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Hubli-Dharwad Sustainable Healthcare Waste

Management Project

1

REPORT

KAP-SECOND (Knowledge, Attitude and Practices)

SUSTAINABLE HEALTHCARE WASTE MANAGEMENT PROJECT, HUBLI-DHARWAD

By

HEALTH CARE WITHOUT HARM AND TOXICS LINK

Hubli-Dharwad Sustainable Healthcare Waste Management Project GD Patil Building, 1st Main 4th Cross, behind Shri Krishna Kalyanmantap,

Phone: +91 836 6455 103, +91 98 8041 02222, email: [email protected]


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SECTION-I 1.0. Knowledge, Attitude and Practice (KAP-II)

1.1. Introduction:

The Hubli-Dharwad Sustainable Healthcare Waste Management Project was set out to

help the hospitals and clinics of the district improve their practices so that they can

reduce harm and save money. Health Care Without Harm and Toxics Link with the

support of Deshpande Foundation have been working with Hubli Dharwad Municipal

Corporation (HDMC) for last year. Since, the knowledge and attitude have a vital impact

on the behaviour of the people, all HDMC staff have been trained once and ongoing

training is conducted on a monthly basis to refresh knowledge and to introduce new staff

members to the subject. Training of trainers has commenced to create a pool of people

experienced in passing on their knowledge and give the HDMC to capability of

maintaining high standards of waste management in the long term. During the last year of

the project, two model wards (Chitaguppi and Old Bus Stand Hospitals) and two model

clinics (Ganesh Pet and Navanagar) have been set up to demonstrate best practice.

The aim of knowledge, attitude and practice (KAP) second was undertaken in early 2009

to review the existing health care waste management status in the project area after one

full year of intervention. The results of the study provide the key data, which shows

improvement in status of knowledge, attitude and practices on biomedical waste

management in the twin city, Hubli Dharwad.

Objectives:

1. Analyzing the overall bio medical waste management status Hubli Dharwad.

2. Assessing the knowledge, attitude and practice of the health care staff in Hubli-

Dharwad


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3. Impact assessment of the bio medical waste management inter4vention in Hubli

Dharwad

1.2. Sampling and Methodology

There are a total of 176 hospitals in Hubli-Dharwad, including 72 facilities that only deal

with outpatients. Under the KAP survey a total 13 health care facilities of the twin city,

Hubli-Dharwad were selected for the study. Of these 13 facilities, 8 facilities belonged

Hubli Dharwad Municipal Corporation (HDMC) wherein the sustainable healthcare

waste management Project was intervened and of the 8 HCMC facilities, the 4 HDMC

health care facilities have the good practice models (two model wards and two model

clinics). A total of 114 respondents were interviewed randomly from the 13 selected

facilities. Of the 114 respondents, 59 respondents belonged to facilities under HDMC

(project intervention sites) and 37 respondents were from the faculties with model wards.

The data was collected with the help of interview schedule prepared on the various

aspects of bio medical waste management. Apart from the interview, the data was also

collected through observation method. With the aim to assess the bio medical waste

management status in the Hubli-Dharwad and the impact of the project in the first year of

intervention, the data was purposefully analyzed at two levels i.e. overall bio medical

waste management status at all the health care facilities and the comparative assessment

of HDMC health care facilities (Project Intervention site) Non- HDMC health care

facilities. The data was analyzed by using SPSS package.

1.3. General Profile of the respondents and facilities:

1.3.1. Age of the respondents:

Of the total 114 respondents 15 per cent of the respondents were in the age group of 20-

30 years of age, 24 percent were in the age group of 31-40 years, 24 per cent were 41-50

years of age and 37 per cent were above 50 years.


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Fig 5: Age of Interviewee

15%

24%

37%

24%

20-30 years

31-40 years

41-50 years

Above 50 years

1.3.2 Gender: The fig. 4 shows that of 114 respondents 83 per cent were female and 17 percent were male.

Fig 4: Gender of Interviewee

17%

83% Male

Female


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1.3.3. Designation of the respondents: The figure 2 shows that of 114 respondents

seven per cent of the respondents were doctors, about 63 per cent were paramedic, about

6 per cent were student, about 33 per cent were auxiliary staff and one of the respondents

was a surgeon.

Fig 2: Designation of Interviewee

8

60

17

38

7

52.6

0.96.1

33.3

010203040506070

Doctor Paramedic HouseSurgeon

Student AuxiliaryStaff

F%

1.3.4. Educational qualification: The figure.3 shows that out of 114 respondents about

3 per cent of the respondents were post graduate, about 9 per cent of the respondents

were graduates, about 66 per cent were educated up to secondary level, about 17 per cent

were educated up to primary level and remaining about 16 per cent were illiterate.

Fig 3: Education qualification

310

64

19 18

2.68.8

56.1

16.7 15.8

0

10

20

30

40

50

60

70

Post Graduate Graduate Secondary Primary Illiterate

F%

1.3.5: Type of Facility of the respondents: Fig 1 shows that of 114 respondents about

21 per cent of the respondents belonged to medical college, about 21 per cent belonged to


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private hospital/nursing home, about 18 percent were from dispensary and about 40

percent of the respondents belonged to maternity health center.

Fig 1:Type of Facility interviewee belong to

24 24 20

46

21.1 21.1 17.5

40.4

0

20

40

60

80

100

Medical CollegeHospital

Private Hospital /Nursing Home

Dispensary Maternity healthcenter

F%

1.3.6. Number of beds in facilities: Fig 6 shows that 33 per cent of the respondents

belonged to more than 100 bedded health care facilities, 28 per cent belonged to 01-25

bedded facilities, 27 per cent respondents belonged to 26-50 bedded facilities and

remaining 12 per cent respondents belonged to 51-100 bedded health care facilities.

Fig 6: No of beds in Facilties

28%

27%12%

33%

01 – 25

26 – 50

51 – 100

More than 100


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1.4.0 FINDING AND ANALYSIS:

1.4.1. Knowledge about waste management policy: Of the total 114 respondents

about 76 per cent of the respondents were aware of the bio medical waste management

rules, about 25 percent knew the name of the rule, while only about 16 percent

respondents had the knowledge of the year of the rule passed and about 60 per cent of the

respondents responded positive about the waste management committee in the health care

facility. Though the knowledge about the name of the rules among the respondents has

increases after the initiation of the project in the area from 10 per cent to 25 per cent but

still needs to be improved.

Fig 7: Knowledge about waste management policy

76.3

25.415.8

60.5

23.7

76.4684.2

39.5

0

20

40

60

80

100

Awareness ofLegislation

Knowledge ofrule name

Knowledge ofrule year

Existence ofWMCinFacility

Yes %No %

1.4.2. Responsibility for the waste management: Figure 8 shows that majority of the

respondents felt that each staff member has crucial role to play in waste management and

felt that it is teamwork. The majority of the respondents felt that the waste management

should be responsibility of the all staff member such as head of hospital (94 %), head of

department (90%), nursing superintendent (98%), pharmacist (84%) and lab supervisor

(87%). While, before the inception of the project most of the respondents had the view

that head of the hospital and nursing supervisor were responsible for the waste

management. This indicates that the project has made considerable improvement on the

attitude towards the responsibility of the staff about waste management.


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Fig 8: Responsibilty about waste Management

89.598.2

84.2 86.8

2.6 5.3 1.087.9 53.5 5.3 0

7.9 8.8

93.9

0

20

40

60

80

100

Head o

f hos

pital

Depart

ment H

eads

Nursing

supe

rinten

dent

Pharm

acist

Lab S

uperv

isor

YES %

NO %

DK %

1.4.3. Knowledge about Centralized Treatment Facility (CTF): Figure 9 shows that

about 59 per cent of the respondents were found to be aware of the authorization of the

facility by state pollution control board for the treatment of bio medical waste by a

centralized facility. However, about 94 per cent of the respondents were aware of that

their waste was collected by the authorized centralized facility.

Fig. 9 : Knowledge about CTF

58.8

93.9

9 6.1

40.4

00

20

40

60

80

100

Authorizion by SPCB Waste Collection by authorizedfacility

YES %NO %DK %

1.4.4: Frequency of collection of waste: Figure 10 shows that majority of the

respondents (75 per cent) mentioned that collection of waste from their health care

facility by centralized facility takes place on daily basis. Eight per cent of the respondents


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mentioned that their facility getting the service of collection of waste by CTF on

alternative days and 10 per cent of them said waste collection service takes place weekly

(5 per cent) and irregular (5 per cent). However, the percentage of the respondents who

pointed out that the collection of waste is taking place in their health care facilities on

daily basis has increased from 64 per cent to 75 per cent, but still there is a scope of

improvement in the disposal of waste.

Fig 10: Frequency of waste colection by CTF

75%

8%

7%

5%

5%

Daily

On alternate days

Tw ice a w eek

Once a w eek

Irregularly

1.4.5: Availability of treatment and disposal options: The figure 11 reveals that of the

total respondents about 91 per cent of the respondents mentioned that their health care

facilities were having the facilities of ‘segregation of waste into coloured containers’ and

‘collection of waste by authorized waste disposal agents’, while about 66 per cent and 65

per cent of the respondents mentioned that their health care facilities having the facilities

of ‘chemical disinfection’ and ‘autoclaving’ respectively.


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Fig 11: Availabilty of treatment and disposal options

91.2

1.8

65.8

5.30.9

64.9

0

91.2

0

14.9

6.18.8

97.4

33.3

93.398.2

34.2

99.1

7.9

98.2

83.3

58.8

0 0.9 0.9 0.9 0.9 0.9 0.9 0.9 1.8 1.8

35.1

0

20

40

60

80

100

120

Segregat ionint o coloredcont ainers

Cont ainment Chemicaldisinf ect ions

Bur ial Deep bur ial Aut oclave Collect ion byrecyclers

Collect ion byaut hor ized

agent s

Burning Incinerat ion Ot her (pleasespecif y)

Yes %No %DK %

1.4.6: Usage of waste treatment and disposal facilities: Figure 12 shows that about 91

per cent pf the respondents mentioned that their health care facilities were utilizing the

facilities of ‘segregation of waste into coloured containers’ and ’collection of waste by

authorized waste disposal agents’, while about 66 per cent and 65 per cent of the

respondents mentioned that their health care facilities having the facilities of ‘chemical

disinfection’ and ‘autoclaving’ respectively. A small number of the respondents did not

know about the disposal. The above two figures i.e. 11 and 12 shows that if the treatment

& disposal facilities are available are being utilized them.


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Fig. 12: Usage of waste treatment and disposal facilties

91.2

0

65.8

0 0

64.9

0

91.2

0 00 1.8 05.3

0.9 0 0 0 0

14.98.8

98.2

34.2

94.799.1

35.1

100

8.8

100

83.3

0

20

40

60

80

100

Yes %

No %

NA %

1.4.7: Segregation of waste: The figure 13 shows that majority of the facilities i.e., 95

per cent of the health care facilities were found to be segregating their waste.

Fig 13: Practice about segregation

95%

5%

Yes

No


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4.8: Segregation responsibility: The figure 14 shows that majority of the respondents

mentioned that the nursing staff & auxiliary staff in their health care facilities do the

segregation of waste and 35 per cent said that it is done by the auxiliary staff only, while

only 5 per cent and one per cent respondents mentioned that the segregation is the

responsibility of the nursing assistant and doctors respectively. In fact, all staff who

produce waste should segregate it at source, to prevent contamination of recyclable waste

and possible harm if waste handlers are left to segregate waste later.

Fig 14: Who does segregation

1%3%

35%

56%

5%

Doctor

Nursing Assistant

Auxiliary staff

Nursing Assistant &Auxiliary staff both

NA

1.4.9: Knowledge about colour coding: The figure 15 shows that majority of the

respondents (85 per cent) were found to be aware about the usage of colour codes for the

disposal of the waste, while 15 per cent were not aware of the colour coding. After the

project intervention the knowledge of the respondents about the colour coding system had

slightly increased from 83 to 85 per cent but still there is a scope of improvement.

Fig 15: Knowledge about colour coding

85%

15%

YES %NO %


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1.4.10: Usage of colour coding: The figure 16 reveals that about 77 per cent and 83 per

cent of the respondents mentioned that their health care facilities were using the red and

blue colour bags/containers respectively for the disposal of waste, while about 66 and 58

per cent of the respondents said that their health care facilities were using the yellow and

black bags respectively. Whereas, about the usage of green bag for recyclables and white

bags only 43 per cent and 15per cent respondents in their health care facilities had

affirmative response.

Fig 16: Usage of Colour codes

77.282.5

14.9

65.857.9

43

22.817.5

85.1

34.242.1

57

0

20

40

60

80

100

Red BlueWhit

eYell

owBlac

k

Green/r

ecyc

ling

YES %NO %

1.4.11: Knowledge & practice about the colour-coded bags: The figure 17 shows that

about 65 per cent and 55 per cent of the respondents were found to be aware of the usage

of blue and red colour bags respectively, while about 44 percent and 43 per cent of the

respondents had the knowledge about the black and yellow bags respectively.

It was also observed that about 40 per cent of the facilities were found to be using the red

bag as well as blue bags correctly, while about 38 per cent and 26 per cent of the facilities

were using the black and yellow bags respectively in a correct way.

The findings reveal that there is a visible gap between the knowledge and practice about

the usage of colour coded bags. However, the knowledge level among the respondents


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about the colour-coded bags is comparatively better than that of the usage of the colour

coded bags in their health care facilities. It indicates that there is a need of emphasis on

the raising awareness among the staff members for the improved practice about the

colour-coded bags in their facilities.

Fig 17: Knowledge & practice about colour coding

43

55.3

64.9

43.9

26.3

40.4 40.4 37.7

0

20

40

60

80

100

Yellow bag Red bag Blue bag Back

Knowledge %Practice %

1.4.12: Labeling of bio hazards symbols: The figure 18 shows that only 33 per cent

respondent’s facilities were found to be having the labeling of bio hazards symbol on

infectious waste, while in remaining facilities, it needs to be initiated. Though the project

has improved the practice of labeling the biohazards symbols but still it needs the special

attention for further improvement.

Fig 18: labelling of bio hazards Symbol

33%

67%

YES %

NO %


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1.4.13: Availability of personal protective equipment (PPE): The figure 19 of the total

the availability of the personal protective equipments was not satisfactory. About 76 per

cent of the respondents mentioned that gloves are available in their health care facilities,

60 per cent said about mask, about 56 per cent had positive response about apron, 35 per

cent said boots, about 34 per cent said goggles and about 22 per cent responded that

trolley for bin are available in their facilities. The availability of the PPE in the health

care facility was not found to be satisfactory. It indicates that availability of the

equipments needs to be improved.

1.4.14: Availability of precautionary measures: The figure 20 shows that the level of

availability precautionary measures in the health care facilities was found to be very low

with respect to the ‘close lid containers’, ‘dedicated trolley for waste’, separate route

from that is used for clean, food materials and trolley for bins’.

Fig. 19 Availabilty of PPE

59.6

76.3

35.1

56.1

34.2

21.9

40.4

23.7

64.9

43.9

65.8

78.1

0

20

40

60

80

100

Mask Gloves Boots Apron Goggles Trolley forbins

YES %NO %


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Fig. 20: Availabilty of precautionary equipments

10.515.8

1.8

93

22.8

89.584.2

98.2

7

77.2

0

20

40

60

80

100

Close LidContainer

Dedicatedtrolley for

waste

Routeseparate fromthat used forclean, food

material

Timings Fixed(Note Timings)

Trolley for bins

YES %NO %

1.4.15: Availability of storage place: The figure 2 shows that of the total 114

respondents, 86 per cent mentioned that the dedicated storage points are available in their

facilities, while 14 per cent of the respondents did not have the dedicated storage point in

their health care facilities.

Fig 21: Avalabilty of decicated storage place

14%

86%

YES %

NO %

1.4.16: Availability of facilities for safe storage of waste: The figure 22 shows that 86

per cent of the respondents mentioned that basic facilities for usage storage of waste are

not available in their health care facilities. It indicates that there a need for the

improvement the facilities for the safe storage of waste.


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Fig. 22: Availability of facilities for safe storage of waste

12.3 14 14 147.9

1.8 0 0 06.1

86 86 86 86 86

0

20

40

60

80

100

Lock and key Location Accessible byvehicle.

Easilycleanable

Inaccessible toanimals and

pests

YES %NO %DK %

1.4.17: Duration of storage of waste in the facility: The figure 23 shows that 83 percent

of the respondents mentioned the duration of storage of waste is one day in their health

care facilities, 6 per cent said two days and 5 per cent said three days while, 5 per cent

respondents did not know about the duration of storage in the facilities.

Fig. 23: Duration of waste storage

83%

6%

5%6%

One dayTwo daysThree daysDo not know


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4.18: Waste collection from the facility: About 89 per cent of the respondents

mentioned that the waste is colleted separately and on a fixed timing in their facilities,

while about the different timing of waste collection from the patients visits about 99 per

cent respondents had negative response.

Fig.24: Waste collection practices

88.6 88.6

0.911.4 11.4

99.1

0

20

40

60

80

100

Waste collectedseparately

Fixed timing of wastecollection

Different timings frompatients visits

YES %NO %

1.4.19: Record maintenance and availability of mercury spill management kit: About

45 per cent of the respondents made affirmative response regarding the existence of

accident reporting system in their health care facility, about 33 per cent respondents

stated that bio hazards symbol on infectious waste is being practised and about 44 per

cent of the respondents responded positively regarding the maintenance of register for

waste disposal in their health care facilities. Only 31 per cent of the respondents

responded in affirmative about the availability of the mercury spill management kit. The

findings show that on all the items of maintenance system health care facilities is not

satisfactory. It indicates that there is a need of further improvement with respect to record

maintenance and the availability of the mercury spell management kit in the facilities.


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Fig. 25: Maintenance sysyten

44.7

32.543.9

31.6

55.3

67.556.1

68.4

0

20

40

60

80

100

Accident reportingsystem

Bio-HazardSymbol on

infectious waste

Register for wastedisposal

Mercury spillmanagement kit

YES %NO %

1.4.20: Bio medical waste disposal method: Figure that 94 per cent of the respondents

mentioned that the disposal of bio medical waste is collected by the authorized hospital

waste agents in their health care facilities, while the 6 per cent respondents mentioned

that it is done through some other methods.

Fig. 26: Bio medical waste disposal method

94%

6%

Collection byauthorized hospitalw aste agent

Other

1.4.21: Attitude about the waste management: The figure 27 shows that about 95 per

cent of the respondents had the positive attitude towards the waste management in terms

of that It an important issue, it is team work and it leads to protection of the workers.

While, about 28 per cent said it is the responsibility of government, 43 per cent said that

it increases the financial burden and about 33 per cent believed that it is an extra work for

the employees. The findings indicates that there is a need of special attention for further


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improvement in the attitude of the staff members especially on the items, namely, it is not

important, it is government’s responsibility, it increases the financial burden and it is an

extra work.

1.4.22: Educational and training programme in the facility: The figure 28.shows that

only about 54 per cent of the respondents could attend the educational or training

programme on waste management. About 92 per cent of the respondents of the

respondents said that there id no facility annual educational & training programme in

their health care faculties. While about all of the respondents were interested to receive

the trainings on the waste management issues.

fig.27: Attitude about waste management

4.4

28.9

97.4

4333.3

96.594.7

71.1

2.6

53.566.7

2.60.9 0 0 3.5 0 0.90

20

40

60

80

100

It is

not i

mporta

nt

Govt's

resp

onsib

ility

It is t

eamwork

Iincre

ases

finan

cial b

urden

An extr

a work

Lead

s to p

rotec

tion

Agree %Disagree %No Comment %


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Fig. 28: Education & training in the facility

54.4

7.9

98.2

45.6

92.1

1.80

20

40

60

80

100

Any training program Any annual education onwaste management

Interest to receivetrainings

YES %NO %

1.4.23: Change in bio medical waste management practice: About 77 per cent of the

respondents admitted that there is an improvement in the bio medical waste management

practice in their health care facilities. While, still 23 per cent of the respondents did not

feel any change in their health care facilities.

Fig. 29: Change in practice about bio medical waste management

77%

23%

YES %

NO %


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1.4.24: Information about bio medical waste management: The figure 30 shows that

59 per cent of the respondents received the information about the bio medical waste

management i.e. either through project training or project person. It indicates that the

project has contributed as major factor in the awareness raising about bio medical waste

amongst the respondents.

Fig. 30: Media of receiving information on bio medical waste

2.6

27.2

0.9 0

50.9

6.01

51.8

8.8

97.4

72.8

99.1 100

49.1

93.9

48.2

91.2

0

50

100

Newsp

aper

Collea

gue

Televis

ionRad

io

Projec

t Trai

ning

Other tr

aining

Projec

t Pers

on

Govern

ment p

rojec

t

YES %NO %


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SECTION-II

2.0. Impact of the project on the Bio Medical Waste Management Aspects

With the view to assess the impact of the health care waste management project the

knowledge, attitude an practice about the about the some of the aspects of bio medical

waste management were in the HDMC and Non HDMC health care facilities were

studied. The staff of the HDMC hospitals have been given training by the project over

one year. The comparative findings of HDMC and Non HDMC health care facilities

have been discussed in the next few pages of this section.

2.1. Knowledge about the waste management policy:

The figure reveals that more number of respondents belonging to HDMC health care

facilities was found to be having correct knowledge about the legislation than that of the

respondents belonging to Non HDMC health care faculties. It indicates that the health

care waste management project in the HDMC health care facilities has improved the

knowledge about the bio medical waste management rules.

Knowledge about rules

98.3

44.1

27.1

52.7

5.5 3.60

25

50

75

100

Awareness ofLegislation

Knowledge ofname of Legislation

Knowledge aboutAct year

HDMC

Non-HDMC


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2.2. Knowledge about CTF:

Knowledge abour CTF

91.5100

23.6

87.3

0

25

50

75

100

CTF authorized by SPCB Waste Collection byauthorized facility

HDMCNon-HDMC

The above figure shows that the knowledge level of the respondents of HDMC health

care facilities about the functioning and the authorization of CTF was found to be higher

than that of the respondents of Non HDMC health care facilities.

2.3. Frequency of collection of waste from the facility

Frequency of waste collection

66.1

1.713.6 10.2 8.5

83.6

14.5

0 0 1.80

25

50

75

100

Daily Alternatedays

Twice aweek

Once aweek

Irregularly

HDMCNon-HDMC


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The collection of waste form the health care facility by the CTF on daily basis was found

to be higher in the Non HDMC health care facilities. It means the waste collection

practice still needs to be improved in the HDMC health care facilities.

2.4. Practice about segregation of waste:

Segregation of waste

93.2 96.4

0

25

50

75

100

Waste segregation is happening

HDMC

Non-HDMC

Almost all HDMC and Non HDMC health care facilities are segregating waste. But the

next graphs show lesser knowledge of the colour codes according to the Rules and

availability and use of correct bags so the segregation will need improvement. In these

aspects, the HDMC hospitals are better.

2.5. Knowledge about colour codes

Knowledge of Colour Codes

91.5

78.2

0

25

50

75

100

Knowledge usage of colour coding

HDMCNon-HDMC


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The knowledge about the usage of colour coded bags also found to be higher in HDMC

health care facilities than that of the respondents belonging to the Non-HDMC health

care facilities.

2.6. Usage of colour coded bags:

Usage Colour codes

74.6 76.3

11.9

59.3 64.4 67.880

89.1

18.2

72.7

50.9

16.4

0

25

50

75

100

Red BlueW

hite

Yellow

Black

Green/r

ecyc

ling

HDMCNon-HDMC

The above figure shows that the majority of the health care facilities were using the

correct colour codes for storing the waste. However, the usage of white colour code was

not found satisfactory. It means that the usage of colour codes still needs to be improved.

2.7. Knowledge about use of colour coded bags:

Knowledge of storage of waste into colour coded bags

45.8

72.9 74.667.8

40 36.4

54.5

18.2

0

25

50

75

100

Yellow bag Red bag Blue bag Black

HDMCNon-HDMC

The knowledge about the storage of waste into the coloured bags of the respondents of

HDMC health care facilities were found to be having better than that of the respondents


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of Non HDMC health care facilities on all the four colour codes. It indicates that the

project has improved the knowledge significantly, but still needs to be improved.

2.8. Practice about the storage of waste into the right colour coded bags:

Practice of storage of waste into colour coded bags

44.1

62.7 62.7 62.7

7.316.4 16.4

10.9

0

25

50

75

100

Yellow bag Red bag Blue bag Black

HDMCNon-HDMC

The findings shows that the practice about the category wise storage of waste into the

correct coded bins in the HDMC health care facilities was found to better than that of the

respondents of Non HDMC health care facilities. It indicates the project has improved the

storage practice significantly in the HDMC health care facilities.

2.9. Practice about the labeling of infectious waste:

Labeling of infectious waste

62.7

00

25

50

75

100

Labeling of infectious waste

HDMCNon-HDMC


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28

The findings show that the majority of the health care facilities were observed to be

labeling the infectious waste, where none of the Non-HDMC facilities were labeling the

infectious waste. It means that the project intervention has significantly improved the

practice of labeling the infectious waste. But still the practice about the labeling of

infectious waste needs to be improved.

2.10. Availability of storage place in the facility:

Storage Place100

29.1

0

25

50

75

100

Availability of decicated w aste storage place

HDMC

Non-HDMC

The above figure shows that all of the HDMC health care facilities were found to be

having the storage place, whereas, only about 29 per cent of the Non-HDMC facilities

were found to be having storage place for the bio medical waste.

2.11. Duration of storage of waste

Duration of waste storage

86.4

3.48.5

1.7

81.8

7.30

10.9

0

25

50

75

100

One day Two days Three days Do not know

HDMCNon-HDMC


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The above findings shows that about 86 per cent of the HDMC health care facilities were

not found to be storing their waste more than one day, while about 82 percent of Non

HDMC health care facilities were observed having the waste storage time ‘not more than

one day’.

2.12. Practice about collection of waste:

Important practices in facility

74.661

72.961

12.71.8

12.70

0

25

50

75

100

Accidentreportingsystem

Labeling ofinfectious

waste

Maintenanceof register

Availability ofMercury spill

kit

HDMCNon-HDMC

The above figure shows that the majority of the HDMC health care facilities were

observed doing the right practices i.e., accident reporting system, labeling of infectious

waste, maintenance of register and availability of mercury spill management kit. It

indicates that the project in the HDMC health care facilities has made a visible

improvement regarding the above said practices.


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SECTION-III

COMPARATIVE ANALYSIS OF KAP-I AND KAP-II

(PRE AND POST INTERVENTION STATUS)

3.1. Introduction

With the view to evaluate the impact of the project in terms of their knowledge, attitude

and practice (KAP) about the health care waste management, the findings of KAP-I and

KAP-II were compared. The first KAP survey was carried out before the initiation of the

project as baseline survey to understand the ground situation i.e. the need and problem to

be emphasized during the intervention. The second KAP survey was done after the 18

months of the initiation of the project. The respondents were chosen randomly from the

various health care facilities in the city. To assess the impact of the sustainable health

care waste management intervention, the findings of KAP-I (pre intervention) and KAP-

II (post intervention) were compared.

3.2. Findings and Discussion:

The comparative findings of pre and post intervention status about the knowledge,

attitude and practices about the different aspects of the bio medical waste have been

discussed in the next few pages.

3.2.1. Awareness about bio medical waste Rules:


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31

Fig. 1. Awareness about BMW Rules

25

76

10

25

0

20

40

60

80

100

Pre Post

Know about legislationKnow the name of rules

Figure 1 shows that of the total respondents only 25 per cent were aware of existence of

any legislation for biomedical waste management in India and only 10 percent of the

health care staff knew the name of the rules. However, after the project intervention about

76 per cent of the respondents were found to be aware of the bio medical waste

management rules, about 25 percent knew the name of the rules. Though, the knowledge

about the name of the rules among the respondents has increased from 10 per cent to 25

per cent but still needs to be improved.

3.2.2. Authorization by SPCB:

Figure 2 shows that in the pre intervention phase, only 23 per cent of the respondents had

the knowledge of authorization required by the health care facility from the state

pollution control board. Whereas in the post intervention scenario 59 per cent of the

respondents were found to be aware of the authorization of the facility by state pollution

control board for the treatment of bio medical waste by a centralized facility.


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32

Fig 2. Authorization by SPCB

23

59

0

20

40

60

80

100

Pre Post

Authorization by SPCB

3.2.3: Knowledge about waste management committee:

Fig 3. Know waste mangement committee

20

61

0

20

40

60

80

100

Pre Post

Know WMC

Figure 3 shows that only 20 per cent of health care staff had knowledge of existence of

waste management committee in their facility whereas, after the intervention 61 per cent

of the respondents responded positive about the waste management committee in the

health care facility.

3.2.4: Responsibility of health care waste management:

Figure 4 reveals that most of the respondents felt that head of the hospital and nursing

supervisor play a significant role in waste management and thus they should be

responsible for it. Whereas, after the project, the attitudes towards the responsibility of

the health care waste management has positively changed. The majority of the


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33

respondents felt that each staff member has crucial role to play in waste management and

feel that it is teamwork. The majority of the respondents felt that the waste management

should be responsibility of the all staff member. This indicates that the project has made

considerable improvement on the attitude towards the responsibility of the staff about

waste management.

Fig 4. Responsibilty of health care waste management

55

94

35

89

65

98

8

84

20

86

0

20

40

60

80

100

Pre Post

Head of the hospital

Department head

Nursing Superintendent

Pharmacist

Lab Supervisor

3.3.5: Frequency about waste disposal:

Fig. 5. Waste disposal frequency

6475

1885 78 55 5

0

20

40

60

80

100

Pre Post

DailyAlternate dayTwice a dayOnce a weekIrregular

Figure 5 shows that the majority of the respondents mentioned that waste disposal from

their health care facility takes place on daily basis (64 percent). Nearly 18 percent of

them said that their facilities dispose health care waste on alternative days. While after

the project the majority of the respondents (75 per cent) mentioned that collection of


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34

waste from their health care facility by centralized facility takes place on daily basis.

However, the number of the respondents mentioned that the collection of waste is taking

place in their health care facilities on daily basis has increased from 64 per cent to 75 per

cent but still there is a scope of improvement in the disposal of waste.

3.3.6: Treatment and disposal option utilized:

Fig. 6. Treatment & dispopsal option utilised

73

91

43

6678

91

0

20

40

60

80

100

Pre Post

Coloured containers

Chemical disinfectant

Collection by authorizedagents

Figure 6: shows that the project has increased the usage of all three treatment and

disposal options, namely ‘segregation of waste into coloured containers’ and ‘collection

of waste by authorized waste disposal agents’, ‘chemical disinfection’ and ‘collection by

authorized facility’.

3.3.7: Responsibility of segregation of waste:

Figure 7 shows that most of the respondents believed that the segregation of waste is the

main responsibility of nursing staff and auxiliary staff. However, after the intervention,

the majority of the respondents mentioned that the nursing staff & auxiliary staff in their

health care facilities do the segregation of waste and 35 per cent said that it is the

responsibility of the auxiliary staff only. It indicates the attitude of the respondents has

changed positively after the intervention


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Fig 7. Segregation responsibilty

55

2.6

68

35

0

56

0

20

40

60

80

100

Pre Post

Nursing assistant

Auxiliary staff

Both

3.3.8: Knowledge about colour codes:

Fig 8. Know colour codes

83 85

0

20

40

60

80

100

Pre Post

Knowledge of colourcodes

Figure 8 reveals that after the project the percentage of the respondents with the

knowledge about the colour coding system has also increased from 83 to 85 per cent that

can be further focused upon.

3.3.9: Knowledge about the colour coded bags:

Figure 9 shows that shows the project has positively affected the availability and usage of

colour coded bags. It indicates that the lack of proper practice of colour code scheme in

the facilities in the pre intervention phase. However, in the post intervention survey the


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majority of the respondents motioned that the different colour codes are being used for

the bio medical waste management

Fig 9. Availabilty of colour coded bags

75 77

50

83

7.5

85

45

86

38

58

0

20

40

60

80

100

Pre Post

RedBlueWhiteYellowBlack

3.3.10: Bio hazards symbols:

Figure 10 shows that only 25% of respondents knew about the bio-hazard symbol, which

is mandatory to be used as label under health care waste management. The knowledge

about the bio hazards symbols among the respondents has increased from 25 to 33 per

cent but still needs special attention.

Fig 10. Know biohazards Symbol

2533

0

20

40

60

80

100

Pre Post

Know biohazardsSymbol


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3.3.11: Maintenance of register:

Fig 11. Know about waste register

18

43

0

20

40

60

80

100

Pre Post

Know about w asteregister

Figure 11 shows that only 18 per cent of the respondents knew about the maintenance of

register for waste management before the project intervention and in the post intervention

scenario, 43 per cent of the respondents were found to be aware of the maintenance of

waste register. However, the number of the respondents having knowledge about the

register has increases but there is further need to be improved upon.

3.3.12: Attitude towards waste management:

Fig 12. Attitude towards waste management

33

4

33 29

100 97

60

4330 33

0

20

40

60

80

100

Pre Post

Not an important

Governmentresponsibility

Team w ork

Financial burden

Extra w ork

Figure 12 shows that the pre intervention scenario shows that 33 % respondents thought

that waste was not an important thing and that it was the responsibility of the government

and 30 per cent respondents disagreed that it was extra work. While, in the post

intervention status, only 4 per cent of the respondents believed that it was not an


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important and 97 per cent said that it is teamwork. It indicates that the project has

changed the attitude positively about the health care waste management

3.3.13: Information exposure through training:

Fig 13. Training attended

35

54

0

20

40

60

80

100

Pre Post

Training attended

Figure 13 shows that only 35 per cent of respondents could attend some medical waste

training before the project intervention. While, during the intervention the 54 per cent of

the respondents mentioned that they have attended the educational or training programme

on waste management. The project has only trained staff at HDMC hospitals, but still

this KAP survey shows real improvements in knowledge attitudes and practices.

In the future training will be expanded and future surveys will be conducted to show

more improvements.

kap-second (knowledge, attitude and practices) sustainable ... · sustainable healthcare waste...

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