thesis pwerpoint

Impact of Waste Management Practices on Health Awareness and Perception Of

Healthcare Personnel and Neighboring Communities In Selected

Hospitals in Iligan City

Iligan Medical Center CollegeSan Miguel Village, Pala-o, Iligan City

College of Nursing, Midwifery and Health Aide

An Undergraduate Thesis Presented to the Faculty of

College of Nursing, Midwifery, and Health Aide DepartmentIligan Medical Center College

In Partial Fulfillment Of the Requirement for the

Degree Bachelor of Science in Nursing

Presented by

Anticamara, Ian Dave

Celdran, Carlos Miguel

Dasmarinas, Ronald

Devocion, Elrence

Limpao, Jamillah

Macataman, Settie Naillah

Moscoso, Renante

Ong, Eleonor

Padayogdog, Marivic

Sabayle, Maila Angela

Tanudra, Elmer

Unabia, Louella Jo

Introduction

All activities of living things on earth produce waste in some

form or the other. both biodegradable and non-

biodegradable hardly had any impact on the environment

until the invention of plastics by the modern man. Solid

waste management is a major problem in most developing

countries of the world due to its ever growing and endless

generation coupled with poor management. The air, the

water and the land are today becoming disposal sinks for

the waste (S. Saini, et al, 2005).

Hospital waste management is one of the biggest challenges

our country is facing today. Public concern over the past

years has been growing with regards to the disposal of

wastes produced by health care facilities in the Philippines

(Morones, 2009).The concern regarding the medical waste is

mainly due to the presence of pathogenic organisms and

organic substances in hospital solid wastes in significantly

high concentrations.

The intent of this paper is to raise the awareness

regarding the importance of proper health care waste

management so as to enhance the quality of the health

care environment. This, along with the lack of local data

creates the need for the assessment of the hazardous

waste management of hospitals in Iligan City.

Theoretical Framework

Florence Nightingale and subsequent nurse scholars have

written about the impact of the environment on human health.

Nightingale described, and staked out, the nurse´s role in

optimizing environments for healing. The environment was the

main emphasis on Nightingales nursing beliefs. She clearly

emphasized that clean environment, fresh air, warmth, noise

control and management of wastes and odors were ways that the

"environment could be altered in such a way as to improve

conditions so that nature could act to cure the patient." (Selanders,

1993). She realized that internal and external environment controls

were both important to the progress of the patient's health.

There is a direct connection between nursing actions and

the health of the environment in health care agencies.

However, in daily practice nurses, whether administering

a medication, changing a dressing, or starting an IV, do

not usually consider the environmental impact of such

activities. To do an adequate assessment of the impact

of nursing care on the environment, one must consider

everything in the environment including the lighting, air

conditioning or heating, electrical equipment and pumps,

elevators, computers, electronic medication dispensing

machines, monitors, and more.

Theoretical Framework

Conceptual Framework

The Independent variable Hospital waste management

practices encompasses three major factors.

Hospitals must have an appropriate waste disposal that ensures

proper segregation, treatment, collection and transportation of the

generated waste by the healthcare facility.

Hospitals must also allocate sufficient safety precautions to

ensure efficient operation such as provision of personal protective

equipment for handling wastes and proper storage area and

equipments.

Hospital programs. These programs must be designed to reach

out to the entire staff, tap existing channels of education, to provide

education on a continuing basis especially for new staff.

Every employee and manager should be made aware of the existing government policies, laws and regulations related to health care waste management. The overall aim of the training is to develop awareness on the health, safety and environmental issues relating to health care waste.

It also helps to create awareness and foster responsibility among hospital patients and visitors to health care establishments regarding hygiene and health care waste management. Public education also plays an important role in health care waste management.

The Dependent variables of this study are the health awareness and perception of health care personnel and neighboring community regarding Hospital waste management.

Conceptual Framework

. SCHEMATIC DIAGRAM

Figure 1.1: The Conceptual Framework of the Study

Independent Variable

Hospital Waste Management Practices

Hospital waste disposal Segregation Treatment Collection and

Transportation Safety precautions

Storage area and equipments

Personal protective equipments/measures

Hospital programs Educational and training

programs on healthcare personnel

Public education

Dependent Variable

Health Awareness and Perception of respondents on hospital waste management:

Health care personnel Neighboring Community

Intervening Variable

Healthcare personnel profile Age Length of service

Community Profile

Age Educational attainment Length of residency

Statement of the Problem

This research attempts to determine the Impact of

Waste Management Practices on Health

Awareness and Perception of Healthcare

Personnel and Neighboring Communities in

Selected Hospitals in Iligan City.

Hypothesis This sector presents an assumption of the relationships

between the variables being studied. A null hypothesis is being utilized and is to be tested and, if found to be true, accepted. If not, it is rejected.

Ho1. There is no significant relationship between hospital waste management practices to the health awareness and perception of the health workers.

Ho2. There is no significant relationship between health workers and community respondents profile to their health awareness and perception.

Ho3. There is no significant relationship between the health workers profile to the hospital waste management practices.

The investigator will utilize the null hypothesis of 0.05 level of significance.

Significance of the StudyThis study attempts to look into the Impact of

Waste Management Practices on Health Awareness and Perception of Healthcare Personnel and Neighboring Communities in Selected Hospitals in Iligan City. Thus, the result of this study will be helpful to concerned institutions and individuals – Hospital Administrators and Staff, to the Nursing Students, to the Community and Future Researchers.

Hospital Administrators

This study could: Serve as an evaluative report that the

respective hospital could use in assessment and identifying venues for future improvement.

Encourage them to formulate effective and sound policies to improve regulatory compliance for the benefit of their agencies and to all personnel working in their hospital

Provide relevant recommendations to hospitals and medical centers on possible ways of managing medical waste disposal.

Chief Nurses This study would:

Help identify a number of personal health, environmental safety, and patient care issues.

Serve as an evaluative report that the chief nurses of the respective hospital could use in assessment and identifying venues for future improvement of his/her division.

Staff Nurses This study would:

Help raise awareness regarding the importance of proper health care waste management so as to enhance the quality of the health care environment.

As nurses will be able to advocate more effectively for environmental conditions that promote health.

Colleges of Nursing This study would:

Help promote the importance of the environmental issues in nursing actions in health care agencies.

That the colleges be a venue for training the future nurses to becoming effective nurses despite the rigors of the chosen career.

Nursing students

This study:

Becomes an inevitable concern as soon as they begin their nursing career.

Would help develop awareness on the health, safety and environmental issues relating to health care waste.

Hospital workers This study would : Help in identifying problems that needs improvement

in proper disposal of healthcare waste to protect the health of workers and prevent spread of nosocomial infections.

It creates:

Public awareness for protection of human health by reducing the exposure of employees, patients, watchers, and entire community to hazardous health care waste

Enhance community relations by demonstrating a commitment to environmental protection.

To the Community

Future Researchers

The document could also contribute to the already existing body of academic knowledge. In that, it serves as a source of information for subsequent research in this area. Hopefully, this will encourage future researchers to explore solutions that will be of assistance to the improvement of quality health care.

Scope and Limitation of the Study Among the selected are the two tertiary

hospitals in the city, Gregorio T. Lluch Memorial Hospital (GTLMH) a government subsidized medical institution, and St. Mary’s Maternity and Children’s Hospital a private medical institution.

There are two types of respondents included in the study. hospital personnel households in the neighboring community.

Definition of Terms To facilitate and to give a better understanding of this

study, there are specific terms, which are defined operationally, or they are given meaning according on how they are used in this study.

Age. In this study, this term was used to denote the total number of years a person has lived.

Awareness. In this study, this term shall refer to the knowledge of the respondents about healthcare waste.

Collection/Transportation. In this study, this term shall refer to the act of removing health care waste from the source or from a communal storage point.

Disposal. In this study, this term shall refer to the discharge, deposit, dumping, placing or release of any health care waste into or on any air, land, or water.

Educational Attainment. In this study, this refers to the highest educational level attained by the respondent.

Hospital programs. In this study, this refers to the educational and training programs the hospital offers to their personnel and to the public.

Length of Service. In this study, this term was used to refer to the length of time, years, or duration of an occupation within a particular job in a hospital.

Length of residency. In this study, this term was used to refer to the length of time, years, or duration of stay within the neighboring community.

Perception. In this study, this term refers to the level of satisfaction of the respondents on the hospitals waste management.

Personal protective equipments/measures. In this study this term refers to the available equipments and measures the hospital provides to protect healthcare personnel from healthcare waste.

Segregation. In this study, this shall refer to a health care waste management practice of separating different waste materials found in health care establishment in order to promote recycling and re-use of resources and to reduce the volume of waste for collection and disposal.

Storage. In this study, this shall refer to the interim containment of health care waste after generation and prior to collection for ultimate recovery or disposal.

Treatment. In this study, this term refers to treating of health care waste to change the biological and chemical character of the waste to minimize its potential to cause harm.

Chapter II

REVIEW OF RELATED LITERATURE AND STUDIESREVIEW OF RELATED LITERATURE AND STUDIES

Medical or healthcare wastes are in the form of solid and

liquid wastes generated in the diagnosis, treatment or

immunization of human beings or animals; in medical

research; or in production of vaccines or other substances

produced from living organisms. They are commonly

generated by hospitals, medical or research laboratories,

clinics, offices of physicians and dentists, veterinarians,long

term-care facilities for example, nursing homes and funeral

homes.

IMPACTS OF HEALTH CARE WASTE

A framework for health care waste management should

always consider health and occupational safety. There

are many potential hazards associated when dealing or

handling health care waste such as physical, chemical

and biological hazards as well as ergonomic factors.

Health care facilities should identify all these specific

environmental and occupational hazards during handling,

storing, treating, and disposing of health care waste.

Exposure to hazardous health care waste can result to

disease or injury. The hazardous nature of health care waste

maybe due to one or more of the following characteristics:

Contains infectious agentsGenotoxicContains toxic or hazardous chemicals or

pharmaceuticalsRadioactiveContains sharps (DOH manual, 2004).

The main groups of people who are at risk of exposure to health hazards associated with health care waste are the following:

Staff of the health care establishments such as physicians, nurses, health care Auxiliaries, and hospital maintenance personnel; Patients in the health care establishments or receiving home care; Visitors, comforters, and caregivers to health care establishment; Personnel and workers providing support services and allied to health care Establishments, such as laundries, waste handling and transportation;Persons transporting hazardous health care waste;

Workers and operators of waste treatment and disposal facilities, i.e. sanitary

landfill including scavengers;

Persons at Risk

• Workers in mortuaries, funeral parlors and autopsy centers;

and

General public (DOH manual, 2004).

Establishments, such as laundries, waste handling and transportation;

Persons transporting hazardous health care waste;

Workers and operators of waste treatment and disposal facilities, i.e. sanitary landfill including scavengers;

Workers in mortuaries, funeral parlors and autopsy centers; and

General public (DOH manual, 2004).

Persons at Risk

Apart from the risk to the patients and health care personnel, consideration

must be given to the impact of health care waste to:

• The general public

• The environment

In particular, attention should be paid to the possible pollution of the air, water

and soil including the aesthetic aspects.

Minimizing the risk to public health and the environment will require actions to

deal with health care waste within the health care establishment such as proper

waste segregation and minimization so that it does not enter the waste

stream requiring disposal.

Impacts of Health Care Waste to Public Health and the Environment

1. General Waste - Comparable to domestic waste, this type of waste does not

pose special handling problem or hazard to human health or to the environment.

2. Infectious Waste – This type of waste is suspected to contain pathogens

(bacteria, viruses, parasites, or fungi) in sufficient concentration or quantity to

cause disease in susceptible hosts.

3. Pathological Waste - Pathological waste consists of tissues, organs, body

parts, human fetus and animal carcasses, blood and body fluids. Within this

category, recognizable human or animal body parts are also called anatomical

waste. This category should be considered as a subcategory of infectious waste,

even though it may also include healthy body parts.

Categories of Health Care Waste

4. Sharps - Include needles, syringes, scalpels, saws, blades, broken glass,

infusion sets, knives, nails and any other items that can cause a cut or puncture

wounds. Whether or not they are infected, such items are usually considered as

highly hazardous health care waste.

5.Pharmaceutical waste - Includes expired, unused, spilt, and contaminated

pharmaceutical products, drugs, vaccines, and sera that are no longer required

and need to be disposed of appropriately.

6.Geotaxis Waste - Geotaxis waste may include certain gyrostatic drugs, vomit,

urine, or feces from patients treated with gyrostatic drugs, chemicals, and

radioactive materials.

Several studies have been done to assess the management of hazardous wastes in the Philippines and abroad. Soncuya et al, (1997)

Majority of the hospitals is not practicing treatment procedures prior to the disposal of their infectious waste and does not adhere to color-coding system required by MMDA Ordinance No. 16. These practices pose significant risks to humans, including direct contact and contamination of surface water or groundwater.

Another study on waste management practices of hospitals in Metro Manila conducted for the Department of Health (DOH) revealed that although most of the hospitals perform waste segregation, less than 50% of the 144 hospitals studied did not have the proper mechanisms for proper waste handling and segregation.

Related Studies

In Sylhet, a study entitled “Hospital Waste Management in Sylhet City”; it was observed that:

•Existing hospital waste collection, and handling and disposal practices of all the hospitals in Sylhet involved transport of wastes by ward boys, maid nurses and other employees from the point of generation to initial storage.

In a similar study done in Dhaka City on Solid Waste Management, it was found out that there were over 500 clinics and hospitals in Dhaka City and majority of the hospitals were not practicing safe disposal of wastes. Waste is collected from small bowls or plastic bins provided for each bed and emptied into larger containers.

Related Studies

Related StudiesBhatia (2003) did a study in Mumbai on “Biomedical

Waste Management: Understanding our civic issues”, health care institutions dump their infectious waste, along with the rest of the non-infectious waste, in the municipal garbage systems, posing a serious risk to public health as well as a risk of scavenging(Bhatia, 2003 ).

Thus, poor management of healthcare waste poses a severe threat to public health and may also damage the environment.

RESEARCH METHODOLOGY

Chapter III

Descriptive Correlational type of research will be used, since this study aims to determine the Impact of Waste Management Practices on Health Awareness and Perception of Healthcare Personnel and Neighboring Communities in Selected Hospitals in Iligan City.

The main purpose is to describe events, phenomena, situations, practices and trends developing through the use of measurement or quantification of events or variables under the study and the relationships that occur naturally between and among them.

Research Design

Research Design

An observation of hospitals in Iligan City will be done regarding waste management practices performed by the different departments of the hospital at the same time survey questionnaires and informal interview will be utilized to gather the necessary information needed for the study. The information to be gathered from this study will be those which exist at the time of the survey.

Research Locale

The City of Iligan, dubbed as the

Industrial City of the South, is a

highly urbanized city in the province

of Lanao del Norte, Philippines, and

the province's former capital.

Serving the medical needs of its

populace are the two hospitals,

among others, that have been home

to teams of doctors, nurses and

aides Gregorio T. Lluch Memorial

Hospital and St. Mary’s Maternity

and Children’s Hospital are the

venues for gathering data on this

particular research.

Respondents of the Study

There are two types of respondents included in the study. First, are the hospital personnel and second are the households in the neighboring community of selected hospitals in Iligan City.

1. Hospital personnel of the following positions:

Hospital Waste ManagerNursesOrderlies/waste handlers

2. Head of the households of the neighboring community

Sampling Design

Purposive sampling will be used in the selection of hospital personnel and household of the neighboring community based on the inclusion criteria.

Purposive sampling is based in the belief that researcher’s knowledge about the population can be used to hand pick the cases to be included in the sample.

This study will purposely select the widest possible variety of respondents and choose subjects who are judged to be typical of the population in question or particularly involved and knowledgeable about the issue under study.

Research Instrument

The study will make use of a self made form of questionnaires as means of collecting data for hospital waste managers, nurses, orderlies and household of the neighboring community.

Observations will be recorded during personal interviews with subjects. Similarly, all items in the checklists are based on the guidelines set on healthcare waste management by the DOH Manual.

Statistical Treatment of Data

The data that will be obtained from the respondents will be tabulated systematically in order to obtain accurate information related to each element of the target population. In analyzing the data gathered from respondents, the descriptive statistical technique like the percentage distribution and mean for the different variables in the study will be used. This reveals the overall average of responses or perceptions of the respondents.

Percentage formula will be used for the profile of the respondents in problems 1 and 2.

% = number of respondents in a group x100%

Total number of respondents

Mean formula will also be utilized for the other problems 3, 4 and 5 of the study.

Where:n = refers to the number of subjectsxi = i th observation in a data set = summation of observation from 1st (i=1) up to the last respondent (n)

For relationship between variables on problems 6, 7, 8, and 9 Pearson’s product will be used.Pearson’s Formula:Pearson’s Formula or Correlation Coefficient: Used to define the strength and direction of a relationship between 2 variables (ex. Age vs. salary) – often presented as a scatter diagram.

Where r is the number of samplesX is the observed value of the first variablesY is the observed value of second variablesN is the number of sample or respondents used in the

analysis

Chapter IV

PRESENTATION, DISCUSSION AND ANALYSIS OF DATA

This chapter presents the data collected in the order stated in the statement of the problem, in the frequency distributions includes the descriptive statistics for each variable.

A total of 18 nurses, 2 waste handlers, and 30 households of the neighboring community were made respondents of the survey. This is composed of 35 respondents from Gregorio T. Lluch Memorial Hospital and 15 from St. Mary’s Maternity and Children’s hospital.

Problem I: What is the profile of the healthcare personnel in terms of the following: 1.1 Age 1.2 Length of Service

Table 1.1 Percentage Distribution According to Age

Table 1.1 Presents the Percentage Distribution According to Age. The table shows that majority or 40% (8 nurses) of the total respondents were within the age range of 24-26 years old. On the other hand, 35% (7 nurses) where within the age range of 21 – 23 years old, 15% (3 nurses) belongs to the age range of 27 – 29 and 10% (2 waste handlers) belongs to the age range of 30 and above. This result can be attributed to the increasing trend of new nurses belonging to ages 21-29 most of them just join the healthcare workforce upon graduation from nursing courses.

Profile Frequency Percentage

Age

21 – 2324 - 26

27 - 29

30 and above

Total

78

3

2

20

35 %40%

15%

10 %

100 %

Table 1.2 Percentage Distributions According to Length of Service

Table 1.2 Presents the Percentage Distribution of the Respondent According to Length of Service Rendered. It shows that majority or 90% of the total respondents have been in service for 3 years and below, but not less than 2 months, and 10 % of them from 4 years and above, but not more than 15 years in service. This result essentially means that nurses working are generally new in this field and can be related to the result in Table 1.1 regarding the age distribution where it has been found out that most nurses are from ages ranging from 21-29 years old. Again, this is attributable to the increasing trend of new nurses and the fact that most nurses in the institutions today are generally young.


Length of Service

3 years and below

4 years and above

Total

18

2

20

90 %

10 %

100 %

Problem II: What is the profile of the community respondents in terms of the following:

2.1 Age2.2 Educational attainment2.3 Length of residency


Table 2.1 Presents the Percentage Distribution According to Age. It shows that majority or 46.67% of the total community respondents belong to the age bracket of 48-70. Out of 30 community respondents, 33.33% belongs to ages 39-47, 10 percent belongs to ages 30-38 and another 10% belongs to 21 – 29 age bracket.


Age

21 – 29

30 - 38

39 - 47

48 - 70

Total

3

3

10

14

30

10 %

10 %

33.33 %

46.67 %

100 %

Table 2.2 Percentage Distribution According to Educational attainment

Table 2.2 Presents the Percentage Distribution According to Educational attainment. It shows that majority or 73.33% of the total population of community respondents are college graduates, 20% have finished high school level, and 6.67% have only reached grade school level.


Educational attainment

Primary level

Secondary level

Tertiary level

Total

2

6

22

30

6.67 %

20 %

73.33 %

100 %

Table 2.3 Percentage Distributions According to Length of residency

Table 2.3 Presents the Percentage Distribution According to Length of residency. It shows that majority or 36.67% of the total population have been a resident in the neighborhood for 7 years and below but not less than 1 year, 23.33 % of them from 8 years to 14 years, another 23.33 % from 15-21 years and 16.67% has been a resident there for more than 22 years but not more than 35 years.

Profile Frequency PercentageLength of Residency

0-7 years

8-14 years

15-21 years

22-35 years

Total

11

7

7

5

30

36.67 %

23.33 %

23.33 %

16.67 %

100 %

Problem II: What is the profile of the community respondents in terms of the following:

2.1 Age2.2 Educational attainment2.3 Length of residency


Table 2.1 Presents the Percentage Distribution According to Age. It shows that majority or 46.67% of the total community respondents belong to the age bracket of 48-70. Out of 30 community respondents, 33.33% belongs to ages 39-47, 10 percent belongs to ages 30-38 and another 10% belongs to 21 – 29 age bracket.

Profile Frequency PercentageAge

21 – 29

30 - 38

39 - 47

48 - 70

Total

3

3

10

14

30

10 %

10 %

33.33 %

46.67 %

100 %

Table 2.2 Percentage Distribution According to Educational attainment

Table 2.2 Presents the Percentage Distribution According to Educational attainment. It shows that majority or 73.33% of the total population of community

respondents are college graduates, 20% have finished high school level, and 6.67% have only reached grade school level.


Educational attainment

Primary level

Secondary level

Tertiary level

Total

2

6

22

30

6.67 %

20 %

73.33 %

100 %

Table 2.3 Percentage Distributions According to Length of residency

Table 2.3 Presents the Percentage Distribution According to Length of residency. It shows that majority or 36.67% of the total population have been a resident in the neighborhood for 7 years and below but not less than 1 year, 23.33 % of them from 8 years to 14 years, another 23.33 % from 15-21 years and 16.67% has been a resident there for more than 22 years but not more than 35 years.


Length of Residency

0-7 years

8-14 years

15-21 years

22-35 years

Total

11

7

7

5

30

36.67 %

23.33 %

23.33 %

16.67 %

100 %

Problem III: What is the status of the waste management practices of the selected hospitals in Iligan City as to the following:

•Waste segregation•Treatment done to the waste before disposal•Collection and transportation of waste•Waste storage area and equipments •Personal protective equipments/measures •Hospital educational programs

Table 3.1 Mean Distribution According to Waste Segregation

Waste Segregation Mean Interpretation

1. I observe proper segregation of wastes. 4.1 Highly Effective

2. Waste from infected patients in isolation wards e.g. dressings from wounds are properly separated from general wastes.

4.1 Highly Effective

3. Terminated IVF, blood and body fluids are properly separated from general wastes.


4. I always make sure that sharps are never mixed with non sharps.


5. I never find needles and syringes and other sharp waste mixed with infectious or general waste.


6. Proper color coding system in the vicinity is followed.


7. Bags and containers for infectious waste are properly marked with the international infectious substance symbol.


8. I separate contaminated sharps such as needles and syringes from uncontaminated sharps such as broken glass and nails.


9. I practice waste minimization. 4.3 Highly Effective

Over all Mean 4.31 Highly Effective

Legend: 0 - 1.25= Poor 1.26-2.5= Less Effective 2.6-3.75= Effective 3.76-5.0= Highly Effective

These results would mean that the respondents apply waste minimization on their respective departments and recycling is their main measure to achieve waste minimization. Waste minimization is centered on the elimination or reduction of the healthcare waste stream. Recycling is collecting waste and processing it into something new. Many items in the hospital can be recycled. Items such as organics, plastic, paper, glass and metal can be recycled easily (DOH Manual). An effective healthcare waste management considers the basic element of waste minimization therefore it is beneficial for all hospitals in Iligan City to implement such measures.

Table 3.2 Mean Distribution According to Treatment of waste


It shows that the respondents of this study concur that they able to treat infectious waste prior to disposal. The purpose of treating healthcare waste is to change the biological character of the waste to minimize its potential to cause harm. In an interview with the waste manager they make use of chemical substance as means of treatment.• These results would mean that the respondents do perform sterilization of pathological waste prior to disposal. • The subjects concur that proper encapsulation is done prior to disposal of sharps are done.

Treatment of waste Mean Interpretation 10. Proper on-site treatment is done prior to the disposal of infectious waste.


11. Proper sterilization prior to the disposal of pathological wastes such as blood and body fluids is done.


12. Proper encapsulation is done prior to disposal of sharps.



Table 3.3 Mean Distribution According to Collection and Transportation of waste

Collection and Transportation of waste Mean Interpretation 13. The establishment utilized wheeled trolleys, containers, or carts in the transportation of healthcare wastes.


14. Waste are collected daily (or as frequently as required) and transported to the designated central storage site.




Table 3.3 shows the Mean Distribution according to collection and transportation of waste.The table shows that garbage collection per daily basis is properly implemented and designated to central storage site.

Table 3.4 Mean Distribution According to Storage area and Equipments

Storage Area and Equipments Mean Interpretation 15. Containers of sharps are puncture-proof and fitted with covers.


16. Wastes are stored according to specific rules. 4.3 Highly Effective

17. Appropriate containers or bag holder in all locations where particular categories of waste may be generated are in place.


18. There is a storage area for healthcare waste which is properly enclosed and is located within the establishment.


19. Colored garbage bags are immediately replaced with new ones of the same type after disposal of waste.

3.55 Effective


Table 3.5 Mean Distribution According to Personal Protective Equipment/ Measures

Personal protective equipment/measures Mean Interpretation 20. Appropriate personal protective equipment in handling waste such as heavy-duty gloves, boots, etc is made available.

3.3 Effective

21. Protective measurements are available such as soap and warm water, and immunization against hepatitis b and tetanus infection.

3.6 Effective

Over all Mean 3.45 Effective


•It has an overall mean of 3.3 and interpreted as effective. These results would mean that majority of the respondents find the availability of appropriate personal protective equipment to be adequate. However, as observed waste handlers lack the use of protective gears which is clearly given less importance. Among staffs who routinely handle health care waste, awareness of the need for safety may decrease with time, which will increase the risk of injury. Periodic refresher course is therefore recommended (DOH manual).

• It has an overall mean of 3.6 and interpreted as effective. Again these results would mean that majority of the respondents find the availability of protective measures to be just adequate.

Table 3.6 Mean Distribution According to Hospital educational programs


Hospital educational programs Mean Interpretation 22. I have undergone training program on hospital waste management.

3.45 Effective

23. The hospital provides annual education on waste management for employee.

3.5 Effective

24. I am taught about the color coding for waste segregation.


25. There is training on how to deal with injuries and exposure in handling healthcare wastes.


26. There are billboards and other propaganda materials on environmental sanitation to motivate cleanliness


Over all Mean 3.75 Effective

• In an interview with their hospital waste manager, it was discovered during an interview that they only train and educate newly hired employees. In developed countries, training programs and educational classes are instituted repeatedly for all personnel and the content of these programs is specifically designed to different personnel (Hospital waste management in Dhaka City, 2005).

•Based on the color coding for waste segregation lecture, The table shows that respondents clearly understand the color coding system in waste segregation.

•The result shows that billboards and other propaganda materials are being utilized in promoting proper waste disposal.

Problem IV: What is the status of the healthcare personnel’s health awareness and perception on hospital waste management:

4.1 Health awareness

4.2 Perception

Table 4.1 Health awareness on Hospital Waste Management


Mean Interpretation

1. I have the knowledge of the definition of clinical waste.

4.85 Strongly Agree

2. I am aware of danger exposed to myself by the clinical wastes

4.8 Strongly Agree

3. I am aware of the danger exposed to others by the clinical wastes

4.75 Strongly Agree

4. I am aware of the effects of the clinical wastes to the environment

4.75 Strongly Agree

5. I am familiar with the waste management policy and procedures for healthcare waste management.

4.65 Strongly Agree

6. I am familiar with the clinical waste management plan by the hospital.

4.65 Strongly Agree

7. I am aware of my duties and responsibilities in maintaining proper waste management

4.75 Strongly Agree

8. I am able to identify various type of clinical wastes 4.65 Strongly Agree

9. I know how to segregate, contain and label the clinical wastes properly

4.6 Strongly Agree

10. I know how to deal with any accident with clinical spills, injury or exposure in handling healthcare wastes.

4.3 Strongly Agree


Table 4.2 Perception on Hospital Waste Management Mean Interpretation

1. Sufficient funds are allocated to healthcare waste management.

3.7 Agree

2. Sufficient human resources are allocated to healthcare waste management.

4 Strongly Agree

3. The storage area access is secured (only accessible for authorized persons).

4.4 Strongly Agree

4. Current practices on healthcare waste collection & on-site transport offer sufficient security.

4.05 Strongly Agree

5. Off-site healthcare waste treatment option is satisfactorily offered by the organization.

3.65 Agree

6. The healthcare waste final disposal site area is secured.

3.9 Strongly Agree

7. The facility has a proper waste management committee who develops a waste management plan for the facility.

4.15 Strongly Agree

8. There are proper written guidelines or a written facility plan on healthcare waste management.

4.25 Strongly Agree

9. The hospital provides enough trash bins in every area of the hospital that provides instructions on waste segregation.

4.35 Strongly Agree

10. Proper safety measures are being followed. 4.3 Strongly Agree 11. Appropriate attention is given to waste management.

4.3 Strongly Agree

12. Proper record keeping of the clinical wastes is done. 4 Strongly Agree 13. Clinical waste management follows the standard procedure.

4.2 Strongly Agree

14. Policies regarding waste segregation are properly disseminated or clear instructions are given to visitors and patients.

4.1 Strongly Agree



Problem V: What is the status of the neighboring community’s health awareness and perception on hospital waste management:

5.1 Health awareness

5.2 Perception

Table 5.1 Awareness on Hospital Waste Management


Mean Interpretation

1. I have the knowledge of the definition of clinical waste.

4.96 Strongly Agree

2. I have sufficient knowledge about the health risk of the clinical wastes to the environment.

4.93 Strongly Agree

3. I have sufficient knowledge about the health risk exposed to myself by the clinical wastes.

4.96 Strongly Agree

4. I have sufficient knowledge about the health risk exposed to others by the clinical wastes

4.96 Strongly Agree

5. I have sufficient knowledge about the protective measures against healthcare wastes.

4.83 Strongly Agree

6. I am aware of the possible transmission routes of diseases from clinical wastes.

4.8 Strongly Agree

7. I am aware that proper disposal of waste is important. 4.86 Strongly Agree

8. I am aware that proper rules and regulations should be implemented regarding waste management.

4.83 Strongly Agree


Table 5.2 Perception on Hospital Waste Management


Mean Interpretation 1. I am satisfied with how the hospital manages their waste over the past years.

4.8 Strongly Agree

2. The hospital waste are properly stored or covered. 4.76 Strongly Agree 3. The hospital’s final disposal site area is secured. 4.76 Strongly Agree 4. The hospital conducts proper awareness about healthcare waste to the community.

4.66 Strongly Agree

5. Staff of the health care establishment is able to explain to incoming patients and visitors the health care waste management policy.

4.53 Strongly Agree

6. Hospital wastes are properly contained which prevents environmental odors from affecting the neighboring community.

4.7 Strongly Agree

7. Community concerns are properly addressed by the hospital about healthcare waste management.

4.56 Strongly Agree


Problem VI: Is there a significant relationship between health awareness and waste management practices of health workers.

Table 6.1 Correlation of the Health awareness of health workers and waste

management practices Variables R Interpretation Hypothesis

Segregation = .306 Not significant Accepted

Treatment = .006 Not significant Accepted

Collection and transportation = .116 Not significant Accepted

Storage area and equipment = .472 Significant Rejected

Personal protective equipment = .086 Not significant Accepted

Hospital educational programs = .107 Not significant Accepted

This means health workers gives much awareness on the storage area and equipment they use. The better is their waste storage practice means that they have higher awareness on the safety protective measures. Health workers have high level of awareness on the impact of medical waste on occupational health as well as environmental issues. To minimize the risk to public health and the environment it is imperative to have a proper storage area and equipments so that injury and infection can be prevented (WHO, 1999).

Problem VII: Is there a significant relationship between perception and waste management

practices of health workers.

Table 7.1 Correlation of the perception of health workers and waste management practices

Variables R Interpretation Hypothesis



Collection and transportation = .630 Significant Rejected

Storage area and equipment = .421 Significant Rejected

Personal protective equipment = .624 Significant Rejected

Hospital programs = .676 Significant Rejected

It means that the better is the waste management practices namely collection and transportation, storage area and equipment, personal protective equipment, and hospital educational programs the greater is their perception on hospital waste management. Similarly, good practices are more likely adhered if hospital management support is well provided. Collection and transportation, and storage area and equipment are perceived by them because it is visible and they can observe the actual activity of waste disposal and storage of waste. Personal protective equipment and measures is related to their perception as they easily observe the supplies that exist and the one’s lacking. Hospital educational program is also related to their perception because they understand the importance of continuous educational and training programs.

Problem VIII: Is there a significant relationship between the profile variables of both health workers and community respondents to their health awareness and perception:

8.1 Health awareness of health workers

8.2 Perception health workers

8.3 Health awareness of community respondents

8.4 Perception of community respondents

Tables 8.1 Correlation of the Health workers profile

variables to their Health awareness.


Age = .047 Not significant Accepted

Length of Service = .168 Not significant Accepted

It shows that respondents profile does not make a difference to their health awareness. Regardless of age and length of service their health awareness stays the same as most of the respondents are nursing graduates and the rest are waste handlers so both have a background on the risk involved with improper waste disposal.

Tables 8.2 Correlation of the Health workers profile

variables to their Perception.


Age = .122 Not significant Accepted

Length of Services = .028 Not significant Accepted

Regardless of age and length of service their perception stays the same as most of the respondents are nursing graduates and the rest are waste handlers so both have a background on the risk involved with improper waste disposal.

Tables 8.3 Correlation of the neighboring community

profile variables to their Health awareness. Variables R Interpretation Hypothesis

Age = .357 Significant Rejected

Educational attainment = .105 Not significant Accepted

Length of residency = .448 Significant Rejected

The impression is that the longer their stay in the community and the higher their age, the greater is their awareness of the need for proper waste disposal to promote and maintain a healthy environment in the community. It is highly noted that with increasing age and length of stay comes with knowledge and experience.

Tables 8.4 Correlation of the neighboring community profile variables to their perception.


Age = .381 Significant Rejected

Educational attainment = .278 Not significant Accepted

Length of residency = .567 Significant Rejected

This finding shows that the longer their stay in the community and the higher their age makes their perception on hospital waste management greater. It is highly noted that with increasing age and length of stay comes with knowledge and experience.

Problem IX: Is there a significant relationship between the profile of health workers and their waste management practices:

9.1 Age

9.2 Length of services

Table 9.1 Correlation of the Waste Management Practices to their Age.




Collection and transportation = .156 Not significant Accepted

Storage area and equipment = .111 Not significant Accepted


Hospital programs = .226 Not significant Accepted

It also shows that the hypotheses of these items are accepted since it stated that both variables have no significance. Respondents age does not make a difference to the waste management practices, since majority of the respondents are generally young.

Table 9.2 Correlation of the Waste Management Practices to their Length of service.




Collection/transportation = .212 Not significant Accepted

Storage area and equipment = .241 Not significant Accepted


Hospital programs = .327 Not significant Accepted

Length of service does not make a difference to the waste management practices, since majority of the respondents are young their length of service and experience are also not that long.

Chapter VSUMMARY, CONCLUSION AND

RECOMMENDATIONSSummary

This study was conducted within Iligan City which aims to seek out the Impact of Waste Management Practices on Health Awareness and Perception of Healthcare Personnel and Neighboring Communities in Selected Hospitals in Iligan City. It aims to explore the different factors of Healthcare personnel profile namely Age, and Length of service with regards to their relationship to their health awareness and perception and to the Hospital waste management practices. It also aims to explore the different factors of Community respondents profile namely Age, Educational attainment, and Length of residency with regards to their relationship to their Health awareness and perception on hospital waste management.

Also, to correlate the relationship of dependent variables Health awareness and perception of health workers with the independent variables Hospital waste management practices namely Waste Segregation, Treatment done to Waste before Disposal, Collection and Transportation of Waste, Waste Storage Area and Equipments, Personal Protective Equipments and Measures, and Hospital Educational Programs.

The study was conducted in the Month of March 2010, employed 18 nurses, 2 waste handlers, and 30 neighboring community respondents from the selected Tertiary Hospitals in Iligan City Namely Gregorio T Lluch Memorial Hospital and St. Mary’s Maternity and Children’s Hospital. A purposive criterion sampling was made on the number of respondents.

A Descriptive-Correlational type of research was used wherein a self report data are obtained from the study sample in order to describe respondents on the variables of interest. A self-made questionnaire was produced and utilized. The content of the self-made questionnaire were brought to the statistician for interpretation and analysis.

Findings of the Study

The following are the Major Findings of this Study:

1. Profile of the healthcare personnel respondents:1.1 Majority of the participants belongs to the 21 – 29 years old age

bracket.

1.2 Majority of the participants have 0-3 years of experience.

2. Profile of the Community respondents:2.1 Majority of the participants belongs to the 48-70 years old age

bracket.

2.2 Majority of the total population of community respondents are college graduates.

2.3 Majority of the of the total population of community respondents have been a resident in the neighborhood for 7 years and below

Waste management practices of the selected hospitals in Iligan City in accordance to their Waste segregation, Treatment done to waste, Collection and transportation of waste, Waste storage area and equipments, Personal protective equipments and measures, and Hospital educational programs:

3.1 The respondents have comparable insight towards waste segregation. It shows that the respondents have over-all mean percentage of 4.31 translated as highly effective which means that proper waste segregation among hospitals is being practiced. It was discovered during an interview with their hospital waste manager that they practice the color-coding system but is not sufficient enough to sustain it due to lack of budget and supplies. However, they were able to develop means on how to manage their healthcare waste through separation of infectious waste from non- infectious waste.


3.2 The respondent’s insight towards treatment done to the waste before disposal has an over-all mean percentage of 4.16 translated as highly effective which means that they are able to treat infectious waste prior to disposal.

3.3 In the collection and transportation of waste the respondents has an over-all mean percentage of 4.25 translated as highly effective which means that garbage collection per daily basis is properly implemented and designated to central storage site with the use of appropriate trolleys and carts.

3.4 The respondent’s insight towards waste storage area and equipments has an over-all mean percentage of 4.18 translated as highly effective. 4 out of 5 items are rated with scales of 3.76-5.0, which means that proper waste storage materials are disseminated in different areas in the hospital. Containers for sharps are all puncture-proof and properly fitted with covers. However, most of the hospital can’t provide enough funds for the container bags. For this reason, containers for waste are not immediately replaced.


3.5 The respondent’s insight towards personal protective equipments/measures has an over-all mean percentage of 3.45 translated as effective which means that the respondents find the availability of appropriate personal protective equipment to be adequate. However, as observed waste handlers lack the use of protective gears which is clearly given less importance.

3.6 On hospital educational programs, it shows that the respondents have over-all mean percentage of 3.75 translated as effective which means that the respondent’s have undergone training regarding hospital waste management. The subjects claimed that annual education on employee is satisfactorily met. However, in an interview with their hospital waste manager, it was discovered during an interview that they only train and educate newly hired employees.


4. The status of the healthcare personnel’s health awareness and perception on hospital waste management.

4.1 The respondent’s health awareness on hospital waste management has an over-all mean percentage of 4.675 and is interpreted as highly effective.

4.2 The respondent’s perception on hospital waste management has an over-all mean percentage of 4.09 and is interpreted as highly effective.

5. The status of the neighboring community’s health awareness and perception on hospital waste management.

5.1 The respondent’s health awareness on hospital waste management has an over-all mean percentage of 4.89 and is interpreted as highly effective.

5.2 The respondent’s perception on hospital waste management has an over-all mean percentage of 4.89 and is interpreted as highly effective.


6. Significant relationship between health awareness and waste management practices of health workers.

6.1 Health awareness in relation to waste management practices: 1 item from the independent variable, Waste storage area and equipments is known to have significant relationship to health awareness. On the other hand, 5 items which are Waste segregation, Treatment done to waste, Collection and transportation of waste, Personal protective equipments and measures, and Hospital educational programs do not show any significance.

7. Significant relationship between perception and waste management practices of health workers.

7.1 Health workers perception in relation to waste management practices: 4 items from the independent variable, Collection and transportation of waste, Waste storage area and equipments, Personal protective equipments and measures, and Hospital educational programs are known to have significant relationship to health workers perception. On the other hand, 2 items which are Waste segregation and Treatment done to waste do not show any significance.


8. Significant relationship between both health workers and community respondents profile variables to their health awareness and perception.

8.1 All items under health workers profile variables have no significant relationship to their health awareness.

8.2. All items under health workers profile variables have no significant relationship to their perception on hospital waste management.

8.3 Neighboring community profile variables namely age and length of service are known to have a significant relationship with the dependent variable, health awareness. The remaining item educational attainment has no significant relationship to their health awareness.

8.4 Neighboring community profile variables namely age and length of service are known to have a significant relationship with the dependent variable, perception on hospital waste management. The remaining item educational attainment has no significant relationship to their perception on hospital waste management.


Significant relationship between the profile of health workers and their waste management practices.

9.1 All items under waste management practices have no significant relationship to the health workers age.

9.2 All items under waste management practices have no significant relationship to the health workers length of service.


CONCLUSIONFrom the data collected, the researchers had summed up the following findings:

1. It was discovered during an interview with their hospital waste manager that they practice the color-coding system but is not sufficient enough to sustain it due to lack of budget and supplies. However, they were able to develop means on how to manage their healthcare waste through separation of infectious waste from non- infectious waste.

2. It is observed that waste handlers lack the use of protective gears which is clearly given less importance. Appropriate personal protective equipment in handling waste such as heavy-duty gloves, and boots are not made available. These findings suggest that readily available personal protective equipments are crucial to ensure their use. Protective measures such as soap are provided but not regularly, and immunization against hepatitis b and tetanus infection are not provided.

3. Garbage bags are not immediately replaced with new ones of the same type after disposal of waste because there are not enough funds for the container bags.

4. Respondent’s have undergone training regarding hospital waste management. However, in an interview with their hospital waste manager, it was discovered that they only train and educate newly hired employees.

5. Although wastes are properly sorted in the hospital, the local government garbage collectors do not follow proper segregation and disposes it in the city dump site - a practice that defeats the purpose of waste segregation in hospitals.

6. Waste storage area and equipments is known to have a significant relationship to the health awareness of health workers.

7. Collection and transportation of waste, Waste storage area and equipments, Personal protective equipments and measures, and Hospital educational programs are known to have significant relationship to health workers perception.

8. Neighboring community profile variables namely age and length of residence are known to have a significant relationship with their health awareness.

9. Neighboring community profile variables namely age and length of residence are known to have a significant relationship with their perception on hospital waste management.

CONCLUSION

RecommendationsConsidering the results and conclusions made,

the researchers offer the following recommendations:

1. Hospitals should conduct regular orientation on the hospitals waste segregation and waste management policies to patients and new staff.

2. Ensure worker safety through education, training and proper personal protective equipments.

3. Reactivate committees and hold monthly meetings to discuss and address issues related to updates on waste management and environmental health awareness.

Recommendations

4. Ensure proper dissemination of information through supervisors/managers of each department and discussed to their members. Hold event such as Waste Management Week or an Infection Control Week once a year.

5. Consider training for all garbage collectors by the DOH, because there is a need for education as to the hazards of improper disposal of healthcare waste.

6. The city government should propose a separate dumpsite for all healthcare wastes and set limit to public access to decrease the risk of epidemics of infectious diseases. Other recommendation for future research would be to determine the waste generation rate of hospitals in Iligan City.

Gregorio T. Lluch Hospital Waste Management

St. Mary’s Maternity and Children’s Hospital

thesis pwerpoint

Documents

health care waste management

patients health health

health care waste education

health ca waste management

hospital waste management

health care facilities

health care agencies

human health