Indian Journal of Medical Microbiology, (2015) 33(1): 129-131
1
Brief Communication
Biomedical waste management: Study on the awareness and practice among healthcare workers in a tertiary teaching hospital L Joseph, H Paul, J Premkumar, Rabindranath, R Paul, JS Michael*
Abstract Bio-medical waste has a higher potential of infection and injury to the healthcare worker, patient and the surrounding community. Awareness programmes on their proper handling and management to healthcare workers can prevent the spread of infectious diseases and epidemics. This study was conducted in a tertiary care hospital to assess the impact of training, audits and education/implementations from 2009 to 2012 on awareness and practice of biomedical waste segregation. Our study reveals focused training, strict supervision, daily surveillance, audits inspections, involvement of hospital administrators and regular appraisals are essential to optimise the segregation of biomedical waste. Key words: Biomedical waste, health care worker, hospital safety, segregation
Introduction Biomedical waste is defined as any solid or liquid waste generated during diagnosis, treatment or immunisation of human beings and animals or during research that may present a threat of infections to humans.[1] A total of 80% of the waste generated in the hospitals is composed of general waste while the remaining 20% comprises of infectious, toxic or radioactive waste.[2] Of this, 20% of the waste is highly infectious and dangerous and could cause serious damage to the society and the environment when it is not properly segregated and disposed off. In India uniform guidelines for practice in the country have been laid down under the Bio-medical Management and handling Rules 1998. The waste management programme in hospitals are in accordance to these *Corresponding author (email: ) Quality Manager, Quality Management Cell (LJ), Infection Control Doctor, Hospital Infection Control Committee (HP), Nursing Superintendent (JP), Hospital Infection Control Committee Nurse (RB), Audit Facilitation Officer (R), Hospital Infection Control Committee, Department of Clinical Microbiology (JSM), Christian Medical College and Hospital, Vellore, Tamil Nadu, India Received: 29-07-2013 Accepted: 10-10-2013 Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.148411
guidelines and aim to minimise cross infection, improve the general hygiene in hospitals and minimise environmental pollution through proper treatment and disposal of waste.[3] The success of biomedical waste management programme rests on the knowledge and practice of the Health Care Worker (HCW). This study was done at a tertiary, teaching hospital in south India with over 2500 beds with an average occupancy of 80% and 6000 outpatients’ everyday on an average. About 2 tonnes of biomedical waste is generated everyday in the hospital and proper segregation of the waste at source is a challenge. It has a multi-disciplinary biomedical waste management committee to oversee the programme. Material and Methods A number of cross-sectional audits had been conducted from 2009 to 2012 on the biomedical waste segregation and the awareness of the HCW on the biomedical waste segregation in the hospital. The results of the audits are collated and presented as a longitudinal study in this paper. • Audit on staff awareness on biomedical waste segregation was conducted in September 2009 and the main focus of this audit was to assess the awareness level among the healthcare workers, doctors and nurses and allied staff with regard to biomedical waste segregation. The audit was done by administering a pre-tested questionnaire to 166 randomly selected health care workers with a response rate of 54% • Audit on segregation was conducted during the month of October 2009 to assess the practice of biomedical waste segregation in 145 areas, which included all wards, Laboratories Operation theatres, investigation areas and intensive care units jointly by infection nurses and the interns Quality Management team by observation of waste segregated at source • Re-audit on segregation was conducted to assess the change in practice after the training sessions and
130
Indian Journal of Medical Microbiology
other implementations between September 2009 and January 2012. Same areas that were audited in October 2009 were re-audited and the same checklist and methodology was adopted • Re-audit was conducted in June 2012 to assess the awareness after the training programmes and sessions conducted regularly between September 2009 and January 2012 with the help of a pre-tested questionnaire to 190 randomly selected health care workers with a response rate of 43%. Results Awareness among healthcare workers
vol. 33, No. 1
different colour bags used for segregation. In comparison to a study conducted at Mahatma Gandhi Dental College Hospital Pondicherry, the knowledge about colour coding of biomedical wastes was 74%.[4] The subsequent audit to assess the practice revealed similar results with the infectious non-plastics segregation 69%, infectious plastics and PPEs segregation 77%, non-infectious waste segregation 86%, sharps segregation 86% and cytotoxic wastes 88%. These audits showed the need to improve awareness among HCW’s and the necessity to develop new strategies achieves good compliance to waste segregation. The initiatives taken are listed below. Setting up the biomedical waste management committee
It was found that the awareness on the segregation of cytotoxic drugs had increased from 53% to 76%, segregation and disposal of sharps from 90% to 98%, infectious plastics from 72% to 83% and from 67% to 85% on the different colour bags used for segregation, which are statistically significant. Actual practice of biomedical waste segregation
A multi-disciplinary biomedical waste management committee was set up in 2009, which includes the administration and the infection control team. This committee is responsible for making hospital specific action plans for biomedical waste management its supervision, monitoring and implementation. Continuous training of staff
As shown in Figure 1 the actual practice of segregation of infectious non-plastic waste has improved from 69% to 93%, infectious plastics and Personnel protective equipment (PPEs) from 77% to 96%, non-infectious waste segregation from 86% to 97% and sharps from 86% to 96%, which are statistically significant. There is no significant improvement in the segregation of cytotoxic waste. Discussion To assess the awareness on Biomedical waste segregation among the healthcare workers, an audit was conducted in September 2009. The results revealed, among the samples audited, 53% were aware of the segregation of cytotoxic drugs, 90% on segregation and disposal of sharps, 72% on infectious plastics. Only 67% were aware of the
In a study done by waste management among doctors showed the necessity of having a balance between effective practical training and theoretical aptitude building among the medical group.[5] Pandit et al., showed that training of staff, both technical and non-technical, is critical for the proper and appropriate management of biomedical waste.[6] A session on biomedical waste management was introduced as part of mandatory training for all HCWS in the institution to improve the awareness. Focussed training session in areas with poor compliance was also done. Biomedical waste management posters Biomedical waste segregation posters highlighting the colour codes for different categories of waste was put in
Awareness on biomedical waste segregation 98%
100%
90%
85%
83% 76%
80%
60%
72%
67%
53%
Sep-09 Jun-12
40%
20%
0% Segregation of Cytotoxic drugs
Segregation of Sharp
Segregation of Infectious plastic
Figure 1: Practice of Biomedical waste at the hospital www.ijmm.org
Colour bags used for biomedical waste segregation.
January - March 2015
Joseph, et al.: Biomedical waste management in a tertiary care centre
all the areas in the hospital as a constant reminder of the need for proper segregation of waste. The posters were multi-lingual and predominantly pictorial.
131
Five colour system of segregation existed in the institution prior to 2009, which was changed to four colours, as recommended by Tamil Nadu Pollution control board simplified the process of segregation.
for bio-medical waste segregation for all HCW is essential to optimise the compliance to effective segregation strict supervision, daily surveillance, frequent audits and inspections are recommended to implement the bio-medical waste management rules in the hospital. Involvement of the hospital administrators and regular appraisal with the status of bio-medical waste management in waste management and quality steering committee play a pivotal role in executing the policies effectively.
Accountability through labels
References
Reducing the number of colour bags used for segregation
Practice of pasting labels on the bags, denoting the location, date and time of disposal of waste generation, prior to sending them to the temporary storage yard ensured accountability, which was substantiated by frequent audits and tracking improperly segregated wastes. Repeated audits and inspections
1.
2. 3.
Repeated audits both scheduled and unscheduled were conducted by the Hospital infection control team and the quality management team. These audits and inspections focussed on interviewing staff to assess awareness, scrutinising the training records and also the actual practice of segregation. Reports of these inspections and audits were sent to administration and respective areas. The recommendations were implemented and followed up by the biomedical waste management committee. Re-audits on waste segregation practice and awareness at were conducted in January 2012 and June 2012, respectively, showed a significant improvement in the above parameters. Conclusion The present study reveals that periodic focused training and emphasis on implementation of the policies laid down
4.
5. 6.
Shukla SR. Manual of Municipal Solid waste, New Delhi, Ministry of urban development May 2000, Ch. 7. p. 117. Available from: netlibrary, http://urbanindia.nic.in/publicinfo/ swm/chap7.pdf [Last accessed on 2013 Nov 11]. Waste from healthcare activities, Fact Sheet. [Internet] November 2011. Available from: http://www.who.int/mediacentre/factsheets/ fs253/en/[Last accessed on 2013 Nov 11]. Joshi SK. Quality Management in Hospitals. Ch. 43. Bio-medical waste management program. New Delhi: Jaypee Publications; 2009. Hospital Waste Management in the Union Territory of Pondichery-An Exploration. Principal Investigator-Dr. Joe Joseph, Co-investigator-Dr. C. G. Ajith Krishnan. 2003-04]. Available from: http://www.pon.nic.in/citizen/science/ ppcc-new/Joe [Last accessed on 2013 Nov 11]. Mohapatra A, Gupta M, Shivalli S, Mishra CP, Mohapatra SC. Biomedical waste management practices of doctors: An online snapshot. Natl J Community Med 2012;3:227-31. Pandit NB, Mehta HK, Kartha GP, Choudhary SK. Management of bio-medical waste: Awareness and practices in a district of Gujarat. Indian J Public Health 2005;49:245-7.
How to cite this article: Joseph L, Paul H, Premkumar J, Paul R, Michael JS. Biomedical waste management: Study on the awareness and practice among healthcare workers in a tertiary teaching hospital. Indian J Med Microbiol 2015;33:129-31. Source of Support: Nill. Conflict of Interest: None declared.
www.ijmm.org
Copyright of Indian Journal of Medical Microbiology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
1
Brief Communication
Biomedical waste management: Study on the awareness and practice among healthcare workers in a tertiary teaching hospital L Joseph, H Paul, J Premkumar, Rabindranath, R Paul, JS Michael*
Abstract Bio-medical waste has a higher potential of infection and injury to the healthcare worker, patient and the surrounding community. Awareness programmes on their proper handling and management to healthcare workers can prevent the spread of infectious diseases and epidemics. This study was conducted in a tertiary care hospital to assess the impact of training, audits and education/implementations from 2009 to 2012 on awareness and practice of biomedical waste segregation. Our study reveals focused training, strict supervision, daily surveillance, audits inspections, involvement of hospital administrators and regular appraisals are essential to optimise the segregation of biomedical waste. Key words: Biomedical waste, health care worker, hospital safety, segregation
Introduction Biomedical waste is defined as any solid or liquid waste generated during diagnosis, treatment or immunisation of human beings and animals or during research that may present a threat of infections to humans.[1] A total of 80% of the waste generated in the hospitals is composed of general waste while the remaining 20% comprises of infectious, toxic or radioactive waste.[2] Of this, 20% of the waste is highly infectious and dangerous and could cause serious damage to the society and the environment when it is not properly segregated and disposed off. In India uniform guidelines for practice in the country have been laid down under the Bio-medical Management and handling Rules 1998. The waste management programme in hospitals are in accordance to these *Corresponding author (email: ) Quality Manager, Quality Management Cell (LJ), Infection Control Doctor, Hospital Infection Control Committee (HP), Nursing Superintendent (JP), Hospital Infection Control Committee Nurse (RB), Audit Facilitation Officer (R), Hospital Infection Control Committee, Department of Clinical Microbiology (JSM), Christian Medical College and Hospital, Vellore, Tamil Nadu, India Received: 29-07-2013 Accepted: 10-10-2013 Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.148411
guidelines and aim to minimise cross infection, improve the general hygiene in hospitals and minimise environmental pollution through proper treatment and disposal of waste.[3] The success of biomedical waste management programme rests on the knowledge and practice of the Health Care Worker (HCW). This study was done at a tertiary, teaching hospital in south India with over 2500 beds with an average occupancy of 80% and 6000 outpatients’ everyday on an average. About 2 tonnes of biomedical waste is generated everyday in the hospital and proper segregation of the waste at source is a challenge. It has a multi-disciplinary biomedical waste management committee to oversee the programme. Material and Methods A number of cross-sectional audits had been conducted from 2009 to 2012 on the biomedical waste segregation and the awareness of the HCW on the biomedical waste segregation in the hospital. The results of the audits are collated and presented as a longitudinal study in this paper. • Audit on staff awareness on biomedical waste segregation was conducted in September 2009 and the main focus of this audit was to assess the awareness level among the healthcare workers, doctors and nurses and allied staff with regard to biomedical waste segregation. The audit was done by administering a pre-tested questionnaire to 166 randomly selected health care workers with a response rate of 54% • Audit on segregation was conducted during the month of October 2009 to assess the practice of biomedical waste segregation in 145 areas, which included all wards, Laboratories Operation theatres, investigation areas and intensive care units jointly by infection nurses and the interns Quality Management team by observation of waste segregated at source • Re-audit on segregation was conducted to assess the change in practice after the training sessions and
130
Indian Journal of Medical Microbiology
other implementations between September 2009 and January 2012. Same areas that were audited in October 2009 were re-audited and the same checklist and methodology was adopted • Re-audit was conducted in June 2012 to assess the awareness after the training programmes and sessions conducted regularly between September 2009 and January 2012 with the help of a pre-tested questionnaire to 190 randomly selected health care workers with a response rate of 43%. Results Awareness among healthcare workers
vol. 33, No. 1
different colour bags used for segregation. In comparison to a study conducted at Mahatma Gandhi Dental College Hospital Pondicherry, the knowledge about colour coding of biomedical wastes was 74%.[4] The subsequent audit to assess the practice revealed similar results with the infectious non-plastics segregation 69%, infectious plastics and PPEs segregation 77%, non-infectious waste segregation 86%, sharps segregation 86% and cytotoxic wastes 88%. These audits showed the need to improve awareness among HCW’s and the necessity to develop new strategies achieves good compliance to waste segregation. The initiatives taken are listed below. Setting up the biomedical waste management committee
It was found that the awareness on the segregation of cytotoxic drugs had increased from 53% to 76%, segregation and disposal of sharps from 90% to 98%, infectious plastics from 72% to 83% and from 67% to 85% on the different colour bags used for segregation, which are statistically significant. Actual practice of biomedical waste segregation
A multi-disciplinary biomedical waste management committee was set up in 2009, which includes the administration and the infection control team. This committee is responsible for making hospital specific action plans for biomedical waste management its supervision, monitoring and implementation. Continuous training of staff
As shown in Figure 1 the actual practice of segregation of infectious non-plastic waste has improved from 69% to 93%, infectious plastics and Personnel protective equipment (PPEs) from 77% to 96%, non-infectious waste segregation from 86% to 97% and sharps from 86% to 96%, which are statistically significant. There is no significant improvement in the segregation of cytotoxic waste. Discussion To assess the awareness on Biomedical waste segregation among the healthcare workers, an audit was conducted in September 2009. The results revealed, among the samples audited, 53% were aware of the segregation of cytotoxic drugs, 90% on segregation and disposal of sharps, 72% on infectious plastics. Only 67% were aware of the
In a study done by waste management among doctors showed the necessity of having a balance between effective practical training and theoretical aptitude building among the medical group.[5] Pandit et al., showed that training of staff, both technical and non-technical, is critical for the proper and appropriate management of biomedical waste.[6] A session on biomedical waste management was introduced as part of mandatory training for all HCWS in the institution to improve the awareness. Focussed training session in areas with poor compliance was also done. Biomedical waste management posters Biomedical waste segregation posters highlighting the colour codes for different categories of waste was put in
Awareness on biomedical waste segregation 98%
100%
90%
85%
83% 76%
80%
60%
72%
67%
53%
Sep-09 Jun-12
40%
20%
0% Segregation of Cytotoxic drugs
Segregation of Sharp
Segregation of Infectious plastic
Figure 1: Practice of Biomedical waste at the hospital www.ijmm.org
Colour bags used for biomedical waste segregation.
January - March 2015
Joseph, et al.: Biomedical waste management in a tertiary care centre
all the areas in the hospital as a constant reminder of the need for proper segregation of waste. The posters were multi-lingual and predominantly pictorial.
131
Five colour system of segregation existed in the institution prior to 2009, which was changed to four colours, as recommended by Tamil Nadu Pollution control board simplified the process of segregation.
for bio-medical waste segregation for all HCW is essential to optimise the compliance to effective segregation strict supervision, daily surveillance, frequent audits and inspections are recommended to implement the bio-medical waste management rules in the hospital. Involvement of the hospital administrators and regular appraisal with the status of bio-medical waste management in waste management and quality steering committee play a pivotal role in executing the policies effectively.
Accountability through labels
References
Reducing the number of colour bags used for segregation
Practice of pasting labels on the bags, denoting the location, date and time of disposal of waste generation, prior to sending them to the temporary storage yard ensured accountability, which was substantiated by frequent audits and tracking improperly segregated wastes. Repeated audits and inspections
1.
2. 3.
Repeated audits both scheduled and unscheduled were conducted by the Hospital infection control team and the quality management team. These audits and inspections focussed on interviewing staff to assess awareness, scrutinising the training records and also the actual practice of segregation. Reports of these inspections and audits were sent to administration and respective areas. The recommendations were implemented and followed up by the biomedical waste management committee. Re-audits on waste segregation practice and awareness at were conducted in January 2012 and June 2012, respectively, showed a significant improvement in the above parameters. Conclusion The present study reveals that periodic focused training and emphasis on implementation of the policies laid down
4.
5. 6.
Shukla SR. Manual of Municipal Solid waste, New Delhi, Ministry of urban development May 2000, Ch. 7. p. 117. Available from: netlibrary, http://urbanindia.nic.in/publicinfo/ swm/chap7.pdf [Last accessed on 2013 Nov 11]. Waste from healthcare activities, Fact Sheet. [Internet] November 2011. Available from: http://www.who.int/mediacentre/factsheets/ fs253/en/[Last accessed on 2013 Nov 11]. Joshi SK. Quality Management in Hospitals. Ch. 43. Bio-medical waste management program. New Delhi: Jaypee Publications; 2009. Hospital Waste Management in the Union Territory of Pondichery-An Exploration. Principal Investigator-Dr. Joe Joseph, Co-investigator-Dr. C. G. Ajith Krishnan. 2003-04]. Available from: http://www.pon.nic.in/citizen/science/ ppcc-new/Joe [Last accessed on 2013 Nov 11]. Mohapatra A, Gupta M, Shivalli S, Mishra CP, Mohapatra SC. Biomedical waste management practices of doctors: An online snapshot. Natl J Community Med 2012;3:227-31. Pandit NB, Mehta HK, Kartha GP, Choudhary SK. Management of bio-medical waste: Awareness and practices in a district of Gujarat. Indian J Public Health 2005;49:245-7.
How to cite this article: Joseph L, Paul H, Premkumar J, Paul R, Michael JS. Biomedical waste management: Study on the awareness and practice among healthcare workers in a tertiary teaching hospital. Indian J Med Microbiol 2015;33:129-31. Source of Support: Nill. Conflict of Interest: None declared.
www.ijmm.org
Copyright of Indian Journal of Medical Microbiology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
