A Study to Assess the Effectiveness of Self Instructional Module on Biomedical Waste Management among the Staff Nurses of the selected Hospitals of Ludhiana, Punjab.

 

Ms. Amandeep Kaur¹, Mrs. Pardeep Kaur²

¹Lecturer, Institute of Nursing Education, GTBS (C) Hospital, Ludhiana

²Assistant Professor, Institute of Nursing Education, GTBS (C) Hospital, Ludhiana

 

 

ABSTRACT:

A quasi-experimental study with single group pretest-posttest design was conducted to assess the effectiveness of Self Instructional Module on Biomedical Waste Management among the staff nurses of the selected hospitals of Ludhiana, Punjab. A total of 50 staff nurses were chosen as study subjects. Self Instructional Module on Biomedical Waste Management was developed. Based on Self Instructional Module, a questionnaire was framed to assess the pretest-posttest knowledge scores of study subjects’. Descriptive and inferential statistical tests were used for data analysis. Mean posttest knowledge scores (26.70) of subjects after administration of Self Instructional Module was found to be significantly (p<0.01) higher than their mean pretest knowledge score (17.52).  In pretest, majority 26 (52%) of subjects secured average knowledge scores followed by 17 (34%) who were having good knowledge scores and 5 (10%) subjects who had poor knowledge scores. Only 2 (4%) subjects had very good knowledge scores. After administration of Self Instructional Module, the level of  knowledge scores of study subjects increased as the result of posttest shows 36 (72%) achieved very good level of knowledge score followed by 14 (28%) who attained good level of knowledge score. None of the subjects were found to be having average, poor or very poor level of knowledge scores. Findings suggest that there was no statistically significant (p>0.05) association between posttest knowledge scores of subjects on Biomedical Waste Management and their age, gender, educational qualification and clinical experience. Hence, administration of Self Instructional Module on Biomedical Waste Management was very effective on staff nurses.

 

 

 

INTRODUCTION:

Medical care is vital for our life and health but the waste generated from medical activities represent real problem of living nature and human world. Every day relatively a large amount of potentially infectious and hazardous waste is generated in the hospitals and nursing homes. Indiscriminate disposal of Biomedical waste and exposure to such waste possess serious threat to environment and human health. The waste produced in course of health care activities carries a higher potential for infection and injury than any other type of waste. Inadequate and inappropriate knowledge of handling of health care waste may have serious health consequences and a significant impact on the environment as well. Globally, this issue has been seriously considered and appropriate waste management systems are being developed and installed.

 

According to Biomedical Waste (Management and Handling) Rules, 1998 of India “Biomedical waste is defined as any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals.¹

 

The hospital waste like body parts, organs, tissues, blood and body fluids along with soiled linen, cotton, bandage and plaster casts from infected and contaminated areas are very essential to be properly collected, segregated, stored, transported, treated and disposed of in safe manner to prevent infections to health care workers as well as general public. According to World Health Organization, of the total amount of waste generated by health-care activities, about 85% is general, non-hazardous waste. The remaining 15% is considered hazardous material that may be infectious, toxic or radioactive. Injections with contaminated needles and syringes in low- and middle-income countries have reduced substantially in recent years, partly due to efforts to reduce reuse of injection devices. Despite this progress, in 2010, unsafe injections were still responsible for as many as 33,800 new HIV infections, 1.7 million hepatitis B infections and 315,000 hepatitis C infections. A person who experiences one needle stick injury from a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3% respectively of becoming infected with HBV, HCV and HIV.²

 

Hospital waste management is a part of hospital hygiene and maintenance activities. In India, the Biomedical Waste (Management and Handling) rules, 1998 and further amendment were passed for the regulation of Biomedical Waste Management. Most of the hospitals have not yet implemented the Biomedical Waste Management rules and is still dumping their waste in municipal garbage dumps without segregation in canals or rivers leading to water pollution. Improper disposal can lead to many diseases in animals as well as humans. Large number of unregistered clinics and institutes also generate biomedical waste which is not controlled.³ In most of the hospitals, the recruitment of staff never gets fulfilled in every field leading to negligence in disposal of Biomedical Waste. As many hospitals are not financially sufficient enough, therefore they are unable to treat and dispose of Biomedical Waste as per guidelines. According to the Ministry of Environment and Forests (MoEF) gross generation of Biomedical Waste in India is 4,05,702 kg/day of which only 2,91,983 kg/day is disposed, which means that almost 28% of the wastes is left untreated and not disposed finding its way in dumps or water bodies and re-enters our system. According to another report of Ministry of Environment and Forests, almost 53.25% of Health Care Establishments are in operation without the adequate authorization from State Pollution Control Board/Pollution Control Committee which means that waste generated from such facilities goes unaccounted and is dumped without any adequate treatment illegally.⁴

 

The staff nurses spend maximum time with patients in the ward than any other member of health team; it increases their exposure and risk to the hazards present in the hospital environment, mainly from Biomedical Waste. They need to be well equipped with latest information, skills and practices about the Biomedical Waste Management.

 

From the personal experience of the investigators, staff nurses have inadequate knowledge regarding Biomedical Waste Management. Keeping in mind the lack of awareness about hazards associated with Biomedical Waste Management among health personnel’s and lack of training regarding the same before recruiting the health personnel, investigators felt that a research study should be conducted to impart knowledge regarding Biomedical Waste Management among staff nurses.

 

MATERIALS AND METHODS:

Objectives:

a)     To evaluate the effectiveness of the Self Instructional Module on Biomedical Waste Management among the staff nurses.

b)     To find out the association between the selected demographic variables and knowledge about Biomedical Waste Management among the staff nurses.

 

Hypothesis:

H₁: There will be significant difference in the posttest knowledge scores as compared to pretest knowledge scores among the staff nurses related to Biomedical Waste Management.

 

H₀: There will be no statistically significant association between the levels of posttest knowledge scores of the staff nurses in relation to the selected demographic variables.

 

METHODOLOGY:

A Quasi-experimental approach was employed to conduct the present study to assess the effectiveness of self instructional module on the Biomedical Waste Management. A Single group, pretest-posttest design was employed to carry out the study. The study was conducted in the Sat Guru Pratap Singh Hospital, Ludhiana, Punjab, India. Target population of the study was all the staff nurses working in the Sat Guru Pratap Singh Hospital, Ludhiana, Punjab available in the month of January, 2015. A total of 50 staff nurses working in the Sat Guru Pratap Singh Hospital, Ludhiana, Punjab were taken.

 

For the purpose of conducting this study, a teaching tool i.e. a Self Instructional Module on Biomedical Waste Management was developed as well as a knowledge assessment tool/questionnaire was developed based on Self Instructional Module to evaluate the pretest and posttest knowledge scores.

 

Prior to the development of the tool the investigator consulted the experts in the field of nursing. Questionnaire consists of two parts: Part A: It consisted five items of demographic data (1-5). Part B: It included 30 (thirty) multiple choice questions, each having 4 (four) alternatives, with 3 (three) distracters and 1 (one) correct answer. Each item of the questionnaire was scored for the correct as well as for the incorrect response. Score 1 (one) was assigned to the correct response and 0 (zero) to the incorrect response. The total score of the questionnaire ranged from 0-30. According to the scores obtained by the study subjects, they were categorized into very good (25-30), good (19-24), average (13-18), poor (7-12) and very poor (0-6) level of knowledge. Before conducting the final study, a pilot study was conducted during the month of December 2014, to find out the practicability and feasibility of the tool. The reliability of the questionnaire was calculated by using Split-half Technique. The data was collected in January, 2015 at Sat Guru Pratap Singh Hospital, Ludhiana, Punjab

 

RESULTS:

As depicted in table-1, from the sample of 50 subjects, majority 39 (78%) each of the subjects, were in the age group of 21-30 followed by 11 (22%) in the age group of 31-40 years.  No subject belonged to the age group 41-50 years or >50 years. Majority 43 (86%) of subjects were females and 07 (14%) rest were males. As per their educational status, maximum 33 (66%) of subjects were GNM, followed by 16 (32%) who had done Basic B.Sc. or Post Basic B.Sc. Nursing and only 1 (2%) subject had M.Sc. done (Nursing). Regarding their clinical experience, majority 30 (60%) of staff nurses clinical experience is below 5 years, followed by 12 (24%) who had their clinical experience between 6-10 years and 8 (16%) had clinical experience between 11-15 years. All of the subjects had earlier attended an educational programme on Biomedical Waste Management.

 

 

TABLE-1: Percentage distribution of demographic characteristics of the subjects.       N=50

 

 

Table-2 depicts that the value of mean posttest knowledge scores (26.70) of subjects regarding Biomedical Waste Management after administration of Self Instructional Module was significantly higher than their mean pretest knowledge score (17.52) with a mean difference of 9.18 which was highly significant (p<0.01).

 

Table-2: Comparison of means of pretest and posttest knowledge scores of the subjects regarding Bio Medical Waste Management

N = 50

N	MEAN KNOWLEDGE SCORES				t-value	p-value
	Pre-test		Post-test
	Mean	S.D.	Mean	S.D.
50	17.52	3.80	26.70	2.41	26.84	0.01

**Highly Significant at 1% level

As indicated in table-3, in pretest, majority 26 (52%) of subjects secured average knowledge scores followed by 17 (34%) who were having good knowledge scores and 5 (10%) subjects who had poor knowledge scores. Only 2 (4%) subjects had very good knowledge scores. After administration of Self Instructional Module, the level of  knowledge scores of study subjects increased as the result of posttest shows 36 (72%) achieved very good level of knowledge score followed by 14 (28%) who attained good level of knowledge score. None of the subjects were found to be having average, poor or very poor level of knowledge scores.

 

TABLE-3: Frequency and percentage distribution of subjects according to their pretest and posttest level of knowledge scores.     N = 50

Pre-test: Highest Score: 27; Lowest Score: 10

Post-test: Highest Score: 30; Lowest Score: 21

 

Table-4 depicts that there was no statistically significant association (p > 0.05) between posttest knowledge scores of subjects about Biomedical Waste Management and their selected demographic variables i.e. age, gender, educational qualification and clinical experience.

 

Table-4: Association between the levels of posttest knowledge scores of the subjects and their selected demographic variables.

Key: VG: Very Good (25-30); G: Good (19-24); A: Average (13-18); P: Poor (7-12); VP: Very Poor (0-6);

NS: Not Significant at 5% level

 

DISCUSSION:

Table 2 depicts the interpretation of H₁ hypothesis indicating that H₁ hypothesis stands accepted as there was highly significant (p<0.01) difference in the posttest knowledge scores among the staff nurses compared to their pretest knowledge scores.

 

Table 4 illustrates that H₀ hypothesis was retained as the association between the staff nurses knowledge scores and their age (in years), gender, educational qualification and clinical experience (in years) was found to be statistically insignificant (p>0.05).

 

The above findings are supported by study conducted by Mohammad Nasir Uddin et al.⁵ A descriptive type of cross sectional study design was used to assess the level of knowledge regarding hospital waste management among senior staff nurses working in Faridpur Medical College Hospital, Bangladesh. All respondents were selected by random sampling. Results of this study revealed that Knowledge about hospital waste and its management is very poor among senior staff nurses. In the answer of knowledge about general waste only 4% gave all correct answers. In the answer of knowledge about infectious waste 63.2% gave one correct answer, of knowledge about pharmaceutical waste only 8% gave all correct answers, and of knowledge about biomedical waste only 7.2% gave all correct answers. In the answer of knowledge about color coded bins collecting waste 53.6% cannot give any correct answer and only 46.4% gave all correct answers and of knowledge about the safe disposal of hospital waste 16% could not give any correct answer.

 

A similar study was undertaken by Siddharudha Shivalli and Vasudha Sanklapur⁶ at a tertiary care hospital of Mangalore, India. Self-administered pretested questionnaire and “nonparticipatory observation” were used for quantitative and qualitative appraisals. Findings of the study concluded that nurse’s knowledge and healthcare waste management practices were not satisfactory. Most (86%) expressed the need of refresher training. No study variable displayed significant association with knowledge.

 

CONCLUSION:

From the findings of the present study, it can be concluded that administration of the Self Instructional Module on Biomedical Waste Management was effective.

 

REFERENCES:

1.     Govt. of India, Ministry of Environment and Forests Gazette notification No 460 dated July 20, New Delhi: 1998: 10-20 [Internet]. 1998 Jan 29 [cited 2014 Dec 1] Available from: http://www.moef.nic.in/legis/hsm/biomed.html

2.     WHO factsheet No253. Nov.2011[cited 2014] Available from:http://www.who.int/mediacentre/factsheets/fs253/en/

3.     Biomedical Waste. From Wikipedia, the free encyclopedia [Internet] 2014 [cited 2014 Dec 1]. Available from: https://en.wikipedia.org/wiki/Biomedical_waste

4.     Centre for Science and Environment. Bio Medical Waste Rules made stringent  [Internet] 2012 Mar28 [cited 2014 Dec1] Available from: http://www.cseindia.org/node/3702

5.     Mohammad Nasir Uddin Mohammad Rashedul Islam, Khadiza Yesmin. Knowledge on Hospital Waste Management among Senior Staff Nurses Working in a Selected Medical College Hospital of Bangladesh. Journal of Waste Management [Internet] 2014 Aug17; Volume 2014 (2014), Article ID 573069, 5 pages Available from:https://www.hindawi.com/journals/jwm/2014/573069/

6.     Siddharudha Shivalli, Vasudha Sanklapur. Healthcare Waste Management: Qualitative and Quantitative Appraisal of Nurses in a Tertiary Care Hospital of India. The Scientific World Journal [Internet] 2014 Nov20 Volume 2014 (2014), Article ID 935101, 6 pages Available from: https://www.hindawi.com/journals/tswj/2014/935101/

 

 

 

 

 

 

 

 

 

 

Received on 29.01.2017       Modified on 18.02.2018

Accepted on 09.03.2018       ©A&V Publications All right reserved