INTRODUCTION

“Children are the world's most valuable resource and its best hope for the future”
(John Fitzgerald Kennedy)

Waste is a change of form of a particular item from one shape to another. It is

useful to the first user but with its transformation after its use, some of the items may be
useful to subsequent users. If subsequent utilization is harmful, it should be removed with
such precautionary measure keeping it out of reach for others. But, the trouble with
throwaway society like ours is that there is no such place as ‘away’. What we think we
have is liable to come back to us .

Medical waste is responsible for serious health hazards. Though the persons
involved in scavenging and housekeeping are handling this aspect, the existing status of
biomedical waste management cannot be said satisfactory due to many shortcomings and
constraints. No specific guidelines and parameters are being followed or implemented by
the staff concerned. They are poorly educated and belong to low category workers,
operating without proper and adequate guidance and supervision .

A primary health centre is a service oriented residential establishment that

provides medical care facilities comprising of observational, diagnostic therapeutic
preventive and rehabilitative services for persons suffering from or susceptible to be
suffering from any kind of disease or injury. The basic concept of waste management in a
primary health centre does not differ from hospital, hotels, school and catering
establishment since the primary health centre renders the same type of basic services. But
some wastes generated in the PHC are too hazardous to be treated negligently and any
carelessness in the management of these wastes in a hospital tends to spread of infection
and contamination of the entire living environment prevailing in the PHC. The delay in
the recovery and overburden of weak patients and immune compromised patients
endanger the patient’s survival and also generate health hazards to the health personnel
and others working in and around the PHC .

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 Today nursing is considered as a professional discipline that includes the art of
applying scientific knowledge to the practice.

Primary health centers and hospitals generate a vast amount of medical wastes
each year. Surprisingly until recent times not enough attention has been paid to the
disposal of the bio medical waste generated. Poor disposal of waste is of paramount
importance because of its infectious and hazardous characteristics . In a study conducted
by WHO the distribution of hospital wastes in developing countries are 80% general
health care wastes, 15.5% pathological and infectious waste, 1% sharp waste and 3%
chemical and pharmaceutical wastes. These wastes may be hazardous as they may
significantly contribute to mortality or serious illness, or pose a substantial hazard to
human health and the environment if improperly managed or disposed. PHC and civic
bodies need to know the local codes and regulations regarding the management and
disposal of waste, for example discharge to the sewer, and discharge to the atmosphere via
incinerator exhausts and discharge on the land via disposal trucks .

Every day while caring for the patients health team members are at risk for
exposure to blood borne pathogens which results in infections such as HIV or hepatitis B.
The risk of infection with HIV/AIDS has stimulated a focus on health care workers health
and safety, and has galvanized efforts towards the prevention of occupational injury and
illness.

Hence when the PHC and the hospitals when addresses the safety of the
health team members they need to ensure or address the issues of awareness program,
morale and safety of work environment.

NEED FOR THE STUDY

Nurses and health team members as a professional is now accountable for its
competence and performance. This has seen the birth of the language “outcomes”.
Outcome is a mechanism to evaluate quality, improve effectiveness and link practices
to professional accountability.

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 Many of our PHCs have neither a satisfactory waste disposal system nor a
waste management and disposal policy. The disposal of waste is entrusted to junior
most staff from the housekeeping and class IV workers without any supervision. Even
pathological wastes are observed to be disposed off in the available open ground
around the PHC with scanty regards to aesthetic and hygienic considerations.

In a study pattern of waste in the Indian cities, the quantity of refuge varied
from 0.48 to 0.06 Kg/ capita / day. On an average the volume of total solid waste
generated in the Indian hospitals and the PHCs is estimated to range between 1 to5 Kg

Occupational safety and health hazards related issues have gained

considerable momentum in India after environmental protection acts. The wastes
generated ranges between 0.5-2.0 Kg per bed per day. It is estimated that annually
about 0.33 million tons of waste is generated in India. At many places authorities are
failing to install appropriate measures for variety of reasons. And one of these reasons
is lack of staff education programme .

Many PHCs and hospitals in various cities across India have glaring
deficiencies in the waste disposal. Indiscriminate waste disposal is ending up with
spreading of various diseases. The major causes cited by the health team members of
the PHCs are the lack of funds, improper staff training and education and non-
availability of space for the land-fill.
A survey conducted by the nongovernmental organization, Shristhi; (2006)
revealed that the rag pickers in Delhi often rummage through the biomedical wastes
and picked up relatively unsoiled bandage and used glucose bottles to sell them.

A WHO study on health care waste has estimated that, of the total waste
generated in the health care facilities, about 85% is non-infectious and 10% is
infectious, but non-hazardous. Based on these estimates the total health care wastes
generated as per 2007 data can be taken as the 555050 tons/annum and hazardous
wastes can be taken as 28250 tons/annum. A proper waste segregation scheme for
separating hospital waste into infectious and noninfectious categories is thus desired

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 Biomedical waste has been disposed of illegally into the garbage and into the
sewers in most of the parts of the world including India. In many places, much of the
biomedical waste particularly disposal syringes and needles are reused and recycled,
which increases the risk of HIV and hepatitis B & C to the handlers and users .

The onus of disposal is at generator site and health team members are highly
responsible for biomedical waste management. They play a leading role in managing
and supervising biomedical waste.

Health team members are the largest occupational group in any health care
agency. By virtue of their job responsibilities they are frequently exposed to the
biomedical waste. The health team members risk of exposure to health hazard and the
health team members as a cause of iatrogenic infections to the patients are equally
challenging issues to the health team members all over the world. If the health team
members are aware of the risks and proper management techniques they can
effectively handle the same challenge. Early recovery of patients and health of the
staff members on clean, healthy and safe surrounding atmosphere. Thus the researcher
felt it as a need to educate the health team members regarding biomedical waste
management as an effective strategy to improve the prevailing health care .

STATEMENT OF THE PROBLEM

A STUDY ON EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING BIOMEDICAL WASTE
MANAGEMENT AMONG HEALTH TEAM MEMBERS OF SELECTED PHC
AT CHANDRASEKHARPUR, BHUBANESWAR.

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OBJECTIVES

The objectives of the study are to

1. Determine the existing knowledge of health team members on biomedical

waste management using a structured knowledge questionnaire
2. Find the effectiveness of structured teaching programme in terms of gain in
knowledge scores of health team members.
3. Find the association between pre-test knowledge scores of health team
members on biomedical waste management with selected demographic
variables.

OPERATIONAL DEFINITIONS

 Effectiveness: refers to the usefulness of structured teaching programme on

biomedical waste as measured by a structured knowledge questionnaire.

 Bio medical waste management: refers to the waste generated during the
diagnosis, treatment or immunization of human beings which includes human
anatomical, animal waste, microbiology and biotechnology waste, sharp wastes,
discarded medicine and cytotoxic drugs, solid waste contaminated with blood and
body fluids, solid disposable waste, liquid waste, and chemical wastes
management from the point of generation to the disposal of waste.

 Structured teaching programme: refers to the information provided to the

health team members regarding biomedical waste management, which includes
waste generation, segregation, and categorization, waste handling and collection,
waste transportation, waste treatment and disposal.

 Health team members: refers to any member working in the health team in the
selected PHC , Chandrasekharpur, Bhubaneswar

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 HYPOTHESES

H: The mean post-test knowledge scores on biomedical waste management of

health team members who have undergone structured teaching programme will
be significantly higher than their mean pre test knowledge scores.

H2: There will be a significant association between the pre-test knowledge score of
health team members on biomedical waste management with selected
demographic variables

ASSUMPTIONS

The investigator assumes that :

1. Health team members working in the selected PHC have some knowledge regarding
bio medical waste management.
2. Health team members have potential to learn about bio medical waste management.
3. Knowledge on bio medical waste management is measurable.
4. Structured teaching programme is an effective way to improve the knowledge.

DELIMITATIONS

The study is delimited to

 Health Team members
 Working in the selected PHC at Chandrasekharpur

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CONCEPTUAL FRAMEWORK

The relationship between research and theory is undeniable. Research without

theory results in discreet information or data which does not add to the accumulated
knowledge of the discipline. Theory guides the research process, forms the research
questions, aids in design, analysis and interpretation. To effectively build knowledge
to research, process should be developed within some theoretical structure that
facilitates analysis and interpretation of findings.
A frame work is the conceptual underpinning of study. In a study based on
theory the framework is referred to as the theoretical framework; in a study that has
its roots in a specific conceptual model, the framework is often called the conceptual
framework. Conceptual framework refers to the interrelated concepts or abstractions
that are assembled together in some rational scheme by virtue of their relevance to a
common theme.
The aim of the present study is to evaluate the effectiveness of a structured
teaching programme on biomedical waste management among health team members
of selected PHC at Chandrasekharpur. The conceptual frame work selected for the
study was based on General system Theory by Bertanlanffy (1968). Researcher
believes that the structured teaching programme will enhance the knowledge about
biomedical waste among health team members.

Output
Output is the energy, material or information that is transferred to the
environment. Changes are the feature of the process that is observable and measurable
as output which should be different from that which is entered into the system i.e.,
input. In the present study output refers to as the evaluation of target group for change
in knowledge regarding biomedical waste management after administration of STP. In
the present study the questionnaire adopted to determine the knowledge of health
team members regarding biomedical waste management. The information thus
acquired could be a feedback to the system, which could help in the maintenance and
improvement of the system.

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SUMMARY

This chapter deals with introduction, Need of the study, objective, operational definition,
hypothesis, assumption, delimitation.

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