educational intervention on knowledge , attitude and practice on biomedical/ health care waste management

1. Educational Intervention on
Healthcare Waste(HCW)
Management among Health care
staffs at Annapurna Neurological
Institute & Allied Sciences
Gajuryal S¹ , Shrestha G¹, Satyal N¹
Annapurna Neurological Institute & Aliied Sciences (ANIAS)

2. Introduction
Healthcare waste are the waste produced in the course
of health care activities during treating,diagnosing, and
immunizing human being or animals or while doing
Study/Research activities.
75-90% Non-Hazardous/General Waste
10-15% -Hazardous

3. WHO Classification
Waste Categories Description and Examples
1.General Waste No risk to human health e.g.: office paper,
wrapper, kitchen waste,
2.Pathological Waste Human Tissue or fluid e.g.: body parts,
blood, body fluids etc.
3.Sharps Sharp waste e.g.:
Needle,scaples,knives,blades etc.
4.Infectious waste Which may transmit bacterial, viral or
parasitic disease to human being, waste
suspected to contain pathogen
eg:labrotory culture,
tissues(swabs)bandage etc.
5.Chemical waste E.g.: Laboratory reagent, disinfectants,
Film Developer
6.Radio-active waste E.g.: unused liquid from radiotherapy or
lab research, contaminated glassware etc.

4. Waste Categories Description with examples
7.Pharmacutical Waste Expired outdated drugs /chemicals
8.Pressurized container Gas cylinder, aerosol cans etc
9.Genotoxic Waste Waste Containing Cytotoxic Drugs(often
Used In Cancer Therapy)
Types and nature of hospital waste depends upon the
service available in hospital and nature of the hospital.

5. Magnitude of the problem
 GLOBALLY- Developed countries generate 1 to 5
kg/bed/day
 Developing countries: 1-2kg/bed/day
 Issues of poor segregation and management

6. Nepal Context
• Kathmandu Metropolitan City & ENPHO have
conducted a study on biomedical waste in hospitals
located in kathmandu.
• Results:1.72kg waste/bed/day
• Out of which 26% of waste was infectious and
hazardous waste.

7. Issues & Problems ?
Exponential growth in health care sector together
with low or non-compliance with guidelines/ protocol
and recommendations.

8. Categories of Person exposed
Sanitation
workers
Medical ,
laboratory &
Paramedical staff
Patients+Visitors

9. Problems associated with Healthcare Waste
 Hospital Acquired Infection
 Environmental problem
pollution – water ,air
 Public Health Problem
Infectious disease transmission, unsafe use of needle
etc

10. Objectives
General
To Access the Impacts of Health Education on
Knowledge, Attitude and Practice of Health Care
Staffs Regarding Healthcare Waste Management
Specific
- To access the Knowledge, attitude and Practice of
health care personnel
- To compare the knowledge, practice and attitude of
health care staffs before & after educational
intervention.

11. Methods
Research Method: Quantitative
Study type: Comparative Cross-sectional study
Study Area: ANIAS
Study Period : 6 months ( July 2017-January 2018)
Study Population: Health care workers (Medical
officers, Nurses, Sanitation staffs )
Sampling Methods/ Techniques: Census Sampling (all
the health care workers)
Sample size (with justification): 65(Census Sampling)

12. Data Collection Tools: Standard Knowledge(9),
Attitude(9) & Practice(10) Questionnaire
Data Collection Technique / Methods (Specify):
Pre test regarding biomedical waste management to
the health care workers with interventional training
session followed by post-training data collection
through same questionnaire after one month.

13. Statistical analysis : Data collected was entered into
structural Microsoft excel and analysed using SPSS
version 17 . Frequency and percentage was presented
in graphical and tabular form. The significance of
differences between pretest and post test score of the
participants was calculated using paired t test.
Ethical Consideration : Nepal Health Research
Council ( NHRC)

14. RESULT

15. Fig 1 :Age wise distribution of participants
4
39
9
6
3 4
0
5
10
15
20
25
30
35
40
45
16-20 21-25 26-30 31-35 36-40 Above 40
Mean Age±SD = 24.03±3.5

16. Fig 2 : Profession wise distribution
36
23
6
0
5
10
15
20
25
30
35
40
Nursing staff Housekeeping Staff Medical Officer

17. Table 1: Pre-post findings on Knowledge (n=65)
Healthcare Waste Management
elements
Pre-intervention
Correct responses N(%)
Post-intervention
Correct responses N(%)
Classification of Healthcare waste 45 (69.2%) 54 (83.1%)
Hospital Healthcare waste manual 50 (76.9%) 60 (92.3%)
Responsibility to dispose Waste 63 (96.9%) 65 (100%)
Waste Collection 60 (92.3%) 65 (100%)
Waste Storage 5 (7.7%) 51 (78.5%)
Healthcare Waste Symbol 25 (38.5%) 62 (95.4%)
Disease from Biomedical Waste 55 (84.6%) 56 (86.2%)
Disposal of Infected waste 10 (15.4%) 29 (44.6%)
Categories of hazardous waste 30 (46.2%) 50 (76.9%)

18. Table 2 :Pre-post findings on Attitude (n=65)
Attitude on Healthcare Management
elements
Pre-intervention
Positive responses N(%)
Post-intervention
Positive responses N(%)
Healthcare Waste Management is an issue 15 (23.1%) 45 (69.2%)
HCW management is the responsibility of
the government
45 (69.2%) 44 (67.7%)
It is the responsibility of health
professionals
50 (76.9%) 59 (90.8%)
It should be segregated 60 (92.3%) 63(96.92%)
Healthcare Waste should be made part of
the undergrad curriculum
65 (100%) 56 (86.2%)
Safe Healthcare waste management is
extra burden
65 (100%) 56 (86.2%)
Knowledge regarding HCW management
is adequate
54 (%) 48 (73.8%)
Requirement of further training 60 (92.3%) 51 (78.5%)
HCW as unnecessary financial burden 60 (92.3%) 49 (75.4%)

19. Table 3 :Pre-post findings on practice (n=65)
Practice on HCW Management elements Pre-intervention
Positive Practice N(%)
Post-intervention
Positive Practice N(%)
Segregation of Healthcare Waste 55 (84.6%) 60 (92.3%)
Disposal of cotton, gauze and other items
contaminated by blood
63 (96.9%) 65 (100%)
Disposal of waste sharps 16 (24.6%) 51 (78.5%)
Disposal of hazardous liquid waste 50 (76.9%) 54 (83.1%)
Immunized against hepatitis B and Tetanus
infection
59 (90.8%) 59 (90.8%)
Annual medical examination 20 (30.8%) 35 (53.8%)
Practice recapping of used needles 36 (55.4%) 37 (56.9%)
Aware of prophylactic procedures after
contact with blood/body fluids
39 (60%) 52 (80%)
Practice of post-exposure prophylaxis for
prevention of HIV infection
50 (76.9%) 41 (63.1%)
Practice the use of protective clothing.
during the collection, segregation, and
transportation of wastes
10 (15.4%) 35 (53.8%)

21. Table 4: Educational interventional impact on
Knowledge , Attitude & Practice
Test
Knowledge Attitude Practice
Mean ±SD p value Mean ±SD p value Mean ±SD p value
Pre -Test 5.46 ±1.23
<0.001
6.62 ±1.22
<0.001
7.01± 1.05
<0.001
Post -Test 7.31 ±1.468 7.25± 1.41 7.84 ±1.30

22. Obstacle ?
Implementation, Training, Supervision

23. Conclusion
• Strict implementation of biomedical waste management
rules & compliance is the need of the hour
• Education intervention can help in upgrading the
knowledge, attitude and practice of the health care waste
management
• Training should be given to respective personal time to
time and should not become merely a one-time activity
• Proper HCW management leads to a healthy & harmless
environment improving the quality of care.

25. Thank You