A Study to assess the knowledge and Practices regarding Biomedical Waste Management among health team members of selected Primary Health Centres, Bangalore South

Gowtham Dev¹, Dr. Thressiamma P. M². Sunil M B³

¹Research Coordinator, Cenre for Gerontoligcal Studies, Kerala University of Health Sciences,

²Principal, Dr. B. R Ambedkar Institute of Nursing (DRBRIN), Kadugondanahalli, Bangalore-560045

³Assistant Professor, College of Nursing, Adesh University, Bathinda, Punjab

*Corresponding Author E-mail: gdev.alackal@gmail.com, drbrain2015@gmail.com, pmthresiamma@gmail.com, sunielgowda@gmail.com

ABSTRACT:

Background: The current health scenario is much diseased with the problem of biomedical waste management. The mismanagement in this arena can result in potential health hazard to the health personals and even to the community. With sophistication in technology and with the introduction of rules on biomedical waste management it cannot be assured that the health settings are safe. Hence a time to time assessment of the knowledge and practices of health team members has to be done. Aims and objectives: The main aim of the study is to assess the knowledge and practices of health team members regarding biomedical waste management and to determine the association of knowledge and practices with the selected demographic variables. Study Design: A descriptive correlational research design was used for the present study. Samples and Sampling technique: A total of 100 health team members were selected for the study using convenience sampling technique. Methods of data collection: Date was collected by using proforma for socio demographic variables, structured questionnaire to assess knowledge and an observational checklist to assess the practices. Results: Data collected were analyzed by using inferential and descriptive statistics. The results of the present study revealed that, 78% among the health team members had moderately adequate knowledge. The practice aspect was also found to be moderately adequate for 64% of respondents. A substantial coefficient of correlation value (r = 0.694) was established between knowledge and practice interpreting that, as knowledge increases practice also increase. The computed Chi-square values to find out the association between levels of knowledge and practice with demographic variables were found to be significant for age, educational qualification, designation and professional experience with P- values of 0.011, 0.001, 0.001and 0.014 respectively at 0.05 level of significance. Conclusion: The study concluded that majority among the health team members were having moderately adequate knowledge and practices. The study also revealed a significant positive correlation between knowledge and practice. A better intervention from the side of Government can still make a hike in existing knowledge and practices thus making the health team members as well as the population safe.

KEYWORDS: Knowledge, practice, health team members, biomedical waste.

INTRODUCTION:

The health status of an individual, a community or a nation is determined by interplay and integration of two ecological factors i.e. the internal environment of man himself and the external environment of man which surrounds him. Disease spreads due to the disturbance in the delicate balance between man and his environment.¹

Everything on this earth is made for a defined purpose. “Anything which is not intended for further use is termed waste”. Nature is a reality, that human life is wholly controlled and influenced by the nature.² Man and environment were in existence from thousands of years ago, without environment man cannot survive. Human interaction with the environment enriches growth and development.³

Generation of waste has been an integral part of human activity since the evolution of the civilization.⁴

The management of waste poses to be a major problem even in developed countries, especially the health care waste. In recent years through advanced training programmes and with the help of sophistication in technology, these countries had handled the problem of waste management. On the other hand the story is different in Indian scenario which is widely rich with huge population, hence giving way for nurturing of uncountable health establishments. Here the reality is that while all the equipment necessary to ensure the proper management of biomedical waste probably exists, the main problem is that the staffs fail to prepare and implement an effective disposable policy.⁵

The quantity of waste generated has increased exponentially over a period of time with the population explosion, and changed scenario of human activity and progress. The world today is facing major disaster due to improperly managed health care waste causing, air, water, soil pollution, global warming and resultant melting of ice caps. The quantity of waste generated per day and per bed differs greatly from hospital to hospital and from one country to another. It also depends upon the mission and infrastructural facilities, treatment and health care facilities and attitudes of the concerned institution. Hence it is high time that we all have to take a stop of the situation, to act in a manner that would make life more livable on this planet for the generations to come and safeguard their interest.⁴

The developed countries managed to overcome the problem of bio-medical waste management with implementation of strict protocols and rules. At the same time in Third world countries like India, the disposal of health care waste posed to be a serious issue. A legal framework for effective management of health care waste and its implementation was severely lacking. In this context, ‘The Biomedical Waste (Management & Handling) Rules’ came into effect from July 1998. In accordance with these rule, it also notifies that no treated Bio Medical Waste shall be kept stored beyond a period of 48 hours. These rules are applied to all persons who generate, collect, receive, store, transport and treat or handle Bio Medical Waste in any form.⁶

Careless and indiscriminate disposal of these wastes by the health-care establishments and research institution can contribute to the spread of serious life threatening diseases like hepatitis and AIDS among those who handle it and the general public.⁷ Health care institutions must be aware of the potential risk in handling infectious waste, and should adhere to the highest standard in transport and disposal. Education of the staff, clients and community about the management of the infectious waste is crucial in today‟s health care arena.⁸ Hence the health team members should be aware of biomedical waste management for their thoughtful precaution in practice, careful management of health and safety, there by ensure that the health care setting are cleaner, safer and healthier for population they care for.⁹

NEED FOR THE STUDY:

Hospitals are health care institutions providing patient care services. It is the duty of hospitals and health care establishments to look after the public health. This may directly be through patient care or indirectly by ensuring a clean healthy environment for their employees and to the community.¹⁰ Current waste management practices are characterized by poor quality collection service and improper disposal at open dumpsites.¹¹

The hospitals are yet to implement the proper disposal of health- care waste and are still dumping their waste in municipal garbage dumps without any segregation. It is disheartening to note that at many hospitals, it is common place to find large dumps of “Biomedical Waste” consisting of used intra venous plastic bottles along with intra venous drip sets and needles, bandages, swabs, drugs, human tissues, blood –soaked items, sanitary napkins and pads. It is shocking to note that most hospitals and health- care centers, in most of the metropolitan cities and towns do not have incinerators and other technologies to treat and dispose biomedical waste. Barring a few large private hospitals in metros, none of the smaller hospitals and nursing homes has effective system to safely dispose of their wastes. The attitude of the government and municipal hospitals is no better than these private hospitals and nursing homes. Some hospitals are still continuing with selling their plastic waste to contractors who recycle or resale them.⁴

Medical waste is classified as more dangerous than ordinary garbage, successful hospital by-product management in India must involve strict maintenance policies, to avoid the spread of disease and prevent the leaching of hazardous chemicals into ground water.¹⁵ Improper handling of infected equipments by the nursing personnel may cause transmission of infection from one patient to another. So it is necessary for the health team members to gain in depth knowledge on correct methods of hospital waste management.¹²

As per a news report given by the Times of India on 07/04/2010, the Jannarogya Andolana Karnataka (JAAK) state chapter of Jan Swasthya Abhiyan conducted a recent inspection of primary health centers across 5 districts – Davangere, Haveri, Bagalkote, Belgaum and Bellary. The inspection revealed gapping loopholes in the management of biomedical waste. The organization also found that medical wastes were being dumped at the entrance of the primary health centers. Hence JAAK demanded implementation of Karnataka public health services guarantee Act and national health Act. While other states like Assam, Gujarat has already enacted and following the suit, Karnataka has been reluctant to implement the Acts.¹²

Another article was published with the heading biomedical waste turns hazardous. The report openly exposes the pathetic situation on unsystematic dumping of bio medical waste and municipal waste in open yards of the city. The Karnataka State Pollution Control Board (KSPCB) has identified 1643 health care establishments in and around Bangalore, of which 1019are in the Bruhat Bangalore Mahanagara Palike (BBMP) limits. Of these, only 490 establishments including various hospitals, clinics, diagnostic centers and blood banks, are attached to common biomedical treatment facilities recognized by Board. The article also emphasized that the health personnel working in these establishments were not aware about the management of biomedical waste.¹³

Hospitals and other health care facilities generate lot of wastes which can transmit infections, particularly HIV, Hepatitis B & C and Tetanus to the people who handle it or come in contact with it. The health team members are at a greater risk of exposure to the hazards present in hospital environment, mainly biomedical waste. They need to be well equipped with latest information, skills and practices in managing this waste for reducing hospital-acquired infections to protect their own health. It is also found that the present knowledge level of health team members regarding biomedical waste management is poor and imparting training will improve their attitude and practices. The health team members must have adequate knowledge to perform their duties that should ensure safe handling, collection, storage, treatment and disposal of biomedical waste.¹⁴

There is a dire need to change the present picture by careful planning; implementation of educational programmes on bio-medical waste management creates awareness about the health hazards in public, patients and health workers.⁴

All the above reasons brings out the fact that effective training programs for all categories of the staff are the need of the time.

The above stated true facts motivated the researcher to undertake a study to identify the knowledge and practice gaps.

OBJECTIVES:

1. To assess the knowledge of the health team members regarding Bio Medical waste management by administering a structured knowledge questionnaire.

2. To observe the practices of health team members regarding Bio Medical Waste management by using an observational check list.

3. To find out the co-relation between knowledge and practices of health team members regarding Bio Medical Waste management.

4. To find out the association between selected demographic variables and knowledge and practice of health team members.

ASSUMPTIONS:

1. Health team members working in the selected primary health centres have some knowledge regarding biomedical waste management.

2. Health team members practice the correct method of biomedical waste management.

3. There should be an association between demographic variables with the knowledge and practice level of health team members regarding biomedical waste managemen

DELIMITATIONS:

1. Study is delimited to health team members working in selected primary health centres of Bangalore South.

2. In present study, the practices of health team members are to be recorded irrespective of their designation and will be screened only through a single observational checklist.

REVIEW OF THE LITERATURE:

Literature related to management of hospital Bio Medical Waste.

A comparative study was conducted on categorization of medical waste generated in Tabriz, Iran to determine the quantity, generation rate, quality, and composition of medical waste generated. Among the 25 active hospitals in the city, 10 hospitals of different sizes, specializations, and categories were selected to participate in the study. The results indicated that the average (weighted mean) of total medical waste, hazardous-infectious waste and general waste generation rates is 3.48, 1.039 and, 2.439 kg/bed per day, respectively. In the hospital waste studied, 70.11% consisted of general waste, 29.44% of hazardous-infectious waste, and 0.45% of sharps waste. The result showed that there were significant differences between the medical waste characteristics of the hospitals studied and the study suggested the implementation of efficient management, training, and segregation program be top priorities to minimize the treatment and disposal.¹⁵

A survey study was conducted for systematic analysis of current biomedical waste management practices in smaller nursing homes and hospitals in Delhi. A total of 53 nursing homes, with bed strengths ranging from 20 to over 200, were included in the study. Data was collected through a questionnaire and field visits. The survey results show that there is a marked improvement in the segregation practices of biomedical waste in small private hospitals and nursing homes. About 70% of nursing homes and hospitals were found to be using a service provider for the collection, management, and disposal of healthcare wastes. 60% of the staff members of nursing homes and private hospitals are found to have aware about the waste management rules and protocols. The study was a relevant data indicative of current practices of healthcare waste management in the nursing homes and small healthcare facilities in Delhi.²⁸

A comprehensive inspection survey was conducted for investigating the medical waste management practices used by hospitals in northern Jordan. A total of 21 hospitals were selected for study. Field visits were used as a tool for getting information on the different medical waste management aspects. The results reported here focus on the level of medical waste segregation, treatment and disposal options practiced in the study area hospitals. The total number of beds in the hospitals was 2296, and the anticipated quantity of medical waste generated by these hospitals was about 1400kg/day. The most frequently used treatment practice for solid medical waste was incineration. Of these hospitals, only 48% had incinerators. As for the liquid medical waste, the survey results indicated that 57% of surveyed hospitals were discharging it into the municipal sewer system, while the remaining hospitals were collecting their liquid waste in septic tanks. The results indicated that the medical waste generation rate ranges from approximately 0.5 to 2.2 kg/bed day, which is comprised of 90% of infectious waste and 10% sharps. The results also showed that segregation of various medical waste types in the hospitals has not been conducted properly. The study revealed the need for training and capacity building programs of all employees involved in the medical waste management.¹⁶

A survey study was conducted for assessing the biomedical waste management practices at Balrampur Hospital, in Lucknow. The study shows that infectious and non-infectious wastes were dumped together within the hospital premises, which were then disposed of with municipal waste at the dumping sites inside the city. All types of wastes were collected in common bins placed outside the patients wards. The hospital does not have any treatment facility for infectious waste. 90% of the laboratories waste is disposed of directly into the municipal sewer without proper disinfection of pathogens, which ultimately reach the Gomti River. 85% ofdisposable plastic items are deposited either inside the hospital grounds, or outside in the community bin for further transportation and disposal along with municipal solid waste. It was found that 33% of rag pickers become exposed to serious health hazards due to injuries from sharps, needles and other types of material used when giving injections. The results of the study demonstrate the need for strict enforcement of legal provisions and a better environmental management system for the disposal of biomedical waste.¹⁷

The Department of Health Policy and Planning, Tokyo, Japan conducted a case study that investigated the Health-Care Waste (HCW) management at each health-care facility level. The study focusedon the amount of HCW, its segregation and the factors influencing HCW management, particularly segregation procedures. The investigation revealed that a high proportion of incorrectly segregated medical waste was found at each level of health-care facility. Re-segregation revealed 39%, 62%, 57% and 37% at national hospital, provincial hospital; district hospital and health centre level, respectively, was poorly segregated. Results showed that the mean of generated HCW was 0.62kg/bed per day (Vientiane Municipality) and 0.38 kg/bed per day (Bolikhamxay) at two study sites. This study recommended that more attention should be given to HCW management at primary health-care facilities.¹⁸

Literature related to knowledge and practice of health personnel.

A case study was conducted to analyze the current biomedical waste management practices in one of the premier healthcare establishments of Lucknow, the Vivekananda Polyclinic. The analysis consisted of interviews with medical authorities, doctors, randomly selected patients and visitors, and paramedical staff involved in the management of the biomedical wastes in the Polyclinic. A general survey format was used to ascertain the efficacy of the implemented measures. The results of the study showed that there exist a high degree negative co- relation between knowledge and practice. There is the need of an on-going training programme in order to develop a model biomedical waste management system in the Polyclinic. There is also a need to create awareness among all other stakeholders about the importance of biomedical waste management and related regulations.¹⁹

A descriptive study was conducted in a tertiary level hospital in New Delhi, India to assess the knowledge, attitude and practices of Bio Medical Waste management among staff. The study enrolled156 respondents, representing doctors and nurses from selected patient care areas. The tool used for data collection was a semi structured questionnaire. The results obtained showed that the consultants have 85% knowledge whereas the knowledge component among nurses was 60%.In regard to attitude nurses scored 100% while consultants scored 80%. In the practice area, the findings showed that scores of consultant were 80% while in nurses it was 100%. Here a significant gap was observed in the knowledge, attitude and practice of the consultants with regard to Bio Medical waste management. ²⁰

A cross –sectional was conducted on the awareness about the various aspects of Bio Medical Waste (BMW) management and disposal among the medical practioners. 30 hospitals with more than 30 beds were randomly selected from Sabarkantha district, Gujarat. The doctors and auxiliary staff of these 30 hospitals were the study population. The results showed that 100% of doctors know about the existence of law related to Bio Medical Waste management but details were not known. The knowledge scores obtained among doctors regarding BMW, the risk of HIV, Hepatitis B and C was 80% while on the part of auxiliary staff was 45%. Hence the study recommended an immediate and urgent need to train and educate all doctors and staff to adopt an effective waste management practices.²¹

A case study was conducted to evaluate the current status of hospital waste management (HWM) of selected hospitals in Bangladesh. The objective of the study was to recognize the existing practice, to determine the knowledge level of doctors and nurses about hospital waste, to identify the weaknesses, and to provide suggestions for improvement. Hospital staff, waste pickers, and local residents were taken as the samples for the study. Structured interview and field observation were the tools used in the study. Through this investigation, it has been quite evident that a satisfactory hospital waste management system in government hospitals and several private clinics is severely lacking. The study indicated that there is a need to improve the handling and disposal methods of hospital waste in almost all the medical facilities.²²

A descriptive study was conducted among health workers in Gaza to identify and highlight the problem of medical waste management. The samples included in the study were health workers in the Gaza Governorates. 400 health workers were taken as samples and data was collected through a questionnaire checklist and interview schedule. The results show that there is no system for medical waste management in Gaza. Segregation is done only for sharps and there are no colour- coded bags. Medical waste is stored and disposed of with domestic waste in primary health care clinics and is incinerated in hospitals, but there are no emission control or safety measures. There are some gaps in knowledge of health care workers, and current practices are inadequate.²³

An observational study was conducted among the Group D‟s for evaluation of their practices regarding disposal of waste. The setting of the study was a medical college with 800 beds. The sample size was 70 and the sampling technique used was purposive sampling. An observational checklist was developed to assess the practice aspects. The findings of the study revealed that 53% of the respondents were having poor practices and remaining percentage was having moderate practices. The significant fact observed was majority disposed harmful biomedical waste along with general waste. It was also observed that while handling potentially hazardous waste red rubber gloves were not worn. The study suggested that there is an immediate need to train Group D‟s regarding colour coding and final disposal of biomedical waste.²⁴

MATERIAL AND METHODS:

Research approach: Descriptive approach

Research design: non-experimental descriptive correlational design. In this design, the investigator assessed the level of knowledge and practices of health team members on management of biomedical waste.

Variables of the study:

Study Variables:

Knowledge and practices of health team members regarding the management of biomedical waste.

Demographic Variables:

Age, gender, educational qualification (general and professional education), designation, experience (in years), and exposure to in-service educational programmes.

Research Setting:

There are a total of 22 primary health centres in bangalore south. The entire primary health centres in bangalore south was selected for the study.

The names of the primary health centres selected for the study were yelchenahalli, konanakuntae, kodichikanahalli, gottigere, begur, singasandra, agara, bommanahalli, v.v.puram, bolare, kaggalipura, basavanagudi, uttarahalli, bangarappanagar, kengeri, kengeri upanagara, kumbalagod, k.gullahalli, sulikere, chandrappa circle, thavarakere and roopena agrahara. The settings were chosen in a manner to include maximum number of health team members in the study.

Population of the study:

All the health team members who are working under different PHC‟s.

Accessible Population:

There a total of about 22 PHC‟s in bangalore south and health team members who meet the inclusion criteria are included in the study.

Sample and sampling technique:

Sample:

100 health team members working in primary health centres in bangalore south and who are available at the time of data collection and fulfill the inclusion criteria selected by using non- probability convenient sampling technique.

DATA COLLECTION TOOL:

The tool consists of 3 sections.

Section A:

Demographic data of health team members.

Section B:

Structured questionnaire to assess the knowledge of health team member.

Section C:

Observational checklist to assess the practices of health team members regarding the biomedical waste management.

RELIABILITY OF THE TOOL:

Reliability of the knowledge questionnaire and observational checklist were established by test- retest reliability technique, using these values co-efficient correlation was done with the help of Karl Pearson‟s formula. The reliability score obtained was r = 0.93 for knowledge and r = 0.92 for practice which showed knowledge questionnaire and practice checklist were highly reliable.

DATA COLLECTION PERIOD:

The investigator conducted the main study 14th March 2011 to 18th April 2011.

RESULTS:

Table: 1, Frequency and percentage of distribution of respondents according to their selected Demographic variables n=100

Sl. No	Demographic variables	Frequency	Percentage
1	Age (years)
	Less than or equal to 30	22	22
	31- 40	46	46
	41- 50	22	22
	51-60	10	10
2	Gender
	Male	24	24
	Female	76	76
3.1	Educational qualification (general)
	Primary	5	5
	Secondary	38	38
	PUC	34	34
	Degree	23	23
3.2	Educational qualification (professional)
	ANM	28	28
	Diploma in nursing	21	21
	Diploma in Pharmacy	10	10
	MLT	8	8
	Health Inspector	4	4
	MBBS	22	22
	None	7	7
4	Designation
	Medical Officer	22	22
	Staff Nurse	20	20
	Pharmacist	10	10
	Lab Technician	8	8
	Junior/ Senior Health Assistant	32	32
	Group D	8	8
5	Professional experience
	1 to 10	67	67
	11 to 20	17	17
	21 to 30	16	16
6	Undergone in service education
	Yes	13	13
	No	87	87
Total		100	100

Description of knowledge and practice scores of health team members regarding biomedical waste management:

The knowledge and practice scores obtained from the respondents were entered to a master sheet and the total scores obtained for each respondent were tabulated. The distribution of respondents according to their knowledge and practices are presented in table -2.

Table-2, Distribution of respondents according to their level of knowledge and practice n=100

Level of knowledge and practice	Number of health team members according to their knowledge score	Number of health team members according to their practice score
Inadequate	5 (5%)	7 (7%)
Moderately Adequate	78 (78%)	64 (64%)
Adequate	17 (17%)	29 (29%)

The knowledge scores of health team members were distributed according to the following categories viz, inadequate knowledge (0-20 marks), moderately adequate knowledge (21-30 marks) and adequate knowledge (31-40 marks). The practice scores were distributed as follows; inadequate practices (0-10 marks), moderately adequate practices (11-15 marks) and adequate practices (16-20 marks).

From Table-2 it is evident that, majority of health team members i.e. 78% of respondents possess moderately adequate knowledge regarding biomedical waste management, only 5% of the respondents had inadequate knowledge on biomedical waste management whereas, it is apparent to see a significant fraction of 17% proved to have adequate knowledge. With regard to practice aspect, 64% of respondents have been practicing according to the biomedical waste management protocols, i.e., they have moderately adequate practices. A significant number of 29% of respondents were practicing by strictly adhering to the protocols of biomedical waste management as mentioned in the observational checklist, and are having adequate practices. On the other hand, only 7% of the respondents had secured inadequate practice scores.

Table -6, Association between knowledge scores of respondents with selected demographic variables n=100

Demographic variables	Categories	Total knowledge		Chi- square value	d (f)	P-value	Inference
		score
		Below	Above
		median	median
Age (yrs)	≤ 30	10	12	1.101	2	0.577	NS
	31-40	26	20
	>40	19	13
Gender	Male	11	13	1.072	1	0.301	NS
	Female	44	32
Educational qualification (General)	Secondary & below	30	13	7.931	2	0.019	S
	PUC	17	17
	Degree	8	15
Educational qualification (Professional)	ANM	17	11	17.558	3	0.001	HS
	Dip. in Nursing	12	9
	MBBS	4	18
	Others	22	7
Designation	Medical Officer	4	18	16.412	3	0.001	HS
	Staff Nurse	12	8
	Junior/ Senior Health Assistant	20	12
	Others	19	7
Professional Experience (in yrs)	1 to 10	35	32	0.864	2	0.649	NS
	10 to 20	11	6
	21 to 30	9	7
Undergone In-service Education	Yes	5	8	1.651	1	0.199	NS
	No	50	37

Note:

1. The responses of some of the demographic variables have been merged as the expected frequencies was less than or equal to 5

2. NS: Not significant (P>0.05); S: significant (P≤ 0.05);

3. Critical value for 1 degree of freedom at 5% level of significance = 3.841

4. Critical value for 2 degree of freedom at 5% level of significance = 5.991

Table -7, Association between practice scores of respondents with selected demographic variables. n=100

Demographic variables	Categories	Total practice score		Chi- square value	d (f)	P-Value	Inference

		Below	Above
		median	median
Age (yrs)	≤ 30	6	16	8.987	2	0.011	S
	31-40	24	22
	>40	22	10
Gender	Male	9	15	2.66	1	0.103	NS
	Female	43	33
Educational qualification (General)	Secondary & below	34	9	24.335	2	0.001	HS
	PUC	8	26
	Degree	10	13
Educational qualification (Professional)	ANM	22	6	24.165	3	0.001	HS
	MBBS	8	14
	Others	19	10
Designation	Medical officer	8	14	21.282	3	0.001	HS
	Staff nurse	3	17
	Junior/ Senior Health Assistant	23	9
	Others	18	8
Professional Experience (in yrs)	1 to 10	28	39	8.542	2	0.014	S
	10 to 20	12	5
	21 to 30	12	4
Undergone In-service Education	Yes	7	6	0.021	1	0.886	NS
	No	45	42

Note:

1. The responses of some of the demographic variables have been merged as the expected frequencies was less than or equal to 5

2. NS: Not significant (P>0.05); S: significant (P≤ 0.05);

3. Critical value for 1 degree of freedom at 5% level of significance = 3.841

4. Critical value for 2 degree of freedom at 5% level of significance = 5.991

The data presented in Table-7 shows that the computed Chi- square value to find out the association between practice scores of respondents with their selected demographic variables were found to be statistically significant for personal variables viz, age, educational qualification (general & professional), designation and professional experience. From Table-10 it is evident that age and professional experience is having a significant association with the practice scores of respondents as their P-values are 0.011 and 0.014 respectively. Furthermore, Table-7 also depicts that educational qualification (general & professional) and designation of respondents have a strong association with their practice scores as they were found to be statistically highly significant, and their P-values are 0.001 and 0.001 respectively.

DISCUSSION:

Findings related to knowledge level of health team members It was noted that, the mean knowledge score of health team members were 27 which is a direct indication that most of health team members had a moderate awareness regarding biomedical waste management. After analyzing the knowledge scores of 100 samples it was found that majority of them had moderately adequate knowledge on biomedical waste management which was found to be 78%. In addition to this inference, 17% among the health team members were found to have adequate knowledge. On the other hand, it was quiet interesting to notice that only 5% among the selected samples had inadequate knowledge on biomedical waste management.

The findings were consistent with findings of by other research study ²⁵, which revealed that, majority of health personals were having moderately adequate knowledge regarding biomedical waste management.

Findings related to practice level of health team members with respect to the practice aspect, the mean practice score of health team members were 14 interpreting that there exists a fair practice on protocols of biomedical waste management. From the analysis of results and inferences drawn from the mean score it was clearly evident that 64% among the selected samples were having moderately adequate practices. Besides these an important fact was that, 29% among these health members were practising strictly adhering with biomedical waste management protocols which was specified in the observational checklist and their practice scores were found to be adequate. Only a little among those selected i.e., 7% had inadequate practices on biomedical waste management.

These findings were consistent with findings of the following study, which revealed that majority of health personals were having moderately adequate practices on biomedical waste management. A better percentage of samples in these above mentioned studies had adequate practices.

A cross-sectional study was conducted at Shri B M Patil Medical College to assess the knowledge, attitude and practise towards Bio Medical Waste management in tertiary health care institution in Bijapur and a total of 334 employees were surveyed, out of which 180 were non-teaching and 154 were teaching staff. Results showed that teaching staff of the hospital gave more correct responses (97.4%) to questions on Biomedical Waste management than the nonteaching staff (80%). Study showed that the majority of (teaching and Non-Teaching) staff were conscious of the measures for safe collection and disposal of Biomedical Waste Management. In this study a need to periodically acquaint the participants with the updated Biomedical Waste management and handling rules was felt. The study recommended strict supervision and surveillance be followed in day-to-day hospital waste management activities.²⁵

Findings related to correlation between knowledge and practice scores of health team members The correlation between knowledge and practice scores was computed with the help of Karl Pearson‟s coefficient of correlation. The correlation between knowledge and practice score of health team members regarding Biomedical waste Management was found to be substantially co-related. The value of “r” was computed to be 0.694 and P-value =0.001, which was found to be significant 0.05 level of significance. Hence, it can be inferred that as knowledge increases the practices also increases, which is an indication of positive correlation.

Findings related to association between knowledge scores of health team members with their demographic variables The computed Chi square value for association between levels of knowledge regarding biomedical waste management was found to be statistically significant for general education qualification, with a P-value of 0.019. Similarly, professional education qualification and designation was found to be highly significant with knowledge scores with a P-value of 0.001 for each respectively. Hence it was inferred that, knowledge regarding biomedical waste management are influenced by educational qualification and designation of health team members.

Findings related to association between practice scores of health team members with their demographic variables The computed Chi square value for association between levels of practice regarding biomedical waste management was found to be statistically significant for age, educational qualification (general and professional), designation and professional experience. The computed P-values for these variables were 0.011, 0.001, 0.001 and 0.014 respectively. Hence, a significant association was found between practice scores and these variables. The P-value of 0.001 suggests that there was highly significant association. In a nut shell, it can be concluded that practices regarding biomedical waste management had a highly significant association with educational qualification and designation of health team members.

The findings of present study concluded that there exist a significant association of knowledge and practice scores with age, educational qualification (general and professional), designation and professional experience. This was found to be consistent with the following study²⁶. In the other study the knowledge and practice scores of ward managers was found to have a significant association with their knowledge and practice scores supported by a P-value of 0.050 at 0.05 level of significance. The finding of this study was also found to be consistent with the present study.

A cross-sectional study was conducted to assess the main stages of hospital waste management including separation, containment, removal and disposal of waste materials in public hospitals affiliated with Tehran University of Medical Sciences (TUMS). The researchers selected 108 units of six hospitals (three general hospitals and three subspecialty hospitals) from those hospitals supervised by TUMS using the cluster sampling method. The measurement was conducted through a questionnaire and direct observation by researchers. Association analysis was done by statistical tests; Fisher exact test and chi-squared using SPSS software. According to the results obtained by the questionnaire, most of the research involved wards scored moderately in terms of quality of their performance in all stages of waste management. About one-fifth of the wards were suffering from poor management of their medical waste and only a minority of wards obtained good scores for managing their waste materials. The findings also revealed significant associations between temporary waste storage and collection and the level of education of the managers (P = 0.040, P = 0.050, respectively). In summary, the study indicated a moderate management in all processes of separation, collection, containment, removal and disposal of waste materials in hospitals with several observed problems in the process.²⁶

CONCLUSION:

The findings of the study revealed that majority of the health team members had moderately adequate knowledge and practices regarding biomedical waste management. It was also evident that there was a substantial correlation between the knowledge and practices of health team members which inferred, as knowledge increases practices also increases. It was interpreted from the results that there exist a significant association between knowledge and practices with age, educational qualification (general and professional), designation and professional experience of health team members.

It was noticeable from the findings that, majority of health team members (87%) were never exposed to any in-service educational programme regarding biomedical waste management. This fact stressed the need to spread the message through conducting in-service educational programmes in primary health centres.

The Department of Health officials, District health officers, policy makers can consider the outcomes of present study to plan educational programmes in the future, which will update the existing knowledge and practices of health team members.

The participation and co-ordination of the Governmental and Non- Governmental organisations are needed for increasing the existing knowledge and practices which will be much helpful in reducing occupational risk and harm to the community thus safeguarding the population.

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Areas of knowledge questionnaire	Adequate f (%)	Moderately adequate f (%)	Inadequate f (%)
General aspects of Biomedical waste management	45%	50%	5%
Categorization of BMW	15%	65%	20%
Segregation of BMW	45%	42%	13%
Handling and collection of BMW	18%	64%	18%
Treatment of BMW	29%	53%	18%
Disposal of BMW	35%	49%	16%
Safety measures followed during BMW	28%	46%	26%
Total knowledge score	17%	78%	5%

Correlation between knowledge and practice	r - value	P-value	Inference
Correlation between knowledge and practice	0.694	0.001	HS