Hospital Waste Management Training Among The Staff Of Dental Teaching Hospitals In Bangalore City: Hospital Waste Management

Table of Contents

ABSTRACT

INTRODUCTION
Aim
Objectives

REVIEW OF LITERATURE

MATERIALS AND METHODS
OBTAINING APPROVAL FROM THE AUTHORITIES
ETHICAL COMMITTEE CLEARANCE
REQUIRED INFORMATION ABOUT THE STUDY AREAS
SAMPLE SIZE:
PILOT STUDY
SCHEDULE OF THE STUDY
IMPLEMENTING THE STUDY
BASE LINE DATA
DETAILS OF THE INTERVENTION
POST INTERVENTION DATA
EVALUATION OF THE INTERVENTION
STATISTICAL ANALYSIS

RESULTS
Age and gender distribution of study participants (At base line)
AT BASELINE

DISCUSSION

CONCLUSION

REFERENCES:

QUESTIONNAIRE FOR DENTIST AND DENTAL AUXILLARY

ACKNOWLEDGEMENT

It is my privilege and honor to express my most sincere and heartfelt thanks to Dr.M R.Shankar Aradhya, Professor and Head, Department of Preventive and Community Dentistry, Oxford Dental College, Hospital and research centre, Bangalore, for his guidance and for providing the opportunity to carry out this study.

I extend my sincere thanks to Dr. Pruthvish.S, Professor and Head, Department of Preventive and Community Medicine, M.S.Ramaiah Medical College, Bangalore, Dr. Lalitha K.S ,Dr. Shalini Pradeep, Dr.Arjunan Isaac for their guidance and advice that has helped me in accomplishing this task.

I extend my humble thanks to our Principal, Dr. K.S. Ganapathy for providing the opportunity to carry out this study. I am grateful to Dr.Suresh K.P, Statistician, for his valuable assistance, guidance and his help in statistical analysis.

I would also like to express my thankfulness to all hospital authorities, staff, who have dedicated part of their valuable time for my study. I would like to express my gratitude to all My Colleagues for their help, support, and co-operation throughout this study.

I shall be forever indebted to all my Family Members who have been constant sources of inspiration and encouragement. I wish to regard my deep appreciation for their immeasurable support, innumerable sacrifices, unstinted help and prayers without which I would not have been what I am today.

Above all I bow my head in gratitude to Almighty for bestowing his blessings on me and helping me make this effort a reality.

Dr.Sushma.Rudraswamy

ABSTRACT

Background and objectives: Growing urbanization has led to several changes in the healthcare sector. While on one hand, access to healthcare services are being provided to the community thereby resulting in the better health for all, improper management of biomedical waste emanating from these healthcare establishments has also given rise to many environmental and health problems.. Most hospitals are not actively involved in addressing this problem. Also, the staffs are not trained in the proper waste management procedures. The present interventional study was conducted to assess the knowledge, attitude and practice about hospital waste management, to provide training programme on hospital waste management and to assess the effect of training among the staff of dental teaching hospitals in Bangalore city.

Methodology: A specially prepared and pre-tested structured questionnaire was given to assess the knowledge, attitude and practices among the staff of dental teaching hospitals and collected personally. One day training programme on the hospital waste management was organized at each dental college. Intervention was evaluated by assessing improvements in their knowledge, change in attitude and practice scores after intervention in comparison to the base line scores.

Results: Two months after intervention there was a 24.4% improvement in knowledge among the dentists, 18.7% improvement among auxiliaries and 23.3% improvement (p<0.001, significant) among the attenders when compared to the baseline knowledge. There was 36.2% change in attitude among the dentists, 33.3% change among auxiliaries, 56.42% and among the attenders (p<0.001, significant) when compared to the baseline attitude. There was a 17.6% change in practice among the dentists, 16.4 % change among auxiliaries, and 4.4 % among the attenders when compared to the baseline practice.

Conclusion: The findings of this study suggest that a training programme increases the knowledge as well as the sense of responsibility resulting in change in attitude and practices. However, to implement an effective and sustainable hospital waste management system: budget support, allocation of resources and technical guidance is required. Large volumes of workload bureaucratic culture and slow percolation of decisions delays the changes that are mandated.

Keywords: Biomedical waste, Hospital waste management, Knowledge, Attitude, Practice.

INTRODUCTION

“Nothing on earth is more international than disease”

Paul Russel

Health and disease have no political or geographical boundaries. In the early Greek, Roman, Egyptian civilizations, the temple of god was used as hospitals. So, hospital is a place of almighty, a place to serve the patient. These are complex institutions which were frequented by people from every walk of life in the society without any distinction between age, sex, race and religion1.

Growing urbanization has led to several changes in the healthcare sector. While on one hand, access to healthcare services are being provided to the community thereby resulting in the better health for all, improper management of hospital waste emanating from these healthcare establishments has also given rise to many environmental and health problems, thereby negating the benefits of the expanding health sector.

It is reported that for the first time the hospital waste management issue was discussed at a meeting convened by the World Health Organization regional office for Europe at Bergen, Norway in 1983. The seriousness of the issue was brought to limelight during the “beach wash- ups” of summer 1988. Investigation carried out by the Environment Protection Agency (EPA) of USA in this regard culminated in the passing of Medical Waste Tracking Act (MWTA), November 19882. With the passage of time the problem has evolved as a global humanitarian issue.

Until fairly recently, hospital waste management was not generally considered an issue. In 1980s and 1990s concerns about exposure to human immunodeficiency virus (HIV) and hepatitis B virus (HBV) led to questions about potential risks inherent in hospital waste3. Thus hospital waste generation has become a prime concern due to its multidimensional ramifications as a risk factor to the health of patients, hospital staff and extending beyond the boundaries of the hospital establishment to the general populations. The management of hospital waste is still in its infancy all over the world. Now hospital waste management is one of the trust areas which are drawing the attention of health authorities and the Government. There is a lot of confusion and problems among the generators, operators, decision-makers and the general community about the safe management.

Hospital waste management has been brought into focus in India recently, particularly with the notification of the biomedical waste management and handling rules. The ministry of environment and forests, government of India notified the bio-medical waste (management and handling) rules on 27 th July 19984 .These rules have been formed in exercise of the powers conferred by sections 6, 8 and 25 of environmental protection act 1986. The rule makes it mandatory for the health care establishment to segregate, disinfect and dispose their waste in eco friendly manner. Clearly, statutory safeguards for biomedical waste management practice in Indian hospitals have still not achieved the desired standards.

Since last few years there has been rapid mushrooming of dental health care set ups catering the needs of people and thereby there is definite increase in the quantity of waste generated. According to a WHO report, around 85% of the hospital wastes are actually non hazardous, 10% are infective (hence, hazardous), and the remaining 5% are non-infectious but hazardous (chemical, pharmaceutical and radioactive). Dental Hospitals generates waste similar to other health care set ups which includes a large component of general waste and a smaller proportion of hazardous waste.

Biomedical waste generated in dental hospitals include sharps, body tissues, chemicals –fixers , mercury, silver thiosulfate, lead foils, fresh mix of amalgam, scrap amalgam etc. and used dental materials. To ensure compliance with the law, these materials must be properly handled, recycled, treated and/or disposed. But more often, in dental hospitals the general wastes and biomedical wastes are allowed to mix thereby rendering the general waste also toxic and hazardous. Most dental hospitals are not actively involved in addressing this problem.

In spite of the fact that the biomedical waste is a great health hazard, the awareness and knowledge regarding biomedical waste handling and disposal is abysmally low and scientific literature search show significant gap in the knowledge, attitude and practice among the staff about hospital waste management 6. Also, the staffs are not trained in the proper waste management procedure which is the need of the hour. Recognizing this need we have to address these issues and provide training programme to impart training, knowledge dissemination, and provide an excellent platform for mooting innovative strategies to integrate “hospital waste management” as a corporate social responsibility, instead of mere social cost.

So, in this view, this study was the first of its kind to assess the knowledge, attitude and practice about hospital waste management and to impart training in proper hospital waste management procedure and to assess the effect of training among the staff of dental teaching hospitals in Bangalore city.

Let the wastes of “the sick” not contaminate the lives of “the healthy”.

Aim

To study the knowledge, attitude and practice about hospital waste management and to assess the effect of training among the staff of dental teaching hospitals in Bangalore city.

Objectives

1. To study the knowledge, attitude and practices towards hospital waste management among staff of dental teaching colleges in Bangalore city.
2. To provide training programme on hospital waste management for the staff of dental teaching colleges in Bangalore city.
3. To assess the effectiveness of hospital waste management training programme on knowledge, attitude and practices among staff of dental teaching hospitals in Bangalore city.

REVIEW OF LITERATURE

Literature search show very limited scientific literature on the knowledge, attitude and practice about hospital waste management among staff of dental teaching hospitals, and also there are no studies done to assess the effectiveness of the training programme on hospital waste management among the staff of dental teaching hospitals. Hence only the related knowledge, attitude and practice studies are considered here.

A national survey7 was conducted to investigate current procedures in New Zealand dental practices for disposal of clinical waste. A questionnaire was sent out to all dental practices in New Zealand. From three mailings 767 useable question­naires were returned (71.3%) of those sent out, 79.0%, of those potentially valid. Responses indicated that 56.4% of dental practices disposed of bloody swabs into the waste paper bin, and 24.4% disposed of contaminated sharp items into the general household refuse collection. Qualitative interviews with dental practi­tioners revealed a lack of concern about disposal of contaminated waste into the general waste. The existence of legislation governing waste disposal was not suffi­cient to motivate many practitioners to comply with guidelines. In some areas there was no specialized waste disposal service available, but some dentists had rejected a specialized service on the grounds of cost or inconvenience.

A study8 investigated the disposal of clinical waste within dental surgeries in Bangkok, Thailand. A questionnaire was sent to all dental practices in the Bangkok Metropolitan Area. The response rate was 57.7 per cent. Few dentists complied with all recommendations for the disposal of waste. Most waste was disposed of into the domestic rubbish stream.

A survey9 was undertaken among 64 dentists working in a teaching hospital of New Delhi. A pre-tested self-administered questionnaire was used to assess knowledge and practices of bio­medical waste management and infection control among these dentists. Questionnaire comprised question on disposal of infectious waste, legislation of biomedical waste management, usage of personal protective equipment and measures adopted to limit the spread of infection. The results showed that not all dentists were aware of the risks they were exposed to and only half of them observed infection control practices. In addition to this, majority of them were not aware of proper hospital waste management.

An investigation 10 at 37 randomly selected clinics in Ramallah and AI-Bireh cities: 31 private practices and 6 public/NGO clinics was done to know about disposal of dental waste. Dentists were interviewed regarding their disposal of different forms of dental waste. Disinfectants and X-ray processing solution were thrown down the drain. For sharps, 13.5% of dentists used puncture-resistant containers (only in the public/ NGO clinics), 45.9% discarded needles directly in the garbage after being recapped and 40.5% placed the used needles and blades in closed plastic bottles before throwing in the general garbage. Blood-soaked dressings and amalgam waste were also thrown in the garbage. While 10.75% of dentists were vaccinated against hepatitis B, 47% of the staff at private clinics were not.

A cross-sectional study11 of 432 private dental practitioners in Bangalore City using a self-administered questionnaire was done to assess the knowledge, attitude and behavior of private dental practitioners on health care waste management in Bangalore City. 64.3% do not segregate waste before disposal and 47.6% hand over health care waste to street garbage collectors; 42.1% felt that there was a lack of waste management agency services and 16.9% felt that a lack of knowledge were the main hurdles. Dentists need education regarding health care waste disposal methods to improve their knowledge. A large proportion of the dentists are not practicing proper methods of health care waste disposal. The existence of legislation governing healthcare waste disposal is not sufficient alone to motivate many practitioners to comply with guidelines.

There is limited relevant scientific literature available with respect to knowledge, attitude and practice about hospital waste management among the staff of dental teaching hospitals, and since dental settings are a part of health care set ups the related studies on health care set ups are considered for review.

A research12 project was conducted to compare waste management in five different European hospitals. The project examined disposal practices, applicable regulations, available infrastructure, and the organization of waste collection and disposal in the hospitals. Regulation and guidance documents relevant to waste management were collected and compared and analysis of waste was undertaken to obtain more detailed information about waste composition and waste segregation. Workshops were held to compare disposal practice in the different hospitals, the influence of legal stipulation and available local infrastructure. The study included basic consideration such as the health and safety of patients and personnel, handling, level of staff knowledge and available infrastructure.

A Survey13 was conducted in Pondicherry, Karaikal, Mahe and Yanam to determine the awareness about waste management policy and practices. Attitude related to the issue was also ascertained. Data was collected from all sections of employees in health care settings. To document the practices, photographs were also taken. Overall response rate was 82%. More than half (52%) of the respondents were not aware of the existence of a legislation and majority (72%) not aware of authorization. Vast majority (74%) did not use any color coding and only a very small percentage (15%) used the bio-hazard symbol. Maintaining a register and auditing virtually did not exist. Majority (80%) regarded this as an issue that needs to be tackled.

A study14 was conducted to know the management of bio-medical waste: awareness and practices in a district of Gujarat. With the objective of assessing the level of awareness about the various aspects of biomedical waste and disposal practices by the medical practitioners this study was conducted. It was a cross sectional study done in 30 hospitals which 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 HIV and Hepatitis B and C, whereas auxiliary staff 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 practice.

A study15 on Knowledge, Attitude and Practice (KAP) was carried out in a tertiary level teaching hospital. The KAP study enrolled 156 respondents, representing doctors and nurses from selected patient care areas. Here, a significant gap was observed in the knowledge, attitude and practice of the consultants, residents and scientists with regard to biomedical waste disposal, to their Knowledge/understanding on the subject. Nursing professionals on the other hand, had an edge over the clinicians as far as attitude and practice of biomedical waste management is concerned although their knowledge on the subject was relatively low. The paramedical staff including laboratory and housekeeping staff had least understanding on the subject, but had higher positive attitude with more practical habits, which may be attributed to strict instructions by authorities and fear for any punitive action.

A cross-sectional survey16 was conducted in eight teaching hospitals of Karachi to evaluate the current practices of segregation approaches, storage arrangements, and collection and disposal systems. The instrument of research was a self administered questionnaire, with four sections, relating to the general information of the institution, administrative information, information regarding Health Waste Management personnel and a check-list of Hospital Waste Management activities. Out of eight hospitals visited 2 (25%) were segregating sharps, pathological waste, chemical, infectious, pharmaceutical and pressurized containers at source. For handling potentially dangerous waste, two (25%) hospitals provided essential protective gears to its waste handlers. Only one (12.5%) hospital arranged training sessions for its waste handling staff regularly. Five (62.5%) hospitals had storage areas but mostly it was not protected from access of scavengers. No record of waste was generally maintained. Only two (25%) hospitals had well documented guidelines for waste management and a proper waste management team.

A cross sectional study17 was conducted in Hamidia hospital to assess the knowledge of the personnel (working staff including doctors, nurses, ward boys, and sweepers). Although the level of knowledge was more among doctors and nurses as compared to ward boys and sweepers. Almost all the respondents among doctors and nurses were aware that improper management of waste causes health hazards while 40-60% of ward boys and sweepers were aware about this fact. All respondents felt that closed containers should be used for collecting waste.

A survey18 was conducted to study the existing medical waste management (MWM) systems in Tanzanian hospitals during a nationwide health-care waste management-training programme conducted from 2003 to 2005. The aim of the programme was to enable health workers to establish MWM systems in their health facilities aimed at improving infection prevention and control and occupational health aspects. During the training sessions, a questionnaire was prepared and circulated to collect information on the MWM practices existing in hospitals in eight regions of the Tanzania. The analysis showed that increased population and poor MWM systems as well as expanded use of disposables were the main reasons for increased medical wastes in hospitals. Some hospitals were using untrained casual laborers in medical waste management and general cleanliness. The knowledge level in MWM issues was low among the health workers. It is concluded that hospital waste management in Tanzania was poor. There was need for proper training and management regarding awareness and practices of medical waste management to cover all carders of health workers.

The study19 pertains to the biomedical waste management practices at Balrampur Hospital. The study shows that infectious and non-infectious wastes are dumped together within the hospital premises, resulting in a mixing of the two, which are then disposed of with municipal waste at the dumping sites in the city. All types of wastes are collected in common bins placed outside the patients wards. The results of the study demonstrate the need for strict enforcement of legal provisions and a better environmental management system for the disposal of biomedical waste in the Balrampur Hospital, as well as other healthcare establishments in Lucknow.

A study20 was conducted to know the overview of biomedical waste management in selected Governorates in Egypt. Five hospitals and ten primary healthcare settings were surveyed using a modified survey questionnaire for waste management. This questionnaire was obtained from the World Health Organization (WHO), with the aim of assessing the processing systems for biomedical waste disposal. Researchers found that biomedical waste is inadequately processed in hospitals and primary healthcare settings due to the absence of written policies and protocols. Accordingly, healthcare staff, patients, the community and the environment may be negatively affected by exposure to the hazards of biomedical waste. The development of waste management policies, plans, and protocols are strongly recommended, in addition to establishing training programs on proper waste management for all healthcare workers.

A study21 done with the aim to assess the awareness about biomedical waste and its disposal practices at the SMHS Hospital of Kashmir, this study included 150 subjects including medical and paramedical staff. The awareness was significantly satisfactory among doctors and nurses whereas there is lack of knowledge and awareness among laboratory personnel and other members of the paramedical staff, which needs effective teaching and training to prevent adverse outcome on human health.

A study22 was conducted in Andhra Pradesh, Maharashtra and Uttar Pradesh in India. 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 segregation, use of colour coding, sharps management, access to common waste management facilities and disposal was collected. 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. Training gained momentum only after the dead-line for compliance was over. Segregation and use of colour codes revealed gaps, which need correction. 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. Surveillance, monitoring and penal machinery was found to be deficient and these require strengthening to improve compliance with the Bio-medical Waste Management Rules and to safeguard the health of employees, patients and communities.

This study23 investigated the medical waste management practices used by hospitals in northern Jordan. A comprehensive inspection survey was conducted for all 21 hospitals located in the study area. Field visits were conducted to provide information on the different medical waste management aspects. The results reported focused on the level of medical waste segregation, treatment and disposal options. The results also showed that segregation of various medical waste types in the hospitals has not been conducted properly. The study revealed the need for training and capacity building programs of all employees involved in the medical waste management.

MATERIALS AND METHODS

This study was conducted to assess the knowledge, attitude and practices towards hospital waste management among staff of dental teaching colleges in Bangalore city. To provide training programme on hospital waste management for the staff of dental teaching colleges in Bangalore city, and to assess the effectiveness of hospital waste management training programme on knowledge, attitude and practices among staff of dental teaching hospitals in Bangalore city.

OBTAINING APPROVAL FROM THE AUTHORITIES

ETHICAL COMMITTEE CLEARANCE

The ethical clearance was obtained from the ethical committee of The Oxford Dental College, Hospital and Research Centre prior to the start of the study

REQUIRED INFORMATION ABOUT THE STUDY AREAS

All the required and relevant information regarding dental colleges that were approved/ recognized by DCI was obtained from the website of the Dental Council of India. In the Bangalore City there are 16 dental colleges approved/ recognized by DCI serving the oral health care needs of the population at large.

SAMPLE SIZE:

Total number of the dental teaching hospitals approved by DCI present in Bangalore city was sixteen. For the purpose of conducting this study cluster sampling procedure was adopted. Fifty percent of the total sixteen dental teaching hospitals that is eight is selected using random selection considering the constraints of limited resources like manpower, finance, and administrative logistics. These eight colleges constituted the cluster for conducting the study. A total population comprising of 283 Dentist, 32 Auxillary, and 76 Attenders were available from these eight dental teaching hospitals in Bangalore city.

Inclusion criteria :

- Staff of dental teaching hospitals willing to participate (dentists, dental auxiliary, attender)

Exclusion criteria:

- Staff of dental teaching hospitals not willing to participate

- Office staff, drivers, staff directly or indirectly not involved in hospital waste generation.

PILOT STUDY

A pilot study was performed on the study population prior to the start of the study in one of the dental teaching hospitals in the month of November 2008. Expert opinion regarding the questionnaire was sought. The pilot study served as a preliminary study to identify any organizational problems, and to check the validity of questionnaire. To check the internal consistency of the questionnaire, the questionnaire was distributed to the dentists and dental auxiliaries and collected back by the investigator on two different days. The results thus obtained were subjected to statistical analysis. Cronbachs alpha value of 0.82 showed good internal consistency of the questionnaire. Similarly the questionnaire for attenders was also checked for internal consistency, which showed good internal consistency with Cronbachs alpha value of 0.84.

Results from this pilot study highlighted the need for minor revisions in the questionnaire. In the pilot study, some questions were unclear to participants; these were revised. The results of the pilot study were discussed with the Professor (Guide). Modifications were made wherever necessary and final study was planned and carried out.

SCHEDULE OF THE STUDY

The project was systematically scheduled to spread over a period of 6 months from April 2009 to September 2009. A detailed weekly and monthly schedule was prepared well in advance by informing and obtaining consent from authorities of respective dental teaching hospital. Even though a detailed schedule plan was prepared well in advance, few adjustments and changes had to be made while working it out practically.

IMPLEMENTING THE STUDY

BASE LINE DATA

Administrator was given a questionnaire to collect the information about hospital waste management, existing policy and practices in their respective dental teaching hospitals.

A specially prepared, and pre-tested structured questionnaire, was given to assess the knowledge, attitude and practices among the staff of dental teaching hospitals and collected personally.

For Dentist and Dental Auxilliary the questionnaire was in English consisting of a set of 30 questions which was further categorized in three sets with 10 questions each on knowledge, attitude and practice. And for Attenders the questionnaire was in Kannada consisting of a set of 15 questions which was further categorized in three sets with 5 questions each on knowledge, attitude and practice.

Questionnaire took less than 15 min to answer. All the answers were kept confidential and were not depicted against their identity.

In each institution the following elements were studied using checklist i.e segregation, colour coding, disinfection, containment, personal protective equipment, reporting of injuries, display of standard operating protocols, in house transport and disposal.

DETAILS OF THE INTERVENTION

One day training programme on the hospital waste management was organized at each dental college. Training was delivered by experts in the field of hospital waste management. Training was given in English to the Dentist and Dental Auxiliary and the local (Kannada) language for the Attenders. Learning media used was Audiovisual Aid- LCD projector.

The duration of training per each cadre was for one and half hour which was interactive, participatory and task focused. The focus of the training was on importance of need to manage the waste in hospitals, the various aspects of management like segregation, disinfection, colour coding, getting them to appreciate that mismanagement of hospital waste puts if not the community to risk at least their lesser privileged colleagues in the hospital, and clearly identifying each ones roles and responsibilities.

The training programme for Dentist and Dental Auxiliary was in three sessions, first session was on “Introduction to hospital waste management”, giving a brief insight about the sources, classification, health hazards and current scenario in regard to hospital waste management. The second session was on “Options available and best practices” for managing various dental wastes like mercury, lead foil, x-ray solution and others. The third session was on “Tips for development of action plan” which included biomedical waste management Rules, Steps for waste management, Health and safety principles of workers and post exposure prophylaxis .

The training programme for the Attenders was focused on need to manage the waste in hospitals, segregation and colour coding, personal protective equipment and post exposure prophylaxis.

The training module included slide presentations, manual on dental hospital waste management, and posters. The overall aim of training was to develop awareness of health, safety and environment issue relating to hospital waste and how these can affect employees in their daily work.

Though several attempts were made to involve each and every participant, still it was not possible to enroll all of them in the study. This was the limitation in the study. So, only the participants who attended training programme were given post intervention questionnaire and were considered for statistical analysis.

POST INTERVENTION DATA

Two months after initial training, the same baseline questionnaire was administered to the staff i.e. Dentist, Dental Auxillary and Attenders and monitoring of the waste management practices was documented using the same check list, used earlier.

EVALUATION OF THE INTERVENTION

Intervention was evaluated by assessing improvements in their knowledge, change in the attitude and practice scores after intervention in comparison to the base line scores. This comparison involved mean and percentage changes in their knowledge, attitude and practice on the hospital waste management. The questionnaire given For Dentist and Dental Auxilliary consisted of a set of 30 questions.

The questionnaire contained 10 questions regarding knowledge on hospital waste management. The correct answers were given a score of 1 and the wrong answers were given a score of 0. So, the knowledge score for an individual could range from a minimum of 0 to a maximum of 10. Also, there were 10 questions regarding attitude. The option strongly disagree were given a score of 1, disagree 2, don’t know 3, agree 4, strongly agree 5. So, the attitude score for an individual could range from a minimum of 1 to a maximum of 50. And for the negative questions, the scoring was done appropriately giving highest score for the right attitude. There were 10 questions regarding practice. One of the questions had 4 subsets of questions. The correct answers were given a score of 1 and the wrong answers were given a score of 0. So, the practice score for an individual could range from a minimum of 1 to a maximum of 13.

And for Attenders the questionnaire consisted of a set of 15 questions. The questionnaire contained 5 questions regarding knowledge on hospital waste management. And one of the questions had 3 subsets of questions. The correct answers were given a score of 1 and the wrong answers were given a score of 0. So, the knowledge score for an individual could range from a minimum of 0 to a maximum of 7. Also, there were 5 questions regarding attitude. The correct answers were given a score of 1 and the wrong answers were given a score of 0. So, the attitude score for an individual could range from a minimum of 0 to a maximum of 5. And there were 5 questions regarding practice. And one of the questions had 3 subsets of questions. The correct answers were given a score of 1 and the wrong answers were given a score of 0. So, the practice score for an individual could range from a minimum of 0 to a maximum of 7.

Evaluation was also done using the check list to document the existing practices.

STATISTICAL ANALYSIS 24, 25, 26

Descriptive statistical analysis has been carried out in the present study. The data so obtained from the study sample was compiled; systematized, tabulated and master table was prepared. SPSS version 15.0 (SPSS Pty Ltd, Chicago, IL, USA) was used for the statistical analyses. From the master table the required data were picked up for data presentation as tables. The data was subjected to statistical analysis wherever required using inferential statistical techniques

Results on continuous measurements are presented on Mean ± SD (Min-Max) and results on categorical measurements are presented in Number (%). Significance is assessed at 5 % level of significance. Student t test (two tailed, dependent) has been used to find the significance of study parameters on continuous scale with in each group. Paired proportion test has been used to find the significance of proportion before and after intervention. Cohen’s d Effect size is calculated to measure the strength of the relationship between two variables.

1. Cronbach’s Alpha: measure of the internal consistency reliability

illustration not visible in this excerpt

Where N = number of items

c = average inter-item covariance among the items

v = the average variance.

2. Student t-test for paired comparisons

Objective: To investigate the significance of the difference between single population means. No assumption is made about the population variances

Abbildung in dieser Leseprobe nicht enthalten

where Abbildung in dieser Leseprobe nicht enthaltenand di is the difference formed for each pair of observations

3. Significant figures

+ Suggestive significance (P value: 0.05<P<0.10)

* Moderately significant ( P value:0.01<P £ 0.05)

** Strongly significant (P value : P£0.01)

4. Cohen’s d Effect size:

illustration not visible in this excerpt

Where

illustration not visible in this excerpt

‘s’ is the pooled standard deviation and is calculated by the formula

illustration not visible in this excerpt

Less than 0.20 – No effect.

0.20– 0.50 – Small (S) effect

0.50 – 0.80 – Medium (M) effect

0.80 – 1.2 – Large (L) effect

More than 1.2 – Very large (VL) effect

Statistical software: The Statistical software namely SPSS 15.0, and Systat 11.0 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc .

RESULTS

An interventional study was conducted to assess the effectiveness of hospital waste management training programme on knowledge, attitude and practices among staff of dental teaching hospitals in Bangalore city. Study participants comprised of 259 Dentists, 26 auxiliaries and 69 attenders from eight dental teaching hospitals in Bangalore city.

Age and gender distribution of study participants (At base line)

Table 1: Age and Gender Distribution among Dentists

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Table 1 shows the age and gender distribution of the dentist participated in the study. Among the 126 male dentists, 25.4 %( n-32) were in the age group of 20-29 years, 57.1% (n-72) in 30-39 years, 10.3 %( n-13) in 40-49 years, 7.1 %( n-9) in 50-59 years respectively. The mean age of male dentist was 34.25±7.21. Among the133 female dentists, 35.3 %( n-47) were in the age group of 20-29 years, 52.6.1% (n-70) in 30-39 years, 10.5 %( n-14) in 40-49 years, 1.5 % (n-2) in 50-59 years respectively. The mean age of female dentist was 32.75±6.25. Among 259 total dentists, 30.5 %( n-79) were in the age group of 20-29 years, 54.8% (n-142) in 30-39 years, 10.4 %( n-27) in 40-49 years, 4.2 %( n-11) in 50-59 years respectively with the mean age of 33.48±6.76.

Table 2: Age and Gender Distribution among Auxiliaries

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Table 2 shows the age and gender distribution of the Auxiliaries participated in the study. Among 15 male Auxiliaries, 20.0 %( n-3) were in the age group of 20-29 years, 46.7% (n-7) in 30-39 years, 20 %( n-3) in 40-49 years, 13.3%(n-2) in 50-59 years respectively. The mean age of male Auxiliaries was 36.33±8.12. Among the 11 female Auxiliaries, 54.5 %( n-6) were in the age group of 20-29 years, 27.3% (n-3) in 30-39 years, 9.1 %( n-1) in 40-49 years, 9.1 %( n-1) in 50-59 years respectively. The mean age of female Auxiliaries, was 33.09±8.63. Among 26 total Auxiliaries, 34.6 %( n-9) were in the age group of 20-29 years, 38.5% (n-10) in 30-39 years, 15.4 %( n-4) in 40-49 years, 11.5 %( n-3) in 50-59 years respectively with the mean age of 34.96±8.33.

Table 3: Age and Gender Distribution among attenders

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Table 3 shows the age and gender distribution of the Attenders participated in the study. Among the 31 male Attenders, 19.4%( n-6) were in the age group of 20-29 years, 22.6% (n-7) in 30-39 years, 51.6 %( n-16) in 40-49 years, 6.5%( n-2) in 50-59 years respectively. The mean age of male Attenders, was 37.35±6.99. Among the 38 female Attenders 7.9 %( n-3) were in the age group of 20-29 years, 47.4% (n-18) in 30-39 years, 44.7 %( n-17) in 40-49 years respectively. The mean age of female Attenders was 36.89±6.72. Among a total of 69 Attenders, 13.0% ( n-9) were in the age group of 20-29 years, 36.2% (n-25) in 30-39 years, 47.8 %( n-33) in 40-49 years, 2.9%( n-2) in 50-59 years respectively with mean age of 37.08±6.79.

AT BASELINE

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Table 4: Assessment of knowledge among dentists regarding hospital waste management

A total of 259 dentists answered the questionnaire at baseline. With regards to the first question, 57.1% of them answered correctly that Segregation of waste into different categories should be done at the point of generation. 82.2% answered correctly that the purpose of “Disinfection before disposal” reduce the risk of transmission of infection, strengthen and support the overall standards of hospital hygiene and also prevents the spread of multidrug- resistant and other nosocomial pathogen. A total of 67.6% of dentist identified the biohazard symbol correctly. With respect to the question regarding technique which is not acceptable for the handling of sharp needles, 82.6% answered correctly that disposing needle in general trash bag was not acceptable. Question 5 assessed the participants’ knowledge regarding personal protective equipments for which 91.1% answered correctly that personal protective equipments prevents the transmission of infection from patient to dental health care personnel and from dental health care personnel to patient . A total of 78% knew that there could be risk posed to the workers by exposure of blood- borne viruses like Hepatitis-B (HBV), Hepatitis-C (HCV) Human immunodeficiency virus (HIV) with needle stick injury. When asked to identify the colour code for Infectious waste, yellow colour was correctly identified by 67.1% of dentists. 94.6 % of the dentists said that Hepatitis-B immunization for health care workers was compulsory and 93.8% responded correctly that post exposure prophylaxis should be initiated as soon as possible after possible HIV exposure in health care worker. 89.6 % knew that mercury and excess amalgam should be stored in water/ fixer solution.

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Table 5: Assessment of attitude among dentists regarding hospital waste management

33.5% strongly of dentists disagreed that segregation of waste at source increases the risk of injury to waste handlers. 53.7% of them strongly agreed decontamination / disinfection reduces chances of infection at baseline. 50.2% strongly agreed that Infectious waste should be put in yellow colored plastic bag. 27.4% strongly disagreed to the statement “Containment of sharps does not help in safe management of hospital waste”. A total of 69.9% of dentists strongly agreed that occupational safety of waste handlers is a must. 35.9% strongly disagreed that reporting of needle stick injury is an extra burden on work. 69.5% strongly agreed that the use of colour codes for segregation of waste is a must. 34.7% strongly agreed that Hepatitis-B immunization prevents transmission of hospital acquired infection and 71.4% strongly agreed to the statement “Post exposure prophylaxis should be initiated as soon as possible”. A total of 60.6% of dentists strongly agreed that excess mercury/ amalgam should be stored in water or fixer solution.

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