http://doi.org/10.33698/NRF0304-Harbans Kaur, Indarjit Walia, Chander Sarin
Abstract : A descriptive study was carried out in Female Surgical unit of Nehru Hospital, PGIMER, Chandigarh to assess the knowledge and practices regarding waste disposal among patients and their relatives. Data were collected by means of a pre-structured interview. Purposive sampling was adopted and a total of 56 patients and 66 relatives of patients were chosen as sample. The selected subjects were studied for their knowledge & practices of waste disposal, which was followed by interview. The study shows that in routine, patients (93%) and their relatives (86%) do not get soiled dressing for disposal. Doctors & staff Nurses are responsible for disposal of the soiled dressing, used needles, used syringes, empty plastic bottles catheters, drainage (after removal). Patients & their relatives (100%) did not get demonstration about waste disposal; most of the time they get instructions from the posters, pasted on the walls in ward where dustbin is placed. Posters are based on Colour code. In each unit one dustbin of black colored is been placed. All the waste from empty wrappers of medicine, fruits, and other waste papers are dispose in that black colored dustbin. Cotton swabs which should be disposed off in the yellow colored dustbin were not disposed of properly by patients (88%) and their relatives (82%). Patients (36%) and their relatives (77%) are having knowledge about waste disposal according to color code and 41 % patients and 73% of their relatives practice waste disposal accordingly.
Key words :
Biomedical waste, Disposal, Patients, Relatives of Patients, Colour code
Correspondence at :
Harbans Kaur
National Institute of Nursing Education, PGIMER, Chandigarh.
Introduction
Despite the statutory provision of Biomedical Waste Management, practice in Indian Hospitals has not achieved the desired standard even after nine years of enforcement of the law. The disposal of waste in medical field is an issue of today’s concern. Hospital and other health care institutions generate “waste” which may be potential health hazards to health workers, the general public and the flora and fauna .1 Careless and indiscriminate disposal of this waste by healthcare establishments and research institutions can contribute to the spread of serious diseases such as hepatitis and AIDS [HIV] among those who handle it and also among the general public.2. 3
Hospital waste means “Any solid, fluid or liquid waste material including its container and any other intermediate product which is generated during short term and long term care consisting observational, diagnostic, therapeutic and rehabilitative services for a person suffering or suspected to be suffering from disease or injury and for parturient or during research pertaining to production and testing of biological during immunization of human beings. Hospital waste includes garbage, refuse, rubbish and Bio-Medical Waste”.3
The quantity of Bio-Medical Waste generated will vary depending on the hospital polices and the type of care being provided. The data available from developed countries indicate a range from 1-5 Kg/bed/day, with substantial inter country and inter specialty differences. Data from developing countries indicate that the range is essentially similar but the figures are lower i.e. 1-2 Kg/day/ patient.4 According to WHO report, around 85% of the hospital wastes are actually non hazardous, 10% are infective [hence, hazardous], and remaining 5% are noninfectious but hazardous [chemical, pharmaceutical and radioactive]. 4
There are many examples and ample evidences that indiscriminate management of Bio-Medical Waste could cause serious hazards to health and environment as cholera, typhoid, dysentery, infective hepatitis, polio, ascariasis, hook worm disease, malaria and filaria etc. Rag pickers in the hospital, sorting out the garbage are at a risk of getting tetanus and HIV infections. Dust may harbour Tubercle Bacilli and other germs, which cause diseases if inhaled. Pathogens in infectious waste may enter the human body through a puncture, abrasion or cut in the skin through mucous membrane by inhalation or by ingestion. The recycling of disposable syringes, needles, IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis, HIV, and other viral diseases.4
The doctors, nurses, technicians, washermans, sweepers, hospital visitors, patients, rag pickers and their relatives are exposed routinely to Bio-Medical Waste and are at more risk from the many fatal infections due to indiscriminate management.4 Poor management of health-care waste can cause serious disease to health-care personnel to waste management workers, patients and to the general public. The greatest risk posed by infectious waste is accidental needle stick injuries, which can cause hepatitis B and C and HIV infection. There are however numerous other diseases which could be transmitted by contact with infectious health- care wastes. During the handling of wastes, injuries occur when needles or other sharps have not been collected in rigid puncture proof containers. Inappropriate design and/or overflow of existing sharps container and moreover unprotected pits increase risk exposure of the health care workers, of waste handlers and of the community at large, to needle stick injuries. Best practices in health care recommend the segregation of sharps at the point of use.5
The reuse of infectious syringes represents a major threat to public health. WHO estimated that, in 2000, worldwide, injections under taken with contaminated syringes caused about 23 million infections of Hepatitis B and Hepatitis C and HIV (Safe Health Care Management Policy Paper). WHO (2002) conducted a study in 22 developing countries showed that the proportion of health care facilities that do not use proper waste disposal methods range from 18% to 64%.5 In developed countries, legislation and good practice guidelines define medical waste and state the various possible ways for collection, transport, storage and disposal of such wastes. In developing countries such as India, however, medical waste materials have not received sufficient attention .6,7
The objective of Biomedical Waste Management is mainly to reduce waste generation, to ensure its efficient collection, handling as well as safe disposal to controls infection and improves safety for employees working in the system. For this to happen, conscious, coordinated and co-operative efforts have to be made right from physicians to ward boys. 8
Education of the staff, patients and community with increasing awareness in general population regarding hazards of hospital waste, public interest, litigations were filed against officials. 3 Some landmark decisions to streamline hospital waste management have been made in the past. These are: Hazardous medical waste should be segregated at source of disinfection before final disposal. [Supreme Court judgment: 1st March 1996]. Ministry of Environment & Forest, Govt. of India issued a notification for Bio-Medical wastes (Management & Handling) Rules 1998 to ensure that medical wastes are handled in a humanly and environmentally safe manner [The Gazette of India (1998)].
Unsafe medical waste disposal in India according to the All India Syringes and Needles Manufacturers Association, at least 20% of syringes sold are from recycled sources. Recycled syringes may harbour deadly viruses such as those causing Hepatitis B & C. Used surgical cotton and bandages are often used to make quilts and mattresses.9
Health and other healthcare establishments in India produce a significant quantity of waste, posing serious problems for its disposal, an issue that has received scant attention. Classification of biomedical waste should be displayed at strategic locations like inside the dressing rooms, nursing stations, pharmaceutical units so that doctors and nurses are aware, preferable in local language so that patients and attendants also benefit from it. Waste should be properly segregated & collected In 4color bags [Red, Blue, Yellow & Black].
Table I : Color Coding and Type of Container
| Sr.No. | Waste classification and category | Types of container as per Colour coding |
| 1. | Human anatomical waste, Animal Waste, solied dressings, plaster castes, cotton. | Yellow, Plastic Bag |
| 2 | Tubings, catheters, IV sets, Microbiology waste. | Red, Plastic Bag |
| 3 | Waste sharps [needles, syringes, Blades, Broken glass | Blue, Puncture proof Plastic Bag |
| 4 | Discarded medicines and cytotoxic drugs, food material, waste paper, paper wrapper, general waste. | Black, Plastic Bag |
Objective
The study was done to assess the knowledge and practices regarding waste disposal among the patients and their relatives.
Materials and Methods
The study was conducted in the Female Surgical Ward of Nehru Hospital at Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. Named after the local deity ‘Chandi’, the city of Chandigarh, well known as the “City beautiful” is a model of architectural grandeur in modern India. It has very good health facilities. Post Graduate Institute of Medical Education and Research (PGIMER), a premier institution for medical and health related research of the country is located in city. Nehru Hospital located in the PGIMER campus is a multi speciality hospital with all facilities under one roof. Female Surgical Ward is situated on 4th floor ‘c’ block. Sanction bed capacity of this ward is 91beds under different units like General Surgery (32Beds) transplant (03 Beds), Plastic Surgery (35 Beds), E.N.T. (09 Beds), Ortho (11 Beds), Dental (O1Beds). Data was collected in the month of January (12th -15th). The target population of study was all the admitted patients and their relatives (1 relative with each patient). Average of admitted patients during period of date collection was 67 approximately. The non-probability, purposive sampling technique was followed. Tool (Structured Interview Schedule) was developed to assess the knowledge and practices regarding waste management. Validity of tool (structured questionnaire) was established by seeking the opinion of 5 experts. After obtaining the permission for study the list of patients was obtained from the ward. 13 subjects were unable to give response. Data was collected from subjects between 9am-12.30pm by the researcher. Subjects were assured that all the information given by them would be kept confidential and used only for research purpose. Interview technique was used to collect data. The data was analyzed as per objectives by applying descriptive and inferential statistics.
Results
Majority of the patients (32%) and their relatives (62%) were from the age group of 20-40 years. Regarding marital status, most of the patients are married (67%) and relatives (84%), belonging to rural (57%) patients and (56%) patient’s relatives. Majority of the patients were illiterate (35%) and relatives were mostly having educational qualification upto matriculation (27%), Most of the patients (55%) were house wives (Table 2). The finding of the study depicted that majority of patients and their relatives disposed off body fluid, urine, and vomit (96%), (100%) respectively. They didn’t get empty vials/ ampoules for disposal (Table 3). Out of total patients (46%) and their relatives (47%) received instructions about waste disposal from professional (doctors, sisters), non-professional (ward servants, sanitary attendants), written material (posters displayed on walls) or other patients. None of the patients get demonstration regarding disposal of waste from Health workers, only one relatives of patients got demonstration (Table 4).
Table 2 : Socio- demographic characteristics of patients and thier relatives
N=69 N=66
| Sr.No | Characteristics | Patients f (%) | Patient’s Relatives f (%) |
| 1. | AGE IN YEARS | ||
| <20 | 17 (25) | 01 (01) | |
| 20-40 | 22 (32) | 41 (62) | |
| 40-60 | 20 (29) | 21 (43) | |
| 60-80 | 10 (14) | 03 (04) | |
| 2. | SEX | ||
| Males | 10 (15) | 33 (50) | |
| Females | 59 (85) | 33 (50) | |
| 3. | MARITAL STATUS | ||
| Unmarried | 23 (33) | 10 (16) | |
| Married | 46 (67) | 56 (84) | |
| 4. | HABITAT | ||
| Rural | 39 (57) | 37 (56) | |
| Urban | 30 (43) | 29 (44) | |
| 5. | EDUCATIONAL QUALIFICATION | ||
| Illiterate | 24 (35) | 13 (20) | |
| Primary | 09 (13) | 11 (16) | |
| Middle | 04 (06) | 05 (08) | |
| Metric | 17 (25) | 18 (27) | |
| High secondary | 06 (09) | 06 (09) | |
| Graduate & Postgraduate | |||
| & professional | 03 (04) | 13 (20) | |
| Not applicable | 05 (08) | 00 (00) | |
| 6. | OCCUPATION | ||
| Unemployed & Retired | 06 (09) | 02 (03) | |
| House-wives | 38 (54) | 26 (39) | |
| Farmer & Self employed | 04 (06) | 1 5 (23) | |
| Govt. & Pvt. Service | 04 (06) | 20 (30) | |
| Children & school going | 17 (25) | 03 (05) |
Table 3: Distribution of frequency of subject’s response regarding disposal of waste in the ward
N=56 N=66
| Sr. | No. | Items | Patients f (%) | Relatives of Pts. f (%) |
| 1. | Soiled dressing | 04 (07) | 09 (14) | |
| 2. | Empty vials/ ampoules | 00 (00) | 00 (00) | |
| 3. | Medicine wrapper | 23 (41) | 42 (63) | |
| 4. | Used syringes/needle | 05 (09) | 07 (10) | |
| 5. | Empty glass / plastic bottle | 09 (16) | 20 (30) | |
| 6. | Body fluid, urine, vomit | 54 (96) | 66 (100) | |
Table 4 : Distribution of frequency of subjects who received Instructions and Demonstration regarding disposal of waste in the ward
N=56 N=66
| Sr.
No. |
Items | Description | Patients f (%) | Relatives of Pts. f (%) |
| 1. | Instructions | From professional/ non -professional/ written material | 26 (46) | 30 (47) |
| About color code | 11 (19) | 23 (35) | ||
| 2. | Demonstration | from health workers | 00 (00) | 01 (01) |
Figure 1: Distribution of frequency of subjects regarding knowledge and practice about waste disposal according to color code
| Patients | 20 | 18 |
| Relatives of Patients | 51 | 48 |
Table 5: Assessment of practice of waste disposal by subjects
N=56 N=66
| Items | Patients f (%) | Relatives of patients f (%) |
| *Dressing material | 32 (57) | 19 (29) |
| *Body fluid, urine, vomit, Ryles tube aspiration | 54 (96 ) | 66 (100) |
| *Empty bottles | 13 (23) | 32 (48) |
| *Cotton swabs | 07 (12) | 12 (18) |
| *Waste from food | 40 (71) | 57 (86) |
| *Disposable syringes | 03 (05) | 06 (09) |
| *Empty wrapper of medicine | 52 (93) | 63 (95) |
| *Plastic tubing, cathers | 02 (04) | 06 (09) |
Discussions
In the field of medical practice statutory public health guidelines for Biomedical waste Management and close monitoring of its compliance alone cannot achieve the ultimate goal, if it is not accompanied with social science approach of mass education motivation and change of mind set in all strata of medical practice. The finding of the present study revealed that active participation of health team workers only disposed off the Bio-medical waste by self which may be because of strict instructions by authorities and fear for punitive action. Patients and their relatives were not aware to dispose of cotton swabs, disposable syringes, plastic tubing, and catheters. Patients have less knowledge compared to their relatives because they had restricted movements due to their surgical condition. They were unable to get the knowledge from written material or other persons. Three fourth of the patients’s relatives had knowledge about colour code but they had incorrect practices to disposed off the waste according to colour code, there was no significant association between knowledge and practice. According to Saraf doctors and nurses had good knowledge of waste managementlO. In another study done by Sham Sunder (2006), according to him there was no significant association between knowledge and practice. Based on the finding of the present study it is recommended that there is need to provide guidelines to patients and their relatives regarding waste management to minimize the risk of infections and communicable diseases because single infected item may produce high risk for the handlers and community.
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