Mrs. Lovera Suresh Ms. M. Ramya

Submitted to: Submitted by:

Mrs. Lovera Suresh Ms. M. Ramya

Head of the Department 1st year M. Sc. Nursing

Paediatriac Nursing Community Health Nursing

2007-2009

Sarvodaya College of Nursing, Sarvodaya College of Nursing, Bangalore – 560 079 Bangalore – 560 079

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE & ADDRESS / Ms. M. Ramya
1st year M. Sc. Nursing
Sarvodaya College of Nursing,
11/2, Agrahara Dasarahalli,
Magadi Main Road,
Bangalore – 560 079
2. / NAME OF THE INSTITUTION / Sarvodaya College of Nursing,
Bangalore – 560 079
3. / COURSE OF STUDY AND SUBJECT / 1st year M. Sc. Nursing
Community Health Nursing
4. / DATE OF ADMISSION OF COURSE / 01-06-2007
5. / TITLE OF THE STUDY / “A Study To Assess The Knowledge, Attitude And Practice On Infection Control Measures Among Sanitary Workers In Selected Areas Of Bangalore With A View To Develop An Information Booklet”
6. / BRIEF RESUME OF THE INTENDED WORK
6.1 Introduction
6.2 Need for the study
6.3 Statement of the problem
6.4 Objectives of the study
6.5 Operational definitions
6.6 Sampling criteria
6.7 Assumptions
6.8 Review of related literature / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7. / MATERIALS AND METHODS
7.1 Source of data
Data will be collected from sanitary workers in selected areas of Bangalore
7.2 Method of data collection –Questionnaire and Observation.
7.3 Does the study require any investigation or intervention to be conducted on the patient or other human beings or animals?
NO
7.4 Has ethical clearance has been obtained from your institution?
Yes, ethical clearance report is herewith enclosed.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

6. Brief resume of THE intended work

6.1 Introduction:

“Health is the right of all human beings”

The urban waste management is drawing increased attention as citizens observe that too much garbage is lying uncollected in the streets, causing inconvenience and environmental pollution and being a risk of public health. Increasingly, the private formal sector is seen as a key participant in the full range of urban waste management activities including collection, transportation, treatment, processing, separation, recycling, composting and disposal of waste.

Municipal solid waste is a collection of discarded liquid and solid materials that serves as a breeding ground for bacteria and fungi. In developing countries, as much as 50% of waste composition may be putrescibles such as kitchen waste. In the past two decades, domestic waste and domestic type industrial waste have increased dramatically. The amount of municipal waste and medical waste had increased rapidly posing rising risks of waste related diseases and mortality, presently a large number of persons are employed in the disposal and manual sorting of waste.1

The waste passes occupational health risks to those who generate, handle, package, store, transport, treat and dispose of them. These wastes may enhance environmental pollution and the spread of infectious diseases, including AIDS, TB, diphtheria, cholera and many others.

In general, workers did not view themselves or the equipment as a possible sources of contamination. Physical contact with human excreta/other raw waste materials contact diseases like hepatitis, diarrhea and suffer eye and skin infections more frequently than people not so employed.2

Some diseases are derived from direct ingestion of infectious micro-organisms; others involve infection through contamination of the food chain, puncture wounds, damage to eye and ear. Hand hygiene and use of infection control measures are the important things to do to prevent transmission of infection.

The international federation of infection control should be able to assist with this type of education. The infection federation of infection control which was founded in 1987 is planning to take a lead in helping to set up organizations for infection control measures.3

6.2 Need for study:

“Cleanliness is next to godliness”

Garbage recycling was first described as an occupational problem during the Second World War. Garbage workers are the individuals who may have the potential to acquire or transmit an infectious agent during the course of his/her work in the work place.4

The waste generated by the public should not harm the health of the worker who handles that waste.

“Prevention is better than Cure”.

A large number of persons are employed in the disposal and manual sorting of waste. Waste collectors are exposed to organic dust containing micro-organisms, vehicle exhaust and bad weather conditions. In garbage sorting plants we found the highest concentrations of micro-organisms in the reception hall where the garbage is dumped from trucks.

In many instances, waste handling is left to lower level workers who operate without any training, guidance and supervision. There is lack of funds to implement safe disposal of waste and use of barrier methods effectively.

The majority of workers had limited understanding of effective cleaning regimes, use of barrier methods to protect themselves and sanitation procedures. This demonstrates the potential benefits of appropriate educational and skills training in reducing the contamination levels.

In developing countries, waste pickers find their livelihood through sorting and recycling of secondary materials. They have high occupational health risks, including risks from contact with human fecal matter, paper that may have become saturated with toxic materials, bottles with chemical residues, needles, bandages from hospitals, batteries containing heavy metals.5

Jeggli S (2005) conducted a study at switcher land among 39 garbage collectors, each for 5 times was observed for use of barrier methods. The use of barrier methods is as follows: Use of gloves: 100%, Aprons: 67.2%, Masks: 88.2%, Proper handling of bags: 85.6% and Hand washing after taking off gloves: 65%.6

John Ke B, Stelzner E (1992) conducted a study among 42 Danish workers, observed each for 5 times, handling waste. All of them wore gloves but only 33.3% and 77.6% wore aprons and masks respectively. Hand washing after taking off gloves was observed in 65% of the occasions.7

Tabasarano (1998) Conducted a study on dumpsite waste pickers in Katmandu, Nepal revealed that 73% did not use soap to wash their hands; 88% did not use their soap to wash their feet; and more than 65% did not change their clothing daily. About 18% regularly waited more than a week between baths and changing clothes. In waste picking families in India, women reported preparing meals immediately after returning home from waste picking, without washing.8

Bhide AD, Sundaresan BB (1994) Conducted an epidemiological surveys conducted on 400 waste pickers in Calcutta, India indicated that waste pickers at open dumps were particularly vulnerable to experiencing increased incidence of respiratory diseases. At Bombay open dumpsites, 25% of the waste workers examined had coughs and 26% experienced dyspnea. The majority (73%) complained of aggravated symptoms of cough and breathlessness during working hours.9

Most disease risks can be reduced by interrupting or containing pathways to exposure to contaminants. Simple measures include: wearing Protective clothing, goggles and respiratory equipment; providing proper air filtration; conditioning and ventilation; controlling emissions; and practicing good hygiene. As a starting point, the people involved in solid waste management in all middle and lower income countries would benefit significantly if a few modest measures were taken to prevent their health.

Municipal solid waste in developing countries commonly is collected through labor intensive system, sometimes using hand. More typically, the waste is placed on the ground directly, thus requiring being shoveled by hand; it is left in an open basket to be picked up by hand. Throwing and handling of bags with both hands were common mistakes. The risk is greatest in developing countries where the contact between the solid waste workers and waste greatest and the level of protection is least.

The reasons for choosing this study is poor countries have greater worker risks i.e.: - collection is by labor intensive system, workers have less protection, many waste pickers are women and disposal is by open dumping.

Education on preventing infection, good practice, frequent medical examination, providing clean drinking water and sanitation facilities, vaccinating against hepatitis A, B, tetanus, polio, diphtheria, rabies etc; should be offered to these less privileged workers. Education on hand washing, use of gloves, aprons, masks, protective goggles, and boots are urgently needed in order to minimize or prevent occupational health and injury problems.

This study has been selected to share the knowledge acquired by the investigator to the benefit of the workers who handle waste. It is important to look into the government participation which is the backbone for the success of any programme. Hence this study aims to assess the knowledge, attitude and practice on infection control measures among sanitary workers and contribute to the health of the sanitary workers.

6.3 Statement of the problem:

“A Study To Assess The Knowledge, Attitude And Practice On Infection Control Measures Among Sanitary Workers In Selected Areas Of Bangalore With A View To Develop An Information Booklet.”

6.4 Objectives of the study:

1. To assess the knowledge, attitude and practice on infection control measures among sanitary workers.

2. To find out the relationship between knowledge, attitude and practice on infection control measures among sanitary workers.

3. To find out the association between knowledge, attitude and practice on infection control measures among sanitary workers with demographic variables.

4. To develop an information booklet on infection control measures.

6.5 Operational definitions:

Knowledge: It refers to the awareness of the sanitary workers on infection control measures as measured by the response to the structured questionnaire.

Attitude: It refers to the feeling/ perception of the sanitary workers towards infection control measures.

Practice: It refers to the preventive measures followed by the sanitary workers regarding control of infection during working hours.

Infection Control Measures: It refers to the preventive measures like hand washing, use of gloves, aprons, masks, goggles, boots followed by the sanitary workers to prevent diseases.

Sanitary Worker: It refers to a person handling waste.

6.6 Sampling criteria

I) Inclusion criteria:

1. Sanitary workers working in municipality.

2. Sanitary workers willing to participate in the study

3. Sanitary workers who will be present at the time of data collection

4. Sanitary workers who can understand Kannada or Telugu.

II) Exclusion criteria:

1. Sanitary workers working other than municipality

2. Sanitary workers not willing to participate in the study

3. Sanitary workers who will not be present at the time of data collection.

4. Sanitary workers who cannot understand Kannada or Telugu.

6.7 Assumptions:

It assumed that sanitary workers will have inadequate knowledge, negative attitude and poor practice on infection control measures.

6.8 Review of related literature:

This chapter reviews some of the literature which is relevant and useful to the present study in identifying and focusing attention on the problem and in the analysis and interpretation of the data.

Cadilhac P(2004) conducted a cross sectional study comparing sewage workers to those not occupationally exposed to it. There is a significant increase in HAV (12%) and this raises the question of whether it is necessary to vaccinate sewage workers against viral hepatitis.10

Vaidya, Sunil R (2003) conducted a study at Bombay in open dumpsites. 95 solid waste workers were surveyed and examined. Of all landfill workers surveyed, 80% had eye problems, 73% had respiratory ailments, 51% had G I ailments, 40% had skin infections/allergies and 22% had orthopedic ailments. Based on clinical examination, 90% had decreased visual acuity. Most workers complained of eye burning, diminished vision, redness, itching, watering. 27% had skin lesions.11

Jurgen Bunger (2000) conducted a cross sectional study at Germany related to health complaints and diseases of 58 compost workers and 53 bio-waste collectors. Results shown were compost workers had significantly more symptoms and disease of the airways and the skin. A significant association between diseases and increased antibody concentrations were found in the compost workers.12

Sigsgaard T (1999) investigated garbage recycling workers at Denmark. It shows a wide range of symptoms and diseases from asthma to gastro-intestinal and skin symptoms and is due to a poor perception of the risks related to organic dust exposure. There is an increased prevalence of respiratory symptoms such as chest tightness and toxic alveolitis.13

Gelberg, Kitty H (1997) study designed to examine acute health effects among employees working at the New York City with special emphasis upon the landfill workers. Study found a high prevalence among landfill employees of work related dermatologic, neurologic, hearing and respiratory symptoms and sore and itching throats than among offsite laborers experienced more neuromuscular symptoms and injuries.14

Egon Math (1997) conducted a study at Austria with 137 employees from sorting, recycling and composting facilities. Among workers occurred subjective complaints such as hoarseness (38%), cough (35%), infections of the respiratory organs (23%), diarrhea (18%), disorders in joints and muscles (13%) and conjunctivitis (12%). Immunization of workers was shocking: only 57% were properly vaccinated against polio, 42% against tetanus and 68% against HAV.15

Zuskin (1996) studied the prevalence of acute and chronic respiratory symptoms and lung function changes in 81 municipal sanitation workers in 1996. There was a significantly higher prevalence of all chronic respiratory symptoms during work shifts. Dryness of nose, throat, eye irritation, diminished forced vital capacity was also observed.16

Sigsgaard T (1997) conducted a cross sectional study of recycling workers to identify adverse health effects of waste handling especially house hold waste in Denmark. Among garbage handling workers, 13.6% experienced irritation of the skin. The odd’s ratio for itching of the skin is 3.78 vomiting and diarrhea in relation to work was 7.51 and 7.30. There is an increase in cadmium levels from exposure to batteries in the waste.17