABLE

102

ntage distribution of nursing personnel a

ter STP level of attitude regarding biomedic

management

BLE (>50) UNFAVOURABLE (<50)

el according

medical waste

AFTER STP

BEFORE STP

103

SECTION – III

Table 4.5(a): Mean Difference of structured teaching programme on

level of knowledge regarding Bio medical waste management

among nursing personnel.

N=300

Category Mean Mean

difference Std.

Deviation “t”-value

General Information

Before STP

5.69 2.35

2.21 16.744****

df=299

After STP 8.04 1.11 p=< 0.00001

Hazards of BMW

Before STP

5.25 2.63

1.82 19.147****

df=299

After STP 7.88 1.43 p=< 0.00001

Waste Segregation

Before STP

5.97 1.87

1.91 15.786****

df=299 After STP 7.84 0.85 p=< 0.00001

Treatment of BMW

Before STP

6.66 1.52

2.33 10.692****

df=299 After STP 8.18 0.85 p=< 0.00001

Overall Score

Before STP

23.57 8.37

7.35 18.391****

d,f=299 After STP 31.97 3.02 p=< 0.00001

****Significant at 0.05 level and 0.001 level (2 tailed)at df=299, t=1.968 at 0.05 and t=3.323 at 0.001 level respectively.

Table 4.5 (a) depicts the mean difference of structured teaching

programme on level of knowledge regarding bio medical waste

management among nursing personnel. The mean difference of general

information was statistically significant (t299= 16.744 p<.00001). The

mean difference related to health hazards was statistically significant

(t229=19.147), p<.00001. The mean difference related to waste

104

segregation was statistically significant t229=15.786, p<.00001. The

mean difference related to treatment of Bio-Medical waste management

was statistically significant t(229)=10.692, p<.00001.

Overall levels of knowledge, before STP the mean score was

23.57 with standard deviation of 7.35. After STP the mean score was

31.97with standard deviation 3.02. The obtained ‘t’ value 18.391 was

highly significant affirming a substantial improvement in the aspect of

overall knowledge among nursing personnel following STP. An average

nurses improved their knowledge from 23.57 to 31.97 after STP. The

difference between after and before STP knowledge scores is t=18.391,

and it was significant overall improvement score of 8.37 is seen in

knowledge.

105

Table No.4.5(b): Mean Difference of structured teaching programme

on level of practice regarding bio medical waste management

among nursing personnel.

N=300

Category Mean Mean

difference Std.

Deviation “t”-value

General Information

Before STP

4.86 3.37

1.34 35.612****

df=299 After STP 8.23 0.93 p=< 0.00001

Hazards of BMW

Before STP

10.88 4.73

3.07 27.757****

df=299

After STP 15.61 1.79 p=< 0.00001

Waste Segregation

Before STP

18.8 9.67

4.98 30.026****

df=299 After STP 28.47 2.6 p=< 0.00001

Treatment of BMW

Before STP

19.62 8.45

4.96 26.862****

df=299 After STP 28.07 2.79 p=< 0.00001

Overall Score

Before STP

54.18 26.2

13.78 30.568****

df=299 After STP 80.38 6.13 p=< 0.00001

****Significant at 0.05 level and 0.001 level (2 tailed) at df=299, t=1.968 and t=3.323 at 0.05 and 0.001 level respectively.

Table 4.5 (b) depicts the mean difference of structured teaching

programme on level of practice regarding bio medical waste

management among nursing personnel. The mean difference of general

information was statistically significant (t299=35.612), p<.00001. The

mean difference related to health hazards on BMWM was statistically

significant (t229=27.75), p<.00001. The mean difference related to waste

segregation was statistically significant t229=30.026, p<.00001. The

106

mean difference related to treatment of Bio-Medical waste management

was statistically significant t(229)=26.862, p<.00001.

Considering overall practice on bio medical waste management

before Structured Teaching Programme the mean score was 54.18 with

standard deviation of 13.78. After STP the mean score was 80.38with

standard deviation 6.13. The obtained ‘t’ value=30.568 was highly

significant affirming a substantial improvement in the aspect of overall

practice among nursing personnel following STP. There was overall

improvement score of 26.2 seen in practice.

107

Table No. 4.5(c): Mean Difference of structured teaching

programme on level of attitude regarding bio medical waste

management among nursing personnel.

N=300

Category Mean Mean

difference Std.

Deviation “t”-value

General Information

Before STP

4.62 2.82

1.31 25.797****

df=299 After STP 7.44 1.31 p=< 0.00001

Hazards of BMW

Before STP

9.63 6.19

1.76 43.703****

df=299

After STP 15.82 1.87 p=< 0.00001

Waste Segregation

Before STP

19.65 6.63

4.95 17.479****

df=299 After STP 26.28 3.58 p=< 0.00001

Treatment of BMW

Before STP

16.81 10.29

3.5 37.302****

df=299 After STP 27.1 3.2 p=< 0.00001

Overall Score

Before STP

50.71 25.94

10.63 33.795****

df=299 After STP 76.65 6.76 p=< 0.00001

***Significant at 0.05 and 0.001 level (2 tailed) at df=299, t=1.968 and t=3.323 at 0.05 and 0.001 level respectively.

Table 4.5 (c) depicts the mean difference of structured teaching

programme on level of attitude regarding Bio medical waste

management among nursing personnel. The mean difference of general

information was statistically significant (t299= 25.797 p<.0001). The mean

difference related to health hazards was statistically significant

(t229=43.703), p<.00001. The mean difference related to waste

segregation was statistically significant t229=17.479, p<.00001. The

108

mean difference related to treatment of Bio-Medical waste management

was statistically significant t(229)=37.302, p<.00001.

With respect to overall attitude, before STP the mean score was

50.71 with standard deviation of 10.63. After STP, the mean score was

76.65with standard deviation of 6.76. The obtained t=33.795 was highly

significant affirming a substantial improvement in the aspect of overall

attitude among nursing personnel following STP. An average nurses

improved their attitude from 50.71to 76.65 after STP. There was overall

improvement score of 25.94 seen in attitude.

109

SECTION – IV

Association between the level of knowledge with demographic variables on biomedical waste management among nursing personnel after STP. Table No. 5.(a): Association of level of knowledge with their selected demographic variables after STP

N=300

Demographic Data

LEVEL OF KNOWLEDGE

AFTER STP

50-75% >75% X

2 df & p

No % No %

Age in years

32.47* 4

p=0.0001 S

Less than or equal to 20 8 14.81 16 6.5 21-30 1 1.85 59 23.98 31-40 12 22.23 90 36.58 41-50 13 24.07 49 19.91 > 50 20 37.03 32 13

Marital status

65.72* 3

p=0.0001 S

Married 19 35.18 177 71.95 Unmarried 5 9.25 14 5.69 Widow 12 22.23 40 16.26 Divorce 18 33.34 5 2.03 Religion

9.85*

2 p=0.0072

S

Hindu 20 37.03 101 41.05 Christian 30 55.56 143 58.13 Muslim 4 7.04 2 0.81

Professional qualification

38.5* 3

p=0.0001 S

ANM 28 51.85 188 76.42 GNM 10 18.51 47 19.1 B.Sc(N) 15 27.78 8 3.25 PC B.SC (N) 1 1.85 3 1.21

Present designation

13.29* 4

p=0.0099 S

Multi Purpose health worker

24 44.45 65 26.42

Health visitor 6 11.12 77 31.3 Staff nurse 13 24.07 71 28.86 Public health nurse 10 18.51 29 11.78 Community health officer 1 1.85 4 1.62

Monthly income in Rupees

10.57* 3

p=0.0001 S

Less than or equal to 10000

26 48.14 5 2.03

10001-20000 14 25.92 65 26.42 20001-30000 7 12.96 96 39.02 >30000 7 12.96 80 32.52

110

Demographic Data

LEVEL OF KNOWLEDGE

AFTER STP

<50% 50-75% X

2 df & p No %

Years of Experience

6.65* 3

p=0.0840 NS

1-5 years 11 20.37 30 12.19 6-10 years 17 31.48 60 24.39 11-15 years 8 14.81 28 11.38 >15 years 18 33.34 128 52.03

Participation in in-service education programme on biomedical waste management

95.94* 1

p=0.0001 S Yes 24 44.45 4 1.62

No 30 55.56 242 98.37 Awareness about biomedical waste management through mass media.

22.06* 2

p=0.0001 S

Mass media 14 25.92 129 52.43 Peer group 8 14.81 109 44.3 Family 32 59.25 8 3.25 Adoption of bio medical waste management policy by PHC 0.14*

1 p=0.7033

NS Yes 12 22.23 49 19.91 No 42 77.78 197 80.08

*.Chi square is significant at the 0.05 level

Table No.5. (a) reveals that the association between socio-

demographic variables and level of knowledge after STP regarding

biomedical waste management.

After STP Chi-Square of age was (X2= 32.47, df=4), marital status

(X2= 65.72, df=3), religion (X

2= 9.85, df=2), professional qualification

(X2=38.59 df=3), present designation (X

2= 13.29, df=4), monthly income

(X2=105.7 df=3) ,year of experience (X

2= 6.65, df=3), participation in in-

service education on biomedical waste management (X2= 95.94, df=1),

111

awareness about bio medical waste management (X2= 220.6, df=2), were

significant at 0.05 level remaining adoption of biomedical waste

management policy by PHC (X2= 0.14, df=1) were not significant.

It indicates that there is a significant association between socio-

demographic variables and level of knowledge after STP.

Table No. 5. (b): Association between level of practice with their selected

demographic variables of nursing personnel after STP.

N=300

Demographic Data

LEVEL OF PRACTICE

AFTERSTP

50-75% >75% X

2 df & p No % No %

Age in years

13.47* 4

p=0.0092 S

Less than or equal to 20 6 23.1 18 6.57 21-30 4 15.4 56 20.44 31-40 12 46.2 90 32.85 41-50 2 7.69 60 21.89 > 50 2 7.69 50 18.25

Marital status

125.2* 3

p=0.0001 S

Married 3 11.5 193 70.44 Unmarried 4 15.4 15 5.47 Widow 3 11.5 59 21.53 Divorce 16 61.5 7 2.55 Religion

30.55*

2 p=0.0001

S

Hindu 4 15.4 117 42.7 Christian 18 69.2 155 56.57 Muslim 4 15.4 2 0.73

Professional qualification

104.2* 3

p=0.0001 S

ANM 3 11.5 213 77.74 GNM 7 26.9 50 18.25 B.Sc(N) 13 50 10 3.65 PC B.SC (N) 3 11.5 1 0.36

Present designation

43.18* 4

p=0.0001 S

Multi Purpose health worker 3 11.5 86 31.39 Health visitor 5 19.2 78 28.47 Staff nurse 6 23.1 78 28.47 Public health nurse 8 30.8 31 11.31 Community health officer 4 15.4 1 10.58

Monthly income in Rupees

6.52* 3

p=0.0886 NS

Less than or equal to 10000 2 7.69 29 26.64 10001-20000 6 23.1 73 35.76 20001-30000 5 19.2 98 27.02 >30000 13 50 74 13.5

113

Demographic Data

LEVEL OF PRACTICE

AFTER STP

<50% 50-75% X

2 df & p No %

Years of Experience

26.14* 3

p=0.0001 S

1-5 years 4 15.4 37 26.28 6-10 years 5 19.2 72 19.12 11-15 years 11 42.3 25 9.12 >15 years 6 23.1 40 51.09

Participation in in-service education programme on biomedical waste management?

18.03* 1

p=0.0001 S Yes 22 84.6 6 2.19

No 4 15.4 268 97.81 Awareness about biomedical waste management through mass media.

67.57* 2

p=0.0001 S

Mass media 7 26.9 136 49.64 Peer group 2 7.69 115 41.97 Family 17 65.4 23 8.39 Adoption of bio medical waste management policy by PHC 72.61*

1 p=0.0001

S Yes 22 55.6 39 14.23 No 4 15.4 235 85.76

*.Chi square is significant at the 0.05 level

Table No.5.(b) reveals association between socio-demographic

variables and after STP level of practice regarding biomedical waste

management.

After STP Chi-Square of age was (X 2= 13.47, df=4), marital

status (X 2= 125.2, df=3), religion (X 2= 30.55, df=2), professional

qualification (X 2=104.2, df=3), Present designation (X 2= 43.18, df=4),

year of experience (X 2= 26.14, df=3), participation in in-service

education on biomedical waste management (X 2= 181.03, df=1),

114

awareness about bio medical waste management (X 2= 67.57, df=2),

adoption of biomedical waste management policy by PHC (X 2= 72.61,

df=1) were significant at 0.05 level. Remaining monthly income (X

2=6.52, df=3) is not significant. It indicated that there was a significant

association with socio-demographic variables and level of practice after

STP.

115

Table No.5.(c): Association between level of attitude with their selected

demographic variables of nursing personnel before STP.

N=300

Demographic Data

LEVEL OF ATTITUDE

BEFORE STP

<50% 50-75% X

2 df & p No % No %

Age in years

45.31* 4

p=0.0001 S

Less than or equal to 20 8 3.57 16 21.05 21-30 36 16.07 24 31.58 31-40 94 41.96 8 10.53 41-50 48 21.42 14 18.42 > 50 38 16.96 14 18.42

Marital status

116.5* 3

p=0.0001 S

Married 183 81.69 13 17.11 Unmarried 4 1.79 15 19.74 Widow 22 9.82 40 52.63 Divorce 15 6.69 8 10.53 Religion

6.51*

2 p=0.03

S

Hindu 95 42.41 26 34.21 Christian 127 56.69 46 60.53 Muslim 2 0.89 4 5.26

Professional qualification

65.6* 3

p=0.0001 S

ANM 184 82.14 32 42.11 GNM 34 15.18 23 30.26 B.Sc(N) 3 1.34 20 26.32 PC B.SC (N) 3 1.34 1 1.32

Present designation

53.94* 4

p=0.0001 S

Multi Purpose health worker

73 32.59 16 21.05

Health visitor 76 33.93 7 9.21 Staff nurse 60 26.78 24 31.58 Public health nurse 13 5.8 26 34.21 Community health officer 2 0.89 3 3.95

Monthly income in Rupees

81.14* 3

p=0.0001 S

Less than or equal to 10000

4 1.79 27 35.53

10001-20000 68 30.36 11 14.47 20001-30000 92 41.07 11 14.47 >30000 60 26.78 27 35.53

116

Demographic Data

LEVEL OF ATTITUDE

BEFORE STP

<50% 50-75% X

2 df & p No %

Years of Experience

82.1* 3

p=0.0001 S

1-5 years 26 11.61 15 19.74 6-10 years 47 20.98 30 39.47 11-15 years 11 4.91 25 32.89 >15 years 140 62.5 6 7.89

Participation in in-service education programme on biomedical waste management?

46.27* 1

p=0.0001 S Yes 6 2.68 22 28.95

No 218 97.32 54 71.05 Awareness about biomedical waste management through mass media.

20.17* 2

p=0.0001 S

Mass media 121 54.02 22 28.95 Peer group 71 31.6 46 60.53 Family 32 14.29 8 10.53 Adaptation of Bio medical waste management policy by PHC 161.6*

1 p=0.0001

S Yes 7 3.13 54 71.05 No 217 96.88 22 28.95

*.Chi square is significant at the 0.05 level

Table No.5 (c) reveals the association between socio-

demographic variables with their level of attitude regarding biomedical

waste management. Before STP Chi-Square of age was (X2= 45.31,

df=4), marital status (X2= 116.5, df=3), religion (X

2= 6.51, df=3),

professional qualification (X2=65.6, df=3), Present designation (X2

= 53.94,

df=4), monthly income (X2=81.14, df=3) ,year of experience (X

2= 82.1,

df=3), Participation in in-service education on biomedical waste

management (X2= 46.27, df=1), awareness about bio medical waste

management (X2=20.17, df=2), adoption of biomedical waste

117

management policy by PHC (X2= 161.6, df=1) were significant at 0.05

level. It indicates that there was a significant association between socio-

demographic variables level of attitude before STP.

118

SECTION – V

ASSESSMENT OF CORRELATION OF KNOWLEDGE, ATTITUDE

AND PRACTICE OF NURSING PERSONNEL BEFORE AND AFTER

STP.

Table No.6 (a): Before and after Structured Teaching Programme

Mean, standard deviation and correlation of overall levels of

knowledge, and practice of nursing personnel on bio medical

waste Management.

N=300

Sl. No Variables BEFORE STP AFTER STP

Mean S.D ‘r’ value (2 tailed)

Mean S.D ‘r’ value (2 tailed)

1 Knowledge 23.57 7.35 0.072

31.94 3.02 0.388*

2 Practice 54.18 13.78 80.38 6.13

*Correlation is significant at the 0.05 level

Table 6 (a) highlights the correlation between knowledge and

practice of nursing personnel regarding biomedical waste management

before and after Structured Teaching Programme.

The table reveals that before Structured Teaching Programme the

obtained mean knowledge was 23.57 (SD= 7.35), practice mean was

54.18 (SD = 13.78). The obtained co efficient of correlation value was

r=0.072at *P<0.01 level. There was no statistically significant correlation

119

of the nursing personnel’s knowledge and practice before Structured

Teaching Programme.

After Structured Teaching Programme, the obtained mean

knowledge was 31.94 (SD= 3.02), practice mean was 80.38 (SD= 6.13).

The obtained co-efficient of correlation value was r=0.388 at *P<0.01

level there was statistically significant correlation of the nursing

personnel’s knowledge and practice after STP. It showed increase in the

levels of knowledge have increased the level of practice. Hence the

hypothesis was accepted.

120

Table 6(b): Before and after Structured Teaching Programme Mean,

standard deviation and correlation of overall levels of knowledge

and attitude of nursing personnel on bio medical waste

management

N=300

Sl. No Variables

BEFORE STP AFTER STP

Mean S.D ‘r’ value

(2 tailed) Mean S.D

‘r’ value

(2 tailed)

1 Knowledge 23.57 7.35 0.509*

31.94 3.02 0.3*

2 Attitude 50.71 10.64 76.65 6.77

*.Correlation is significant at the 0.05 level

Table 6 (b) highlights the correlation between knowledge and

attitude of nursing personnel regarding biomedical waste management

before and after STP.

The table reveals that before Structured Teaching Programme

mean knowledge score was 23.57 (SD= 7.35), attitude mean score

was 50.71 (SD = 10.64) and after STP mean knowledge score was

31.94 (SD= 3.02) and attitude mean score was 76.65 ( SD= 6.77).

Before and after STP the obtained co-efficient of correlation value

was r=0.509 and r=0.3 significant at (*P<0.01) and (*p< 0.05),

respectively. This commended a positive co- relation before and after

STP levels of knowledge and attitude, which confirmed that an increase

in the levels of knowledge have increased in the levels of attitude.

Hence the hypothesis was accepted.

121

Table 6(c): Before and after STP mean, standard deviation and

correlation between overall levels of practice and attitude of

nursing g personnel on bio medical waste management before and

after STP

N=300

Sl. No Variables BEFORE STP AFTER STP

Mean S.D ‘r’ value (2 tailed)

Mean S.D ‘r’ value (2 tailed)

1 Practice 54.18 13.78 0.726*

80.38 6.13 0.786*

2 Attitude 50.71 10.64 76.65 6.77

*.Correlation is significant at the 0.05 level

Table 6 (c) highlights the correlation between practice and attitude

of nursing personnel regarding biomedical waste management before

and after STP.

The table reveals that Before STP mean practice score was 54.18

(SD=13.78), attitude mean score was 50.71 (SD=10.64) After STP mean

practice score was 80.38 (SD= 6.13) and attitude mean score was 76.65

(SD= 6.77).

The obtained co-efficient of correlation value was r=0.726 and

r=0.786 significant at (*P<0.01) and (*p< 0.05) before and after STP

respectively, commended a positive co- relation before and after STP

levels of practice and attitude, which confirms an increase in the levels

of practice have increased in the level of attitude. Hence the hypothesis

was acceptable.

CHAPTER V

Discussion, Summary, Major

Findings, Conclusions,

Implications, Limitations and

Recommendations

122

CHAPTER – V

Discussion, Summary, Major Findings, Conclusions,

Implications, Limitations and Recommendations

This chapter presents the discussion and brief outline of

summary, major findings, conclusions, Implications, limitations and

recommendations. The conclusion of the study are drawn on its

implications for the nursing and health care services followed by its

limitations. It also lists the suggestions and recommendations for the

future research in this fields.

Discussion

This chapter discusses findings of the study derived from

statistical analysis with its pertinence to the objectives for the study and

related literature. The findings of the study based on objectives were :

The study was undertaken to assess the level of knowledge,

attitude and practice towards biomedical waste management

among nursing personnel before structured teaching programme

Before Structured Teaching Programme 43.33 % (130) of nurses

were having moderately adequate knowledge, 29.34 % (88) were having

adequate knowledge and remaining 27.33 % (82) of them were having

inadequate knowledge. Investigator assessed the level of knowledge on

123

different aspects of biomedical waste management, with respect to

general information, before Structured Teaching Programme mean

score was 5.69 with standard deviation of 2.21, In relation to hazards of

BMWM before STP mean score was 5.25 with standard deviation of

1.82. Regarding segregation, before STP mean score was 5.97 with

standard deviation of 1.91. Regarding treatment, before STP mean

score was 6.66 with standard deviation of 2.33. Regarding overall

knowledge, before Structured Teaching Programme mean score was

23.57 with standard deviation of 7.35.

Investigator assessed the level of practice before implementing

structured teaching program, 70.67 % (212) of nurses were having fair

practice level, 24.33 % (73) were having poor practice level and

remaining 5% (15) of them were having good practice level. Researcher

assessed the level of practice on different aspects of biomedical waste

management with respect to general information, before Structured

Teaching Programme mean score was 4.86 with standard deviation of

1.34. In relation to hazard of Bio Medical Waste Management before

Structured Teaching Programme mean score was 10.88 with standard

deviation of 3.07. Regarding segregation, before STP mean score was

18.8 with standard deviation of 4.98.Regarding treatment of Bio Medical

Waste Management before STP mean score was 19.62 with standard

124

deviation of 4.79. Regarding overall practice, before STP the mean

score was 54.18 with standard deviation of 13.78.

Investigator assessed the level of attitude before implementing

structured teaching program, 74.67% (224) of nurses were having

favourable attitude, 25.33 % (76) were having unfavourable attitude.

Investigator assessed the level of attitude on different aspects of

biomedical waste management. With respect to General information

before STP mean score was 4.62 with standard deviation of 1.31. In

relation to hazard of Bio Medical Waste Management before STP mean

score was 9.63 with standard deviation of 1.76, Regarding segregation

of BMWM before STP mean score was 19.65 with standard deviation of

4.95.Regarding treatment of BMWM before STP mean score was

16.81with standard deviation of 3.5. Regarding overall attitude, before

STP mean score was 50.71with standard deviation of 10.63.

Similar findings were noted in a study conducted by Sowmya. V

(2013) on Bio medical waste management among health care personnel

working at PHC’S of Anekal Taluk. The sample size comprised of 78

health care personnel’s selected through complete enumeration (Simple

Random sampling). Knowledge was assessed by a structured

questionnaire and practice was assessed by observational checklist and

data was analysed using descriptive and inferential statistics. Results

125

shows that the health care personnel had moderately adequate

knowledge regarding biomedical waste management. The current

system of practice of biomedical waste management at primary health

centres was neither too satisfactory nor unsatisfactory but was as per

the guidelines to a certain extent. The problems faced were almost

common in all the primary health centres.

Assess the level of knowledge, attitude and practice towards

biomedical waste management among nursing personnel after

structured teaching programme.

After STP 82 % (246) of nursing personnel were having adequate

level of knowledge, 18 % (54) of nurses were having moderately

adequate and none of them having inadequate knowledge. Investigator

assessed the level of knowledge on different aspects of biomedical

waste management after implementation of structured teaching

program. With respect to general Information after STP mean score was

8.04 with standard deviation 1.11. In relation to hazard after STP mean

score was 7.88 with standard deviation 1.43. Regarding segregation of

BMW after STP mean score was 7.84with standard deviation 0.85.

Regarding treatment of BMMW, after STP the mean score was 8.18 with

standard deviation 0.85, regarding overall knowledge, after STP mean

score was 31.97with standard deviation 3.02.

126

Investigator assessed the level of practice after implementing

structured teaching program. 91.33 %( 274) of nursing personnel were

having good practice level, 8.67 %( 26) of nurses were having fair

practice level and none of them were having poor practice level.

Investigator assessed the level of knowledge on different aspects of

biomedical waste management after implementation of structured

teaching program. With respect to general information on Bio Medical

Waste Management after STP mean score was 8.23with standard

deviation 0.93. In relation to hazard of Bio Medical Waste Management

after STP mean score was 15.61with standard deviation 1.79.

Regarding segregation of Bio Medical Waste Management, after STP

mean score was 28.47with standard deviation 2.6. Regarding treatment

of Bio Medical Waste Management after STP mean score was 28.07with

standard deviation 2.79. Regarding overall practice after STP mean

score was 80.38with standard deviation 6.13.

Investigator assessed the level of attitude after implementing

structured teaching program, 100 %( 300) of nursing personnel were

having favourable attitude and none of them were having unfavourable

attitude. Investigator assessed the level of attitude on different aspects

of biomedical waste management. With respect to general Information

on Bio Medical Waste Management after STP mean score was 7.44with

standard deviation 1.31. In relation to hazard of Bio Medical Waste

127

Management, after STP mean score was 15.82 with standard deviation

1.87. Regarding segregation of Bio Medical Waste Management after

STP mean score was 26.28 with standard deviation 3.58. Regarding

treatment of Bio Medical Waste Management after STP mean score was

27.1with standard deviation 3.2. Regarding overall attitude after STP

mean score was 76.65with standard deviation 6.76.

Similar findings were noted in a study conducted by SImple M

(2005) on Bio medical waste management among staff nurses in a

private hospital at Mangalore. The sample comprises of 30 staff nurses

selected by using a multi stage random sampling technique. Structured

knowledge questionnaire was used to collect the data .The findings of

the study reveal that the mean percentage of knowledge score of the

nursing personnel was 50.29% in pre-test and it was 84.39% during the

post-test. The knowledge of nursing personnel is not influenced by the

age, years of experience and exposure to in-service education.

Find out the effectiveness of structured teaching programme

by comparing the levels of knowledge, attitude and practice

towards biomedical waste management among nursing personnel

before and after structured teaching programme.

128

Paired ‘t’ test was used to find out the effectiveness of structured

teaching programme on knowledge. The mean difference of general

information was statistically significant (t299= 16.744 p<.00001). The

mean difference related to health hazards was statistically significant

(t229=19.147), p<.00001. The mean difference related to waste

segregation was statistically significant t229=15.786, p<.00001. The

mean difference related to treatment of Bio-Medical waste management

was statistically significant t(229)=10.692, p<.00001. Overall levels of

knowledge, before STP the mean score was 23.57 with standard

deviation of 7.35. After STP the mean score was 31.97with standard

deviation 3.02. The obtained ‘t’ value 18.391 was highly significant

affirming a substantial improvement in the aspect of overall knowledge

among nursing personnel following STP. An average nurses improved

their knowledge from 23.57 to 31.97 after STP. The difference between

after and before STP knowledge scores is t=18.391, and it was

significant overall improvement score of 8.37 is seen in knowledge.

Regarding the levels of practice of nursing personnel the mean

difference of general information was statistically significant

(t299=35.612), p<.00001. The mean difference related to health hazards

on BMWM was statistically significant (t229=27.75), p<.00001. The mean

difference related to waste segregation was statistically significant

t229=30.026, p<.00001. The mean difference related to treatment of Bio-

129

Medical waste management was statistically significant t(229)=26.862,

p<.00001. Considering overall practice on bio medical waste

management before Structured Teaching Programme the mean score

was 54.18 with standard deviation of 13.78. After STP the mean score

was 80.38with standard deviation 6.13. The obtained ‘t’ value=30.568

was highly significant affirming a substantial improvement in the aspect

of overall practice among nursing personnel following STP. There was

overall improvement score of 26.2 seen in practice.

With regard to the levels of Attitude, the mean difference of

general information was statistically significant (t299= 25.797 p<.0001).

The mean difference related to health hazards was statistically

significant (t229=43.703), p<.00001. The mean difference related to

waste segregation was statistically significant t229=17.479, p<.00001.

The mean difference related to treatment of Bio-Medical waste

management was statistically significant t(229)=37.302, p<.00001. With

respect to overall attitude, before STP the mean score was 50.71 with

standard deviation of 10.63. After STP, the mean score was 76.65with

standard deviation of 6.76. The obtained t=33.795 was highly significant

affirming a substantial improvement in the aspect of overall attitude

among nursing personnel following STP. An average nurses improved

their attitude from 50.71to 76.65 after STP. There was overall

improvement score of 25.94 seen in attitude.

130

Similar findings were noted in a study conducted by Mohd. Faisal

Khan (2004) hospitals produce many type of waste materials. Many of

the hospitals neither have a satisfactory waste disposal system nor a

waste management and disposal policy. BMW possess a wide variety of

health and safety hazards for clients and nursing personnel’s. Safe and

effective management of hospital waste generated by health care

institution is not only a legal necessity but also a social responsibility.

BMWM is not given due importance at the peripheral level, this had

prompted the researcher to elicit knowledge, practice and attitude of

nursing personnel at the peripheral level, through this study to promote

safe and effective waste management, which will be of immense value

and safe and sound ecological system.

Present study results shows that structured teaching programme

was effective in improving the knowledge attitude and practice regarding

bio medical waste management among nursing personnel.

Find out the association between knowledge, attitude and

practice of nursing personnel on biomedical waste management

and their selected demographic variables

After STP chi-Square of age was (X2= 32.47, df=4), marital status

(X2= 65.72, df=3), religion (X

2= 9.85, df=2), professional qualification

131

(X2=38.59 df=3), present designation (X

2= 13.29, df=4), monthly income

(X2=105.7 df=3) ,year of experience (X

2= 6.65, df=3), participated in in-

service education on biomedical waste management (X2= 95.94, df=1),

awareness about bio medical waste management (X2= 220.6, df=2), were

significant at 0.05 level whether following biomedical waste

management policy by PHC (X2= 0.14, df=1) were not significant. It

indicates that there is a significant association between socio-

demographic variables and levels of knowledge following STP.

With respect to the levels of practice After STP, chi-Square of age

was (X2= 13.47, df=4), marital status (X

2= 125.2, df=3), religion (X

2= 30.55,

df=2), professional qualification (X2=104.2, df=3), present designation

(X2= 43.18, df=4),year of experience (X

2= 26.14, df=3), participated in in-

service education on biomedical waste management (X2= 181.03, df=1),

awareness about bio medical waste management (X2= 67.57, df=2),

adaptation of biomedical waste management policy by PHC (X2= 72.61,

df=1) were significant at 0.05 level. Remaining monthly income (X2=6.52,

df=3) is not significant. It indicates that there is a significant association

between socio-demographic variables and levels of practice following

STP.

Considering the level of attitude regarding biomedical waste

management before STP, chi-square of age was (X2= 45.31, df=4),

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marital status (X2= 116.5, df=3), religion (X

2= 6.51, df=3), professional

qualification (X2=65.6, df=3), present designation (X

2= 53.94, df=4),

monthly income (X2=81.14, df=3) ,year of experience (X

2= 82.1, df=3),

participated in in-service education on biomedical waste management

(X2= 46.27, df=1), awareness about bio medical waste management

(X2=20.17, df=2), adaptation of biomedical waste management policy by

PHC (X2= 161.6, df=1) were significant at 0.05 level. It indicates that there

is a significant association between socio-demographic variables and

levels of attitude following STP.

Similar findings were noted in a study conducted by SZ Quazi

(2004) . Universal precaution and safe waste disposal among private

medical practitioners in a slum area of Mumbai which revealed that

significant difference was found with MBBS qualification having correct

knowledge (p<0.0000066), years of experience and correct knowledge

(p<0.02) and training attended and correct knowledge (p<0.00136) of

universal precaution and safe waste disposal.

Find out the relationship among knowledge, attitude and practice

of nursing personnel on biomedical waste management.

With regard to knowledge and practice of nursing personnel

before STP, the obtained mean knowledge was 23.57 (SD= 7.35),

practice mean was 54.18 (SD = 13.78). The obtained co efficient of

correlation value is r=0.072at level. There was no statistically significant

133

correlation of the nursing personnel’s knowledge and practice before

STP. After STP the obtained mean knowledge was 31.94 (SD= 3.02),

practice mean was 80.38 (SD= 6.13). The obtained co-efficient of

correlation value is r=0.388 at level there was statistically significant

correlation of the nursing personnel’s knowledge and practice after STP.

It shows increase in the levels of knowledge have increased the level of

practice.

Considering the knowledge and attitude of nursing personnel

before STP, mean knowledge score was 23.57 (SD= 7.35), attitude

mean score was 50.71 (SD = 10.64) and after STP mean knowledge

score was 31.94 (SD= 3.02) and attitude mean score was 76.65

(SD= 6.77). The obtained co-efficient of correlation value is r=0.509 and

r=0.3 significant, which commends that an increase in the levels of

knowledge have increased the level of attitude.

With respect to the practice and attitude of nursing personnel

before STP ,mean practice score was 54.18 (SD=13.78), attitude mean

score was 50.71 (SD=10.64) and after STP mean practice score was

80.38 (SD= 6.13) and attitude mean score was 76.65 ( SD= 6.77).

The obtained co-efficient of correlation value is r=0.726 and r=0.786

significant. Which confirms that an increase the levels of practice have

increased the level of attitude.

134

A similar study was conducted by N. Mathar Mohideen (2005) to

assess the Knowledge, Attitude and Practices of Nurses Regarding ‘Bio

Medical Waste Management’ at Raichur. Highly positive correlation was

observed between the knowledge and attitude (r=0.610) at 5%

significant level. Moderately positive correlation was observed between

the knowledge and practice (r=0.501) at 5% significant level. Less

positive correlation was observed between the attitude and practices

(r=0.297) at 5% significant level. Knowledge, attitude and practices are

interdependent.

Summary

A study was under taken by the investigator to assess the

effectiveness of structured teaching program on knowledge, attitude and

practice towards Bio-Medical waste management among nursing

personnel in selected primary health centers of Karimnagar (dist),

Andhra Pradesh.

Objectives of the study:

1. To assess the level of knowledge, attitude and practice towards

biomedical waste management among nursing personnel before

structured teaching programme

2. To assess the level of knowledge, attitude and practice towards

biomedical waste management among nursing personnel after

structured teaching programme.

135

3. To find out the effectiveness of structured teaching programme

by comparing the levels of knowledge, attitude and practice

towards biomedical waste management among nursing personnel

before and after structured teaching programme.

4. To find out the association between knowledge, attitude and

practice of nursing personnel on biomedical waste management

and their selected demographic variables

5. To find out the relationship among knowledge, attitude and

practice of nursing personnel on biomedical waste management.

Hypothesis of the study were:

H1: There will be significant difference in the levels of knowledge of

nursing personnel before and after structured teaching programme.

H2: There will be significant difference in the levels of attitude of nursing

personnel before and after structured teaching programme.

H3: There will be significant difference in the levels of practice of

nursing personnel before and after structured teaching programme.

H4: There will be significant association between the knowledge,

attitude and practice of nursing personnel with their selected

demographic variables on biomedical waste management.

H5: There will be a significant correlation between the knowledge,

attitude and practice of nursing personnel on biomedical waste

management.

136

The conceptual framework adopted for the study was based on

the PENDERS HEALTH PROMOTION MODEL. The model seeks to

increase the individual and community well being the model focuses on

modifying factors, cognitive perceptual factors and likely hood of

participants in health promoting behavior.

For the purpose of logical sequence, the review of literature was

divided into two sections.

A] General Information regarding Bio-medical waste management.

B] Studies and related literature on Bio-medical Waste management.

Section I : Studies related to knowledge, attitude and practices on bio-

medical waste management among nursing personnel.

Section II : Studies and literature related to effects of improper Bio-

medical waste management.

Section III : Studies and literature related to proper management of Bio-

waste.

The research approach used in the study was Pre experimental

approach. In the present study one group pre and post test design was

selected to assess the effectiveness of structured teaching programme

on knowledge, attitude and practice towards bio-medical waste

management among nursing personnel. The population in this study

comprised of Multipurpose health assistance (520), Health visitors (68),

public health nurses(34), community health officers (5), staff nurses (70)

137

working in 76 primary health centres of Karimnagar district, totalling to

696. Simple random sampling technique was adopted. The study

included a total of 300 samples. Out of 76 primary health centres, 60

primary health centres of Karimnagar district were selected. Tool for

data collection has been classified into

TOOL I- Structured questionnaire to assess the knowledge of nursing

personnel on biomedical waste management

TOOL II- A five point attitude scale (likert) to assess the attitude of

nursing personnel on biomedical waste management

TOOL III- Observation rating scale to assess practice of nursing

personnel on biomedical waste management

The tool was validated and tested for reliability by using Pearson’s

correlation reliability. The instrument was found to be reliable as the

reliability co-efficient was r = 0.84. Reliability of the attitude scale was

established by using Cronbach’s alpha. The instrument was found to be

reliable as the reliability co-efficient was r = 0.83 [After STP]. Reliability

of the practice scale was established by using inter-rater reliability

method. The instrument was found to be reliable as the reliability co-

efficient was r = 0.86 [after STP]. The pilot study was conducted with the

aim to assess the feasibility to conduct the final study. The data for pilot

study was obtained from 30 nursing personnel. The investigator

obtained a written permission from District medical and health officer,

138

Karimnagar (dist). Informed consent was obtained from the study

subjects. Out of 76 primary health centres 60 primary health centres

were included for the main study .The data was collected from Dec

2009-Feb 2010.The nursing personnel were gathered in DM&HO lecture

hall. The investigator introduced self and general instructions were

briefed to the respondents. The tools were distributed and collected

back (before STP).Practice was assessed by investigator through

observational check list. The final data collection period from June 2010

to February 2011. The data collection took 40 mins and the STP was

administered in four sessions. The structured teaching programme was

administered, after test was conducted following the structured teaching

programme. The data obtained from the nursing personnel will be

analyzed using both descriptive and inferential statistics.

Data was analysed by using Statistical Package Statistical

Science 16.0 after preparing master data sheet. The collected data was

analysed, interpreted and discussed.

Major findings of the study

Significant difference in the levels of knowledge of nursing

personnel before and after structured teaching programme.

� Before Structure Teaching Programme 130(43.33 %) of nurses

had moderately adequate knowledge, it is interesting to know that

none of them had inadequate knowledge after STP.

139

� Overall levels of knowledge, before STP the mean score was

23.57 with standard deviation of 7.35. After STP the mean score

was 31.97with standard deviation 3.02. The obtained ‘t’ value

18.391 was highly significant affirming a substantial improvement

in the aspect of overall knowledge among nursing personnel

following STP.

� An average nurses improved their knowledge from 23.57 to 31.97

after STP. The difference between after and before STP

knowledge scores is t=18.391, and it was significant overall

improvement score of 8.37 is seen in knowledge. Therefore the

research hypothesis H1 was accepted.

Significant difference in the levels of practice of nursing personnel

before and after structured teaching programme.

� Before STP 212(70.67%) of nurses were having fair practice level.

After STP none of them were having poor practice level.

� Considering overall practice on bio medical waste management

before Structured Teaching Programme the mean score was

54.18 with standard deviation of 13.78. After STP the mean score

was 80.38with standard deviation 6.13. The obtained ‘t’

value=30.568 was highly significant affirming a substantial

improvement in the aspect of overall practice among nursing

personnel following STP. There was overall improvement score

140

of 26.2 seen in practice. Therefore the research hypothesis H2

was accepted.

Significant difference in the levels of attitude of nursing personnel

before and after structured teaching programme.

� Before STP 224 (74.67%) of nurses had favourable attitude. After

STP 300 (100%) of nursing personnel had favourable attitude and

none of them had unfavourable attitude

� With respect to overall attitude, before STP the mean score was

50.71 with standard deviation of 10.63. After STP, the mean score

was 76.65with standard deviation of 6.76. The obtained t=33.795

was highly significant affirming a substantial improvement in the

aspect of overall attitude among nursing personnel following STP.

An average nurses improved their attitude from 50.71to 76.65

after STP. There was overall improvement score of 25.94 seen in

attitude. Therefore the research hypothesis H3 was accepted.

Association between the knowledge, attitude and Practice of

nursing personnel with their selected demographic variables.

� The association between socio demographic variables and levels

of knowledge After STP, regarding Bio medical waste

management. After STP, Chi-Square value of age, marital status,

religion, professional qualification, present designation, monthly

141

income, year of experience, participation in in-service education

on biomedical waste management, awareness about bio medical

waste management, were significant at 0.05 level. It indicates that

there was a significant association between socio-demographic

variables and level of knowledge after STP

� The association between socio demographic variables and levels

of practice After STP regarding Bio medical waste management.

After STP Chi-Square value of age, marital status, religion,

professional qualification, present designation, year of experience,

participated in in-service education on biomedical waste

management, awareness about bio medical waste management,

adaptation of biomedical waste management policy by PHC were

significant at 0.05 level. It indicated that there was a significant

association between socio-demographic variables and level of

practice after STP.

� The association between socio-demographic variables and level

of attitude. Before STP chi-Square value of age, marital status,

religion, professional qualification, present designation, monthly

income, year of experience, participated in in-service education on

biomedical waste management, awareness about bio medical

waste management, adaptation of biomedical waste management

policy by PHC were significant at 0.05 level. It indicates that there

was a significant association between socio-demographic

142

variables and level of attitude before Structure Teaching

Programme. Hence the research hypothesis H4 was accepted.

Correlation between the knowledge, Attitude and practice of

nursing personnel.

� The obtained co efficient of correlation value is r=0.072 at

(**P<0.01) level. There was no statistically significant correlation

of the nursing personnel’s knowledge and practice before STP.

After STP the obtained co-efficient of correlation value is r=0.388

at **P<0.01 level there was statistically significant correlation of

the nursing personnel’s knowledge and practice After Structure

Teaching Programme. It showed increase in level of knowledge

have increased the level of practice. Hence the hypothesis H5

was accepted.

� The obtained co-efficient of correlation value is r=0.509 and r=0.3

significant at **P<0.01 and *p< 0.05 .Before and after Structure

Teaching Programme respectively. This commends a positive co-

relation both before and after Structure Teaching Programme

levels of knowledge and attitude, which confirmed that an

increase in the levels of knowledge have increased in the levels of

attitude. Hence the hypothesis H5 was accepted.

� The obtained co-efficient of correlation value is r=0.726 and

r=0.786 significant at **P<0.01 and *p< 0.05 before and after

143

Structure Teaching Programme respectively, commended a

positive co- relation before and after Structure Teaching

Programme levels of practice and attitude, which confirmed an

increase in the levels of practice have increased in the level of

attitude. Hence the hypothesis H5 was accepted.

CONCLUSION

1. The present study concluded that structured teaching programme

was an effective mode to create awareness among nursing

personnel.

2. The study concluded that Structure Teaching Programme helps to

improve the knowledge, attitude and practice of nursing personnel on

biomedical waste management.

3. Overall study conclusions: Nursing personnel improved their

knowledge, practice and attitude after Structure Teaching

Programme.

4. Statistically there is a significant association between the knowledge,

attitude and practice of nursing personnel with their selected

demographic variables.

5. Statistically there is a significant correlation between knowledge,

practice and attitude of nursing personnel regarding biomedical

waste management before and after STP.

The investigator having analyzed the data has come to the

conclusion that the knowledge of Nursing personnel had more influence

144

on their attitude and practice. This is a significant finding that the health

care institutes should organize in-service education and orientation

programme regarding Bio medical waste management which will enable

the safe and effective practice of Bio medical waste management,

among nursing personnel

IMPLICATIONS

The investigator has drawn the following implications from the

studies which are the vital concern for nursing practice, nursing

administration, nursing education and recommendations for nursing

research.

NURSING EDUCATION

The nurse educator re-orients the nursing and Para medical

curriculum incorporating Bio-medical waste management in curriculum.

She can introduce ecology, ecological balance and conservation of

nature in curriculum. The nurse should actively and periodically organize

continuing education programme on Bio-medical waste management

through training programmes, conference, workshops, demonstrations,

seminars and symposiums to the health care providers of the Health

care delivery system (HCDS) and update their knowledge and practice.

145

NURSING PRACTICE

Community health nurse should be equipped with the knowledge

on Bio medical waste management, inform, educate, communicate and

motivate on first level health care providers on Bio medical waste

management to bring about a change. Health centres in the grass root

level should enforce standards for disposal of bio medical waste as

compulsion. Health care settings should conduct orientation programme

to all the employees with respect to bio medical waste management.

NURSING ADMINISTRATION

As an administrator the community health nurse should be

instrumental in effecting policy making at state and national level and

chalk out relevant programme aiming at popularizing the bio medical

waste management policy. The nurse administrator should secure a

higher inter sectoral co ordination and involve the related departments in

waste management communities and can affect legislation in this

regard. She can coordinate with the population control board and

ministry of environment and forest in providing suggestions to maintain

the ecology.

NURSING RESEARCH

The nursing profession is increasingly in the development of

scientific knowledge relating to its practice. Research becoming a major

146

force in nursing and is being used to change practice, education and

policy. The budding investigators should conduct similar studies on a

large scale. In depth study on biomedical waste management should be

pursued. Extensive approaches should be implemented in this area to

identify several more effective method of education, this study be a base

line for further studies to build upon.

LIMITATIONS

1. The researcher could have conducted the study on large section

of health care providers this could not be done due to limitations

2. The study was limited to female nursing personnel who were

working in selected PHC’s.

3. The study was limited to the nursing personnel who were studied

either ANM GNM B.Sc Nursing or Post B.Sc Nursing.

4. The study was limited to the nursing personnel who were willing to

participate in the study.

RECOMMENDATIONS

• A study can be on conducted on larger samples.

• A follow up study can be conducted among all categories of health

personnel (medical and Para medical) in different settings.

• A similar study could be conducted in public sector and private

sector setting.

147

• A similar study could be conducted on sample with different

demographic variables.

• A similar study can be conducted as a retrospective study among

health care providers who had adopted bio medical waste

management policy at their work place regarding their practice.

• A comparative study can be conducted with different groups of

personnel.

• A similar study can be conducted in large number of samples to

generalize the findings.

• A study can be conducted to identify the problems faced while

practicing bio medical waste management.

• A similar study can be conducted by using incense and

observation check list by using interview and observation checklist

as instruments for data collection.

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148

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http://www.igcm.org.in/test.asp?.2010/35/2/369/66871. 35(2),369

41. Moritz J.M., (1995. June 30)“Current legislation governing clinical

waste disposal”., Journal of Hospital Infection., Vol-30., 521-30.

42. Nadhi Jindal; (2006 Feb) “HCV in health care workers” Indian

Journal of medicine; Vol-123,; 79 – 180.

43. Parul Singhal (2015) knowledge, attitude, and practices regarding

biomedical waste management among the health-care workers,

International Journal of Medical Science and Public Health, 4(11):

1540-1544.

154

44. Puranik DS (2013 1 jan- April) “Biomedical waste management and

health care providers”, International Journal of Medicine and

Biomedical Research, Bangalore Volume 2 Issue, 28-25

45. Rahman, Ahmed & Ullah. ”A study on hospital waste management in

Dhaka city”., Hospital sanitation in Bangladesh; Procedure of 12th

Int. conf. on solid waste management.

46. Ritu Singh (2002 Dec)“The role of an information booklet on

Biomedical waste management for nurses”., The Nursing Journal of

India., Vol. LXXXXIII., No.12.,., 271 – 72.

47. Roopali., (1989 Sep)“Management of infections waste by U.S.

Hospitals”., JAMA., Vol-262., No 12, 22-29.

48. Sagar Borker (2013), “Knowledge, attitude and practice about bio-

medical waste management among personnel”, US National Library

of Medicine enlisted journal, 6(4 ): 3 76 -3 8 0.

49. Saini S, Nagarajan SS, Sarma R K, (2005) Knowledge attitude and

practices of biomedical waste management amongst staffs of a

tertiary level hospital in India, Journal of the Academy of Hospital

administration, ,vol 17,No2,1.

50. Shalini Sunderam (2015) knowledge and practice regarding

biomedical waste management, Indian Journal of community health,

publication of Indian Association of preventive and social medicine

Vol 27, No 1

155

51. Shamsundar., “Knowledge, Attitude, and Practice of Universal

precautions and Occupational Safety among nursing professionals

in tertiary centers in Bangalore”., Indian society of hospital waste

management.,Vol-15.,No-1., 27-30

52. Shantanu Tyagi (2016) Knowledge, attitude and practices of

biomedical waste management among health care personnel,

International Journal of Community Medicine and Public Health,

3(1): 309-313.

53. Sharma V., Sharma A. (1993. Jan.), “A study of disposal of hospital

waste in a rural teaching hospital”., Journal of Academic Hospital

Administration., Vol 5., No 1., 43 – 46.

54. Studmicki J., (1992) “The management of hospital medical waste.

How to increase efficiency through a medical waste audit”., Hospital

top., Vol – 70., No 2.,., 11-20.

55. Suwanne. (2002), “Study on waste from hospital and clinics in

Phitsanulok”., Journal of Health and Allied Services., 1(3).,.

56. Swathi (2006 Nov) on a waste., “taking care of waste”., Nightingale

Nursing times;Vol.2.,No 8.., 24-26.

57. Vasantha Kalyani (2016) Bio Medical Waste Management,

International Journal of Recent Scientific Research, Vol. 7, Issue, 6,

12217-12219

58. Veena S.R., (2003 Dec) “child programme on hazards of plastic

waste and its safe disposal” health action Vol.16,No.12,Pp19-21.

156

59. Willson. P, Hassan G, Wani NA, Baba A, Kadri S M, Khan Nazir M

S; SHMS Hospital Srinagar,J K Practitioner (2007) Awareness of bio

medical waste management amongst staffs of government;

14(1);60-61.

REPORTS

60. International symposium in Karachi. (2001, Oct.). Need for

integrated efforts, with the communities involvement, for solid waste

management in cities and towns.,

61. Safe disposal of clinic waste, (1992). Health Services Advisory

Committee., HSE., UK.,

62. The hospital in rural and urban districts.,( 1992) WHO., Geneva.,.

63. WHO’s (1998).suggested Gurdug principles and practices for the

sound management of hazardous hospital wastes.,

64. World Health Organization., (1994). Managing Medical Waste in

developing countries.,

65. World Health Organization., (1999). Safe Management of waste

from health care activities., Geneva.,

66. World health organization (2016).BMWM rules 2016,Vikas pedia in

energy &environment .Geneva.

67. Environmental protection agency (2015 June) EPA Collaboration

with Europe, Washington DC.

157

68. Clifton RD(1985-2004) workbook for designing ,implementing for

evaluating a sharp injury prevention policy Atlanta USA.

NEWSPAPER

69. Karthik Subramanian., (2004, June 11th). “Stray feeding on

biomedical waste at Kodumgaiyur dumping ground”., The Hindu.

70. Karthik Subramanian., (2004 June 9th). “The Hindu, Hospitals

dumping body parts in dust bin”., The Hindu.

71. Ramya Kannan., (2004 June 11th).. “Private hospitals doing better in

bio waste management”., The Hindu.

72. Reena Martins., (1999 Oct. 13). “Despite guidelines city hospitals

dump waste in bins”., The Times of India., Mumbai.

WEBSITES:

1. http://www.who.int/immunization safety safe injections/en/

2. http://www.healthcarewaste.org/

3. http://www. who. Int/ water sanitation health/ medical waste

4. http://www. Solution exchange- un. Net.in/ environment

5. http://www who.int/water sanitation health/medical waste

6. http,//pubmedd.com

7. www.google.co.in

8. http.//kspcb.kar.nic.

9. http.//www.enviorment.gov.pk.

10. www.nic.in/ministry of environment and forest.

ANNEXURES

158

Annexure I

Letter seeking permission to conduct study in Karimnagar District,

Andhra Pradesh.

From, Dr.T.M.Krishnavenu, Research Guide, Bangalore.

To, The DM & HO, Karimnagar District, Andhra Pradesh. Sir,

Sub:-Permission for conducting study.

This is to introduce Mrs. DEVI BUELA JANET Ph D., scholar,

Vinayaka Missions Research Foundation, Salem who is conducting a

Research project in partial fulfilment of year PhD programme. She has

chosen the topic.

“A study to assess of effectiveness of structured teaching

program on knowledge, attitude and practice towards Bio-Medical

waste management among nursing personnel in selected primary

health centres of Karimnagar (Dist), Andhra Pradesh”.

Kindly give her permission to conduct research project in your

area,

Thanking you,

Your Sincerely,

159

Annexure II

Letter granting permission to conduct study in Karimnagar Dist.

From, The Dist Medical & Health Officer Karimnagar. A.P. To, DR. T. M. Krishnaveni Research Guide, Bangalore.

Sir,

Sub: - Permission to conduct Research Project.

Ref:- Your letter dt july 2009

Mrs. DEVI BUELAJANET Ph.D. Scholar of Vinayaka Missions’

research foundation, Salem is permitted to conduct her Research project

at selected primary health centre of Karimnagar District. Andhra

Pradesh.

Sd /-

Medical Officer,

Karimnagar.

160

Annexure III

District Medical and Health office, Ethical Committee Approval Letter

Date:12/07/2009

To

Mrs.DEVI BUELA JANET, H.No. 2-10-1144/1145 (New), Jyothi Nagar, Karimnagar Telangana. Ref : A study to assess of effectiveness of structured teaching program on knowledge, attitude and practice towards Bio-Medical waste management among nursing personnel in selected primary health centres of Karimnagar (Dist), Andhra Pradesh. Dear Prof.Devi Buela Janet We have received from you following study related documents. a. protocol b. research tool c. structured teaching programme d. informed consent form in English e. superintendent permission letter f. content validity At the ethics committee meeting held on 15/07/2009,your reference letter and above mentioned documents were examined and discussed after due consideration ,the study related documents were approved in their presented form ,and the committee has decided approve the conduct of the aforementioned study under your guides direction . The members who attended the meeting at which your trail proposal was discussed are S.NO. Name of the member Designation Gender

1 Dr. subhadra Chairperson Female 2 Dr.alem Member Male 3 Dr.surendranath sai Member Male 4 Dr.M.L.N. reddy Member Male 5 Dr.shyam sundhar Member Male

161

I am in need of your esteemed help and co-operation .i shall be

pleased to you if you kindly grant me permission to carry on the foresaid

activity in your esteemed organization and help me in this regard.

You are required to submit a report to the Ethics committee at the

completion of the project.

Thanking you.

Yours sincerely

162

Annexure IV

Letter to experts for their opinion on content validity.

From, Mrs.DEVI BUELA JANET, H.No. 2-10-1144/1145 (New), Jyothi Nagar, Karimnagar. To, Respected Sir/Madam,

Sub: - Requesting letter to gather opinion & suggestions of experts

for content validity of Research tool.

I, Mrs. DEVI BUELA JANET, PhD scholar in Vinayaka missions

Research foundation Salem, I have selected the topic for the research

project to be submitted to Vinayaka Missions RFS as a partial fulfilment

of university requirement for PhD .

Topic: - “A Study to assess the effectiveness, of structured

teaching programme on knowledge, Attitude and practice towards

Bio–medical waste management among nursing personnel in

selected primary Health centres of Karimnagar district, A.P.”

On this behalf, I have developed a structured interview schedule

which is organized in the following headings.

Part- I: Demographic data

Part-II: Assessment of knowledge of Nursing Personnel on Bi-Medical

Waste Management.

Part-III: Assessment of attitude of Nursing Personnel on Bio-medical

waste management.

163

Part-IV: Assessment of Practice Nursing Personnel on Bio-Medical

Waste management.

I request you to go through the content and validate in terms of

relevance and accuracy, I also request you to give valuable suggestion

and modification and issue validity certificate.

Thanking You,

Yours faithfully

Mrs. DEVI BUELA JANET,

ENCLOSURES:

1. Self addressed stamped envelope.

2. Statement and objectives

3. Tool

4. Validity certificate.

164

Annexure V

List of Experts Consulted for Content Validity

1. Dr. Prof. K. Lalitha, M.Sc (N) Ph. D

Asst. Professor,

Department of Nursing,

NIMHANS

Bangalore – 560029

2. Dr. K. Raja Lakshmi, M.Sc (N) Ph. D

Principal,

MIOT College of nursing,

Chennai.

3. Dr. Nagarajaiah, M.Sc (N) Ph. D

Asst. Professor

NIMHANS

Bangalore.

4. Dr. Kasthuri, M.Sc (N) Ph. D

Oxford college of Nursing

Bangalore

5. Dr. Surendranath Sai, (Surgeon)

District Training (DTT) team

Civil hospital campus,

Karimnagar.

165

6. Dr.M.L.N.Reddy (Surgeon

T.H.W.

Civil Hospital Campus,

Karimnagar.

7. Dr.T.M.krishnaveni.

Director of Nursing

Mallige College of nursing section III

HMT layout, Bangalore.

8. Dr.B.S.Shakunthala

Dean

AE & CS Maruthi CON

Bangalore.

9.Dr.Yogesh.S.N.

Director

Sky institute of occupational health safety &environment

Bangalore

10.Dr.A.V.Raman

Director of nursing education and research

Westfort CON

Thrissur,

Kerala.

11. Dr. Shyam Sunder, M.D

Asst. Professor

Dept of Pathology

Prathima Institute of Medical Sciences

Karimnagar.

166

12. Dr. S. Porselvan, Ph.D

Professor HOD

Department of Statistics

Rama Chandra Medical College and Hospital

Porur,

Chennai 600011

167

ANNEXURE VI Description of Items

S.NO DOMAIN KNOWLEDGE ATTITUDE PRACTICE

1

Types of

Bio-Medical

Waste

1,2,3,4,5,6,7,8,9,10 Jan-13

0 (10 Items) (2 Items)

2

Hazards of

Bio-Medical

Waste

1,2,3,4,5,6,7,8,9,10 10,11,16,17 0

(10 Items) (4 Items)

3

Segregation

of Bio-

Medical

Waste

1,2,3,4,5,6,7,8,9,10 3,4,5,19,18,14,15 1,2,3,4,5,6,7,8,9,10,15

(10 Items) (7 Items) (11 Items)

4

Treatment

of Bio-

Medical

Waste

1,2,3,4,5,6,7,8,9,10 2,6,7,8,9,12,20 11,12,13,14,16,17,18,19,20

(10 Items) (7 Items) (9 Items)

5 TOTAL 40 20 20

168

ANNEXURE VII

DATA COLLECTION SCHEDULE

Sl.

No.

No. of

samples Before- test Time STP After test

1 5 15.12.2009 8a.m to 5 p. m 16.12.09 23.12.09

2 5 16.12.2009 8a.m to 5 p. m 17.12.09 24.12.09

3 5 17.12.2009 8a.m to 5 p. m 18.12.09 26.12.09

4 5 18.12.2009 8a.m to 5 p. m 19.12.09 28.12.09

5 5 19.12.2009 8a.m to 5 p. m 21.12.09 29.12.09

6 5 21.12.2009 8a.m to 5 p. m 21.12.09 30.12.09

7 5 21.12.2009 8a.m to 5 p. m 22.12.09 2.1.10

8 5 22.12.2009 8a.m to 5 p. m 23.12.09 4.1.10

9 5 23.12.2009 8a.m to 5 p. m 24.12.09 5.1.10

10 5 24.12.2009 8a.m to 5 p. m 26.12.09 6.1.10

11 5 26.12.2009 8a.m to 5 p. m 28.12.09 7.1.10

12 5 28.12.2009 8a.m to 5 p. m 29.12.09 8.1.10

13 5 29.12.2009 8a.m to 5 p. m 30.12.09 9.1.10

14 5 30.12.2009 8a.m to 5 p. m 31.12.09 11.1.10

15 5 31.12.2009 8a.m to 5 p. m 2.1.10 12.1.10

16 5 2.1.2010 8a.m to 5 p. m 4.1.10 13.1.10

17 5 4.1. 2010 8a.m to 5 p. m 5.1.10 14.1.10

18 5 5.1. 2010 8a.m to 5 p. m 6.1.10 15.1.10

19 5 6.1. 2010 8a.m to 5 p. m 7.1.10 16.1.10

20 5 7.1. 2010 8a.m to 5 p. m 8.1.10 18.1.10

21 5 8.1. 2010 8a.m to 5 p. m 9.1.10 19.1.10

22 5 9.1. 2010 8a.m to 5 p. m 11.1.10 20.1.10

23 5 11.1. 2010 8a.m to 5 p. m 12.1.10 21.1.10

24 5 12.1. 2010 8a.m to 5 p. m 13.1.10 22.1.10

25 5 13.1. 2010 8a.m to 5 p. m 14.1.10 23.1.10

169

Sl.

No.

No. of

samples Before- test Time STP After test

26 5 14.1. 2010 8a.m to 5 p. m 15.1.10 24.1.10

27 5 15.1. 2010 8a.m to 5 p. m 16.1.10 25.1.10

28 5 16.1. 2010 8a.m to 5 p. m 18.1.10 26.1.10

29 5 18.1. 2010 8a.m to 5 p. m 19.1.10 27.1.10

30 5 19.1.2010 8a.m to 5 p. m 20.1.10 28.1.10

31 5 20.1. 2010 8a.m to 5 p. m 21.1.10 29.1.10

32 5 21.1. 2010 8a.m to 5 p. m 22.1.10 30.1.10

33 5 22.1. 2010 8a.m to 5 p. m 23.1.10 31.1.10

34 5 23.1. 2010 8a.m to 5 p. m 25.1.10 1.2.10

35 5 25.1. 2010 8a.m to 5 p. m 26.1.10 2.2.10

36 5 26.1. 2010 8a.m to 5 p. m 27.1.10 3.2.10

37 5 27.1. 2010 8a.m to 5 p. m 28.1.10 4.2.10

38 5 28.1. 2010 8a.m to 5 p. m 29.1.10 5.2.10

39 5 29.1. 2010 8a.m to 5 p. m 30.1.10 6.2.10

40 5 30.1. 2010 8a.m to 5 p. m 31.1.10 7.2.10

41 5 31.1.2010 8a.m to 5 p. m 1.2.10 8.2.10

42 5 1.2. 2010 8a.m to 5 p. m 2.2.10 9.2.10

43 5 2.2. 2010 8a.m to 5 p. m 3.2.10 10.2.10

44 5 3.2. 2010 8a.m to 5 p. m 4.2.10 11.2.10

45 5 4.2. 2010 8a.m to 5 p. m 5.2.10 12.2.10

46 5 5.2. 2010 8a.m to 5 p. m 6.2.10 13.2.10

47 5 6.2. 2010 8a.m to 5 p. m 7.2.10 14.2.10

48 5 7.2. 2010 8a.m to 5 p. m 8.2.10 15.2.10

49 5 8.2. 2010 8a.m to 5 p. m 9.2.10 16.2.10

50 5 9.2. 2010 8a.m to 5 p. m 10.2.10 17.2.10

51 5 10.2. 2010 8a.m to 5 p. m 11.2.10 18.2.10

52 5 11.2. 2010 8a.m to 5 p. m 12.2.10 19.2.10

53 5 12.2. 2010 8a.m to 5 p. m 13.2.10 20.2.10

170

Sl.

No.

No. of

samples Before- test Time STP After test

54 5 13.2. 2010 8a.m to 5 p. m 14.2.10 21.2.10

55 5 14.2. 2010 8a.m to 5 p. m 15.2.10 22.2.10

56 5 15.2. 2010 8a.m to 5 p. m 16.2.10 23.2.10

57 5 16.2. 2010 8a.m to 5 p. m 17.2.10 24.2.10

58 5 17.2. 2010 8a.m to 5 p. m 18.2.10 25.2.10

59 5 18.2. 2010 8a.m to 5 p. m 19.2.10 26.2.10

60 5 19.2. 2010 8a.m to 5 p. m 20.2.10 27.2.10

171

ANNEXURE VIII

Evaluation Criteria checklist for Content Validity of Tool

OPINION OF EXPERTS REGARDING QUESTION OF TOOL

KNOWLEDGE ASPECTS

Q.No. Appropriate Not Appropriate Suggestions

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

172

Q.No. Appropriate Not Appropriate Suggestions

32 33 34 35 36 37 38 39 40

ATTITUDE ASPECTS

Q.No. Appropriate Not Appropriate Suggestions

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

173

PRACTICE ASPECTS

Q.No. Appropriate Not Appropriate Suggestions

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20

174

Annexure IX

Subjects informed consent form for participation in research study

Participation: You are being asked to participate in study regarding

topic on “Bio-medical waste management”.

Purpose: To evaluate the effectiveness of structured teaching

programme on knowledge, attitude and practice towards Bio-Medical

waste management among nursing personnel.

Selection: Selection will be based on inclusion and exclusion criteria.

Procedure: If you agree to participate the investigator will conduct

interview regarding knowledge, attitude and practice on biomedical

waste management. Then implementing structured teaching program

later at the 7 day interval you will be interviewed again.

Risk: There is no risk involved.

Benefits: The study will benefits you personally, as it can improve your

quality of care given to the client.

Cost: There is no cost to participate in this study.

175

Confidentiality: Your identity will be known only to the investigator and

information obtained will be published in thesis and may be published in

journals. But your identity will not be revealed.

Authorisation: I have read the above statements and I have

understand the purpose of the study and what is expected from me. I

Vimala.S agree to participate in this research. I understood that I may

refuse to participate and that I may withdraw from study. I have received

a copy of their consent form for my own prior to administration of

structured questionnaire on Biomedical waste management.

Signature of subject:

Signature of Investigator:

Date:

176

Annexure X

CERTIFICATE FOR ENGLISH EDITING

TO WHOM SO EVER IT MAY CONCERN

This is to certify that tool developed by Mrs. D. Buela Janet Ph.D.

scholar for her study “ A Study to assess the effectiveness of structure

teaching programme on knowledge ,attitude & practice towards Bio-

Medical waste management among Nursing personnel in selected

Primary Health Centres of Karimnagar (Dist.),Andhra Pradesh”, is edited

for the English language appropriateness by Mrs. Jyosthna

__________________

Signature

Date :

Place :

177

ANNEXURE - XI

Questionnaire to assess the Knowledge, Attitude and Practice on

Bio - Medical Waste Management.

PART I

DEMOGRAPHIC DATA

1 Age in years [ ] A < 20 B 21-30 C 31-40 D 41-50 E > 50 2 Marital status [ ] A Married B Unmarried C Widow D Divorce 3 Religion [ ] A Hindu B Christian C Muslim 4

Professional qualification

[ ]

A ANM B GNM C B. Sc(N) D PC B.SC (N) 5 present designation [ ]

A Multi Purpose health worker

B Health visitor C Staff nurse D

Public health nurse

Community health officer

178

6 Monthly income in Rupees

[ ]

A Less than or equal to 10000

B 10001-20000 C 20001-30000 D >30000 7 Years of experience [ ] A 1-5 years B 6-10 years C 11-15 years D >15 years 8 Have you attended in service education programme

on biomedical waste management? [ ]

A Yes B No 9 Awareness about biomedical waste management

through mass media. [ ]

A Mass media B Peer group C Family 10 Whether your primary health centre is following bio

medical waste management policy [ ]

A Yes B No

179

PART-II

SECTION-A

KNOWLEDGE QUESTIONNAIRE ON BO-MEDICAL WASTE

MANAGEMENT

1 The waste which is produced during the course of health care activities is called as. [ ]

A Domestic Waste

B Bio-Medical Waste

C Municipal Waste

2 The source of health care waste is. [ ] A Hospital & Health center

B Home

C Don’t know

3 The Bio-Medical waste includes [ ] A Risk waste

B Non-risk waste

C Both a & b

4 The waste that is included in the non-risk waste is [ ] A Paper & Packing

B Office waste

C Both a & b

5 The infectious waste which is produced in the hospitals & Primary health centers is.

[ ]

A Gases

B Blood & blood products

C Food residues

6 Waste suspected to contain pathogens is. [ ] A Chemical Waste

B Infectious waste

C Toxic Waste

7 The gaseous waste, liquids & solids, contained with radio nuclides are called?

[ ]

A Chemical Waste

B Infectious Waste

C Radioactive Waste

180

8 The waste such as infected needles, syringes & broken glass are called?

[ ]

A Pathological Waste

B Sharp Waste

C Non-risk Waste

9 Human anatomical waste includes. [ ] A Placenta

B Biopsy parts

C Both a & b

10 The other name for non-risk waste is? [ ] A General Waste

B Anatomical Waste

C Domestic Waste

SECTION-B

QUESTIONNAIRE TO ELICIT KNOWLEDGE ON HAZARDS OF

IMPROPER WASTE MANAGEMENT.

11 The main health hazards related to medical waste is [ ] A AIDS B Cancer C Skin infections 12 The hazard due to improper Bio-Medical Waste

Management is except [ ]

A Noise pollution B Land pollution C Air pollution 13 The hazard due to the improper disposal of sharps

causes [ ]

A Needle prick injury B Green stick injury C Thread stick injury 14 The rag pickers become susceptible to various diseases

due to the dumping of waste in to the [ ]

A Municipal bins B Pits C Kitchen garbage 15 Animals acquire infections through grazing on which

waste that is not properly disposed [ ]

A Infectious Waste B Chemical Waste C Both a & b

181

16 Poor infection control can lead to nosocomial infection in particularly in which disease.

[ ]

A HIV / Hepatitis B Peptic ulcer C Cancer 17 Intoxication either by acute (or) chronic exposures are

caused due to [ ]

A Chemical & Pharmaceutical waste B Kitchen waste C Anatomical waste 18 Health hazards caused from radioactive waste are [ ] A Headache B Dizziness / vomiting C Both a & b 19 The main groups exposed to hazardous health care

waste are [ ]

A Doctor / Nurses B IT Professionals C Business men 20 Health hazards related to health care waste can result

due to [ ]

A Careless management of bio waste B Exposure of Nursing Personnel C Improper handling of bio-waste

SECTION-C

QUESTIONNAIRE ON KNOWLEDGE OF BIO-MEDICAL WASTE

SEGREGATION

21 The progress separating waste at the point of generation is called

[ ]

a Waste reduction b Waste transportation c Waste segregation

22 According to universal precautions, which colour coding referred to disposal of solid and infectious waste

[ ]

a Red b Black c Yellow

182

23 Based on universal precautions, which colour coding indicates the disposal of plastic/rubber waste

[ ]

a Yellow b Red c Blue

24 Which colour coding indicates the non-hazardous hospital waste

[ ]

a Yellow b Blue c Black

25 Which container is used to dispose sharps? [ ] a Puncture proof transparent container b Black colored container c Rexene container

26 The advantage of waste segregation is except [ ] a Reduces cost b Protects the health personnel c Time consuming

27 Waste segregation should be done [ ] a During final disposal b During transportation c At the point of generation

28 Based on the universal precautions color coding indicates disposal of radioactive waste.

[ ]

a Blue b Green c Red

29 Based on the universal precautions which color coding is indicates disposal of Chemical waste.

[ ]

a Red b White c Black

30 Based on the universal precautions color coding indicates disposal of Human Anatomical waste.

[ ]

a Yellow b Red c Blue

183

SECTION-D

QUESTIONNAIRE ON TREATMENT OF BIO-MEDICAL WASTE

31 The process that change the characters of hazardous into less-hazardous waste.

[ ]

A Waste treatment B Waste handling C Waste segregation 32 The method of treating human, anatomical waste is [ ]

a Incineration b Disinfections c Auto calving

33 Infectious waste should be disposed by [ ]

a Microwave b Deep burial c Incineration

34 The general waste is disposed finally by [ ]

a Municipal garbage b Microwave c Dustbin

35 Expired drugs are disposed in [ ]

a Incineration b Land fill c Dumping

36 The sharps are disposed finally after disinfections is [ ]

a Sharp pits b Land fill c Dumping

37 The technologies available for waste treatment and disposal are except

[ ]

a Fumigation b Incineration c Autoclave d Don’t know

38 The final disposal of Health Care waste is [ ]

a Sanitary landfill b Open dumping c Draining in to sea

39 The recyclable waste material is [ ]

a Paper and card board b Soiled dressings c Outdated medication

184

40 The type of waste which should not be incinerated is [ ]

a Sealed ampoules

b Needles

C Soiled dressings

185

TOOL-II

LIKERT SCALE TO ASSESS THE ATTITUDE OF NURSING PERSONNEL

ON BIO-MEDICAL WASTE MANAGEMENT

Sl. No ITEMS SA A UD DA SDA

1 I Strongly believe that all the contents in the waste bin should not be emptied daily.

2 Some of the Bio-Medical waste are recycled

3 I feel that colour coding must be emphasized in all health care institution for waste segregation

4 I Prefer to wear protective device while handling infectious waste

5 I favour the practice of waste collection, segregation and disposal of waste

6 I personally feel that all the nursing personal should undergo training in waste management

7 I believe the treatment of bio medical waste will Prevents the transmission of infectious diseases

8 I strongly believe that all primary health centres must follow bio medical waste management policy

9 I will always discuss about the importance of waste management with other healthcare providers

10 I favour the bio medical waste management as it is an effective method to Prevent hazards to the community

11 I feel that all bio medical waste are hazardous

12 I strongly feel that all the nursing personal are not aware of bio medical waste management policy

13 I believe that all bio medical waste should be mixed

14 I don't think that hospital and primary health centre must supply adequate protective devises to the nursing personal

15 sealing of waste bin is not necessary before transportation

16 I think that all categories of hospital waste should not be segregated before disposal

17 I don’t think that waste management will successfully Prevents health hazards

18 All bio medical waste are only incinerated

19 I don’t think that bio medical waste must be transported by covered containers

20 Training is not necessary for nursing personal about bio medical waste management.

5 4 3 2 1 SA- Strongly Agree

A- Agree

UD- Undecided

DA- Disagree

SDA- Strongly Disagree

186

TOOL-III OBSERVATION RATING SCALE TO ASSESS THE PRACTICE OF NURSING

PERSONNEL ON BIO-MEDICAL WASTE MANAGEMENT

Sl. No Items 5 4 3 2 1

1 Segregates different categories of waste at the point of generation.

2 Does not mix infectious waste with the non - infectious waste.

3 The Human Anatomical waste such as placenta, uterus etc, are disposed in yellow bag

4 Infectious waste such as dressings, cotton napkins are disposed in red bag.

5 Disposes plastic objects such as folly’s catheter, urine bags etc in blue bag.

6 Disposes rubber, article like catheter and gloves in blue bag

7 Disposes sharp instruments like needle in blue bag.

8 Disposes plastic & rubber items after destroying & disinfecting them

9 Identifies different colour coding system and disposes appropriately

10 Ensures the change of bags when it is 3/4th full to Prevent risk of spillage

11 Ensures the use of Incinerator as a method of treating human anatomical waste.

12 Ensures the use of Autoclaving as a method to disinfect plastic & rubber articles

13 Takes adequate Precaution when disposing the waste.

14 Destroys sharp instruments before final disposal to avoid re use

15 Takes adequate Precaution so that general waste are not mixed with Infectious Bio - Medical waste.

16 Makes visits to oversee proper procedure of waste management by cleaning staff.

17 Constantly monitors the methods of pre- treatment. Treatment of waste transportation of waste on and off site.

18 Ensures accident reporting while handling (or) during transportation of the waste

19 Makes arrangement to train all the health care providers in Bio- Medical waste management.

20 Reports directly regarding final disposal of waste to the department of Environment (or) office of commissioner

5 All the time/consistently 4 Most of the time 3 Occasionally 2 Now & then / less times 1 Never

187

ANNEXURE - XII

ANSWER KEY

Sl. No Key Answer Score 1 B 1 2 C 1 3 B 1 4 C 1 5 A 1 6 B 1 7 C 1 8 B 1 9 C 1 10 A 1 11 A 1 12 C 1 13 B 1 14 A 1 15 C 1 16 B 1 17 c 1 18 c 1 19 a 1 20 b 1 21 c 1 22 a 1 23 c 1 24 b 1 25 a 1 26 b 1 27 c 1 28 b 1 29 a 1 30 c 1 31 a 1 32 c 1 33 c 1 34 a 1 35 c 1 36 b 1 37 a 1 38 c 1 39 c 1 40 b 1

188

Annexure XIII

Certification of Content Validity

This is to certify that Mrs. DEVI BUELA JANET PhD scholar in

Vinayaka Mission University, Salem has been sent the research tools of

her study titled “A Study to assess the effectiveness of structural

teaching programme on knowledge, attitude & practice towards Bio-

Medical waste management among Nursing personnel in selected

Primary Health Centres of Karimnagar (Dist.), Andhra Pradesh”, for

content validity is found relevant.

Place: Signature of the Expert

Date:

Address:

189

Annexure XIV

STRUCTURED TEACHING PROGRAMME

INTRODUCTION

Good Morning,

I am Mrs. Devi Buela Janet, Ph.D. scholar conducting A Study to

assess the effectiveness of structural teaching programme on

knowledge, attitude & practice towards Bio-Medical waste management

among Nursing personnel. I request you to participate in this study by

giving your valuable answers to the questions being asked.

Your responses will be kept confidential and be used only for the

stated purpose.

D. Buela Janet

190

STRUCTURED TEACHING PROGRAMME

Topic: Biomedical waste management

Group: Nursing Personnel

Places: DM&HO hall of Karimnagar District..

Duration: 60 minutes

Method of teaching: Lecture cum demonstration

AV aids: Flash cards, Black board, pamphlet, Leaflet, Transparencies

and posters and LCD.

General objective: The nurses in selected hospitals will be able to

acquire knowledge attitude and practice about biomedical waste

management and able to implement the correct practices in their

working area.

Specific objectives:

The nurses will be able to

1. define Bio Medical Waste

2. explain the sources of Bio Medical Waste

3. classify types of Bio Medical Waste

4. list the hazards of improper Waste Management

5. identify the methods of segregation of Bio Medical Waste

6. discuss the modes of treating Bio Medical Waste

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tives

3

Min

T

o in

tro

du

ce

the

top

ic o

n

BM

WM

INT

RO

DU

CT

IO

He

alth

c

nu

rse

s an

d t

h

the

gu

ard

ian

s

He

alth

care

is

hea

lthca

re

ser

spe

cific

ally

infr

ast

ruct

ure

a

of

‘hea

lth c

are

’

pro

ble

ms

of

the

he

lpin

g t

he

pa

the

du

ty o

f th

e

to e

nsu

re s

pee

ma

inta

inin

g

en

viro

nm

ents

.

19

1

C

on

ten

t T

eac

he

r’s

Le

arn

er’

s

Ac

tivit

y

UC

TIO

N

ea

lthca

re p

ers

onn

el

incl

ud

ing

do

cto

rs,

nd t

he p

ara

me

dic

al

sta

ff,

wh

o w

ill b

e

dia

ns

of

the

hea

lth o

f th

e c

om

mu

nity

,

re

is

hig

hly

cr

itica

l a

nd

ess

en

tial

re

serv

ice

, e

xtra

a

tten

tion

is

ne

ede

d

lly

to

the

issu

es

con

cern

ing

ture

an

d tr

ain

ing

. T

he

wh

ole

co

nce

pt

ca

re’ i

s p

ayin

g a

tten

tion

to

the

min

ute

of t

he

pa

tien

t, n

urs

ing

, co

mfo

rtin

g a

nd

he p

atie

nt

till

he

/sh

e i

s w

ell

aga

in.

It is

of

the

en

tire

hea

lthca

re e

sta

blis

hm

ent

spe

ed

y re

cove

ry o

f th

eir

patie

nt’s

by

ing

cl

ean

an

d

infe

ctio

n fr

ee

en

ts.

Intr

odu

ces

the

top

ic

to n

urs

es

Th

e

tea

che

r

exp

lain

s

Nu

rse

s

are

liste

nin

g

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

Bla

ck b

oa

rd

En

um

era

te

the

con

cep

t of

he

alth

19

2

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

W

hile

ba

sic

san

itatio

n an

d

clea

nlin

ess

ha

ve a

lwa

ys b

een

ma

nda

tory

re

qu

irem

en

ts i

n

hea

lthca

re

est

ab

lish

men

ts,

the

re

are

o

the

r

issu

es

such

as

bio

me

dic

al

wa

ste

wh

ich

is o

ften

ign

ore

d t

hat

it ca

n b

e d

irect

ly r

esp

on

sib

le f

or

the

spre

ad

of

dis

ea

ses

in

the

g

ene

ral

com

mun

ity a

nd

sp

ecifi

cally

am

on

g h

ealth

ca

re

pe

rson

s.

Th

e m

inis

try

of

envi

ron

men

t a

nd f

ore

sts,

Go

vern

men

t o

f In

dia

ha

s is

sued

a n

otif

ica

tion

on

b

iom

edic

al

wa

ste

(m

anag

em

en

t a

nd

han

dlin

g)

Ru

les

in 1

99

8.

Th

ese

ru

les

de

fine

the

du

ties

and

re

spon

sib

ilitie

s o

f in

stitu

tion

s

gen

era

ting

bio

med

ica

l wa

ste

. Im

ple

men

tatio

n o

f

en

viro

nm

enta

l la

ws

is n

ot

the

re

spon

sib

ility

of

19

3

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

go

vern

men

t a

lon

e,

bu

t a

ctiv

e

part

icip

atio

n

of

citiz

en

s is

ess

entia

l. T

he

re i

s a

lso

a n

ee

d to

cre

ate

aw

are

ne

ss a

mo

ngst

pe

ople

eng

age

d i

n

ho

spita

l w

ork

a

nd

h

ealth

ca

re

asp

ect

s a

nd

edu

cate

th

em

. It

will

b

e

ap

t if

regu

lar

pro

gra

mm

e

will

b

e

und

ert

ake

n

by

any

inst

itutio

ns

ge

nera

ting

an

d h

an

dlin

g b

iom

ed

ica

l

wa

ste

fo

r h

ea

lth c

are

pe

rso

nne

l ass

oci

ate

d w

ith

act

ual h

and

ling

of t

he w

ast

e.

2 M

in

De

fine

bio

me

dic

al

wa

ste

?

De

fin

e B

io m

ed

ica

l w

as

te:

Bio

me

dic

al

wa

ste

is,

“a

ny

wa

ste

, w

hic

h

is

ge

ne

rate

d

durin

g d

iagn

osi

s,

tre

atm

ent

or

imm

un

iza

tion

of h

um

an

be

ing

s o

r an

ima

ls.”

He

alth

ca

re

wa

ste

is

e

xtre

me

ly

ha

zard

ou

s if

it is

no

t m

an

age

d p

rop

erly

, it

can

Te

ach

er

de

finin

g

Nu

rse

s

are

taki

ng

no

tes

Tra

nsp

are

ncy

Wha

t is

bio

med

ica

l

wa

ste

?

19

4

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

lea

d

to

serio

us

hea

lth

an

d

en

viro

nme

nta

l

pro

ble

ms.

H

ealth

care

w

ast

e

is

diff

ere

nt

fro

m

ou

r d

om

est

ic w

ast

e a

nd m

ust

be

seg

reg

ate

d,

colle

cte

d,

sto

red

, tr

an

spo

rted

a

nd

dis

po

sed

pro

perly

. C

han

ces

of

vect

ors

lik

e

cats

, ra

ts,

mo

squ

itoe

s,

flie

s a

nd

stra

y d

og

s g

etti

ng

infe

cted

a

nd

be

com

ing

ca

rrie

rs

wh

ich

a

lso

spre

ad d

ise

ase

s in

the

co

mm

unity

.

5 M

in

To

exp

lain

the

so

urc

es

of b

io

me

dic

al

wa

ste

SO

UR

CE

S O

F B

IO-M

ED

ICA

L W

AS

TE

So

urc

es

of

bio

me

dic

al

wa

ste

a

re

dis

cuss

ed

he

re b

ase

d o

n in

stitu

tion

:

1.

Ho

sp

ita

l a

nd

h

ea

lth

ca

re c

en

ters

– G

ovt

ho

spita

ls –

urb

an h

osp

itals

/dis

pen

sarie

s, r

ura

l

hea

lth c

ente

rs,

PH

Cs

CH

Cs

- P

riva

te h

osp

itals

and

nu

rsin

g h

om

es.

-

Va

ccin

atin

g c

ente

rs.

Te

ach

er

exp

lain

ing

N

urs

es

are

rece

ptiv

e

Wha

t are

the

sou

rce

s o

f bio

me

dic

al

wa

ste

?

19

5

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

2. C

lin

ics

/Off

ices

:

� P

riva

te n

urs

ing

ho

me

s.

� P

hys

icia

n’s

clin

ics

� D

en

tal c

linic

s

� S

pe

cia

l clin

ics

(AN

C, P

NC

, ch

ild c

linic

s,

� S

TD

s cl

inic

, RC

H c

linic

s e

tc)

3.

Me

dic

al

res

ea

rch

ce

nte

rs

an

d

lab

ora

tori

es

:

� M

ed

ica

l re

sea

rch

an

d tr

ain

ing

est

ablis

hm

en

ts.

� R

ese

arc

h o

rga

niz

atio

ns.

� D

iagn

ost

ic la

bora

torie

s (p

ath

olo

gy,

mic

rob

iolo

gy)

4.

An

ima

l’s

in

sti

tuti

on

s:

� A

nim

al h

ouse

s.

� V

ete

rina

ry in

stitu

tes.

19

6

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

� S

laug

hte

r ho

use

s.

5.

Blo

od

b

an

ks

a

nd

c

ollec

tio

n

ce

nte

rs/d

on

ati

on

cam

ps

.

6.

Bio

-te

ch

no

log

ica

l in

sti

tute

s

an

d

pro

du

cti

on

un

its

.

7.

Bio

me

dic

al

wa

ste

ca

n a

lso

be g

en

era

ted

at

ho

me

, if

h

ea

lth

ca

re i

s b

ein

g p

rov

ide

d

the

re t

o a

pa

tie

nt.

WH

O

ha

s cl

ass

ifie

d

wa

ste

s g

ene

rate

d

in

ho

spita

ls in

to t

he f

ollo

win

g t

ype

s:

10

Min

T

o c

lass

ify

typ

es

of

wa

ste

?

Typ

es

of

Was

te

Ge

nera

l w

as

te

A

ltho

ugh

the

re

is

so

mu

ch

haza

rd

fro

m

ho

spita

l w

ast

e,

65

-70

pe

r ce

nt

of

the

wa

ste

gen

era

ted

in

a h

osp

ital

is n

on i

nfe

ctio

us

and

non

-ha

zard

ou

s. T

he

se a

re g

ene

ral

wa

ste

and

Te

ach

er

is

cla

ssify

ing

Nu

rse

s

are

liste

nin

g

Mo

del

Wha

t are

typ

es

of

Bio

me

dic

al

wa

ste

?

19

7

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

can

be

ma

nag

ed

ea

sily

, if

seg

rega

ted

pro

perl

y

at s

ourc

e.

Ge

ne

ral

wa

ste

o

r no

n-r

isk

wa

ste

incl

ude

s ite

ms

like

pap

er,

ca

rdb

oard

b

oxe

s,

pla

stic

p

ack

ag

ing

, m

eta

l bo

xes

and

ki

tch

en

wa

ste

is a

lso

ano

the

r ki

nd

of g

ene

ral w

ast

e.

Ge

ne

rally

d

ry

wa

ste

ca

n

be

sold

fo

r

recy

clin

g w

hile

kitc

he

n w

ast

e c

an

be

co

mp

ose

d

at c

onve

nie

nt

site

insi

de

the

ho

spita

l.

Ge

nera

l wa

ste

th

oug

h e

asy

to

ha

nd

le,

nee

ds

to

be

man

age

d w

ith c

are

. It

mu

st b

e s

eg

reg

ate

d

fro

m in

fect

ed w

ast

e.

19

8

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

Infe

cti

ou

s w

as

te

“P

ort

ion

of

bio

me

dic

al

wa

ste

wh

ich

ma

y

tra

nsm

it vi

ral,

ba

cte

rial

or

para

sitic

dis

eas

es,

if

con

cen

tra

tion

a

nd

viru

len

ce

of

pa

thog

en

ic

org

anis

ms

is m

ore

”.

� T

his

ca

tego

ry i

ncl

ud

es

cultu

res

and

sto

cks,

blo

od

and

b

loo

d

pro

du

cts

of

infe

ctio

us

age

nts

fro

m la

bo

rato

ry w

ast

e f

rom

su

rge

ries

and

au

top

sie

s

� W

aste

s o

rig

ina

ting

fro

m i

nfe

ctio

us

pa

tien

ts

in is

ola

tion

wa

rds.

� W

aste

tha

t ha

s b

ee

n in

co

nta

ct w

ith in

fect

ed

pa

tien

ts u

nde

rgo

ing

he

m d

ialy

sis.

� W

aste

tha

t h

as

bee

n in

co

nta

ct w

ith a

nim

als

ino

cula

ted

with

an

infe

ctio

us

dis

ease

.

19

9

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

Pa

tho

log

ica

l w

as

te:

C

on

sist

s o

f tis

sue

s, o

rga

ns,

bo

dy

pa

rts,

hu

man

fe

tuse

s an

ima

l ca

rca

sse

s; a

nd m

ost

ly

blo

od a

nd b

od

y flu

ids.

Ap

art

fro

m t

he

infe

ctio

us

na

ture

of

this

wa

ste

, its

ap

pro

pria

te d

isp

osa

l is

req

uire

d o

n e

thic

al g

roun

ds.

Infe

cte

d p

las

tics

:

D

ispo

sab

le

item

s lik

e

syri

ng

es,

tu

bes,

glo

ves

etc

is

se

gre

ga

ted

in

red

lin

ers

,

au

tocl

ave

d

or

mic

row

ave

an

d

then

sh

redd

ed

and

wa

she

d b

efo

re d

isp

osa

l.

Su

ch

trea

tme

nt

pre

ven

ts

the

ir

valu

e a

nd

ren

ders

th

eir

re

use

a

nd

ren

de

rs

the

m

ste

rile

and

use

less

. It

is

ad

visa

ble

th

at

such

wa

ste

is

tre

ate

d a

t si

te t

o a

void

an

y ri

sk o

f re

pack

ing

20

0

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

and

re

use

. C

hlo

rina

ted

pla

stic

s sh

ould

ne

ver

be

inci

nera

ted

as

the

ir in

cin

era

tion

can

em

it d

ioxi

n,

fura

ns,

and

oth

er

hyd

roca

rbo

ns

in th

e a

ir.

Sh

arp

s:

S

ha

rps

are

th

e m

ost

d

ang

ero

us

com

pon

en

ts

of

hea

lthca

re

wa

ste

, w

hic

h

can

inju

re t

he

hea

lthca

re p

ers

onne

l an

d a

ll th

ose

com

ing

in

to

con

tact

w

ith

this

w

ast

e.

Sh

arp

item

s in

clud

e n

ee

dle

s, b

lad

e s

calp

el

and

me

tal

sha

rps,

bro

ken

an

d u

nb

roke

n g

lass

ma

teria

l.

Ch

em

ica

l w

as

te

T

he

h

osp

ital

ma

y g

ene

rate

ch

em

ical

wa

ste

lik

e d

isin

fect

ant,

in

sect

icid

es,

pe

stic

ide

s

etc

. fu

rth

erm

ore

, ch

em

ica

lly

con

tam

ina

ted

20

1

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

con

tain

ers

are

als

o g

ene

rate

d.

The

co

nta

ine

rs

sho

uld

b

e

cle

ane

d a

nd

mu

tila

te

but

ne

ver

reu

sed

or

recy

cle

d f

or

ma

king

con

tain

ers

, fo

r

sto

ring

sub

sta

nce

s, f

or

hum

an

an

d a

nim

al u

se.

Ra

dio

ac

tive

was

te:

R

ad

ioa

ctiv

e c

he

mic

al d

yes

and

iso

tope

s

of

vario

us

ele

me

nts

a

re

fre

que

ntly

u

sed

fo

r

dia

gno

sis

an

d t

rea

tme

nt.

Ra

dio

act

ive

wa

ste

is

the

refo

re g

ene

rate

d a

t th

e si

te o

f d

iag

nosi

s a

nd

tre

atm

en

t. R

ad

ioa

ctiv

e

wa

ste

m

ay

be

solid

,

liqu

id o

r ga

seou

s in

form

.

Mo

del

5 M

in

list t

he

ha

zard

s o

f

imp

rop

er

wa

ste

HA

ZA

RD

S

OF

IM

PR

OP

ER

W

AS

TE

MA

NA

GE

ME

NT

:

� T

he

ma

in r

isk

gro

up f

or

ha

zard

s o

f h

ealth

care

are

Do

cto

rs,

nur

ses

,oth

er

para

med

ica

l

Th

e

Te

ach

er

Exp

lain

s

Nu

rse

s

Ch

art

s

Wha

t are

the

ha

zard

s o

f

imp

rope

r

wa

ste

20

2

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

ma

nag

em

ent

pro

fess

iona

ls

� P

ricks

/ cu

ts

fro

m

sha

rps

like

ne

edle

s,

bla

des,

bro

ken

gla

sse

s, s

calp

els

etc

.

� I

nfe

ctio

ns

du

e t

o c

on

tact

with

pa

tien

ts,

the

ir

blo

od,

rela

ted

to

spu

tum

, U

rine

, st

oo

l a

nd

oth

er

bod

y flu

ids.

� A

llerg

ies

du

e to

d

ust,

smo

ke

fum

es

and

che

mic

als

.

� T

he

ma

in h

ea

lth h

aza

rd r

ela

ted

to m

ed

ica

l

wa

ste

is A

IDS

He

alt

hc

are

p

ers

on

ne

l a

nd

th

e

ge

nera

l

co

mm

un

ity f

ac

e h

aza

rds

fro

m:

� R

ad

ioa

ctiv

e

and

cy

toto

xic

me

dic

ine

s

gen

era

lly g

ive

n t

o c

an

cer

patie

nts

. T

hese

if

left

exp

ose

d c

an

ca

use

de

ath

or

dis

abili

ty t

o

an

yon

e.

are

liste

nin

g

ma

nag

em

ent?

20

3

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

� H

igh

ly in

fect

iou

s d

ise

ase

s w

hic

h c

an s

pre

ad

in t

he c

om

mu

nity

un

less

pro

per

pre

cau

tion

s

are

take

n.

� C

hro

nic

e

xpo

sure

to

ch

em

ica

l a

nd

pha

rma

ceu

tica

l wa

ste

ca

n c

ause

into

xica

tion

� D

ispo

sab

le i

tem

s th

at

can

be

re

pack

ed

and

reso

ld c

au

sin

g s

pre

ad o

f in

fect

ion

s.

� T

he

in

dis

crim

ina

te

du

mp

ing

o

f un

trea

ted

ho

spita

l w

ast

e

in

mu

nic

ipa

l b

in

incr

ea

sing

the

po

ssib

ility

of e

pid

em

ic.

� V

ect

ors

lik

e c

ats

, ra

ts,

mo

squ

itoe

s, f

lies

and

stra

y, D

ogs,

ge

ttin

g i

nfe

cted

and

be

com

ing

carr

iers

wh

ich

als

o s

pre

ad

dis

ea

ses

in

th

e

com

mun

ity.

� D

um

pin

g o

f ki

tche

n g

arb

ag

e w

hic

h c

au

ses

rag

pic

kers

to

be

com

e m

ore

su

sce

ptib

le t

o

20

4

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

vari

ous

dis

ea

ses.

5 M

in

id

en

tify

the

me

tho

ds

of

seg

reg

atio

n

of b

io

me

dic

al

wa

ste

SE

GR

EG

AT

ION

T

he

pro

cess

of

sepa

ratin

g w

ast

e a

t th

e

po

int

of

gene

ratio

n is

ca

lled

se

gre

gatio

n.

It

sho

uld

be

ca

rrie

d o

ut a

t th

e p

oin

t o

f g

ene

ratio

n

to

kee

p

gen

era

l w

ast

e

fro

m

beco

min

g

infe

ctio

ns.

Ad

va

nta

ges

of

se

gre

ga

tio

n:

� W

aste

min

imiz

atio

n

� E

ffect

ive

wa

ste

ma

nag

em

en

t

� D

ecr

ease

in

exp

ense

s in

curr

ed in

man

ag

ing

wa

ste

� R

edu

ce r

isk

of

infe

ctio

n a

nd p

rote

cts

hea

lth

care

pe

rso

nne

l.

� P

reve

ntio

n o

f in

fect

ion

and

he

alth

ha

zard

s to

Te

ach

er

exp

lain

ing

Nu

rse

s

ask

ing

dou

bts

Po

we

r p

oin

t

Ho

w d

o y

ou

seg

reg

ate

bio

me

dic

al

wa

ste

?

20

5

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

com

mun

itie

s liv

ing

in

the

vici

nity

o

f th

e

ho

spita

l w

ho

m

ay

be

exp

ose

d

to

the

Infe

ctio

us

hosp

ital w

ast

e.

� T

he

wa

ste

ha

s to

be

se

gre

ga

ted

in

co

lou

r

cod

ed

line

rs

pla

ced

in

a

ppro

pria

te

size

d

lidde

d b

ins.

Wh

ite

: U

sed

fo

r se

gre

ga

ting

offi

ce/n

on in

fect

ed

dry

wa

ste

.

Gre

en

: U

sed

fo

r ki

tch

en w

ast

e.

Re

d:

use

d f

or

dis

pos

al

of

solid

an

d i

nfe

ctio

us

wa

ste

. R

ed b

ag

s sh

ou

ld n

eve

r be

inci

ne

rate

d.

Ye

llo

w:

use

d fo

r h

igh

ly

infe

ctio

us

item

s lik

e

ana

tom

ica

l w

ast

e

pa

tho

log

ica

l w

ast

e,

blo

od/b

ody

fluid

so

ake

d

cotto

n.

An

ato

mic

al

wa

ste

s in

ye

llow

la

be

led

lin

ers

a

re

sen

t fo

r

inci

nera

tion

/dee

p b

uria

l.

20

6

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

Blu

e:

use

d

for

gla

ss

item

s an

d

pre

fera

bly

sho

uld

be

pu

nct

ure

pro

of.

Tra

ns

luce

nt

pu

nc

ture

p

roo

f o

r s

tain

less

ste

el:

use

d f

or

need

le,

bla

de

s e

tc a

nd

sh

ould

be

pu

nct

ure

pro

of.

Jerr

y ca

ns,

ca

rdb

oard

bo

xes

or

sta

inle

ss s

tee

l co

nta

ine

rs a

re o

ften

use

d t

o

colle

ct m

eta

l sha

rps.

Le

ad

co

nta

iners

: us

ed

for

sto

ring

rad

ioa

ctiv

e

wa

ste

un

til th

e te

n h

alf

life

pe

riod

.

Bla

ck

: u

sed

fo

r st

orin

g c

he

mic

als

an

d c

hem

ica

l

con

tain

ers

. C

yto

toxi

c w

ast

e a

nd in

cin

era

tor

ash

etc

.

15

Min

Dis

cuss

the

mo

des

of

tre

atin

g b

io

me

dic

al

TR

EA

TM

EN

T O

F B

IO-M

ED

ICA

L W

AS

TE

WA

ST

E T

RE

AT

ME

NT

.

T

he

te

rm 't

rea

tme

nt'

refe

rs t

o t

he p

roce

ss

tha

t m

odifi

es

the

wa

ste

in s

om

e w

ay

be

fore

it is

Te

ach

er

dis

cuss

ing

Nu

rse

s

Po

we

r P

oin

t

Wha

t are

the

diff

ere

nt

me

thod

s o

f

tre

atin

g b

io

20

7

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

wa

ste

ta

ken

to

its

fina

l re

stin

g p

lace

. T

he

pro

cess

th

at

cha

nge

s th

e c

ha

ract

ers

of

ha

zard

ou

s in

to l

ess

ha

zard

ou

s w

ast

e

is

calle

d

wa

ste

tr

ea

tme

nt.

Tre

atm

en

t is

m

ain

ly

req

uire

d

to

dis

infe

ct

or

de

con

tam

ina

te

the

w

ast

e,

rig

ht

at

sou

rce

so

tha

t it

is n

o l

on

ger

the

so

urc

e o

f p

ath

oge

nic

org

anis

ms.

Th

is t

reat

me

nt

he

lps

to c

han

ge

th

e

cha

ract

ers

o

f ha

zard

ous

into

le

ss

haza

rdou

s

wa

ste

. A

fte

r su

ch t

rea

tme

nt,

th

e r

esi

du

e c

an

be

han

dle

d s

afe

ly,

tra

nsp

ort

ed a

nd

sto

red

.

Tre

atm

en

t te

ch

no

log

ies

Au

toc

lav

e:

In

an

au

tocl

ave

, w

ast

e i

s tr

ea

ted

un

der

hig

h te

mpe

ratu

re a

nd p

ress

ure

fo

r 1

ho

ur o

r 45

min

ute

s re

spe

ctiv

ely

. T

his

re

sult

in s

teri

liza

tion

of

wa

ste

, st

eril

iza

tion

is

the

de

stru

ctio

n o

f a

ll

liste

nin

g

me

dic

al

wa

ste

?

20

8

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

tech

nolo

gie

s sh

ou

ld

be

fo

rm

of

mic

rob

ial

life

incl

udin

g

viru

ses,

fu

nga

l o

r b

act

eria

l ta

ken

be

fore

en

d

spo

res.

P

last

ic,

me

tal

and

g

lass

item

s ca

n b

e a

uto

cla

ved

. A

uto

cla

ve w

ast

e i

s

then

sh

red

ded

a

nd

wa

she

d.

Aft

er

be

ing

pro

cess

ed

th

e w

ast

e w

hic

h is

ste

rile

, sh

ou

ld b

e

shre

dde

d a

nd

sa

fest

pla

ce fo

r re

cycl

ing

.

Hyd

roc

lave

Th

is i

s a

lo

w h

ea

t th

erm

al

pro

cess

wh

ich

is a

n i

nno

vatio

n o

f th

e a

uto

cla

ve d

esi

gne

d to

app

ly

ste

am

an

in

dire

ct

hea

ting

so

urc

e,

allo

win

g to

tal d

eh

ydra

tion

of

wa

ste

.

In

ad

diti

on

the

wa

ste

is

a

lso

inte

rna

lly

ag

itate

d a

nd

fra

gm

ente

d t

o a

ttain

hig

h d

eg

ree

20

9

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

of

ste

riliz

atio

n

of

all

wa

ste

co

mp

on

ents

a

nd

pa

rtic

les.

Th

e t

rea

tme

nt

time

is 1

5 m

inu

tes

at

132

o

C o

r 3

0 m

inu

tes

at

12

1o

C a

chie

ve l

eve

l 6

.8

ste

riliz

atio

n.

T

his

is

a l

ow

he

at

the

rma

l p

roce

ss w

ith

the

diff

ere

nce

in t

he s

en

se t

ha

t u

nlik

e o

the

r lo

w

hea

t p

roce

sse

s w

hic

h

hea

t th

e

wa

ste

fr

om

ou

tsid

e,

this

he

atin

g o

ccu

rs i

nsi

de t

he

wa

ste

ma

teria

l.

Mic

row

av

es

M

icro

wa

ves

are

e

lect

rom

agn

etic

w

ave

s

21

0

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

tha

t en

ter

into

or

pe

ne

tra

te m

ate

rials

. It

is t

he

po

rtio

n

of

ele

ctro

ma

gne

tic

spe

ctru

m,

lyin

g

be

twe

en

300

meg

a

h

ert

z a

nd

.30

0,

000

me

ga

he

rtz.

He

re h

igh

fre

qu

ency

mic

row

ave

ca

use

s

mo

lecu

les

with

in

the

w

ave

to

vi

bra

te,

gen

era

ting

he

at f

rom

with

in.

P

last

ics

an

d g

lass

ite

ms

can

be

tre

ate

d b

y

mic

row

ave

, cy

toto

xic,

ra

dio

act

ive

m

ate

rial,

me

tal

sha

rps

can

not

be

tre

ate

d b

y th

is m

eth

od

Mic

row

ava

ble

w

ast

es

are

in

trod

uce

d

in

a

spe

cia

l tr

eatm

en

t ch

am

be

r,

wh

ich

h

eats

th

e

wa

ste

to

97

0 c

and

10

00 C

.

Ch

em

ica

l d

isin

fec

tio

n

Ho

spita

l w

ast

e

e.g

. in

fect

ed

pla

stic

s,

21

1

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

rub

ber

and

me

tal i

tem

s ca

n b

e t

rea

ted

by

usi

ng

vari

ous

che

mic

als

lik

e

ble

ach

, a

nd

sod

ium

hyp

och

lori

te

etc

. d

isin

fect

ion

sh

ould

e

nsu

re

corr

ect

co

nce

ntr

atio

n,

exp

osu

re,

time

a

nd

pen

etr

atio

n.

Th

is m

eth

od

of

trea

tme

nt

is m

ost

effe

ctiv

e a

nd

it is

no

t re

quire

larg

e in

vest

me

nts

,

bu

t if

not

pro

pe

rly d

one

can

be

in

effe

ctiv

e a

nd

cau

se i

nfe

ctio

n.

Fo

r in

sta

nce

blo

od o

r or

ga

nic

ma

teria

l a

ctiv

ate

s h

ypo

chlo

rite

an

d h

ence

th

is

me

thod

w

ou

ld

be

Ine

ffect

ive

fo

r tr

ea

ting

th

e

wa

ste

with

hig

h o

rgan

ic.

Inc

ine

rati

on

I

nci

ne

ratio

n

is

the

p

roce

ss

by

wh

ich

com

bust

ible

m

ate

rials

a

re

bu

rne

d,

pro

du

cing

com

bust

ion

g

ase

s a

nd

no

n-c

om

bust

ible

21

2

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

resi

due

s an

d a

sh.

Th

ey

use

hig

h t

em

pe

ratu

re

com

bust

ion

un

der

con

tro

lled

co

nditi

on

s to

con

vert

wa

ste

co

nta

inin

g i

nfe

ctio

us

wa

ste

and

pa

tho

log

ica

l ma

teria

l in

to in

ert

min

era

l res

idue

s

and

g

ase

s.

The

h

um

an

an

ato

mic

al

wa

ste

,

exp

ired

d

rug

s a

re

dis

pose

d

by

this

m

eth

od.

Ne

edle

s sh

ou

ld n

ot

be in

cine

rate

d.

Co

nve

nti

on

al

inc

ine

rato

r:

It is

si

ng

le

cha

mb

ere

d

and

it fu

nct

ion

s w

ith

the

he

lp

of

wo

od

.

Ele

ctr

ica

l in

cin

era

tor:

It

is

a

lso

si

ng

le

cha

mbe

red

. It

fun

ctio

ns

with

th

e

he

lp

of

ele

ctric

ity.

Fo

r 4

0

kg/h

our

bu

rnin

g r

equ

ired

93

-kW

/Hr

ele

ctric

ity.

21

3

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

Oil

fir

ed

in

cin

era

tor

It

is

mu

ltip

le c

ham

bere

d.

It f

un

ctio

ns

with

the

he

lp o

f so

me

ele

ctric

ity a

nd

oil.

Th

e

follo

win

g

ca

teg

ori

es

o

f th

e

ho

sp

ita

l

wa

ste

ca

n b

e in

cin

era

ted

.

� S

urg

ica

l, a

uto

psy

an

d o

bst

etr

ica

l w

ast

e l

ike

pla

cen

ta.

� H

um

an

and

an

ima

l tis

sue

co

nta

inin

g

pa

thog

en

s w

hic

h a

re I

nfe

ctio

us.

� D

ialy

sis

an

d w

ard

w

ast

e

wh

ich

h

ave

h

ad

con

tact

with

blo

od

An

d b

od

y flu

id.

� I

sola

tion

roo

m w

ast

es

� B

lood

an

d b

lood

pro

du

cts

21

4

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

Co

mp

ac

tio

n

Co

mp

act

ion

te

chn

iqu

es

are

u

sed

to

red

uce

th

e

wa

ste

vo

lum

e

an

d a

ffe

ct

wa

ste

ide

ntit

y g

en

era

lly

a

hyd

rau

lic

ram

is

us

ed

to

com

pre

ss t

he w

ast

e a

ga

inst

a r

igid

su

rfac

e,

so

tha

t it

ge

ts c

om

pre

sse

d o

r co

mp

act

ed.

It w

ill n

ot

affe

ct t

he n

atu

re o

f th

e w

ast

e b

y it

will

de

stro

y

the

co

nta

ine

rs.

Gri

nd

ing

an

d s

hre

dd

ing

Th

ese

a

re

use

d to

co

nve

rt

me

dic

al

wa

ste

s in

to a

mo

re h

om

ogen

ou

s fo

rm s

o t

hat

the

y a

re e

asi

ly h

and

led

. T

he

re t

he w

ast

es

are

ph

ysic

ally

b

roke

n d

ow

n

by

pri

ma

ry

an

d

seco

nda

ry s

hre

dd

ing

in

one

pa

ss i

nto

sm

alle

r

pa

rtic

les

and

th

e e

quip

me

nts

are

ma

inta

ine

d a

t

21

5

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

neg

ativ

e p

ress

ure

to

en

sure

tha

t n

o m

ate

rial

esc

ape

fro

m o

uts

ide

.

Pu

lve

riza

tio

n

Th

is

is

a

pro

cess

b

y w

hic

h

wa

ste

is

red

uce

d b

y o

ne

ten

th i

n v

olu

me

. T

he s

yste

m

con

sist

s o

f w

ast

es

an

d

the

co

nta

ine

r b

ein

g

pla

ced

o

n

a

larg

e

en

clo

sed

in

clin

e

con

veyo

r

and

ca

rrie

d

to a

fe

ed

ho

ppe

r w

he

re

a

larg

e

volu

me

o

f w

ate

r a

nd

so

diu

m

hyp

och

lori

te

(ble

ach

so

lutio

n)

are

intr

odu

ced

.

Th

e w

ast

e i

s to

rn i

nto

sm

all

shre

ds a

nd

fed

alo

ng

with

ch

orin

e s

olu

tion

into

an

ultr

a h

igh

spe

ed

ham

me

r m

ill

con

sist

ing

o

f cl

ose

d

cha

mb

er

in

wh

ich

la

rge

st

eel

bla

des

spin

a

t

21

6

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

app

roxi

ma

tely

3,6

00

re

volu

tion

s p

er

min

ute

.

B

y th

e

act

ion

o

f th

is,

clo

th

item

s a

re

red

uce

d

to

fibro

us

pu

lp,

gla

ss

is

red

uce

d

to

san

d,

sha

rps

and

o

the

r m

eta

l ob

ject

s a

re

red

uce

d t

o s

ma

ll sa

fe p

art

icle

s, s

oft

tub

ing

and

dia

lyze

r fil

ters

are

co

mp

lete

ly p

ow

de

red

.

Fin

al d

isp

osa

l m

eth

od

s

(i)

La

nd

filli

ng

:

T

his

is

the

mo

st s

atis

fact

ory

me

tho

d o

f

ga

rba

ge

is

b

y la

nd

d

iscu

ssio

n

fina

l d

isp

osa

l

fillin

g.

Infe

ctio

us

wa

ste

sh

ou

ld b

e d

ispo

sed

by

this

me

thod

.

H

ow

eve

r th

e

site

o

f la

ndfil

l h

as

to

cho

sen

.

21

7

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

� A

wa

y fr

om

th

e s

ensi

tive

aq

uife

rs a

nd

sco

res

of

wa

ter.

� A

wa

y fr

om

pu

blic

vie

w

� S

ign

bo

ard

s sh

ould

be

pu

t at

the

se s

ites.

La

nd

filli

ng

is

do

ne

by a

ny o

f th

e f

oll

ow

ing

me

tho

ds

a.

Tre

nch

me

thod

– L

ong

tre

nch

2-3

me

ters

dee

p a

nd

3-1

0 m

ete

rs w

ide

de

pend

ing

up

on

loca

l co

nd

itio

n,

is m

ad

e.

Th

e t

rea

ted

wa

ste

is id

eally

co

mp

act

ed u

p to

2 m

ete

rs,

cove

red

with

exc

ava

ted

ea

rth

.

b.

Ra

mp

me

tho

d-

Th

is is

we

ll su

ited

wh

ere

th

e

terr

ain

is

m

ode

rate

ly

slo

pp

ing

an

d

som

e

exc

ava

tion

is

do

ne

to

secu

re

cove

rin

g

ma

teria

l.

21

8

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

c.

Are

a

me

tho

d-

Th

e

trea

ted

w

ast

e

is

dep

osi

ted

p

ack

ed

an

d co

nso

lida

tes

in

un

iform

la

yers

u

p

to

2-2

.5

me

ters

d

ee

p.

Ea

ch l

aye

r is

se

ate

d o

n i

ts e

xpo

sed

su

rfa

ce

with

a

m

ud

cove

r a

t le

ast

1

2”

thic

k to

pre

ven

t in

fest

atio

n o

f file

s an

d r

oden

ts e

tc.

(ii)

Pit

bu

ria

l

T

his

is

su

itab

le

for

sma

ll ca

mp

s o

r

inst

itutio

ns,

wh

ere

in

a s

ma

ll p

it o

f si

ze 2

Mts

.

by

2 M

ts.

is d

ug

and

the

wa

ste

are

pu

t th

ere

with

10

cm s

oft

be

twe

en

ea

ch l

aye

r o

f w

ast

e,

wh

en

th

e l

eve

l is

alm

ost

fu

ll. I

t is

clo

sed

with

thic

k la

yer

of s

oil.

C

on

ten

ts

get

de

com

po

sed

4

-6

mo

nth

s

time

.

21

9

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

Sa

fe p

it

A

pit

is d

ug

acc

ord

ing

to

th

e r

eq

uire

men

t

of

the

ho

spita

l. A

ll th

e s

ide

s o

f th

e p

it sh

ould

be

pla

ste

red

w

ith

cem

en

t. A

cy

lind

rica

l m

et

led

pip

e o

f 4

inch

es

dia

me

ter

or

mo

re is

fix

ed

at

the

ceili

ng o

f th

e p

it. T

he

ope

nin

g o

f th

e m

eta

l p

ipe

sho

uld

ha

ve

larg

e

in f

aci

lity.

T

he

sha

rps

are

dep

osi

ted

in

th

is p

it th

roug

h t

he

pip

e f

rom

the

non

-pu

nct

ura

ble

tra

nsp

are

nt

con

tain

er.

(iii

) C

om

pre

ing

Co

mp

rein

g

is

a

me

tho

d

of

com

bin

ed

dis

posa

l o

f re

fuse

an

d n

igh

t so

il o

r sl

udg

e.

It is

a p

roce

ss o

f na

ture

wh

ere

by

org

an

ic m

atte

r

bre

aks

do

wn

un

de

r b

act

eria

l a

ctio

n r

esu

ltin

g i

n

the

form

atio

n

of

a re

lativ

ely

st

ab

le

ma

teria

l

22

0

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

calle

d

com

pre

ing

w

hic

h

ha

s co

nsi

de

rab

le

ma

no

rial

valu

e

as

it co

nta

ins

nitr

ate

s a

nd

pho

sph

ate

s.

Dis

po

sa

l o

f w

as

te w

ate

r

Was

te w

ate

rs a

nd

liq

uid

wa

ste

s fr

om

the

kitc

hen

, ca

fete

ria

and

la

und

ry

sho

uld

be

dra

ined

in

to t

he

mun

icip

al/c

ivic

dra

ins.

In

ca

se

no

sew

er

conn

ect

ion

s a

re

ava

ilab

le

in

the

ho

spita

l, th

ey

sho

uld

de

velo

p

the

ir o

wn

sew

era

ge

tre

atm

ent p

lan

ts.

S

oa

k p

its c

an

be

a u

sefu

l me

thod

fo

r fin

al

dis

posa

l o

f liq

uid

w

ast

es

in

rura

l o

r sm

all

hea

lthca

re

inst

itutio

ns,

a

s th

ey

we

re

che

ap,

sim

ple

to

bu

ild

and

re

qu

ire

only

to

ols

for

22

1

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

dig

gin

g.

Th

e d

raw

ba

ck i

s th

at

it is

no

t e

ffect

ive

in r

ain

y se

aso

n.

Dis

po

sa

l o

f a

na

tom

ica

l a

nd

p

ath

olo

gic

al

wa

ste

:

T

his

mu

st b

e i

nci

ne

rate

d,

the

ash

ca

n b

e

sen

t fo

r sp

eci

aliz

ed la

ndfil

ls, a

s it

is s

teril

e.

Dis

po

sa

l o

f s

harp

s

All

sha

rps

need

to

b

e d

isin

fect

ed

or

ste

riliz

ed t

hro

ugh

mic

row

avi

ng

, au

tocl

avi

ng

or

dry

hea

ting

and

the

n s

en

t fo

r fin

al d

ispo

sal.

Dis

po

sa

l o

f ra

dio

acti

ve

wa

ste

Ra

dio

act

ive

w

ast

e

mu

st

be

sto

red

in

22

2

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

spe

cia

l co

nta

ine

rs u

ntil

te

n t

ime

s th

eir

ha

lf-lif

e

pe

riod

be

fore

the

wa

ste

tra

nsp

ort

ed

. It

sh

ould

then

d

isp

ose

d

in

secu

red

la

nd

fills

. L

iqu

id

rad

ioa

ctiv

e

wa

ste

sh

ould

b

e d

isch

arg

ed

in

to

dra

ins

on

ly a

fte

r its

ten

ha

lf lif

e p

eri

od is

ove

r.

Dis

po

sa

l o

f c

yto

tox

ic w

as

te

Sm

all

am

oun

ts o

f cy

toto

xic

wa

ste

ca

n b

e

bu

ried

at

site

or

inci

nera

ted

. La

rge

r q

uan

titie

s, it

pro

duce

d

shou

ld

be

sen

d

for

secu

red

la

nd

fillin

g th

rou

gh p

rop

er

syst

em

.

Re

co

mm

en

da

tio

n in

ha

nd

lin

g o

f w

as

te

� N

eve

r p

ut p

last

ics

in y

ello

w b

ag

s.

� P

last

ics

sho

uld

no

t be

inci

ne

rate

d.

� W

aste

sh

ould

n

eve

r tr

an

sfe

rre

d

fro

m

one

22

3

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

bag

to o

the

r ba

g

� T

rolle

y sh

ould

be

u

sed

fo

r tr

an

spo

rta

tion

insi

de t

he h

osp

ital.

Ad

min

istr

ati

ve

as

pe

cts

T

he

se

rvic

e c

ha

rge

co

llect

ed r

ange

s fr

om

Rs.

2

.50

-ad

min

istr

ativ

e

4/b

ed

/da

y in

m

ost

pla

ces

in

the

co

untr

y w

he

n

the

se

rvic

es

pro

vid

ed

.

Pre

sc

rib

ed

au

tho

rity

:

Th

e st

ate

po

llutio

n c

on

tro

l bo

ard

is

the

pre

scrib

ed

au

tho

rity

at t

he

sta

te le

vel.

� E

very

a

uth

oriz

ed

pe

rson

ha

s to

m

ain

tain

reco

rds

dis

cuss

ion

re

late

d

to

gene

ratio

n,

colle

ctio

n,

rece

ptio

n,

sto

rag

e,

tra

nsp

ort

atio

n,

22

4

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

tre

atm

en

t Etc

.

� I

f a

ny

acc

ide

nt o

ccu

rs in

an

y in

stitu

tion

it h

as

to b

e r

ep

ort

ed

.

� I

n

case

o

f vi

ola

ting

bio

med

ica

l w

ast

e

ma

nag

em

en

t ru

les,

th

e

adm

inis

tra

tor

is

pun

ish

able

-Im

pris

onm

en

t fo

r 5

ye

ars

or

fine

of 1

lakh

rup

ee

.

RO

LE

O

F

HE

AL

TH

C

AR

E

PE

RS

ON

NE

L

IN

BIO

ME

DIC

AL

WA

ST

E M

AN

AG

EM

EN

T

Med

ica

l O

ffic

er:

1.

Ma

kes

arr

an

gem

en

ts t

o t

rain

all

the

hosp

ital

pe

rson

ne

l on

b

io-m

ed

ica

l w

ast

e

ma

nag

em

en

t.

2.

Ro

utin

e

supe

rvis

ion

of

ho

spita

l pe

rso

nne

l

for

pro

pe

r im

ple

me

nta

tion

of t

his

sch

em

e.

3.

En

sure

s co

mp

lian

ce o

f th

is s

che

me

in a

ll

22

5

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

the

prim

ary

he

alth

ce

nte

rs u

nde

r h

is c

ontr

ol.

4.

Ma

kes

nece

ssa

ry

arr

ang

em

ents

fo

r

pu

rcha

se o

f ma

teria

l fo

r th

is p

rog

ram

me

.

5.

Ch

eck

s ne

cess

ary

re

cord

s p

erio

dic

ally

.

6.

En

sure

s ad

equ

ate

tra

inin

g o

f a

ll co

nce

rne

d

sta

ff fo

r w

ast

e m

ana

ge

me

nt.

7.

Ta

kes

initi

ativ

e

to

org

aniz

e re

fre

she

r

cou

rse

s e

very

3 t

o 6

mo

nth

s fo

r st

aff

in t

he

ho

spita

l.

8.

Dis

cuss

es

with

sa

nita

ry in

spe

cto

r th

e p

rop

er

fun

ctio

nin

g o

f th

is s

che

me

.

9.

En

sure

s a

ccid

ent

rep

ort

ing

w

hile

h

and

ling

or

durin

g tr

ansp

ort

atio

n o

f su

ch w

ast

e.

10

. Re

spo

nsi

ble

fo

r im

ple

men

tatio

n

of

gu

ide

line

s,

inst

ruct

ion

s an

d

laid

d

ow

n

po

licie

s.

22

6

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

11

. Re

spo

nsi

ble

to

h

ighe

r a

uth

orit

y fo

r a

ll

sta

ges

of w

ast

e m

an

age

me

nt.

12

. Re

port

s d

irect

ly r

eg

ard

ing

fin

al

dis

po

sal

of

wa

ste

to

th

e D

ep

art

me

nt

of

En

viro

nm

en

t o

r

offi

ce o

f C

om

mis

sio

ner.

13

. Mo

nito

rs t

he

wh

ole

pro

gra

mm

e a

nd

lo

cate

suff

icie

nt

fund

s an

d m

an

po

we

r fo

r e

ffic

ien

t

ope

ratio

n o

f w

ast

e m

an

age

me

nt.

14

. Ma

inta

ins

liais

on

with

wa

ste

dis

posa

l offi

cer.

Nu

rsin

g s

up

eri

nte

nd

en

t:

1.

Su

pe

rvis

es

imp

lem

enta

tion

o

f sc

hem

e

by

ho

spita

l pe

rso

nne

l.

2.

Ro

utin

e s

upe

rvis

ion

of

the

wa

rds

esp

eci

ally

for

wa

ste

seg

rega

tion

.

3.

Re

spo

nsi

ble

to

m

edi

cal

supe

rinte

nden

t fo

r

22

7

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

all

stag

es

of

ma

nag

eme

nt.

He

ad

nu

rse

:

1.

Se

cure

s ne

cess

ary

su

pp

ly.

2.

Su

pe

rvis

es

imp

lem

enta

tion

o

f sc

hem

e

by

wa

rd p

ers

onn

el.

3.

Su

pe

rvis

es

wa

ste

se

gre

ga

tion

a

t th

e

gen

era

tion

po

int.

4.

En

sure

s th

at

seg

reg

atio

n,

dis

infe

ctio

n

and

de

stru

ctio

n o

f w

ast

e t

ake

s

5.

Pla

ce p

rom

ptly

at

wa

rd le

vel.

S

taff

nu

rse

:

1.

Pa

rtic

ipa

tes

in

seg

reg

atio

n

of

wa

ste

gen

era

tion

po

int.

2.

Su

pe

rvis

e an

d

Gu

ide

s cl

ean

ing

st

aff

in

22

8

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

pro

ced

ure

o

f se

gre

ga

tion

, d

isin

fect

ion

a

nd

mu

tila

tion

of w

ast

e.

3.

Te

ach

es

cle

anin

g st

aff

in

m

eth

od

of

che

mic

al d

isin

fect

ion.

4.

En

sure

s th

at

the

wa

ste

is

dis

infe

cte

d a

nd

tra

nsp

ort

ed t

o t

he

garb

age

po

int

by

the

end

of t

he

sh

ift.

5.

Re

gula

rly

mo

nito

rs t

ha

t th

e r

igh

t m

eth

od o

f

wa

ste

ma

nag

em

ent

is c

arr

ied

ou

t.

He

alt

h v

isit

ors

/pu

blic

hea

lth

nu

rses

:

1.

Pa

rtic

ipa

tes

in

wa

ste

se

gre

ga

tion

a

t th

e

po

int o

f gen

era

tion

.

2.

Su

pe

rvis

es

the

su

b

cen

ters

, co

vere

d &

pro

vid

es

guid

elin

e.

3.

En

cou

rage

s th

e m

ulti

pu

rpo

se h

ea

lth w

ork

er

22

9

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

(f)

to p

ract

ice

pro

pe

r d

ispo

sal o

f wa

ste

.

4.

En

sure

s th

e s

up

ply

of

wa

ste

co

llect

ion

bin

s

in e

ach

su

b c

entr

e.

5.

Ma

inta

ins

liais

on

with

w

ast

e

dis

po

sal

offi

cers

.

Ph

arm

ac

ist:

P

ha

rma

cist

sh

all

be r

esp

on

sib

le f

or

the

sou

nd

ma

nage

me

nt

of

pha

rma

ceu

tica

l st

ore

s

and

in p

art

icu

lar

sha

ll.

1.

Giv

e

ad

vice

re

ga

rdin

g

form

ula

tion

o

f a

pt

pro

ced

ure

fo

r m

ana

gem

en

t o

f

pha

rma

ceu

tica

l w

ast

e

&

coo

rdin

ate

imp

lem

en

tatio

n o

f th

is p

roce

dure

.

2.

En

sure

th

at

the

co

nce

rne

d

hosp

ital

sta

ff

rece

ive

ad

equ

ate

tra

inin

g i

n ph

arm

ace

utic

al

23

0

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

wa

ste

ma

nag

em

ent

pro

ced

ure

.

Sa

nit

ary

in

sp

ec

tor:

1.

Su

pe

rvis

es

imp

lem

enta

tion

o

f p

rog

ram

me

by

cle

an

ing

sta

ff.

2.

Su

pe

rvis

es

pro

cess

o

f se

gre

gatio

n,

dis

infe

ctio

n a

nd

de

stru

ctio

n.

3.

Ch

eck

s w

ast

e tr

ansp

ort

atio

n.

4.

Su

pe

rvis

es

cha

ngin

g

of

ba

gs

an

d

rep

lace

men

ts.

5.

Vis

its e

ach

wa

rd a

nd u

nit

to o

vers

ee

pro

pe

r

pro

ced

ure

o

f w

ast

e

ma

nag

em

en

t b

y

cle

anin

g s

taff.

6.

Co

-ord

ina

tes

with

h

ead

n

urs

es

an

d

sta

ff

nu

rse

s in

ma

tters

rel

ate

d to

ho

spita

l w

ast

e

ma

nag

em

en

t.

23

1

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

Mu

ltip

urp

ose

hea

lth

ass

ista

nt

(m/f

):

1.

Pa

rtic

ipa

tes

in h

osp

ital

wa

ste

seg

rega

tion

at

the

po

int o

f gen

era

tion

.

2.

En

sure

s th

e p

rope

r su

pply

of

wa

ste

bin

s in

sub

cen

ters

.

3.

Sh

ou

ld

stri

ctly

fo

llow

th

e

rule

s o

f w

ast

e

ma

nag

em

en

t w

hile

co

ndu

ctio

n o

f a

nte

nata

l

clin

ics,

imm

un

iza

tion

s &

de

live

ries.

4.

Ma

inta

ins

reco

rds

& r

ep

ort

s.

Co

nc

lus

ion

T

he

m

ana

ge

men

t of

b

iom

edic

al

wa

ste

req

uire

s d

ilige

nce

a

nd

care

fr

om

a

ch

ain

o

f

peo

ple

, st

art

ing

with

the

nu

rse

or

do

cto

r w

ho

use

th

e

equ

ipm

en

t, su

pplie

s th

at

beco

me

23

2

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

wa

ste

, co

ntin

uin

g

thro

ugh

to

th

e

hosp

ital

atte

nda

nt,

or

an

cilla

ry s

taff

wh

o p

rovi

des

cle

an

bag

s o

r co

nta

ine

rs a

nd

ca

rrie

rs s

hou

ld b

e a

wa

y

fro

m

the

w

ast

e,

on

to

th

e

me

cha

nic

s a

nd

tech

nic

ian

s w

ho

ke

ep

the

ve

hic

les

and

equ

ipm

ents

in g

ood

co

nd

itio

n a

nd

fin

ish

ing

with

the

pe

rson

re

spon

sib

le f

or

en

surin

g t

hat

wa

ste

is d

isp

ose

d o

f in

the

co

rre

ct w

ay.

If

an

y o

f th

ese

are

ca

rele

ss i

n t

he

ir w

ork

, o

r a

llow

sca

ven

ge

rs

acc

ess

to

the

wa

ste

, th

e c

ha

in i

s b

roke

n a

nd

dan

ge

rs.

Hen

ce i

t is

th

e r

esp

on

sib

ility

of

hea

lth

care

pe

rson

nel t

o d

isp

ose

the

bio

me

dic

al w

ast

e

in a

n e

ffici

ent

ma

nne

r in

ord

er

to p

rom

ote

the

clie

nts

he

alth

spe

cific

ally

an

d c

om

mun

ity h

ealth

at l

arg

e.

23

3

D

ura

tio

n

S

pe

cif

ic

Ob

jec

tive

s

C

on

ten

t T

ea

ch

er’

s

Le

arn

er’

s

Ac

tiv

ity

Au

dio

V

isu

al

Aid

s

E

va

lua

tio

n

BIB

LIO

GR

AP

HY

1.

Pa

rks.

, (2

002

) T

ext

boo

k o

f p

reve

ntiv

e a

nd

So

cia

l m

ed

icin

e.,

1

7th

ed

itio

n.,

Jab

alp

ur.

,

M/s

.Ba

na

rsid

as

Bh

an

ot

Pu

blis

he

rs.,.

, 5

63 –

66

.

2.

G.

Gn

ana

P

rasu

na T

. V

asu

ndh

ara

T

ula

si

(201

3)

text

bo

ok

of

com

mun

ity

hea

lth

nu

rsin

g I

I; 1

st E

diti

on;

Hyd

era

bad

; F

ron

tline

Pu

blic

atio

ns;

29

3-9

4

ANNEXURE – XV

MAP