|Year : 2020 | Volume
| Issue : 1 | Page : 31-35
Knowledge, attitude, and practices about biomedical waste management as per 2016 rules among resident doctors and nursing staff in a tertiary care specialty hospital: A cross-sectional study
Pranjal Dey1, Basudeb Das2
1 Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
2 Department of Psychiatry and Administration, Central Institute of Psychiatry, Ranchi, Jharkhand, India
|Date of Submission||17-Aug-2020|
|Date of Decision||27-Aug-2020|
|Date of Acceptance||17-Sep-2020|
|Date of Web Publication||16-Nov-2020|
Department of Psychiatry, Central Institute of Psychiatry, Ranchi - 834 006, Jharkhand
Source of Support: None, Conflict of Interest: None
Background: During the health-care delivery process, healthcare establishments generate hazardous bio-medical wastes (BMWs) which need for appropriate handling and management to prevent environmental and public health hazard. Different healthcare professionals should have adequate knowledge, attitudes, and practices with respect to BMW management. Honorable Supreme Court of India had led down the guidelines on BMW (Management and Handling) Rules in 1998, which was amended in 2016 by the Environment ministry.
Objective: To assess knowledge, attitude, and practices regarding BMW management among the resident doctors and nursing staff in a tertiary care specialty teaching hospital as per new BMW Management Rules, 2016.
Study Design: This was an institution based cross-sectional study.
Methods: Predesigned, pretested, structured questionnaires were administered on fifty resident doctors and fifty nursing staff of the hospital with their prior consent. Data were analyzed using SPSS-25. Chi-square test and independent-sample t-test were applied for the analysis.
Results: Both groups had adequate and comparable knowledge about BMW management. The nursing group had significantly more favorable attitude and adequate practice in comparison to resident doctors (P = 0.0001). There was lack of adequate training in both the groups significantly more in resident doctors. Regarding practices, resident doctors had more inadequate practice regarding handling, segregation, disposal, reporting, and record maintenance of BMW than nursing staff.
Conclusion: Nursing staff have a better attitude and good practice than the resident doctors about BMW management. There should be a regular training program regarding BMW management for both the cadres of health-care workers.
Keywords: Attitude, bio-medical waste management, hospital, knowledge, nursing staff, practice, resident doctors
|How to cite this article:|
Dey P, Das B. Knowledge, attitude, and practices about biomedical waste management as per 2016 rules among resident doctors and nursing staff in a tertiary care specialty hospital: A cross-sectional study. J Med Soc 2020;34:31-5
|How to cite this URL:|
Dey P, Das B. Knowledge, attitude, and practices about biomedical waste management as per 2016 rules among resident doctors and nursing staff in a tertiary care specialty hospital: A cross-sectional study. J Med Soc [serial online] 2020 [cited 2020 Dec 5];34:31-5. Available from: https://www.jmedsoc.org/text.asp?2020/34/1/31/300552
| Introduction|| |
During the health-care delivery process, healthcare establishments generate hazardous bio-medical wastes (BMWs). BMW is a unique category of waste by the quality of its composition, source of generation, its hazardous nature and the need for appropriate protection during handling, treatment and disposal. Inadequate and inappropriate knowledge of handling of healthcare waste may have serious health consequences and a significant impact on the environment as well., Acceptable management of BMW management begins from the initial stage of the generation of waste, segregation at the source, storage at the site, disinfection, and transfer to the terminal disposal site; these steps play a critical role in the disposal of waste., It is essential that the different professionals engaged in the health-care sector have adequate knowledge, attitudes, and practices (KAP) with respect to BMW management.,
In our country, the Honorable Supreme Court of India had led down the guidelines on BMW (management and handling) Rules in 1998. Again the Environment ministry released the new amended BMW Management Rules, 2016, which has brought in a wider and more comprehensive regime for BMW management. Under the new regime, the coverage has increased to include healthcare waste produced at home also provided for pretreatment of laboratory waste, blood samples, etc., It mandated bar code system for proper control. It also has simplified categorization and authorization.
Teaching institutes play a critical role in the health care setup as future health-care professionals and caregiver to the community are trained from these places. This includes different trainee, resident doctors, and nursing staff. These technically trained staff has an important role in managing the BMW through their knowledge, attitude, and practices. Studies documented from different parts of the country still convey that there are gaps in the knowledge, lacunae in the attitudinal component and inconsistency in the practice aspects of BMW management among these healthcare professionals, especially as per new BMW Management Rules, 2016.
With this background, this study was conducted with the main objective to assess the knowledge, attitude, and practices of BMW management among the resident doctors and nursing staff in a tertiary care specialty teaching hospital as per new BMW Management Rules, 2016.
| Methods|| |
Study area and setting
This study was conducted in a specialty teaching hospital situated in the Eastern part of India. This hospital provides tertiary care specialty treatment with outdoor, indoor, emergency facilities. Apart from these facilities, this hospital is well equipped investigational facilities in the Pathology, Biochemistry, and Radiology department. Every day a large quantity of BMW is produced in the hospital. As a teaching hospital, it has a good number of trainee resident doctors along with consultants and nursing staff.
Study design and population
An institution-based cross-sectional study was conducted from January 1, 2020 to June 30, 2020. Study participants were fifty randomly selected resident doctors and nursing staff of the hospital in each group who were willing to give informed consent. Resident doctors in the hospital are senior residents and junior residents, undergoing postgraduate degree and diploma in the concerned subject. Nursing staff are those working in the hospital section as a regular employee.
Study protocol and measurements
After obtaining informed consent, questionnaire was distributed in closed envelope to the study participant requested to return within 10 days with genuine response without undue help. Prior approval was taken from the institutional review board. The pretested, predesigned, valid structured questionnaire was administered. This was divided into four parts such as demographic and working pattern data of the participants and questions about knowledge, attitude, and practice of BMW management. All data forms underwent scrutiny for logical inconsistencies, skip patterns and missing values. Incomplete questionnaires were taken back to the study participants for completion.
Data management and analysis
The data were coded and entered into Microsoft Excel software and analyzed using SPSS version 25 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp). Mean scores were calculated and used as cut off point to categorize KAP scores of the study participants as adequate knowledge, favorable attitude, and adequate practice scores. The percentages and their 95% confidence intervals have been presented. Group differences of categorical variables were computed by using Chi-square test. Comparisons of variables between two groups were made using an independent t-test. Value of P < 0.05 was taken as significant in all aspects.
| Results|| |
Socio-demographic characteristics and working pattern
In this study, both the groups were comparable in the variables like job category and the working department. However, there were significant differences in gender, age, education, working experience, and working hours between nursing staff and resident doctors [Table 1].
Knowledge, attitude and practice of study participants
Regarding knowledge, both the groups had adequate and comparable knowledge in most of the items. However there were significant differences in attitude and practice score between the groups (P = 0.0001). Nursing group had more favorable attitude and adequate practice in comparison to resident doctors [Table 2]. Among the resident doctors, there was unfavorable attitude and inadequate practice toward following the various steps of segregation, transportation, and disposal of the BMW. There were lacunae among resident doctors in the practice of maintaining of records and reporting to the appropriate authority. Both the groups had an inadequate training program, significantly more in the resident doctors' group [Table 3].
|Table 2: Comparison of knowledge, attitude and practice score between resident doctors and nursing staff|
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|Table 3: Few significantly different item score in knowledge, attitude and practice between the two study participants group|
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| Discussion|| |
The response rate in our study was quite good in comparison to previous studies., The study was conducted on predesigned and pretested questionnaire, and cross-sectional study design was selected as a similar design was adopted in other studies.,,
Socio-demographic characteristics and working pattern
In this institute majority of nursing staff were female; hence, majority of the responders in this category. Majority of resident doctors were in the age group 26–30 years, which was similar in the previous study where the younger employee in 26–30 years was higher responder and better knowledge. Majority of resident doctors were fresh medical graduates while the nursing group had almost equal distribution in all education subcategory. Regarding working experience majority of the resident, doctors had 1–5 years of experience while nursing staff had more than 10 years of experience. This may be because most of the study responders were junior residents who did not have long time experience after graduation in hospital settings. On counting the working hours, junior resident doctors have more than 8 h of duty per day, including emergency duty, while senior nursing staff had 8 h of duty per day as per duty roster [Table 1].
Knowledge, attitude, and practice in the study participants
Knowledge about BMW management rules among the technically qualified personnel like the doctors, nurses was adequate and better than that in previous studies., However, surprisingly, there was a lack of adequate training programs in both the groups significantly more in the resident doctors [Table 3]. A similar result was reflected in studies conducted on nursing staff., The overall knowledge of resident doctors was comparable with nursing staff in the study instead of a lack of any training program. The reason may be knowledge component of the doctors was more desirable compared to nursing staff also most of the junior residents were fresh medical graduates with good knowledge components of the doctors was more desirable compared to the nursing staff of knowledge about the BMW management from the subject of community medicine. Knowledge about color coding of containers and waste segregation was also found to be adequate in both the cadres, which was in concordance with previous studies.,
The attitude toward BMW management of resident doctors was low in comparison to nursing staff, specifically regarding treatment, disinfection, and disposal of the waste than nursing staff [Table 3]. This was mainly attributed to the lack of formal training, rotating duty roster, lesser working experience, and more duty hours per day in comparison to nursing staff. This was similar to the findings from other studies.,
Adequate practice scores of the study participants were better than previous studies., Higher practice scores found in the nursing staff in the present study may be due to higher responsibilities assigned to them in the handling of BMW, which was similar to the findings of previous studies., Resident doctors had more inadequate practice regarding handling, segregation, disposal, reporting, and record maintain of BMW than nursing staff [Table 3]. Probably, this difference could be due to better accessibility of Biomedical Waste Management (BMWM) equipment, training opportunity, and Guidelines in nursing staff.,
Limitations of the study
The study was conducted with self-report questionnaire, which might be influenced by social desirability. Hence, direct observational data on knowledge, attitude, and practices on BMWM might be more accurate. Again the study was conducted in a single-specialty hospital, so the results could not be generalized for all categories of the hospital. Senior doctors and consultants were not included in the study as they were involved in the clinical area more in the supervisory level. Hence in working experience, both categories of the study participants were not comparable.
| Conclusion|| |
Overall, the KAP toward BMW management among the study respondents were satisfactory. Regarding attitude and practices of BMW management, nursing staff have a better attitude and good practice than the resident doctors. There was a lack of formal training about BMW management as per BMW management and handling rules 2016, in both categories of study participants, more in the resident doctors group. The lower level of awareness about hospital waste handling may have a direct impact on the overall process of safe disposal of BMW, causing environmental and public health hazards.
| Future Recommendation|| |
An effective and goal-oriented frequent training program targeting both the cadres of health-care workers is an important way to improve knowledge, attitude, and practices about BMW management. There should be strict implementation of BMW management rules in the health-care facility to improve the quality of patient care. Working hours of the resident doctors should be as per norms so that they remain motivated in the safe handling of BMWs. There should be adequate reporting and maintaining of BMW management record.
The author would like to acknowledge gratitude to all resident doctors and nursing staff of the institute who sincerely participated in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]