RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

SYNOPSIS

FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / Name of the candidate / Mrs. SHYLINE KOTIAN
2. / Name of the Institution / Diana College of Nursing
No. 68, Chokkanahalli,
Jakkur Post,
Bangalore-560 064.
3. / Course of Study and Subject / Masters of Science in Nursing Community Health Nursing
4. / Date of Admission to Course / 28.06.2008
5. / Title of the Topic / Effectiveness of structured Teaching Programme on Biomedical Waste management among health team members of selected Primary health centers at Kodagu District, Karnataka

6. Brief resume of the intended work

Introduction

Biomedical waste means any waste, which is, generated during the diagnosis, treatment of immunization of human beings or animal, and in research activities pertaining there to or in the production or testing of biological. There biomedical waste is a major health hazards for the community. The perpetual increase in generation of waste from healthcare setting and its improper disposal have drawn attention of environmentalists, the media and general public (Sunil 2007).

Let the waste of “The Sick” not contaminate the lives of the health. The waste produced in the course of health care activities carries a higher potential for infection and injury, therefore it is essential to have safe and reliable method for its handling. Inadequate and inappropriate handling of health care waste may have serous public health consequence and significant impact on the personnel and environment.

Harish (2006) started that Medical waste should be managed according to its type on characteristics for waste management to be effective; the waste should be managed at every step, from acquisition to disposal proper handling, treatment and disposable of biomedical waste are important elements of health care programme. Safe and effective management of waste is not only a legal necessity but also a social responsibility.

Waste is the resource in unwanted place. As the need for health care is increasing day by day the health care settings are also increasing. By a result of this health care waste is also increasing. If properly designed and applied, waste management can be a relatively effective and an efficient compliance related practice (Sunil 2007).

Hospital waste management has been brought into focus in India recently, particularly with the notification on the BMW (management and handling) rules 1998. the role makes it mandatory for the health care establishment to segregate, disinfect and dispose their waste in eco – friendly manner (Panthaiki Dhun, 2000).

The 75% to 90% of the waste produced by the health care providers is not risk or “General” Health care waste. It comes mostly from administrative and house keeping functions of the health care establishment, and may also include waste generated during maintenance of health care premises. The remaining 10%to 25% health care waste is regarded as hazardous and may create a variety of health risk (Biomedical waste handling rules, 1998).

According to biomedical waste management and handling rules 1998 only 10 to 15% of waste is hazardous waste, rest 75 – 90% of waste is general waste of managing the waste. Inappropriate treatment and final disposal of the wastes can lead to adverse impact to public health, to occupational health and safety, and to the environment. Unfortunately, most economically, developing country suffers a variety of constraints to adequately managing these wastes. Generally in developing countries, few individuals in the staff of the healthcare facility are familiar with the producers required for a proper waste management programme. Furthermore, the management of waste usually is delegated to poorly educated laborers who perform most activities without proper guidance and insufficient protection. Hence, it is felt that PHC’s even though seems to be smallest unit of health center, may produce good quantity of waste. Thus, researcher finds it is necessary to out the existing practice of bio – medical waste management in PHC and prepare a need based waste management module (Commission of European Union 1995).

6.2  Review of Literature

Review of literature refers to the activities in identifying and searching for information on a topic and developing a comprehensive picture of the state of knowledge on the topic.

Review of literature is organized under following heading

Section A Biomedical waste management

Section B Segregation and collection BMW

Section C Treatment of BMW

Section D Final disposal of BMW

Section E Hazards due to improper waste management

Section F Universal precautions

Section G Need for training on BMW

Section A: Biomedical waste management

Rasheed (2001) conducted cross sectional study on hospital waste management in the teaching hospitals of Karachi. The objective of study was to evaluate the current practice of segregation approaches, storage arrangements, and collection and disposal system. In this study eight teaching hospitals, were selected under convenient sampling technique. The results of the study revealed that two hospitals were segregating sharps, pathological waste, chemical, infections, pharmaceutical and pressurized container at source. Only tow hospital, were provided with protective devises, one hospital had training sessions for staff on waste handling, five hospitals dispose the waste by burning in incinerator. Tow hospitals dispose of by municipal landfill. One hospital was burning waste in open air without any specific treatment. This shows proper training programme and management is needed regarding awareness and practice of waste survey on medical waste management.

Da Silva (2001) from department of hydraulic and sanitation federal university of Santa Maria has conducted survey on medical waste management in the south brazil. In the study on 91 health care institutions includes 21 hospitals, 48 health centers, 22 clinical laboratories, the main aim of the survey is to provide information about management, segregation, generation, storage and disposal of medical waste. Average generation rate of total infectious biological waste in the hospitals were estimated to be 0.570 kg/bed/day respectively. The result about management aspect revealed that practice in most health care facilities do not comply with the principles stated in Brazilian legislation.

The waste generally dumped together in public place such as the hospital surroundings, in the road side or city corporation dustbin. Many doctor and nurses are not fully aware abut what constitute as medical waste. An interview among staff members reveals that they were suffering forms various infectious diseases such as viral hepatitis B and C, Typhoid, skin disease / allergy, Diarrhoea, dysentery, tuberculosis and malaria.

Section B: Segregation and collection

Corku (2006) engineering faculty of environmental engineering department turkey has conducted survey on medial waste management in trachea region of turkey. The objective of the study to analyze the present status of medical waste management and subsequently to draw up a policy regarding with generation, collection, onsite handling, storage processing, recycling, transportation, safe disposal of medical waste, results of the study shows that trachea has poor management system in all the sets of waste management. The current disposal method is hazard to the public health and environmental. Ladfill site with many scavengers were present for recycling materials. It was found that staff in health cares establishments was unaware about hazards of medical waste.

Miyazaki M. Department of hygiene and preventive medicine, fukuok university Japan, this articles enumerates the HCWM in Japan, the waste management practice is carried out in accordance with waste disposal law of 1970. the first rule of infectious waste management was regulated in 1992 and infectious waste are defined as the waste materials generated in medical institution, as a result of medical care or research which contain pathogens. That has the potential to transmit infectious disease. According to revised criteria for infections waste management by the ministry of environmental 2004, infectious waste materials are divided into three categories; the form of waste; the place of waste generation; the kind of infectious waste. According to regulation were elaborated for the management of medical waste in Austria, Canada and USA on the basis of foreign experiences. The medical waste is proposed to manage into categories as follows:

1.  Waste that should be handled in special way within and outside the health care facilities

2.  Waste that should be handled in a special way within the health care facilities.

3.  For incautious waste, basic requirement is the segregation and collection of waste.

Color-coding is proposed to identify the content of containers and bags. B. Ramakrishna Goud, D. Gopinath has conducted survey on in house waste containment efforts in selected health care institution of Bangalore city. In the survey 88 health care institutions were assessed. The in house waste containment efforts were assessed based on checklist developed for the purpose of assessing the over all waste management system. HCI both bedded and non bedded were included. Results of survey was 56.52% were using without lid containers in bedded HCT, 64.72% were using without lid container in non bedded HCI. It was further observed that the required importance was not given to the quality and material of the waste contains to be used for different categories of waste. In many places cardboard were used to contain infectious waste.

Section C: Treatment

University of Norht Carolian School of medicine has conducted study on use of inorganic hypo chlorite (bleach) in health care facilities. This report enumerates Hypo chlorite has used as a disinfectant for more than 100 years. It was has many of the properties of an ideal disinfectant, including a broad ant microbial activity, rapid bactericidal action, reasonable persistence in treated potable water, easy of use, solubility in water, relative stability, relative non toxicity at use concentrations, no poisonous residuals, no color, no staining, and low cost. Hypochlorite is lethal to most microbes, although viruses and vegetative bacteria are more susceptible than endoscopes forming bacteria, fungi, and protozoa. Clinical uses in health care facilities include hyper chlorination of potable water to prevent legionella colonization; chlorination of water distribution system used in hem dialysis enters, cleaning of environmental surfaces, disinfections of laundry, local use to decontaminate blood spills, disinfections of equipment.

Section D: Final disposal of health care waste.

Sharma V. Sharma A, P.S. Medical College and hospital karmasd Gujarat has conducted descriptive study on disposal of health care waste in rural teaching hospital. The aim of the study to observe and analyze the waste disposal pattern in a 500 bedded multidisciplinary hospital located in a rural area. The data were collected by means of pre-structured interviews and on the spot observation of the various stages in the waste disposal chain. It was observed that the hospital does not have a documented wasted management and disposal policy. The disposal of waste is not properly supervised and is exclusively entrusted to the junior most staff form the house-keeping department. The disposal of all categories of hospital waste, even pathological waste were observed to be disposed on the open ground. Both the internal as well as external transportation of hospital waste were found to be for form satisfactory.

Department of environmental science and Engineering in china published article an “future solution, for treatment and disposal of hazards waste in china” as per this report the treatment and disposal of hazardous waste in china is summarized on the basis of the results of the declaring and registration project initiated nationally in 196. a principle framework for sound management of hazardous waste is proposed, which includes three levels of technical solutions. Large-scale enterprises are encouraged to recycle, to treat and to dispose of waste by means of constructing facilities and to have extra capacities available to the public for a reasonable fee. Municipal government, principle government and central government are to plan construct-centralized facilities to recycle, treat and dispose of waste. For solution at manufacturing level, recycling is identified as the main approach. Many of these studies shows lack of good individual exposure information. The health impacts of new waste management technologies and the increasing use of recycling and composting will require assessment and monitoring.

Section E: Hazards due to improper waste management

An international perspective on hazardous waste practice USA, it describes in developing countries, public health attention is focused on urgent health problems such as infection disease, malnutrition, and infant mortality. As a country develops and gains economics resources, more attention is directed to health concern related hazards of chemical waste. It is difficult to compare the quantities of hazardous waste produced in difference countries because of difference n how hazards waste is defined. Hazards waste that escape into the environment most often impact the on public through air and water contamination. An effective strategy for managing hazards waste should encourage waste minimization, recycling, and reuse over disposal. Developing countries are especially in need of low technologies for managing hazardous waste.

Section F: Universal Precautions

School of care science, U.K. Conducted a survey of community nurses experience and practice on universal precautions. Aim of the study is to protect health care workers from blood bone infections. Community nurse often have to deliver care to people in less than ideal home condition; The important aim is to explore community nurse, experiences and practices of using universal precautions. A questionnaire survey was used of this study. All community learning disability nurses, community mental health nurses and geriatric community nurses from one health authority were surveyed (n=543) with a response rate of 70%. The majority of community nurses reported compliance with universal precautious, although a small number of nurses of stated that they resealed needles in inappropriately stored sharps containers, inadequately were glove and experienced difficulties in hand washing. The study was concluded with clinical practice of community nurses work in unique and unpredictable environment, which may result in nurses being unable to comply with existing universal precaution guidelines.

Jackson M M has conducted study on infection precautions, what works and what does health personnel are at risk for exposure to may potentially infectious organisms particularly hepatitis B and human immune deficiency virus in the blood of patients whose blood borne pathogen status is unknown. This study has assessed three strategies for reducing risk of occupational at exposure to health care workers i.e the body substance isolation system, universal precautions and sharps safety procedures. The occupational health hierarchy of worker safety that includes engineering controls, work practice modifications administrative control and personal protective equipment has presented.