RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

1. NAME AND ADDRESS OF THE

CANDIDATE Mrs. SHWETHA B L

GLOBAL COLLEGE OF NURSING, GAT

CAMPUS, IDEAL HOMES TOWNSHIP,

RAJARAJESHWARINAGARA,

BANGALORE -560098 BANGALORE

-560098.

2. NAME OF THE INSTITUTION GLOBAL COLLEGE OF NURSING, GAT

CAMPUS, IDEAL HOMES TOWNSHIP,

RAJARAJESHWARINAGARA,

BANGALORE -560098

3. COURSE OF STUDY AND

SUBJECT

I YEAR M.Sc. NURSING, MEDICAL

SURGICAL NURSING.

4. DATE OF ADMISSION 01/06/2012

5. TITLE OF THE TOPIC “A study to evaluate the effectiveness of

structured teaching programme on BIO-

MEDICAL WASTE MANAGEMENT

among GNM internship students in selected

nursing schools of Bangalore”.

1

BRIEF RESUME OF THE INTENDED WORK

Introduction

Advances in medical facilities with the introduction of sophisticated instruments have increased the

waste generation per patient in health care units. The rapid mushrooming of hospitals has increased the

quantity of hospital waste production.1

Biomedical waste is defined waste which is generated during the diagnosis, treatment or

immunization of human beings or animals or in research activities pertaining thereto, or in the production of

testing of biological.2

Biomedical waste consists of solids, liquids, sharps and laboratory waste that are potentially

infectious or dangerous and are considered bio-waste. It must be properly managed to protect the general

public, especially healthcare and sanitation workers who are regularly exposed to biomedical waste as an

occupational hazard. Proper handling, treatment and disposal of biomedical waste are important elements of

healthcare infection control programme.3

Improper management of waste generated in health care facilities causes a direct health impact on

the community, the health care workers and on the environment. The waste generated in institutions

essentially consists of solids and liquid, which may be hazardous, infectious and non-infectious. It has been

estimated that up to 85% to 90% of the waste generated in hospitals is non-infectious (free with any body

fluids, which is similar to domestic waste). Remaining 10% to 20% of waste that is of concern because it is

hazardous and infectious. . In addition, waste that is un-segregated and not treated in the right manner would

cause environmental pollution affecting the health of the community. 4

2

Appropriate waste management system have been developed and installed globally to handle both

hazardous and non-hazardous Bio-Medical Waste.1 Bio medical waste management has got popularity in

recent days due to its importance in hospital administration. It involves proper planning and effective

implementation of various practices that are necessary for different categories of employees working in the

hospitals. Knowing the importance of bio medical waste management and to regulate it, the ministry of

environment and forests under Government of India has made the environment protection act in 1986. 5

6.1 NEED FOR THE STUDY

Hospital is a place of almighty a place to serve the patient. Since beginning the hospital are known

for the treatment of sick persons but we are unaware about the environment. Now it is well established fact

that there are many adverse and harmful effects to the environment include human beings which are caused

by the biomedical waste generated during patient care.6

In a study of pattern of waste in Indian cities, the quantity of refuse varied from 0.48 to 0.06kg/per

capita per day with total compost able matter varying from 30 to 40 percent. On an average, the volume of

total solid waste in hospitals in India is estimated to range between 1kg and 3kg per day on a per bed basis.

In a teaching hospital of 100 beds, solid waste averaged 1.5kg per day. It is estimated that about 0.5kg out of

this consists of food waste. In a study carried out in the family wing of a large hospital, the composition of

waste was bandages, gauge and cotton wool waste 34.1 per cent, coal ash 31.6 per cent, foliage 13.5 percent,

food waste 11.5 percent and glass, bottle, etc 1.8 percent. A 1988 study at ALLMS revealed that 67.5

percent waste originated from wards, 13.4 percent from OPD and 19.1 percent from the service area.7

A study was conducted to assess the level of awareness about the various aspects of biomedical

waste and disposal practices by the medical practitioners. It was a cross sectional study. 30 hospitals with

more than 30 beds minimum were randomly selected from Sabarkantha district, Gujarat. The doctors and

auxiliary staff of those 30 hospitals were the study population. While all the doctors knew about the

existence of the law related to biomedical waste but details were not known. Doctors were aware of risk of 3

HIV and Hepatitis B and C, whereas auxiliary staff (ward boys, ayabens, sweepers) had very poor

knowledge about it. There was no effective waste segregation, collection, transportation and disposal system

at any hospital in the district. There is an immediate and urgent need to train and educate all doctors and the

staff to adopt an effective waste management practices.8

A study was conducted to assess knowledge, attitude, and practices of doctors, interns, nurses,

laboratory technicians, attenders and housekeeping staff regarding biomedical waste management in

Bangalore. Results shows that Doctors, nurses have better knowledge than other staff regarding health care

waste management. Results shows that doctors, nurses have better knowledge than other staff regarding

health care waste management. Knowledge regarding the colour coding and waste segregation at source was

found to be better among nurses and laboratory staff. Regarding practices related to health care waste

management among nurses were better. 9

It is estimated that 10-25% of health care waste is hazardous, with the potential for creating a variety

of health problems. Bio-medical waste (BMW) collection and proper disposal has become a significant

concern for both the medical and the general community. Since the implementation of the Biomedical Waste

Management and Handling Rules (1998), every concerned health personnel is expected to have proper

knowledge, practice, and capacity to guide others for waste collection and management, and proper handling

techniques. 10

The waste produced in the course of healthcare activities carries a higher potential for infection and

injury than any other type of waste. Inadequate and inappropriate knowledge of handling of healthcare waste

may have serious health consequences and a significant impact on the environment as well. So investigator

himself felt that awareness through teaching programme is effective way for GNM internship students to

equip themselves with latest information about knowledge of biomedical waste management, which help

them to work effectively in the hospital.

4

6.2 REVIEW OF LITERATURE

A review of literature is an essential aspect of scientific research. It helps the investigators to

establish support for the need for the study, select research design, developing tools and data collection

technique.

This review of literatures is classified under following headings:

Review related to biomedical waste management

Review related to knowledge on Health personal among biomedical waste management

Review related to knowledge on nursing personal regarding biomedical waste management

Review Related To Biomedical Waste Management

The study was conducted in hospital waste management awareness and practice Andhra Pradesh,

Maharashtra and Uttar Pradesh in Hospitals/nursing homes and private medical practitioners in urban as

well as rural areas and those from the private as well as the government sector were covered. Information

on (a) awareness of bio-medical waste management rules, (b) training undertaken and (c) practices with

respect to waste management. Awareness of Bio-medical Waste Management Rules was better among

hospital staff in comparison with private medical practitioners and awareness was marginally higher among

those in urban areas in comparison with those in rural areas. About 70% of the healthcare facilities used a

needle cutter/destroyer for sharps management. Access to Common Waste Management facilities was low

at about 35%. Dumping biomedical waste on the roads outside the hospital is still prevalent and access to

Common Waste facilities is still limited.11

A study was carried out bio-medical waste management in the U.T. Chandigarh to assess the

generation and disposal of biomedical waste in the various medical establishments in the urban and rural

areas of the U.T. Chandigarh. It was found that there were 474 medical establishments in the U.T.,

Chandigarh including Nursing Homes, Clinics, Dispensaries, Pathological labs, Hospitals, Veterinary

Institutions and Animal houses. The total quantity of bio-medical waste generated in Chandigarh is 811.35

5

kg/day and the rate of generation of bio-medical waste varies from 0.06 kg/day/bed to 0.25 kg/day/bed.

Though the major hospitals are equipped with incinerators, proper bio-medical waste management system is

yet to be implemented. The medical establishments in the rural area and smaller ones in the urban area

dispose off their bio-medical waste along with municipal solid waste and no waste management system

exists. 12

A study was conducted Bio-medical solid waste management in an Indian Hospital to assess the

waste handling and treatment system of hospital bio-medical solid waste and its mandatory compliance with

Regulatory Notifications for Bio-medical Waste (Management and Handling) Rules, 1998, under the

Environment (Protection Act 1986), Ministry of Environment and Forestry, Govt. of India, at the chosen

KLE Society's J. N. Hospital and Medical Research Center, Belgaum, India and (ii) to quantitatively

estimate the amount of non-infectious and infectious waste generated in different wards/sections. During the

study, it was observed that: (i) the personnel working under the occupier were trained to take adequate

precautionary measures in handling these bio-hazardous waste materials, (ii) the process of segregation,

collection, transport, storage and final disposal of infectious waste was done in compliance with the

Standard Procedures, (iii) the final disposal was by incineration in accordance to EPA Rules 1998, (iv) the

non-infectious waste was collected separately in different containers and treated as general waste, and (v) on

an average about 520 kg of non-infectious and 101 kg of infectious waste is generated per day (about 2.31

kg per day per bed, gross weight comprising both infectious and non-infectious waste).13

Review Related To Knowledge on Health Personal Regarding Biomedical Waste

Management

A study on biomedical waste management awareness and practices in the districts of Madhya

Pradesh. The aim was to assess the awareness and existing practices regarding biomedical waste and its

management. It was carried out both rural and urban health care facilities of smaller district from January to

June 2008. Medical, paramedical, non medical personnel working at the current position for at least 6

6

months were included the study participants to assess the awareness. The results showed that awareness

regarding biomedical waste management was highest among doctors followed by paramedical staff and least

among non medical staff. The study concluded that regular orientation and reorientation training programs

should be organized for hospital staff and strict implementation of guidelines of biomedical waste

management to protect themselves and hospital visitors.14

A study was conducted to assess knowledge, attitude, and practices of doctors, nurses, laboratory

technicians, and sanitary staff regarding biomedical waste management. This was a cross-sectional study.

The study was conducted among hospitals (bed capacity >100) of Allahabad city. Medical personnel

included were doctors (75), nurses (60), laboratory technicians (78), and sanitary staff (70). Results shows

that Doctors, nurses, and laboratory technicians have better knowledge than sanitary staff regarding

biomedical waste management. Regarding practices related to biomedical waste management, sanitary staffs

were ignorant on all the counts. The study concludes that importance of training regarding biomedical waste

management needs emphasis; lack of proper and complete knowledge about biomedical waste management

impacts practices of appropriate waste disposal.15

A study was undertaken to assess the Biomedical waste(BMW) management practices in a

tertiary care, teaching hospital of Ludhiana, Punjab. A 10% sample was selected randomly from each

of the 3 categories of staff comprising 476 doctors, 378 nurses and 142 paramedical staff, on rolls. A

semi-structured questionnaire was used to obtain information from respondents. The study showed gaps in

the knowledge of all three categories of respondents. The knowledge of the existence of the BMW

Management Rules 1998 was better in doctors than in the nurses or the paramedical staff, but

knowledge of the practical aspects of BMW management was better in nurses and paramedical staff.

The BMW management practices in the hospital were satisfactory, except for a deficiency in supply of

needle-cutters in 40.9% wards. 16

7

Review Related To Knowledge Of Nursing Personal On Biomedical Waste

Management

A study was conducted to assess Knowledge, Attitude and Practices (KAP) about Biomedical waste

(BMW) management among nursing, technical and housekeeping staff. The study was conducted in the

private hospitals and nursing homes in Karimnagar town of Andhra Pradesh. There are approximately 267

private hospitals, and clinics. By a systematic random sampling method, 47 private hospitals were selected

and study was performed on 500 study subjects. The KAP of the nursing,technical and the house keeping

staff of the concerned hospitals. Analysis of data was done by using various statistical measures i.e.,

percentage, Chi-square test. The data was collected from 47 Private hospitals having 237 nurses, 131

technicians and 132 housekeeping staff. Assessment of knowledge regarding BMW Management among

study subjects reveals that 95.8% of subjects had knowledge about the health hazards. Only 1.6% of study

subjects had knowledge about the 10 categories of BMW. It is also found that 47.2% of Nurses, 26.4% of

Technicians and 26% of housekeeping staff were having positive attitude towards BMW management

(P<0.05, significant). Study also reveals that 45.4% Nurses, 25.8% Technicians and 13.8% of Housekeeping

staff are practicing / following BMW management rules (P<0.05, significant).17

A study was conducted to assess the knowledge of bio medical waste management among nursing

personnel at G T P Hospital Delhi. 30 samples were randomly selected and data collection was done using a

structured questionnaire. The findings showed that 66.6% of the staff nurses aware about the generation of

bio medical waste and 77.5% aware about the categorization and segregation.92.22% of the staff nurses

aware about the transport and 66.66%aware about the treatment and final disposal of bio medical waste and

70% aware about the needle disposal.99.66% of the nursing personnel desired the hospital authority to do

more regarding the awareness of bio medical waste management.18

A Cross Sectional study was conducted on development of a waste management protocol based on

knowledge and practice of health personnel at Almansoura university hospital Egypt. 200 samples were

8

taken for the study and data collection was done using a self administered questionnaire for nurses and

doctors and an interview questionnaire for house keepers. Observation checklist was used for assessment of

the performance. The result was only 27.4% of the nurses, 32.1% of housekeepers and 36.8% of the doctors

had satisfactory knowledge. Concerning practice, 18.9%of the nurses, 7.I % of the house keepers, and none

of the doctors had adequate practice. Nurses knowledge score had a statistically significant weak positive

correlation with the attendance of training courses(r==0.23, p<0.05). The majority of the doctors, nurses,

and housekeepers have unsatisfactory knowledge and inadequate practice related to health care waste

management. The knowledge among nurses is positively affected by attendance of training programs. Based

on the findings, a protocol for healthcare waste management was developed and validated. It is

recommended to implement the developed waste management protocol for the surgical departments in the

designed hospital, with establishment of waste management audits.19

STATEMENT OF THE PROBLEM

“A study to evaluate the effectiveness of structured teaching programme on BIOMEDICAL WASTE

MANAGEMENT among GNM intership students in selected nursing schools of Bangalore.

6.3 OBJECTIVES OF THE STUDY

1. To assess the knowledge regarding Biomedical Waste Management among the internship students in

selected nursing school of Bangalore.After the post test.

2. To evaluate the effectiveness of structured teaching programme on BIOMEDICAL WASTE

MANAGEMENT among the internship students in selected nursing schools of Bangalore.

3. To find out the association between knowledge regarding BIOMEDICAL WASTE

MANAGEMENT among the internship students in selected nursing schools of Bangalore. With their

selected demographic variable.

6.4 HYPOTHESIS

H1: There will be a significant difference in knowledge among internship student regarding biomedical

waste management before and after administration of structured teaching programme.

9

H2: There will be a significant association between the level of knowledge among internship students

regarding biomedical waste management with their selected demographic variables.

6.5 OPERATIONAL DEFINITIONS

Evaluate: - It refers to assess the level of knowledge among internship students on biomedical waste

management based on their pre and post test knowledge.

Effectiveness: - It refers to significant gain in knowledge regarding biomedical waste management as

determined by pre-test and post test knowledge scores.

Structured teaching programme: It refers to systematic arrangement of source to impact knowledge

regarding various aspects of biomedical waste management

Knowledge: - It refers to the responses given by students in the aspect of questionnaire regarding

biomedical waste management.

Biomedical waste management: In this study, it refers to any waste which is generated during diagnosis,

treatment or immunization of human beings and research activities

Internship students: Refers to students those who are completed 3 years general nursing course and they

were under the 6 months training program in nursing.

7 MATERIAL AND METHOD

7.1 Sources of data Data will be collected from students in

selected nursing schools in Bangalore

7.2 Method of data collection A structured questionnaire is used for the

Collection of data.

7.2.1 Definition of the study subject Nursing students who are studying in

GNM Interns ship in selected schools of

Bangalore.

7.2.2 Inclusion and exclusion criteria

(a) Inclusion criteria Nursing students of both genders who are, 10

a) Present at the time of data collection.

b) Willing to participate in the study

b)Exclusion criteria Nursing students who,

a) Have been already underwent classes

on Biomedical waste management.

7.2.3 Research design Pre experimental design, one group pre-

test and post-test research design.

7.2.4 Setting Selected Nursing schools in Bangalore.

7.2.5 Sample technique Non probability convenient sampling.

7.2.6 a) Sample size

b) Duration

60 samples

4 Weeks.

7.2.7 TOOLS OF RESEARCH The structured questionnaire schedule Will

be constructed in two parts:

Part1: Demographic data.

Part2: The knowledge on Biomedical

waste management.

7.2.8 COLLECTION OF DATA After getting permission from the principal

the investigator will get written consent

from the internship students. Then the

investigator herself will collects the data

from internship students by using

structured questionnaire to assess the pre

test knowledge. After collect the data the

investigator will provide structured

teaching programme to the internship

students. After 7 days of administration of

STP the investigator will collect data by

using structured questionnaire to assess the

post test knowledge.

11

7.2.9. Method of data Analysis and

Presentation

1) The investigator will use descriptive and

inferential statistics to analyse the data.

2) The analysed data will be presented in

the form of tables, diagram graphs, where

ever necessary.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE

CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMAL?

No.

7.4. HAS ETHICAL CLEARANC BEEN OBTAINED FROM YOUR INSTITUTION?

o Permission has been obtained from the principal of the institution.

o Informed written consent`will be obtained from the participants prior to the study.

o Privacy, confidentiality and anonymity will be guarded.

o Scientific objectivity of the study will be maintained with honesty and impartialiy.

12

8. LIST OF REFERENCES

1) Bhagya Bhaskar , Hema Nidugala , Ramakrishna Avadhani. Biomedical Waste Management –

Knowledge And Practices Among Healthcare Providers In Mangalore. Nitte university journal of health

science,march 2012;29(1):issn 2249-7110. Available from:http://www.bagyabs@gmail.com.

2) BT Basavanthppa. Foundamental of nursing . 2nd ed. New delhi: Jaypee brothers; 2009. page no 692-

693.

3) Hegde V, Kulkarni RD, Ajantha S. Bio medical waste management.Journal of oral maxillofacial pathol,

2007; 11( 1):5-9.

4) Bio medical waste an over view: :

http://www.bcpt.org.in/webadmin/publications/pubimages/biomedical.pdf

5) Dr. D. Rama Mohan, Dr. M. Veera Parasad, Dr. Kanagaluru Sai Kumar. Impact of training on bio

medical waste management astudy and analysis. International journal of multidisciplinary management

studies, 6june 2012;2(6). Avaliable from: http://www.Zenithressearch.org.in/ISSN 22498834

6) A.G.Chandorkar.et.al.,(2008),Hospital waste management. 3rded: Hyderabad:Paras publishers;2008.

7) B M Sakharkar; Principles of hospital administration and planning. 2nd ed. New delhi:Jaypee brothers;

Page No. 277 – 279.

8) 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 Oct-Dec;49(4):245-7. Avaliable

from:http://www.ncbi.nlm.nih.gov/pubmed/16479910.

9) Study about awareness and practices about health care waste management among hospital staff in a

medical college hospital, Bangalore. 18831366[PubMed - indexed for MEDLINE]

13

10) MC Yadavannavar, Aditya S Berad, and PB Jagirdar. Biomedical Waste Management: A Study of

Knowledge, Attitude, and Practices in a Tertiary Health Care Institution in Bijapur. Indian journal of

community medicine,2010 Jan; 35(1):170-171. Avaliable from:

http://www.ncbi.nlm.nih.gov/pmc/articles/pmc 28883501.

11) Rao PH . Report: Hospital waste management--awareness and practices: a study of three states in India.

Waste Manag Res. 2008 Jun;26(3):297-303. Avaliable from: http://www.ncbi.nlm.nih.gov/pubmed

18649579.

12) Singh K , Arora SK, Dhadwal PJ, Singla A, John S. Bio-medical waste management in the U.T.,

Chandigarh. Journal of environmental science Eng. 2004 jan; 46(1):55-60.Avaliable

from:http://www.materials.com.ass/index.php?page=profil&profil=1006.

13) Patil GV , Pokhrel K. Biomedical solid waste management in an Indian hospital: a case study, waste

management. 2005;25(6):592-9. Avaliable from: http://www.ncbi.nlm.nih.gov/pubmed 15993343

14) Manoj Baasal.et-al. journal of community medicine 2011; 2 (3); 203 Avaliable from:

http://www.ijmm.org/aricles.aspx issn=0255-0857.

15) Vanesh Mathur, S Devivedi , M A Hassan R P Misra. knowledge, attitude and practice about bio

medical waste management among health care presonals. A cross section study. Indian J Community Med.

2011 Apr-Jun; 36(2): 143–145. Avaliable from: http://www.ncbi.nlm.nih.gov/pcm/artcles PMC3180941

16) Savan Sara Mathew1, A. I. Benjamin2, Paramita Sengupta2. A. I Benjamin. Assessment of biomedical

waste management practices in a tertiary care teaching hospital in Ludhiana. July-Dem

2011;2(2).Avaliable from:www.doaj.org/doaj?func&id=829849.

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17) N. Nirupama*, Mohd. Shafee, G.S. jogdand . Knowledge, Attitude & Practices Regarding Biomedical

Waste Management. 2nd National Conference On Students’ Medical Research (2009), 09-10 January

2009;  

18) Prabhakar U, Makhija N. A Study to assess the knowledge of Bio-medical waste management in nursing

personnel of G T P Hospital Delhi. Nursing Journal of India, 2004; 95(8): 173-174.

19) Mostafa G M A, Shazly M M, Sherief W F. Development of a waste management protocol based on

knowledge and practice of health personnel in surgical Departments, Waste management. 2008; 29:430-

439. Avaliable from: htpp://www. Ncbi.nlm.nih.gov/pmc/articals/pmc3180941.

15

9.SIGNATURE OF THE

CANDIDATE

10REMARKS OF THE GUIDE

11.1NAME AND DESIGNATION OF

THE GUIDE

Mr. Gopalakrishnan. K

HOD & Assoc. Prof

Medical Surgical Nursing Dept.

11.2SIGNATURE

11.3CO-GUIDE (IF ANY)

11.4SIGNATURE

11.5HEAD OF THE DEPARTMENT Mr. Gopalakrishnan. K

HOD & Assoc. Prof

Medical Surgical Nursing Dept.

11.6SIGNATURE

12.1REMARKS OF THE PRINCIPAL

12.2SIGNATURE

16