|Year : 2018 | Volume
| Issue : 2 | Page : 127-132
Level of understanding of revision of biomedical waste rules, 2016 among nursing students in Shimla, Himachal Pradesh
Ankit Chaudhary, Anjali Mahajan
Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
|Date of Web Publication||9-Apr-2018|
Department of Community Medicine, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Biomedical Waste Management (BMW) Rules came into legislation in 1998 with periodic amendments; two in 2000, one in 2003 with latest revision of rules in 2016. It is essential to assess the level of awareness of health personnel regarding revisions in health related policies so that they are updated adequately for provision of quality health care services. Methodology: A cross sectional study was undertaken in November 2016 among 203 nursing students students to ascertain their level of understanding of recent amendments in BMW management rules. A 35 item, self administered, pretested, structured, closed ended, anonymous questionnaire was used for data collection. Results: The scores of the majority (86.2%) of the participants fell in poor category, 13.3% in fair, only 0.5% in good while none in excellent category. The scores gradually increased from second to final year; 9.80 ± 2.36, 11.38 ± 2.48 and 12.02 ± 2.79 respectively (P < 0.001). Nearly 60.3% and 86.2% of the participants showed positive attitude and safe practice habits respectively. Conclusion: For effective implementation of biomedical waste management practices in the hospitals; periodic sensitization and continuous training programs focusing on the recent amendments and advances should be made mandatory.
Keywords: Biomedical waste, biomedical waste management rules, nursing students
|How to cite this article:|
Chaudhary A, Mahajan A. Level of understanding of revision of biomedical waste rules, 2016 among nursing students in Shimla, Himachal Pradesh. CHRISMED J Health Res 2018;5:127-32
|How to cite this URL:|
Chaudhary A, Mahajan A. Level of understanding of revision of biomedical waste rules, 2016 among nursing students in Shimla, Himachal Pradesh. CHRISMED J Health Res [serial online] 2018 [cited 2019 Mar 21];5:127-32. Available from: http://www.cjhr.org/text.asp?2018/5/2/127/229588
| Introduction|| |
The term “Biomedical waste (BMW)” means any waste, which is generated during the diagnosis, treatment, or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps, including the categories mentioned in Schedule I of the Government of India's BMW (Management and Handling) Rules 2016.
While the aim of health personnel is reducing health problems, eliminating potential risks, and treating sickness; healthcare services inevitably create waste which itself may pose a threat to health. The waste generated during healthcare-related procedures carries a higher potential for infection and injury than any other type of waste. Inadequate and inappropriate knowledge of handling of healthcare waste may have serious health consequences and a significant impact on the environment as well.
The quantum of waste generated in India is estimated to be 1–2 kg/bed/day in a hospital and 600 g/day/bed in a clinic. 85% of the hospital waste is nonhazardous, 15% is infectious/hazardous. Mixing of hazardous results into contamination and makes the entire waste hazardous. Hence, there is a necessity to segregate and treat. Improper disposal increases the risk of infection; encourages recycling of prohibited disposables and disposed drugs; and develops resistant microorganisms.
The legislation regarding BMW management came into existence in 1998. Since then, these have been revised and amendments have been made over the period; two in 2000, one in 2003 and with latest being made in 2016. However, no legislation can ensure the success of program if awareness of the healthcare personnel regarding the knowledge of rules, recent advances and amendments are lacking. For waste management to be effective, the waste should be managed at every step, from generation to disposal.
Therefore, the present study was undertaken with the objective of finding out the awareness regarding recent advances in BMW management and the factors having an impact on this awareness among nursing students.
| Materials and Methods|| |
The study was conducted among nursing students of Government Nursing College at Shimla, Himachal Pradesh.
The study participants included nursing students who attended clinical posting, i.e., second, third, and fourth professional years of Government Nursing College at Shimla, Himachal Pradesh.
A descriptive analytical cross-sectional study.
The study was conducted over a period of 1 month in November 2016.
There were 210 students enrolled in second, third, and fourth professional year of the Nursing College. Seven students who were absent on the day of data collection were excluded from the study. Therefore, a total of 203 students were included in the study.
- Students who gave consent to take part in the study
- Questionnaires with more than 70% responses were included.
- Those who do not consent to participate in the study.
A 35 item, self-administered, pretested, structured, closed ended, anonymous questionnaire was used for data collection measuring the awareness in three sub-dimensions: knowledge-based 25 questions comprising legislation (5 items), application and authorization (5 items), duties and functioning of occupier and common BMW treatment facility (5 items), segregation, packaging, transportation, and storage (10 items); attitude based five questions and practice-based 5 questions.
Knowledge-based questions had either one or two response categories. One mark was allocated for a correct response and zero for an incorrect response. Maximum scoring for knowledge-based question was 25. The knowledge scores were categorized into four categories, i.e., poor (<13), fair (14–17), good (18–21), and excellent (22–25).
Attitude and practice-based items were framed using a Likert scale. Attitude-based questions had responses in the order of “Disagree,” “Agree” and “Strongly agree.” Practice-based questions had responses as “Never,” “Sometimes,” and “Always” while question number 5 had responses as “Not vaccinated,” “Partially vaccinated,” and “Fully vaccinated.”
Data were entered into Microsoft Excel spreadsheet and transferred to Statistical Package for the social science (SPSS) software version 20.0, IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. IBM Corp, Armonk, NY, USA. Descriptive statistics were presented in the form of mean scores ± standard deviations. Discrete variables were presented in percentages and proportions of each. Mean scores were compared using ANOVA test and further Tukey Post hoc test was applied to compare any two individual groups (classes). Student t-test was applied to compare mean scores between two groups. P < 0.05 was considered as statistically significant. Two-tailed significance tests were used for all analysis.
Ethical approval for the study was taken from the institutional ethics committee. Written informed consent of the participants was taken. To keep the data anonymous, personal identifiers of the study participants were omitted.
| Results|| |
A total of 203 female nursing students were included in the study. Age of the participants ranged from 18 to 26 years with a mean age 20.86 ± 1.77 years. Out of 203 participants, nearly 70 had some previous training or sensitization program on this subject. However, none of the study participants had attended such training program after the implementation of these rules in March 2016.
Assessment of knowledge, attitude, and practice on bio-medical waste management
Response to knowledge-based questions on BMW management is given in [Table 1]. About 90.6% correctly identified the biohazard symbol. Nearly 76.8% of respondents did not know exemptions of these rules. About 92.1% lacked the knowledge that these rules don't cover general waste. About 39.9% responded that BMW is not collected on holidays. Only about 16.7% knew that BMW categories had been scaled down to four. Near 49.3% responded with ten categories depicting old guidelines. Majority (85.7%) participants didn't know where to keep discarded medicines. Only 17.2% knew about the use of white bags for contaminated sharps, whereas 77.8% responded with the blue category which was mentioned in earlier guidelines. Only 21.2% knew about the time limit for BMW storage.
The total mean score for knowledge was 10.76 ± 2.67 with scores of 9.80 ± 2.36, 11.38 ± 2.48 and 12.02 ± 2.79 for the second, third, and fourth professional year students, respectively. This difference was statistically significant (P< 0.001). On post hoc test, the fourth professional year had a higher score by a margin of 2.22 (confidence interval [CI]: 1.30–3.08) in comparison to second-year students (P< 0.001). Fourth-year students also had better score than third-year students by a slight margin of 0.64 (CI: 0.33–1.61), but this difference was statistically insignificant. [Table 2] shows the mean scores of different professional years.
|Table 2: Mean knowledge score of nursing students regarding bio.medical waste management|
Click here to view
The scores of the majority (86.2%) of the participants fell in poor category, 13.3% in fair, only 0.5% in good while none in the excellent category. [Table 3] summarizes the scores according to category.
Those who lacked any previous training, sensitization program or class on BMW management had a lesser average score of 10.46 ± 2.92 while those who had previous exposure scored more and had a score of 11.34 ± 2.02. The mean difference of score was - 0.884 (CI: 1.574–0.194) which was statistically significant (P = 0.03). [Table 4] shows the knowledge scores in accordance with previous training status of participants.
However, it is worth mentioning that out of 70 participants who had previous training, only 9 (12.9%) scored more than 13 (good category score) and rest 87.1% scored less than 13 (poor category score). Out of 133 who did not have any previous training exposure, 19 (14.3%) scored more than 13.
[Table 5] shows the responses to attitude-based questions on BMW management. The response showed a favorable positive attitude toward the topic of discussion. About 67% strongly stated that there should be continuous sensitization program regarding the BMW management. Nearly 19.2% stated that their institution was not handling BMW in accordance with rules and standard guidelines.
[Table 6] shows response to practice based questions on BMW management. Approximately 95.6% stated that they were doing appropriate segregation according to the color coding. About 4.4% stated that they do not report the accidental injuries to the appropriate authority. Nearly 86.2% of respondents admitted mixing BMW with general waste all the time. About 84.7% responded to have received all three scheduled doses of Hepatitis B vaccine.
| Discussion|| |
This study was conducted among nursing students to assess their level of knowledge, attitude, and practice patterns regarding recent amendments in BMW management rules. Healthcare workers are the frontline workers in the management of BMW generated in the hospitals. During handling BMW, the inadequate knowledge and indulgence in unsafe practices would be a potential threat not only to oneself but also to all those in the proximity.
The study found out that there was a highly unsatisfactory level of knowledge with nearly 86.2% of participants falling in poor category score regarding recent amendments in BMW management [Table 3]. This finding points toward the dire need of continuous medical education for all health personnel so that they are abreast with the recent advances.
In this study, it was found that only 34.5% of students had some kind of previous sensitization regarding BMW management [Table 7]. This is almost equal to study conducted by Mukesh et al., where 35% of participants had previous training. The level of knowledge was in commensuration with the previous orientation and training program regarding BMW management.
In this study, it was found that the fourth professional year students had better knowledge scores than the 2nd and 3rd year students [Table 2]. This may be due to the prolonged clinical exposure and more theoretical and practical experience. This finding was similar to a study conducted in a dental institute at Kothamangalam.
Nearly 83.7% of participants were aware of recent title changes regarding BMW rules. Majority of participants (90.6%) correctly identified biohazard symbol which was more than that found out by Haider et al., in which 76.7% of students identified the symbol positively.
Only 16.7% knew that BMW categories had been narrowed down to four from earlier ten. About 59.1% of respondents did not know about the replacement of chlorinated bags by nonchlorinated bags. Mere 14.3% of participants knew about proper disposal of discarded medicines. Only 17.2% of participants responded correctly about the disposal of contaminated sharp objects. One striking finding was that participants responded in all genres, i.e., legislation, application and authorization, duties of occupier and particularly in segregation, treatment and disposal category according to previous guidelines; thus reinforcing the dire need for periodic hands on training program for all categories of health personnel.
Regarding attitude of the participants, study revealed that 91.6% of respondents agreed that segregation at the point of generation reduces the risk to health personnel. This was slightly better in comparison to the study conducted by Asadullah et al., in which 90.4% agreed. Only 11.8% of respondents considered BMW management as an unnecessary extra burden on them which is a bit more than that found by Madhukumar and Ramesh in Bangalore wherein 9.9% participants felt this. Majority of participants (97.5%) felt the need of continuous sensitization and training programs in their institution. This was more than the findings of study by Radha, wherein only 60% stated the need of training. In the present study, about 19.2% agreed that their institution was not handling BMW according to standard guidelines.
Regarding to practice pattern among participants, 95.6% of participants submitted that they were segregating the waste according to color coding. About 83.3% respondents stated that they were putting contaminated sharps in the puncture proof containers. About 13.8% of participants admitted mixing BMW and general waste which was less than a study conducted in Amritsar where 17.5% were mixing both wastes. In contrary to study conducted by Patil et al. in which only 41.8% were immunized for Hepatitis-B, about 84.7% of our study subjects reported that they were fully vaccinated against disease.
| Conclusion|| |
The study highlights that the level of understanding of the latest BMW management rules among nursing students was not satisfactory albeit they reflected positive attitude and practice patterns. Healthcare personnel are the key persons dealing with human lives, therefore the present study emphasizes that they should be subjected to regular training programs so that their knowledge is continually updated and they are capable of providing quality patient care. Safe health care practices can be ensured only if there is adequate knowledge and awareness regarding these rules. Therefore, for effective implementation of BMW management practices in the hospitals; periodic sensitization and continuous training programs focusing on the recent amendments and advances should be made mandatory.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mathur V, Dwivedi S, Hassan M, Misra R. Knowledge, attitude, and practices about biomedical waste management among healthcare personnel: A cross-sectional study. Indian J Community Med 2011;36:143-5.
] [Full text]
Government of India, Ministry of Environment and Forests. Bio-Medical Waste (Management and Handling) Rules. Gazette of India; 27 July, 1998. Available from: http://www.envfor.nic.in/legis/hsm/biomed.html
. [Last accessed on 2017 Sep 20].
Sood AG, Sood A. Dental perspective on biomedical waste and mercury management: A knowledge, attitude, and practice survey. Indian J Dent Res 2011;22:371-5.
] [Full text]
Kumar M, Singh RK, Varshney U, Rawat V. Awareness and practices about bio-medical waste among health care workers in tertiary care hospital of Haldwani, Nainital. Natl J Med Res 2015;5:47-51.
Sanjeev R, Kuruvilla S, Subramaniam R, Prashant PS, Gopalakrishnan M. Knowledge, attitude, and practices about biomedical waste management among dental healthcare personnel in dental colleges in Kothamangalam: A cross-sectional study. Health Sci 2014;13:1-12.
Haider S, Kumari S, Kashyap V, Sunderam S, Singh SB. A study on knowledge and practice regarding biomedical waste management among staff nurses and nursing students of Rajendra Institute of Medical Sciences, Ranchi. Indian J Community Health 2015;27:135-8.
Asadullah MD, Karthik GK, Dharmappa B. A study on knowledge, attitude and practices regarding biomedical waste managemnt among nursing staff in private hopitals in Udupi city, Karnataka, India. Int J Geol Earth Environ Sci 2013;3:118-23.
Madhukumar S, Ramesh G. Study about awareness and practices about health care wastes management among hospital staff in a medical college hospital, Bangalore. Int J Basic Med Sci 2012;3:7-11.
Radha R. Assessment of existing knowledge, attitude and practices regarding biomedical waste management among the health care workers in tertiary care rural hospital. Int J Health Sci Res 2012;2:14-9.
Narang RS, Manchanda A, Singh S, Verma N, Padda S. Awareness of biomedical waste management among dental professionals and auxiliary staff in Amritsar, India. Oral Health Dent Manag 2012;11:162-8.
Patil SP, Tambe MP, Patil PJ, Bhagwat VR. Awareness of healthcare workers regarding biomedical waste management (BMW) at tertiary care government hospital in dhule (Maharashtra). NJIRM 2013;4:74-9.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]