Knowledge and Practices of Health Care Waste Management Among Healthcare Workers at FMC, Owo, Ondo State
CHAPTER ONE
Objective of the study
The main objective of this study is to examine the Knowledge and practices of health care waste management among Healthcare workers at FMC,Owo, Ondo state. Specifically the objective of this study is to:
- Examine health care workers’ knowledge on waste management in Federal Medical Center, Owo.
- Explore and describe health care workers’ attitude towards correct waste management.
- Assess health care workers’ practice on compliance with the waste segregation.
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
Literature review is a critical summary of research on a topic of interest, often prepared to put a research problem in context or to summarise existing evidence (Polit & Beck, 2008). A review of the literature assisted the researcher to identify what other researchers have done and reported on the research problem. Its main goals are to place the current study within the body of literature and to provide context for the particular reader. Literature review substantiates the research, shows that a problem exists and establishes the need for the present study. The researcher used the literature review process to develop a comprehensive understanding of the topic. The literature review process helped the researcher to identify gaps in current knowledge and begin to establish the conceptual or theoretical frame work to be used in the study (Norwood, 2010). It identified findings and views from previous studies in order to provide intellectual context for positioning the study in relation to other studies. The literature reviewed was on types of medical waste, knowledge, practices, environmental and health impact of practices. A review of international and local sources from peer reviewed sources and from expert organizations in health and environmental issues was done.
TYPES OF MEDICAL WASTE
Medical waste is categorised into different types, namely: infectious waste, pathological waste, sharps, pharmaceutical waste, chemical waste, radioactive waste, cytotoxic agents and human or anatomical waste. Infectious waste is any waste contaminated with viable micro-organisms capable of transmitting a disease. Pathological waste includes body fluids, secretions and surgical specimens. Sharps are any objects capable of inflicting a penetrating injury, which may or may not be contaminated with blood and or body substances. This includes needles and any other sharp objects or instruments designed to perform penetrating procedures. Pharmaceutical waste includes pharmaceutical products such as drugs and medicinal chemicals that are no longer usable in patient treatment and have been returned from patient care areas, have expired or have been contaminated. Chemical waste comprises of discarded solid, liquid and gaseous chemicals. Examples may be from diagnostic or experiential work, or from cleaning, housekeeping or disinfecting procedures. Chemical waste may be hazardous or non- hazardous (Health Professions Council of South Africa, 2008). Radioactive waste is material contaminated with radioactive substances which arises from medical or research use of radionuclides (Chartier, Emmanuel, Prüss, Rushbrook, Stringer, Townend, Wilburn & Zghondi, 2014).
Cytotoxic agents are substances that have a deleterious effect upon cells, commonly used in the treatment of cancer, for example chemotherapy agents. Pressurised containers consist of aerosol cans or disposable compressed gas containers that may explode if incinerated or accidentally punctured. Human or anatomical waste is waste consisting of tissues, organs, body parts, products of conception and animal carcasses (Health Professions Council of South Africa, 2008).
CHAPTER THREE
RESEARCH METHODOLOGY
INTRODUCTION
In the previous chapter the literature review was presented. In this chapter the researcher presents the research designs and all the components of the research design. This served to clarify the implementation of the quantitative methods in order to understand the knowledge and practice of health care workers with regard to waste management at Federal Medical Center, Owo. The chapter concluded with a description of the research design, measures for ensuring trustworthiness and ethical standards that have been adhered to during the study to ensure the scientific value of the study.
RESEARCH DESIGNS
A research design is a set of logical steps taken by the researcher to answer a research question (Brink, Van der Walt & Van Rensburg, 2006). The researcher in this particular study wanted to assess the knowledge, attitudes and practices of health care workers on waste Management. A quantitative, descriptive, cross-sectional study design was used. Firstly, it was quantitative in the sense that it measured all relevant variables objectively at a specific time and did not include an experimental or a control group. Secondly, it was cross- sectional, because the study was conducted in the present time to examine what currently existed and was characterized by the fact that all data were collected at one time (De Vos, Strydom, Fouche & Delport, 2011; Brink et al, 2006). Thirdly, a descriptive quantitative approach was used to assess the status of waste segregation in the two hospitals as well as to describe the knowledge, attitudes and practices (KAP) of health care workers in their settings on waste Management practice.
POPULATION OF THE STUDY
The population is the entire group of persons or objects that is of interest to the researcher and which met the criteria onto which the researcher wishes to investigate. The group should have a set of characteristics about which the researcher wishes to draw a conclusion (Brink, 2010).
In this study, the population of interest was doctors, nurses, ward assistants and cleaners working at FMC. The target population was doctors, nurses, ward assistants and cleaners working at selected wards such as medical, gynecologic, and surgery and postnatal. The study population was selected from this target population. For objective one and two of this study, the study populations for 14 wards were: nurses (N=62), doctors (N=21), ward assistants (N=7) and cleaners (N=21) according to the change list allocations and doctors call list at the two facilities. The total study population estimate was (N=111), after random selection. The study population was HCWs in the inpatient wards and on day shift and night shift these being 6 medical wards, 4 surgery wards, 2 gynecology wards and 2 postnatal wards. These wards were selected on the ground that they generated infectious and non-infectious wastes on a daily basis. In total, they were 14 wards.
For objective number three, target populations were 14 wards that met inclusion criteria and study population were 7 wards that were assessed by use of checklist to underpin and analyse the existing situation on how health care workers Manage wastes.
CHAPTER FOUR
PRESENTATION AND DATA ANALYSIS OF THE RESULT
INTRODUCTION
The research designs of this study were described in chapter 3. The study population and the sampling methods that were used to obtain the sample were presented, as well as the research instruments (self-administered questionnaires and checklist) that were used for data collection were discussed. The data was analysed quantitatively and presented in numerical forms.
In this chapter, the researcher presents the findings obtained from the analysis conducted on the data that were collected using self-administered questionnaires and checklist tools, as well as in view of the objective questions that assessed the knowledge, attitudes and practices of health care workers on waste Management.
The findings and the discussion were divided into four sections. The first section A presents the social demographic data. The second section B presents the findings on the knowledge of health care workers on waste Management. The third section C presents the attitude of health care workers on waste Management and the way in which these attitudes influence their daily practices. The fourth section D presents the findings on the practice of health care workers on waste Management. The researcher was available when the respondents were completing the questionnaires, but she limited her own contribution to the completion of the questionnaire to the absolute minimum (De Vos et al, 2011).
CHAPTER FIVE
DISCUSSION, CONCLUSION, RECOMMENDATIONS
INTRODUCTION
This is the final chapter of this research study and focuses on discussing the research findings and the results presented in Chapter 4. It also contains an evaluation of the overall purpose of the study, together with its three objectives. Subsequently, conclusions are drawn and recommendations are made. The overall purpose of this study was to explore the knowledge, practice and attitude of health care workers on waste Management in Federal Medical Center (FMC) Owo, Ondo state.
Accordingly, it is concluded that the research aim was achieved to a large extent by the findings of this study. To justify this conclusion, the findings were appraised against the research intention and the three research objectives for the study. These objectives were: 1) To examine health care workers’ knowledge on waste Management in Federal Medical center, Owo; 2) To explore and describe health care workers’ attitude towards correct waste Management; and 3) To assess health care workers’ practice on compliance with the waste Management. The researcher administered questionnaire to 100 health care workers at Federal Medical center, Owo.
DISCUSSION OF FINDINGS
This chapter presents the discussion obtained from the analysis conducted on the data that were collected using self-administered questionnaire, checklist as well as in view of the objectives that assessed the knowledge, attitude and practice of health care workers on waste Management. Since, we have not found any study in Namibia addressing the same objectives, key strength of this study was that this assessment of KAP related to waste Management gave us a unique opportunity to provide information about a topic which is lacking in our country.
It also helps to identify the gaps between the current KAP among the health-care workers involved in waste Management and the future desired state that should be reached.
Section A: Demographic data of health care workers on waste Management
Respondents were (n=100) that includes 53 nurses, 20 doctors, 20 cleaners, and 7 ward assistants that have participated in the study. The demographic data that was discussed are gender, age, profession, duration of current work experience, hospital and the ward where the health care workers were working. Genders for all participants were 25% for male and 75% for female. Among nurses who respondents, 10 (18. 9%) were male, while 43 (81. 1%) were female; 11 (55. 0%) doctors were male, while 9 (45. 0%) were female. Meanwhile, both 7 (100%) ward assistants were female and lastly, cleaners 4 (20. 0%) were male and 16 (80. 0%) were female.
The oldest respondent in the sample was 64 years old, while the youngest was 23 years old. Meanwhile 4 (4. 0%) respondents did not state their ages. A large proportion of (34.4%) of the respondents were aged between 20 and 30 years, followed by (26%) in the age categories of 41-50. Furthermore, (25%) respondents were in the age categories of 31 to 40 age groups and (14.6%) fell into the age categories of 50 and above. The mean ages of all participants were 37.4 (SD 13.0) years, Median 36.5 and Mode 28. However, the mean ages per profession were as follows: Doctors 35. 7(SD 9.0), Nurses were 38. 3 (SD 13. 2), Ward assistants were 35.7 (SD 16. 5) and Cleaners were 37 (SD 15. 3) years.
Section B: (Objective 1) Knowledge of health care workers on waste Management
Knowledge about waste Management is important for all health care workers as lack of knowledge about waste Management may jeopardise infection control in the health facilities. The study revealed that 95. 0% of doctors, 86. 8% of nurses, 85.7% ward assistants and 90.0% of cleaners who participated in the study knew that health care wastes are hazardous and could pose health risks if not properly segregated. That means doctors’ score were higher than the other 3 occupational categories on this item. This might also be explained by the fact that they have more in-depth understanding due to their higher education and professional levels. Doctors scored higher on red plastic bags 95%, ward assistants 86%; while nurses and cleaners scored exceptionally well with 96% and 100% respectively. Meanwhile, nurses and ward assistants scored high on green plastic bags knowledge, 89% and 86% respectively, while doctors scored 55% and cleaners 65% and this can be attributed to the fact that the two formers are dealing with soiled linen on a daily basis.
Section C: (Objective 2) attitude of health care workers on waste Management
Regarding the attitude of health care workers towards waste Management and disposal at the two training hospitals, the respondents were asked to rank themselves the way they segregate wastes by circling a number to best indicate their rating. On average, HCWs that strongly agreed that they always put wastes in the correct plastic bags were 57(57%). The percentage of HCWs that strongly agreed that safe disposal is of utmost importance for preventing infection transmission 83(83.0%). For this study, the main outcome of interest was that higher percentage of HCWs (83.3%) strongly agreed on this statement and that was a good indication that they know how to prevent infections. This was followed by 80(80.0%) of HCWs who strongly agreed that wearing personal protective equipment reduces the risk of contracting infection. While those who strongly agreed that waste disposal is a team work and not a hospital management responsibility were 64(64.0%). Furthermore, HCWs that strongly agreed that efforts in safe waste disposal are a financial burden on the administrative department of the hospital were only 37(37.0%). These study findings are in agreement with findings of another study conducted in Egypt that researched on some of the above statements such as; safe waste disposal should be a priority, waste disposal is teamwork not a hospital responsibility, and that disposal of waste is a financial burden on the hospital. In their study, the proportion of housekeeping staffs had showed a higher significant approval of these statements than other HCWs categories.
Section D: (Objective 3) practice of health care workers on waste Management
On the practice of health care workers on waste Management, wards were assessed using a checklist to analyze the existing situation of waste Management practice of health care workers. Practices among HCWs were not found up to standard in some of these wards. On observation of the wards; black, red, green and clear plastic bags were found in all the wards (100%), while yellow plastic bags were not in 4 (57%) of the hospital wards assessed. According to the ward supervisors, this problem had been going on for months. This unavailability of yellow plastic bags had already underpinned the circumstances in which HCWs were working. That means, wastes that were supposed to be put in yellow plastic bags ended up in wrong plastic bags and eventually wrongly disposed of.
The World Health Organization suggested that a biohazardous symbol should be attached to the plastic bag used to indicate to others the types of wastes segregated in the specific plastic bag. Meanwhile, incorrect disposal of blood-contaminated fomites was observed in 2(28. 6%) wards, while such observation was not seen in 5 (71. 4%) of the wards. Practices could only be improved by regular and proper trainings and by allocating the proper budget for colour coded plastic bags. This was concurred by the study that was done in Pakistan which concluded that poor resources and lack of healthcare worker’s training in infectious waste resulted in poor waste management at hospitals.
CONCLUSION
It was concluded that training of personnel was not adequate and did not cater for all different level of health care workers. Some of the waste handlers did not segregate wastes properly, but mixed them up and a large amount was incinerated including the wastes that would otherwise have been non-infectious. The study concluded that regular orientation and re- orientation training programs should be organized for all hospital staff and strict
implementation of guidelines of biomedical waste management that includes waste Management, to protect themselves and hospital visitors (Othigo, 2014). Moreover, for effective implementation of waste Management practices in the hospitals, it requires mandatory periodical sensitization to improve the biomedical waste knowledge and practices among health care workers.
RECOMMENDATIONS
The results of this study show that not all of these HCWs possessed good knowledge and attitude towards waste Management. Doctors and nurses who were least trained are knowledgeable with colour coded plastic bags surrounding their area of work ,whereas cleaners and ward assistants who scored high on waste Management training possessed good knowledge almost with all colour coded plastic bags. However, the unavailability of yellow plastic bags in one hospital wards jeopardise efforts in safe waste disposal and can lead to financial burden of the hospital and the Ministry at large. Meanwhile, lack of yellow plastic bags in the wards underpinned the poor practice of health care workers as it was observed in the wards kitchen, where black plastic bags were used instead.
At times, HCWs might also ended up putting wastes in wrong plastic bags such as red plastic bags making the quantity more and overloaded, but is not really infectious waste. Moreover, wastes that was put in wrong plastic bags and has to go for incineration would overload the incinerators unnecessarily. Wastes that were taken to state landfills were weighted and they charged some amount of money from the FMC. Improper waste Management might add up unnecessary kilograms on such plastic bags and the Ministry of Health and Social Services ended up paying a huge amount of money. Furthermore, in some wards areas where plastic bags were loaded from the wards, bags were accumulated there and it became smelly and unhygienic.
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