“A Study to Assess the Knowledge, Attitude and Practices of

Nurses Regarding ‘Bio Medical Waste Management’

In Selected Hospitals of Raichur”

by

N. MATHAR MOHIDEEN

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences
Bangalore, Karnataka

In Partial fulfillment
of the requirement for the degree of
Master of Science in Nursing

in

Medical Surgical Nursing

Under the guidance of

Dr. K.P. Neeraja
Professor and Head of the Department

Department of Medical Surgical Nursing

Navodaya College of Nursing, Raichur

May, 2005

i
 CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A Study to Assess

the Knowledge, Attitude and Practices of Nurses Regarding Bio

Medical Waste Management in Selected Hospitals of Raichur” is a

bonafide research work done by [Link] Mohideen in partial

fulfillment of the requirement for the degree of Master of Science in

Nursing.

Signature of the Guide

Date: [Link]
Place: Raichur [Link], [Link](N), M.A (Socio), Ph.D,

Professor, Head of Department

Navodaya College of Nursing,
Raichur.

ii
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF
THE INSTITUTION

This is to certify that the dissertation entitled “A Study to Assess

the Knowledge, Attitude and Practices of Nurses Regarding Bio-

Medical Waste Management in Selected Hospitals of Raichur” is a

bonafide research work done by [Link] Mohideen under the

guidance of Dr. [Link], [Link], [Link](N),M.A (Socio), Ph.D.,

Professor and Head of Medical Surgical Nursing Department,

Navodaya College of Nursing, Raichur.

Signature of the HOD Signature of the Principal

Dr. K.P. Neeraja Dr. R. Vasundhara

[Link], [Link](N),M.A (Socio), Ph.D, R.N;R.M;R.P.H.N.M.N.
Professor [Link](Psy),P.G.D.,H.E;Ph.D
Head of Medical Surgical Nursing Principal
Department Navodaya College of Nursing Raichur.
Navodaya College of Nursing,
Raichur.

Date: Date:
Place: Raichur Place: Raichur

iii
Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled “A Study to

Assess the Knowledge, Attitude and Practices of Nurses Regarding

Bio Medical Waste Management in Selected Hospitals of Raichur” is

a bonafide and genuine research work carried out by me under the

guidance of Dr. [Link], [Link], [Link](N), M.A (Socio), Ph.D.,

Professor, Navodaya College of Nursing, Raichur.

Date: Signature of the Candidate

Place: Raichur [Link] MOHIDEEN

iv
 COPY RIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of heath

Sciences, Karnataka shall have rights to preserve, use and disseminate

this dissertation/thesis in print or electronic format for academic/research

purpose.

Date: Signature of the candidate

Place: Raichur ([Link] Mohideen)

© RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE; KARNATAKA

v
 ACKNOWLEDGEMENT

“Praise the Lord o my soul!

I will praise the Lord as long as I live”.
“The expression of gratitude is a reflection of one thoughts”.

First of all, I would like to offer a deepest sense of everlasting

gratitude to God Almighty who has given strength and wisdom to make
this thesis a reality.

I wish to acknowledge my heartfelt gratitude to my research guide

[Link], [Link], [Link](N),M.A (Socio) Ph.D., Professor of
Medical and Surgical Nursing, Navodaya College of Nursing, Raichur.
Who taught me to reach out of the stars, to dream and to achieve what I
aspire for and her innovative and inspiring ideas, patience corrections,
valuable guidance and constructive criticism which all have gone into
making of this thesis interesting and worth while.

I express my deep gratitude to Dr. R. Vasundhara R.N; R.M;

R.P.H.N., M.N., [Link](Psy), P.G.D.,H.E;Ph.D., Principal, Navodaya
College of Nursing, Raichur for her valuable suggestions, timely support
and constant moral support, which contributed to enrich the strength.

I would like to extend my sincere thanks to all experts who

contributed their time and efforts towards the validation of the tool.

I extend my special thanks to [Link] Gulnaz, Lecturer,

Navodaya College of Nursing, Raichur for her excellent co-operation,
support in getting permission in civil hospital for the conduction of
study.

vi
 I wish to thank [Link], Lecturer, Navodaya College of
Nursing, Raichur and [Link], Lecturer, Navodaya College of
Nursing, Raichur for their support and co-operation.

I wish to express my gratitude to Mr. Porchelean, Biostatistician,

Ramachandra Medical College, Chennai, for his co-operation in statistical
analysis.

I convey my special thanks to the Medical Superintendents and

Nursing Superintendents for giving me permission to conduct study in
their hospital and I extend my deep gratitude to the nurses for their active
participation in the study.

I am greatly indebted to my parents, Mr. [Link] Thangam,

Mrs. Jaffer Nisha and my Chacha [Link] who stood side to
me at all times of need and helped me in various ways in achievement of
my goal and made me to reach higher stars of the sky and my dreams
come to true.

I express my heartfelt thanks to my brothers [Link] Kani and

Mr. Mohammed Farook for their prayers and encouragement.

I express my special thanks to my friends Mr. Umapathi and

Mr. Syed Ali for their constant encouragement.

I do take this privilege to thank Mr. Moin Proprietor of Comtech

Computer centre and staffs Miss. Banu and Miss. Ramanjunamma for
their co-operation and support in typing final thesis.

vii
 No research dissertation can be completed without unrelenting
support of all those good hearted people who have helped me tirelessly to
make this thesis work possible one. The heart is full and the words are
few to express my sincere gratitude towards those helping hands, may
God bless them.

Date: Signature of the candidate

Place: (Mr. N. Mathar Mohideen)

viii
 LIST OF ABBREVIATIONS USED

CPCB - Central Pollution Control Board.

BMWM - Bio Medical Waste Management

HCW - Health Care Waste

[Link]. (N) - Bachelor of Science in Nursing

GNM - General Nursing and Midwifery

ICU - Intensive Care Unit

OPD - Out Patient Department

OT - Operation Theatre.

Key words in likert scale

SA - Strongly Agree

A - Agree

U - Undecided

D - Disagree

SD - Strongly Disagree

ix
 TABLE OF CONTENTS

[Link] CHAPTERS PAGE NO

I INTRODUCTION
ƒ Background of the Study 1
ƒ Significance of the Problem 7
ƒ Statement of the Problem 12
ƒ Objectives of the Study 12
ƒ Operational Definitions 12
ƒ Variables 13
ƒ Assumptions 16
ƒ Delimitations 16
ƒ Hypotheses 17
ƒ Conceptual Frame Work 18
ƒ Organization of the Report 22

II REVIEW OF LITERATURE
• Studies related to knowledge regarding 24
BMWM.
• Studies related to practices regarding 26
BMWM
• Studies related to attitude regarding 33
BMWM

III METHODOLOGY
ƒ Research Approach 35
ƒ Research Design 36

x
 ƒ Setting of the Study 38
ƒ Population 40
ƒ Sampling technique 40
ƒ Criteria for the selection of the sample 41
ƒ Sample Size 41
ƒ Limitations 41
ƒ Method of Data Collection 42
ƒ Development of the Tool 42
ƒ Description of the tool 43
ƒ Ethical Consideration 45
ƒ Validity 45
ƒ Pilot Study 46
ƒ Reliability 46
ƒ Data Collection Procedure 47
ƒ Plan for Data Analysis 48

IV RESULTS 50

V DISCUSSION 109

VI SUMMARY 114

VII CONCLUSION 121

VIII IMPLICATIONS AND 123

RECOMMENDATIONS

IX INFORMATION MODULE 127

ABSTRACT 164

BIBLIOGRAPHY 168

ANNEXURES 173

xi
 LIST OF TABLES

SL. PAGE
TABLES
NO NO
1. Percentage distribution of Nurses by their age and sex. 51

2. Percentage distribution of Nurses by their professional 55

background.

3. Percentage distribution of Nurses by their working background 61

4. Percentage distribution of Nurses with their working facilities. 64

5. Percentage distribution of Nurses based on their knowledge on 66

BMWM.

6. Percentage distribution of Nurses based on their knowledge 67

regarding definition and classification of biomedical waste.

7. Percentage distribution of Nurses based on their knowledge 68

regarding waste segregation.

8. Percentage distribution of Nurses based on storage and 70

transportation of waste.

9. Percentage distribution of Nurses based on their knowledge 71

about treatment facilities in biomedical waste management.

10. Percentage distribution of Nurses based on their knowledge 73

regarding administrative aspects of biomedical waste

management.

xii
11. Percentage distribution of Nurses based on their attitude on 74

BMWM.

12. Percentage distribution of Nurses based on their attitude 75

towards biomedical waste management related to positive

items.

13. Percentage distribution of Nurses based on their attitude 77

towards biomedical waste management related to negative

items.

14. Percentage distribution of Nurses based on their practice on 79

BMWM.

15. Percentage distribution of Nurses based on their practices 80

regarding identification and segregation of waste.

16. Percentage distribution of Nurses based on their practices 82

regarding protective measures, monitoring and maintenance

role.

17. Association between the Knowledge of Nurses regarding 83

BMWM with their Age.

xiii
18. Association between the Knowledge of Nurses regarding 85

BMWM with their Sex.

19. Association between the Knowledge of Nurses regarding 86

BMWM with their Professional background.

20. Association between the Knowledge of Nurses regarding 89

BMWM with their Working background.

21. Association between the Attitude of Nurses regarding BMWM 91

with their Age.

22. Association between the Attitude of Nurses regarding BMWM 93

with their sex.

23. Association between the Attitude of Nurses regarding BMWM 94

with their Professional background.

24. Association between the Attitude of Nurses regarding BMWM 97

with their Working background.

25. Association between the Practices of Nurses regarding BMWM 99

with their Age.

26. Association between the Practices of Nurses regarding BMWM 100

with their Sex.

27. Association between the Practices of Nurses regarding BMWM 101

with their Professional background.

xiv
28. Association between the Practices of Nurses regarding BMWM 104

with their Working background.

29. Association between the Knowledge, Attitude and Practices on 106

BMWM and available facilities in the Hospitals.

30. Correlation between the Nurses Knowledge, Attitude and 107

Practices on BMWM.

xv
 LIST OF FIGURES

SL. PAGE
FIGURES
NO NO
1 Conceptual Frame Work based on General System 21
Theory.
2(a) Schematic Diagram for the Research Design of the 37
Study.
2(b) Map showing area under the study 39
3 Percentage distribution of Nurses by their Age. 53
4 Percentage distribution of Nurses by their Sex. 54
5 Percentage distribution of Nurses by their 57
Professional Qualification.
6 Percentage distribution of Nurses by their 58
Designation.
7 Percentage distribution of Nurses by their 59
Experience.
8 Percentage distribution of Nurses by their Previous 60
Orientation Training on BMWM.
9 Percentage distribution of Nurses with their 62
Working Background (Type of Hospital).
10 Percentage distribution of Nurses with their 63
Working Background (Working Area).
11 Percentage distribution of Nurses with their 65
available facilities Related to BMWM.

xvi
 LIST OF ANNEXURES

Sl. ANNEXURES PAGE

No NO

I Letter Requesting for Conducting the Main Study 173

II Letter to Experts for Content Validity 174

III Content Validity Certificate 175

IV List of Experts consulted 176

V Consent Letter from the participants 179

VI • Structured Interview Schedule to assess the 180

Knowledge, Attitude regarding BMWM

VII • Observation Check List to assess the 191

practices regarding BMWM

VII Scoring Key 193

xvii
 1. INTRODUCTION

Background of the study:

“Life goal is to achieve high standards, High standards can be

achieved from good health, Good health can be achieved
from safest living, Safest living can be achieved
from cleanliness and avoiding hazards.”

“CLEANLINESS IS NEXT TO GODLINESS”

The essence of cleanliness was aptly captured by the Dravidians,

who in 5000 BC gave due emphasis to town planning, safe and effective
sewage systems which got all solid and liquid wastes generated by the
population. They were indeed the pioneer’s as far as scientific waste
management is considered, which is borne out from the excavations of
mohanje-Daro and Harappa. As a matter of fact all Ancient Civilizations
insisted specifically for care of cleanliness and hygiene, so as to remain
free from diseases.1

The twentieth century witnessed, rapid mushrooming of hospitals

in the public and private sector dictated the needs of expanding
population and the advent and acceptance of “disposables” has made the
generation of hospital waste as significant factor in today’s hospitals.

1
 Over the year’s, a metamorphic change has occurred in the role of
hospitals from that of housing, the terminally ill patients of
communicable diseases, to that of a social institute providing preventive,
promotive and curative care and also a centre of Education, Research and
Training.2

Hospitals and other health care institutions generate ‘waste’ day in

and day out which may be potential health hazard to the health worker’s,
the general public and the flora and fauna of that area. The adequate
management of waste assumes tremendous importance in a country like
India, whose economy forces the poverty stricken and the ignorant “rag
picker’s” to sift and sort through dumped waste material in order to eke
out of living2.

Time and again the audio visual and print media has highlighted
the desperation and pathetic conditions of these people, but the apathy of
the powers that have managed to give this problem less importance than
what it deserves. So that unscrupulous elements have moved in and
unorganized sectors. A number of documentaries have been made and
reports compiled regarding improper waste management in the majority
of health care institutions2.

The WHO regional office for Europe convened a “working group”

on hospital waste management in collaboration with Norwegian
Government, at Bergen from 28th June to 1st July, 1983, which was the
first time where medical specialist’s, hospital engineers, hospital
administrators from nineteen European countries were participated. The
purpose of the meeting was to review recent developments in the
handling, transport, treatment and disposal of waste from health care

2
establishments and to prepare guidelines for a code of practice to be used
by administrators, engineers and others in industrialized countries3.

In South-East Asian region, Hospital Waste Management has now

become a serious concern, largely due to reports in the print and
audiovisual media which brought into limelight the plight of rag pickers
who rummage through the waste and segregate materials which are sent
for recycling4.

To bring out the issue of Hospital Waste Management to the

attention of the decision makers, the environment Health Unit of South
East Asia Regional Office (SEARO) carried out a questionnaire survey
during June-September 1994 to assess the status of Hospital Waste
Management in the countries and to identify the area which needs
improvement.4

The issue of improper Hospital Waste Management in India was

first highlighted in a petition filed by Dr. B.L. Wadhera in 1996 against
the Union of India in the Honorable supreme court hearing the afore
mentioned case in connection with safe disposal of hospital wastes
ordered that,

• All hospitals with 50 beds and above should install incinerators or

any other effective alternate method under their own administrative
control before 30th November, 1996.
• The incinerators or alternative methods should be filled with
necessary pollution control mechanism, approved by and
confirming to the standards laid down by central pollution control
board.

3
 • The CPCB and Delhi pollution committee should regularly send its
inspection teams in different areas to ascertain that the collection,
transportation and disposal of garbage, waste is carried out
satisfactorily and file reports accordingly5.

Pursuant to the directives of the Honourable Supreme Court, the

Ministry Of Environment and Forests, Government of India issued certain
draft rules called Biomedical waste management and handling rules,
1995.

In a workshop held in, may 1997, most of the representatives of

various hospitals failed to appreciate their responsibility to implement the
steps of management. It was noted that for most of the health facilities,
waste management is a non-existent problem, with no one responsible for
the same and “buck passing” is the commonest excuse advanced by
them6.

The notification served by the Ministry Of Environment and

Forests, Government of India on 27th July, 1998 called as “Bio-medical
waste management and handling rules”. These rules have been made by
the central government, in exercise of the power conferred by sections 6,
8 and 25 of the environment (protection) act, 1986. Any violations to
these rules are punishable by 5 years rigorous imprisonment or a fine of
rupees five thousand. The main rules are only described pertaining to
segregation, collection and transportation.

4
Rule 6(i):
“Every hospital, nursing home, clinic by whatever name called
generating medical wastes, shall install an incinerator or other facility in
the premises or shall set up a common facility in accordance with the
directions given by the appropriate authority within a period of nine
months from the date of commencement of these rules.

Rule 12:
Responsibility of generators and operators bio medical waste
facility.

Rule 12(I):
“A generator or operator of biomedical waste facility shall take all
measures as the central government may, with a view to preventing
damage or adverse effect to the environment and life sustained in it and
notify in the official gazette from time to time in this behalf”.

Rule 12(2):
“A generator or operator of a biomedical waste facility shall house
in the month of January every year a detailed information about the types
and quantities of bio medical waste collected or handled by them during
the preceding year to the appropriate authority”.

Rule 13 deals with:

Related to Segregation, packing and transportation.

Rule 13(1):
“An authorized person handling any biomedical waste shall
segregate all categories of such wastes prior to its storage, transportation,
treatment and disposal”.

5
Rule 13(2):
“All segregated wastes shall be subjected to specific treatment and
disposal methods.”

Rule 14:
Related to Treatment and disposal

Rule 14(i):
“All biomedical wastes shall be treated and disposed off strictly in
accordance with proper treatment options.

Rule 14(2):
“All wastes which are required to be destroyed by incineration or
any other treatment, disposal and duly approved by the appropriate
authority shall be treated and disposed off only in a facility authorized
under these rules”.

Rule 14(3):
“All wastes which are not incinerable shall be pretreated and shall
be disposed off in an environmentally sound manner by authorized person
in such sites identified by the appropriate authority for this purpose”.

Rule 14(4):
“All waste from handling of living or non living pathogens and
genetically engineered organism or products shall be treated and disposed
off by such methods as the central government may notify in the official
gazette”.

6
Rule 14(5):
“No person shall dump, discharge, dispose or cause to be dumped,
buried, discharged or disposed any waste in any place other than a site
identified for the said purpose by the appropriate authority”.

Rule 14(10):
“Every hospital, nursing home, clinic, laboratory, by whatever
name called, generating biomedical wastes shall not dispose off such
wastes on open land, municipal dustbin and let the untreated liquid into
the sewers.

Rule 14(11):
“No person shall recycle or reuse or cause to be recycled or reused
any such waste except glassware, provided that such glassware are
disinfected and reused for in house purpose only”. 7

Significance of the Problem

“Health care waste management concerns us all, let’s work
together for a healthy environment”
Bio medical waste is any waste, which is generated during
diagnosis, treatment or immunization of human beings or animals.8

Healthcare waste is generally defined as, “all waste generated by

healthcare facilities, such as hospitals, clinics, laboratories and also
includes waste from veterinary facilities”. Although healthcare waste
comprises a very small portion of the entire waste stream, it deserves
special attention because of the hazard it can pose to human health, if not
managed properly. It is also complex because of the variety of wastes

7
generated by health care facilities. Waste requiring special attention
includes, those that are potentially infectious, sharps e.g.: needle,
scalpels, other objects capable of puncturing the skin, plastic waste
generated from health care establishments, pharmaceutical waste and a
variety of chemically hazardous waste used in laboratories etc9.

The cross sectional survey was done in Pune and Pimpri

Chinchwad during 2002-2003, the findings were:
• Only 54 healthcare establishments follow the biomedical waste
management rules.
• About 60 per cent of the healthcare establishment admitted and
recorded 4-5 cases of used needle pricking every day. Lack of
awareness and ineffective handling were only adding to the risk
factors of the nursing and house keeping staff.
• Less than 37 per cent of the healthcare establishment use colour
coded liners and lidded containers.
• Many of them continue to use municipal bins on roadsides. Many
of them had confusion in colour coding and treatment. Many of
them were throwing untreated and unmultilated needles and
syringes into municipal garbage bins. Certain waste items also
collected for repacking and resale in the rural areas.10

An extensive survey on ‘hospital waste management’ in the healthcare

establishment of Kannur, 2003 was undertaken by Centre for
Environment and Education. The findings of the survey were:
• About 42 per cent of the city either incinerate or burn the infected
plastics in the open.

8
 • None of the hospital goes for disinfecting or sterilization of the
infected plastics before dumping them into municipal bins or in the
open.
• Infected wastes are often sold to recycling agents for repacking.
• 71 per cent of the healthcare establishments discharge the liquid
waste, which may contain infectious organism or hazardous
chemicals into drains.11

In the hospitals there is a generation of infectious waste is 25 per

cent remaining 75 per cent is non infectious. Due to improper segregation
of whole waste which will become infectious.

The problems identified by the National High Power Committee

were:
• Injuries from sharps to all categories of hospital personnel and
waste handlers.
• Nosocomial infections in-patients results from poor infection
control practices and poor waste management practices.
• Risk of infections outside the hospitals for waste handlers,
scavengers and at times for general public.
• Risk associated with hazardous chemicals, drugs being handled by
persons handling wastes at all levels.
• Disposable items were being repacked and sold.
• Drugs, which have been disposed being repacked, and sold12.

Biomedical waste in remote places such as rural and semi urban

areas, hilly and coastal areas may not generate to large amount but
nevertheless, its management is of grave concern primarily because low

9
awareness about such matters can gradually lead to pollution of air.
Awareness and sensitivity to the issue is percolating down to these areas
because of the furore created in the bigger cities. Waste in these areas has
to be managed in a different manner depending on factors such as
topography, accessibility to services, cost of equipment, transport,
operation, maintenance and community acceptability.

Owing to the terrain in the hilly areas, for instance, waste that may
accumulate could be washed downstream into the local waterways in the
monsoons. The people living in the vicinity are therefore exposed to the
danger from bacteria and viruses in used syringes and needles and other
biomedical waste floating in the waters.

In a small town called, Pokhara at the foot of the Annapurana

mountain of Himalayas in Nepal. Here, piles of hospital waste are left
along roadsides, occasionally burned with Kerosene. People pass by these
piles of waste and often walk over them ignorant about the hazards they
are facing. These wastes are washed down into the river, that flows within
the town. Ultimately, the affected will also go to the hospitals for
treatment, resulting in more hospital waste left to float down the river and
spread illness to others.9

Nurse’s responsibilities are multidimensional in the care of the

client in the hospitals and clinics. They play a pivot role in co-ordinating
the client care because they are constantly with the patient 24 hours.
Patient and nurse can be considered as a single unit, which is a point
around, in which various activities performed by the health care
professionals. Bio medical waste is generated at the patients’ level and

10
nurse is the first one who has to deal with it, sometimes it is the nurses
responsibility to see that and takes appropriate care in segregating and
treating it, in the desirable way14.

Health and safety of the nursing staff is cardinal feature of

biomedical waste management. It cannot be activated without the co-
operation of each and every health personnel and client, however nursing
personnel play vital role in management of biomedical waste.

Biomedical waste management is a recent trend in proper wastage

disposal. Our country is conducting many programmes and activities to
enrich the healthcare professionals. In Raichur upto now no systematic
study is dealt in this aspect related to waste management by professionals.
During the clinical experience the Investigator observed the improper
waste management in hospitals. So the Investigator is interested to assess
the knowledge, attitude and practices of nurses regarding bio-medical
waste management and create awareness among the nurses. Hence the,
Investigator is interested to conduct the research project in the present
study area.

11
Statement of the problem
“A study to assess the knowledge, attitude and practices of nurses
regarding ‘bio-medical waste management’ in
selected hospitals of Raichur”.

Objectives
• To assess the Knowledge, Attitude and Practices of nurses
regarding biomedical waste management.
• To analyze the relationship between the Knowledge, Attitude and
Practices of nurses related to biomedical waste management and
with selected variables.
• To describe the relationship among the knowledge, attitude
practices of nurses with regard to biomedical waste management.
• To prepare information module for the nurses on biomedical waste
management.

Operational definitions:
• Knowledge:
The level of awareness and understanding of nurses about
biomedical waste management.
• Attitude:
The specific view or opinion or behaviour of nurses regarding
biomedical waste management.
• Practices:
The level of utility of resources related to biomedical waste
management.

12
• Nurses
Individuals who are professionally trained and are providing health
care services to the client in health care institutions and in the
community.
• Biomedical waste Management
The action of managing solid or liquid waste including its
container produced during the health care activities.
• Selected Hospitals
The hospitals, which are having, bed strength of 75 and above are
considered for the study. (Navodaya Medical College Hospital and
Research Centre, District Civil hospital, Opec hospital, Navodaya
diagnostic centre, Bandari hospital and Nandini hospital).

• Selected variables

Variables under the study

Variable is an attribute of a person or object that varies, that is,
takes on different values.

Two types of variables are identified in the study. They are

• Dependent variable
• Independent variable

Dependent variable
The outcome variable of interest, the variable that is hypothesized
to depend on or caused by another variable, the independent variable.

In this study knowledge, attitude and practices of nurses regarding

biomedical waste management was the dependent variable.

13
Independent variable
The variable that is believed to cause or influence the dependent
variable.
In this study if refers to age, sex, professional qualification,
experience, designation, previous orientation training, type of hospital,
working area and available facilities.

Age:
It refers to chronological age of the nurses. For the present study it
is categorized into
a) 20-25 years
b) 26-30 years
c) 31-35 years
d) 36-40 years
e) Above 41 years

Sex:
It refers to gender. It is categorized into
a) Male
b) Female

Professional qualification:
It refers to educational qualification of the nurses. For the present
study, the nurses with the following qualifications are considered as
sample.
a) General Nursing and Midwifery
b) [Link] (Nursing)

Experience:
It refers to years of working period. The following ranges of
experience are considered for the study.

14
 a) 0-5 years
b) 6-10 years
c) 11-15 years
d) 16-20 years
e) More than 20 years

Previous orientation training:

It refers to any training on biomedical waste management,
previously exposed or not
a) Yes
b) No

Type of hospital:
It refers to co-ordination authority of hospital. The hospitals were
categorized as:
a) Government hospital
b) Semi government hospital
c) Private hospital

Working area:
It refers to job placement unit. For the present study the working
area has been described in terms of:
a) Intensive care unit (it includes all the intensive care unit)
b) Wards (it includes medical, surgical, ophthalmology, ENT,
labour room, antenatal, postnatal, special ward, paediatrics,
outpatient department).
c) Casualty and emergency department.
d) Operation theatre

15
 Available facilities:
It refers to the resource that helps to meet proper waste
management. For the present study the following facilities were
considered.
a) Colour coding system
b) Incinerator
c) Autoclave
d) Microwave
e) Shredder
f) Needle cutter or destroyer
g) Connection with pollution control board

Assumptions
• Better knowledge and positive attitude of the nurses would lead
to better practices.
• Tool employed for the study would be adequate and sufficient
for gaining information about knowledge, attitude and practices
of nurses.
• Nurses will extend co-operation in providing factual
information.
• Information module will help the nurses to improve their
knowledge, attitude and practices related to biomedical waste
management.

Delimitations:
• The study was limited to nurses who were working in selected
hospitals.
• The study was limited to the nurses who were studied either
General nursing and midwifery or [Link] (Nursing).

16
 • The study was limited to the hospitals, which were having bed
strength of 75 and above.
• The study was limited to the nurses who were willing to participate
in the study.

Hypotheses:

H1 - There will be a significant association between the

knowledge, attitude and practices of the nurses and with
selected socio demographic variables.

H2 - There will be significant relationship between the knowledge

level of nurses and the attitude level of nurses regarding
biomedical waste management.

H3 - There will be significant relationship between the knowledge

level and the practices of nurses about biomedical waste
management.

H4 - There will be significant association between the attitude

level and practices of nurses regarding biomedical waste
management.

17
 Conceptual Frame Work:

A conceptual framework is a group of concepts and a set of

proportions that spell out the relationship between them. Conceptual
framework plays several interrelated roles in the progress of science. The
overall purpose is to make scientific findings meaningful and
generalizable15.

Conceptual frame work is interrelated concepts or abstractions that

are assembled together in some rational scheme by virtue of their
relevance to a common theme, some times referred to as conceptual
scheme15.

The Theoretical frame work of the study is based on concept of

General Systems Theory by Ludwig vonbertalanftly16.

Systems theory is used by several disciplines as a way to explain

interactions and changes that result from interactions. A system consists
of interrelated components known as subsystem and is also a part of a
supra-system. Each system has a function and the system has a purpose.

All living systems are open systems and are surrounded by a

semipermeable boundary through which there is exchange of energy and
information between the system and environment.

18
In the present study,
Supra system : Hospital
System : Nurses
Sub System:
• Incharge/Head nurses
• Staff nurses

Input:
The information and energy that the system receives from the
environment provided input for the system. In the present study nurses
age, sex, professional qualification, experience, designation, previous
orientation, type of hospital, working area and available facilities were
considered as input.

Throughput
The system uses, organizes and transforms the input in a process
known as throughput. Existing level of knowledge, attitude, and practices
among the nurses will be the throughput.

Out put:
From the throughput releases information and activities related to
handling of biomedical waste management as out put. With the help of
structured interview schedule, attitude scale and observation checklist, the
adequacy and inadequacy will be expressed.

19
Feed back.
Because of these interactions, change in one part of the system
affects the entire system and results in rebound changes. Planning would
take into consideration ways in which interventions directed towards one
part of the system would affects and change the entire system.

The nurses who are falling moderate and low knowledge,

moderately favorable and unfavorable attitude and moderately adequate
and inadequate practices categories will be imparted by the information
module. This will help for the system to bring effective change.

20
Diagram

21
Organization Of The Report

The report of the study is organized into nine chapters

Chapter-I Introduction

Chapter-II Review of literature

Chapter-III Methodology

Chapter-IV Results

Chapter-V Discussion

Chapter-VI Summary

Chapter-VII Conclusion

Chapter-VIII Recommendations and Implications

Chapter IX Information Module

The study concluded with Abstract, Bibliography and

Annexures

22
 2. REVIEW OF LITERATURE

Review of literature on the research topic makes the researcher

familiar with the existing studies and provides information, which helps
to focus on a particular problem and lay foundation upon which, to base
new knowledge. It creates accurate picture of information found on the
subject16.

One of the major functions of a literature review is to ascertain

what in already known in relation to a problem of interest. It is a written
summary of state of existing knowledge on a research problem16.

A review of literature involves systematic identification, location,

scrutinization and summary of written materials that contain information
on a research problem.

The review of literature has been categorized into:

• Studies related to knowledge on bio medical waste management.

• Studies related to practices regarding bio medical waste

management.

• Studies related to attitude on bio-medical waste management.

23
(i) Studies related to Knowledge on bio medical waste management
A study was conducted on knowledge level of Health care
personnel from choithram hospital on biomedical waste management.
Exploratory research approach was used to collect the data. Population of
the study includes the health personnel of different categories. Simple
random sampling technique was used. Sample size includes 30 doctors,
50 nurses, 38 nursing assistants and 150 class IV employees. A
structured knowledge questionnaire and interview schedule was used with
the maximum score of 30. Doctors had a mean of 17.8. Nurses had a
better score of 21.54 as mean. The mean knowledge score of nursing
assistant was 10.07 and group IV workers was 8.26 as mean score17.

A study was undertaken to assess the hospital waste management

awareness among the health care personnel during 1996-1997 and 2001-
2003, regarding the type and nature of waste generated in the hospitals,
its segregation, disposal and the use of disinfectants and incinerators in a
tertiary hospital in New Delhi. Orientation programmes on hospital waste
management were provided regularly to health care personnel. At the end
of the programmes, all health care personnel were evaluated by
questionnaire based tests and group discussions. A random check of the
hospital waste management was also conducted. It was observed that the
awareness level for waste segregation and disposal was found to 90.0
per cent during the year 2001-2003 as compared 40-75 Per cent observed
during 1996-1997. Where as during 2001-2003, 70 per cent would
answer about the proper disposal of infectious waste during random
checks of the site was observed that in the majority of placers had noticed
mixing of waste18.

24
 A study was conducted on the role of an information booklet on
biomedical waste management in orthopedic wards of Guru Teg Bahadur
hospital, Shahara, Delhi. The research approach adopted for the study
was evaluative research with one group pre test and post test design.
Total enumeration sampling technique was used to obtain an adequate
size of sample. A structured questionnaire, observation check list and the
booklet was administered to 32 nursing personnel. It was observed that
less than half of staff nurses were aware of various risk and methods of
treatment and disposal of biomedical waste, post test scores were
significantly higher than the pre test scores. The information booklet was
found highly acceptable and useful by nursing personnel19.

School Of Environment Resource and Development was conducted

a study to evaluate the current status of hospital waste management in
Bangladesh. The aim was to recognize the health affect of the existing
practices, to determine the awareness of doctors and nurses about hospital
waste, to identify the weakness and to provide suggestions for
improvement of hospital staff, waste pickers and local residents. They
were interviewed and strictly observed. Through this, the lacking of the
system was identified. Hospital waste was dumped together in public
places and in city corporation dustbin. Many doctors and nurses were not
fully aware about what constitutes as medical waste. Laboratory analysis
shows existing contamination of infectious agents in the environment20.

A study was conducted on awareness about biomedical waste

management and infection control among dentists of a teaching hospital
in New Delhi. 64 dentists working in the same hospital were considered
as sample. Self-administered questionnaire was used to assess the

25
knowledge, and practices of biomedical waste management and infection
control among the dentists. The results shown that, all the dentists were
not aware of risks they are exposed to and only half of them observed
infection control and practices. In addition to this majority of the sample
were not aware of proper hospital waste management21.

(ii) Studies related to practices regarding biomedical waste

management
A survey was conducted among the health care workers in a health
care institution in Mumbai. Totally 100 respondents was taken. It
includes MBBS students, Internal Medical Officers and staff nurses.
Structured interview schedule was used to collect the data. It reveals that,
segregation of waste at the point of generation and colour coding of bags
was 41 per cent and 38 per cent among HCW’S who had attended the
training as compared to 34 per cent and 26 per cent respectively who did
not attend training. Use of needle cutter and proper method for disposal
of sharps was observed by 67 per cent22.

A study was conducted to reveal the existing knowledge and

practices in hospital waste management in Iran. A survey was performed
in the medical referral center in the southern half of the country. The
findings of the study revealed that, there was no separation of hazardous
and non hazardous waste, an absence of rules and reputation for disposal
of waste, disposal of hospital waste along with municipal waste.
Insufficient training ineffective treatment was noticed. They were
recommended to have strict rules and regulations on hospital waste
management23.

26
 A survey of community health nurses knowledge and practices on
waste management was taken by University of Glomorgan. A
questionnaire survey was used for this study. All community learning
disability nurses, community mental health nurses and general
community nurses were surveyed with the response rate of 70 per cent.
The investigator noticed unique and unpredictable environment. A small
number of nurse’s re-sheathed needles and it was stored inappropriately,
inadequately wore gloves, experienced in hand washing, and the waste
was not stored and transported properly. The knowledge scores were very
low. It indicates the need of training in all these aspects24.

A study was conducted on effective medical waste management in

King Fahad National Guard Hospital, Saudi Arabia. The hospital was
having 2 incinerators. But they were not able to manage the waste
properly. So they assessed the knowledge and practices of health care
workers by using questionnaire and observational checklist. It was found
inadequate. So in service training and polices was given for their staffs.
After this they found effective results25.

A study was conducted to assess the knowledge and practices of

nursing personnel regarding hospital waste management and seek their
relationship to selected factors in a hospital of Jaipur, Rajasthan.
Multistage sampling technique was used to select 104 nurses. The tool
used for data collection was a structured questionnaire. The study
findings were revealed that the nursing personnel were having inadequate
knowledge and practices. There was no significant correlation between
knowledge and practices26.

27
 A study was conducted on a programme for reducing biomedical
waste. In the total waste 18.5 per cent of waste was being disposed of as
biomedical waste. In Wellesley Hospital in Toronto, waste audit was
conducted. They noticed the improper techniques. The hospital pays
nine times more to dispose of biomedical waste that it does landfill waste;
a goal was set to reduce bio medical waste to 8 per cent of total waste.
They have given education and training for their staff in the aspects of
redefining and reviewing the biomedical waste. They observed the
practices continuously after 18 months they have achieved the level of
biomedical waste is 7.9 per cent27.

A study was conducted to evaluate the dental waste because there

is cross infection risk and potential danger for environmental associated
with mismanaged waste. Knowledge of waste composition and
development of proper waste management alternatives are necessary. In
this study eight hospitals were examined in Turkey. Total waste coming
from the clinics was related with the number of procedures conducted on
patients at clinics. Only a small fraction of the waste was hazardous.
Hazardous waste was segregated separately. They followed the waste
collection rules properly28.

A study was conducted on usefulness of documentation in

biomedical waste in tertiary care center, New Delhi. A four year
screening was conducted from 1999-2003 .It was showed that segregation
of the waste was followed strictly according to biomedical waste rules in
70 per cent of cases regarding disposal of non-infectious waste while it
was only 60 per cent of infectious wastes. The institution made
compulsory record system on biomedical waste management. It was

28
mentioned in each and every department in the hospital. This
documentation book contains type of waste, colour code of the bags,
ward, transporter name and the check of incharge of the ward. After this
documentation system, the practices were improved29.

Bhopal Memorial hospital and Research centre conducted a

qualitative and quantitative evaluation of processing and disposal waste.
Questionnaire was prepared regarding generation of waste and they also
conducted audit on BMWM. Monitoring of system showed results within
acceptable limits30.

A study was conducted to assess the current situation regarding the

management of biomedical waste in three hospitals in Irbid. One private,
one teaching and one public hospital were considered for the study.
Observation was made in these hospitals. In these hospitals patients, bed
and type of hospital were revealed to be significant factors on quantity of
waste generated. These hospitals do not follow methods of waste
disposal31.

A study was conducted to know the present situation of waste

management in Iran. Totally 15 private hospitals were taken for the
study. Observational checklist was used to gather the information .The
study findings were revealed that nine of the hospitals equipped with
incinerator, six of them have operational problem in incinerator. There
were no training courses about hospital waste management. Segregation
of waste was not done properly. Two hospitals were using containers
without lids for transport of wastes32.

29
 A study was conducted among the 149 health care establishments
in Pune. Observation was made in these health care establishments. In
that, only 54 health care establishments are following biomedical waste
management rules. 75 per cent nursing staff are found to be using gloves
while handling the waste. 4-5 cases of needle injuries are reported every
day. They recommended rules and regulation for biomedical waste
management33.

A study was conducted on assessing the cross infection prevention

measures. In this study, barrier techniques and waste management was
observed in the dental clinic, Nigeria. Less than 30 percentage of dental
surgeons and less than 50 percentage of the students discarded sharp
materials into yellow and sharp bin. Liquid waste was well disposed off
through drain for on-word flow of facilities these poor practices was
noticed34.

A study was conducted on management of infectious waste in

home care setting. Most information published on the management of
infectious waste in the home care based on hospital to home practice. The
investigator observed the poor practices for disposal of infectious waste.
They insisted for developing Law and regulating bodies and waste control
polices in the community35.

A study on the epidemiology of needle stick and sharp instrument

accidents was conducted. A cross-sectional survey of a random sample
of health care workers regarding details of needle stick and sharp injuries
within the previous year was taken. The study setting was in the
university hospital Corvallis. Needle stick accidents during the previous

30
year were reported by 27 percentage of dentists, 81 per cent of surgeons,
32 percentage of non surgical physician and 31 per cent of nursing staff.
Circumstances associated with needle stick injuries includes unexpected
patient movement, related to disposal, needle recapping, accidental. In
that handling or disposal of used needle was 23 per cent36.

National Environmental Engineering Research Institute, Nagpur

Conducted a study on “Health care waste management in India”. The
prevailing situation was analyzed covering various issues like quantities
and proportion of different constituents of waste, handling, treatment and
disposal methods in various health care units. The waste generation rate
ranges from 0.5 to 2.0 kg per bed per day. 0.38 million tones of waste
were generated in India. The solid waste in the hospital consists of
infectious waste 30-35 per cent, plastics 7-10 per cent, disposable
syringes 0.3-0.5per cent, glass 3-5 per cent and other general waste 40-45
per cent. In general, the wastes are collected in a mixed form, transported
and disposed along with municipal waste. They recommended for
appropriate staff training programme37.

A study was conducted on health care risk waste and its

management in Saudi Arabia. A health care waste management
questionnaire was applied in 27 hospitals, and 16 primary health centers
and clinics. The tool quantity of health care risk waste in 24 hours in
each of these establishments was weighed and the practice was observed.
The mean amount of all health care waste generated is 25.207 tons/year.
The practices were not with in acceptable limit. So they recommended
formulating standards for health care waste management. 38

31
 The study was carried out in order to observe and analyze the waste
disposal patterns in a 500 bedded hospital located in rural area in Gujarat.
Data was collected by means of pre structured interviews and on the spot
observations of various stages in the waste disposal chain. Complete
enumeration sampling method was used to select the sample. The
disposal of waste was not properly supervised. Pathological wastes were
observed to be disposed off on the open ground. There was no policy on
waste management. Both the internal as well as external transportation of
hospital wastes was found to be far from satisfactory39.

A study was conducted on placement of sharps disposal system in

hospital by mount Sinai medical center. Annual health questionnaire
were distributed on a quarterly basis to all 8000 employees in an
academic medical center in a large eastern United States metro politician
city asking each employee whether they had experienced a needle stick
injury since the last questionnaire. Questionnaires from active floor
nurses were separated and hand tallied in 1987, 1989, and 1990 the later
two years being after impenetrable sharps disposal system had been
placed in nursing stations and individual patient’s room. Total needle
stick injury in staff nurses reported during three years 20.5 per cent, 23.2
per cent, 21.8 per cent, not significant. Thus a constant reported needle
stick incidence rate may paradoxically represent a modest preventive
effect of a hospital sharp disposal system40.

A descriptive study conducted to demonstrate how a group of

nurses in the clinical setting can identity and implement a safe sharp
disposal strategy to enhance safety. The aim of this study was to
determine safer method of disposing used sharp items. The findings
indicated that many factors could contribute to inappropriate disposal of
used sharp items41.

32
 A study on needle stick injuries and needle disposal was conducted
in Minnesota nursing home. Responses were received from 297 of 349
(85 per cent) homes, nearly all homes (92.5 per cent) provided education
for new nursing employees about use and disposal of needles. Disposal
method was generally consistent. But needle stick injuries was noticed.
No institutions were having the policy for management of disposal of
needle safety and avoidance of needle stick injuries42.

(iii) Studies related to attitude on biomedical waste management

A study conducted in Deen Dayal Uphadyay hospital on waste
management. The staffs were given education by the waste management
committee of the time of joining and while working regarding biomedical
waste management. Protective gear was made available to the health care
personal handling waste. Staffs were evaluated pre and post training. Pre
results shows inadequate knowledge, attitude and practices on waste
management. After the training there was a sea change in the knowledge,
attitude and practices among nurses. The wastes were transported
separately. Waste bags were labeled at generation points43.

The evaluation of current beliefs and practices on hospital waste

management was done in 400 bedded Brazilian hospital. It was also
interesting to note that the highest generation rate per patient per day was
found in private rooms and the lowest rate in the public ones. The beliefs
were found within acceptable limit. The practices were based on current
Brazilian legislation44.

33
 A study was conducted to evaluate the knowledge, attitude and
practice of the personnel with respect to the prevention of nosocomial
infection. Five regional hospitals in Senegal were taken for the study.
Data were collected in two ways, a questionnaire was used to evaluate
knowledge and by observing the attitudes and practices of the personnel.
Reusable instruments were washed directly with bare hands or by
individuals wearing used surgical gloves. The equipment for autoclaving
was unsuitable. Biomedical waste was not decontaminated and it was
collected poorly and disposed of directly in the environment. None of the
sites visited had a program of waste incineration. The scores of
knowledge, attitude and practices were very low45.

A study conducted in Kasturaba Medical College Hospital,

Manipal on issues involved in hospital waste management. The
quantities of hospital waste generated are 0.775 kg per patient per day.
Out of this biomedical waste constitute on 6.27 per cent. Through all
resources have been provided, a large implementation gap for waste
management was seen because of attitudinal problem. Many of them
showed negative attitude towards BMWM. Incineration has been
advocated as a viable method of disposal46.

34
 3. METHODOLOGY

Research methodology includes steps, procedures and strategies for

gathering and analyzing the data in a research investigation47.

Research methodology is a way to systematically solve research

problem.

The present study was aimed at assessing the knowledge, attitude

and practices of nurses regarding biomedical waste management.

This chapter deals in detail with the methodology adopted for the
study. It also describes the rationale for research approach, choice of the
research design, setting of the study, population, sample and sampling
technique, sample size, method of date collection, development of the
tool, description of the tool, ethical considerations, validity, pilot study,
reliability of the tool and plan for data analysis.

Research approach
Descriptive approach provides an accurate portrayal or account of
characteristic feature of a particular individual, event or group in life
situations for the purpose of discovering new meaning, describing what
exists, determining the frequency with which something occurs and
categorizing information48.

35
 The Investigator adopted descriptive approach to assess the
knowledge, attitude and practices of nurses regarding biomedical waste
management for the present study.

Research design
A researcher’s over-all plan for obtaining answers to the research
questions or for testing the hypotheses is referred to as research design.
The research design spells out the basic strategies that the researcher
adopts to develop information that is accurate and interpretable49.

The research design guides the researcher in planning and

implementing the study in a way that is most likely to achieve the
intended goal.

36
 Research approach
Descriptive Study

Purpose
Assessment of knowledge, attitude and practices
of nurses regarding bio medical waste
management

Study setting
Govt. and private hospitals which are having bed
strength of 75 and above

Target population
Nurses who are working in hospitals

Accessible population
Qualified nurses working in selected hospitals of
Raichur
Sampling
Technique (simple
Sample random technique
120 nurses from selected hospitals by complete
enumeration
method)
Data collection instrument
Structured interview schedule, likerts five point
attitude scale, and observation checklist.

Low knowledge, Average knowledge, High knowledge,

unfavourable moderately favourable favourable
attitude, inadequate attitude, moderately attitude, adequate
practices. adequate practices. practices.

Preparation of information module

Fig 2a: schematic representation of research design

37
Setting of the study
The physical location and condition in which the data collection
takes place in the study.

Raichur is one of the backward district situated in Northern

Karnataka. It has an area of 60 sq km and it consists of 5 towns and 300
villages.

To meet the felt needs of the people in Raichur, the district hospital
and five private hospitals are situated in different corners of the city.

Name of the hospital Bed strength Location

District hospital 350 Hyderabad Road
(Govt. Hospital)
Opec Hospital 350 Hyderabad Road
(Semi Govt. Hospital)
Navodaya medical 350 Navodaya Nagar
college hospital &
Research centre
(Private)
Bandari Hospital 75 Gunj Road
(Private)
Nandini Hospital 75 Station road
(Private)
Navodaya Diagnostic 75 Gunj road
Centre (Private)

Navodaya medical college hospital was taken for pilot study and it
was not included in the main study and other five hospitals were
considered for main study.

38
 INDIA

KARNATAKA

Raichur

Civil hospital Opec hospital

Bandari hospital Nandini hospital
Navodaya diagnostic centre Navodaya Medical college
hospital

Fig. 2 b Map showing areas under study

39
Population
Population is the entire aggregation of the cases that meet a
designed set of criteria50.

Population of the study comprised of the nurses who are working

in selected hospitals.

Sample
Sample consists of the subjects of the population selected to
participate in the study51.

In the present study, sample consists of 120 nurses who are

working in selected hospitals of Raichur.

Sampling technique
Sampling is the process of selecting the portion of population to
represent the entire population50.

Cluster-sampling method is a form of sampling were large

groupings are selected first, with the successive sub sampling of smaller
units. Accordingly hospitals which are having 75 and above only listed
out and Navodaya Medical College Hospital and Research Centre was
selected randomly for pilot study and it was not considered for final
study.

Simple random sampling is the most basic type of probability

sampling, where in a sample frame is created by enumerating all
members of a population of interest and then selecting a sample from the
sample frame through completely random procedures. The other
hospitals were chosen by simple random sampling method and complete
enumeration method was used in selection of the sample, 120 nurses were
selected as a sample for present study.

40
Criteria for sample selection
The sampling frame structured by the researcher includes the
following criteria.

Inclusion criteria
• The nurses who are working in government, semi government and
private hospitals in Raichur.
• The nurses who are willing to participate in the study.
• The nurses who are available at the time of data collection.
• The nurses who studied either GNM and [Link].(N)course

Exclusion criteria
• Nurses who were selected for the pilot study.
• Nurses who were not willing to participate in the study.
• Nurses who were not available at the time of data collection.

Sample Size
120 nurses were considered as a sample for the present study.

Limitations
• The study was limited to nurses who were working in selected
hospitals.
• The study was limited to the nurses who were studied either
General nursing and midwifery or [Link] (Nursing).
• The study was limited to the hospitals, which were having bed
strength of 75 and above.
• The study was limited to the nurses who were willing to participate
in the study.

41
Method of data collection
The instrument is a vehicle that could best obtain pertinent data to
the study and at the same time adds to the body of knowledge in the
discipline.

Based on the study objectives, the instrument was divided into 4

sections

Section A : Demographic data

Section B : Knowledge questionnaire (structured interview schedule).
SectionC: Likerts five point attitude scale (structured interview schedule).
Section D : Observational check list

A structured interview schedule was made to the assess the

knowledge and attitude and observational checklist was used for
assessing the practices regarding biomedical waste management.

Development of the tool

The tool was prepared by the Investigator after a thorough review
of literature and based on expert’s suggestion.

A structured interview schedule, likerts five point attitude scale and

observation check list was prepared on biomedical waste management to
assess the knowledge, attitude and practices of nurses.

42
Description of the tool
Section A: Demographic data
The first section of the tool consists of items related to data
regarding personal and baseline characteristics of the nurses. It includes
age, sex, professional qualification, experience, designation, previous
orientation, type of hospital, working area and available facilities where
there are working.

Section B: Knowledge questionnaire related to biomedical waste

management.
The tool consists of 30 items from all the aspects of biomedical
waste management. (Annexure VI).
Part A : Definition and classification 4 items
Part B : Segregation 10 items
Part C : Storage and transport 3 items
Part D : Treatment 9 items
Part E : Administrative aspects (Rules and 4 items
regulations)

The items were closed ended questions specifically of multiple

choice type. The total score was 30. Each correct response was carried
“one score”. The tool was prepared in English.

The knowledge of the respondents was arbitrarily categorized into

three categories:
Low knowledge : 50%
Average knowledge : 51-75%
High knowledge : above 76%

43
Section C: Attitude scale
This section contains 14 statements framed into a likert type
attitude scale, which gives the attitude of nurses regarding biomedical
waste management. Each attitude item was having five options i.e.
strongly agree (SA), Agree (A), undecided (UD), Disagree(D), strongly
disagree(SD).There were seven positive and seven negative
items.(Annexure-VI).

The response for each item was measured as a five point scale into:
Options Positive statements Negative statements
Strongly agree 5 1
Agree 4 2
Undecided 3 3
Disagree 2 4
Strongly 1 5
disagree

The maximum score was 70.

The attitude of the respondents was arbitrarily categorized as follows

0-14 15-28 29-42 43-56 57-70

SD D UD A SA

Negative attitude Positive attitude

44
The attitude of the respondents was arbitrarily categorized into:
Unfavourable attitude : below 40%
Moderately favourable attitude : 40-70%
Favourable attitude : above 70%

Section D: Observational checklist

This section contains 14 items to assess the practices regarding
biomedical waste management. Each item was observed by the
Investigator and scored. The maximum score was 15.

The practices of the respondents was arbitrarily categorized as follows:

Inadequate practices : below 40%
Moderately adequate practices : 40-70%
Adequate practices : above 70%

Ethical consideration
• Permission was obtained from the ethical committee of Navodaya
College of Nursing.
• Permission was obtained from Medical & Nursing Superintendents
of selected hospitals.
• Consent was obtained from the sample.

Content validity
The content validity refers to the degree to which an instrument
measures what it is supposed to measure.

The prepared instrument along with the objectives, operational

definitions, blue print, scoring key and a criteria checklist for validation
were submitted to 20 experts which includes 4 consultants, 11 nurse

45
educators, one bio-statistician, 2 psychologists and 2 clinical nurse
specialists for establishing content validity. The final tool consists of 30
items in knowledge questionnaire, 14 items in attitude scale and 14 items
in observational checklist (Annexure-IV).

Pilot Study
Pilot study is a smaller version of a proposed study conducted to
develop and or to refine the methodology, such as the treatment, the
instrument or data collection process. The pilot study was conducted in
Navodaya Medical College Hospital, Raichur from 22.01.05 to 28.01.05.
The permission was obtained from Medical Superintendent of the
Selected Hospitals to conduct the study (Annexure-I). 12 subjects were
selected by simple random sampling technique. The purpose of the study
was explained to each respondent and written consent was obtained from
them and assured confidentiality. The tool was administered and the data
was collected. Data analysis was done by using descriptive and inferential
statistics.

After the pilot study the fool was found to be feasible, practicable
and applicable. The sample chosen for pilot study was not considered for
final study.

Reliability
Reliability of an instrument is the degree of consistency with which
it measures the attribute it is suppose to measure. It refers to the extent to
which the same results are obtained on repeated administration of the
instrument.

46
 In order to establish the reliability of the tool, test-retest method
was used for assessing the knowledge and attitude items, inter-rater
reliability was used for testing the practice items. Respondents were
randomly chosen and the knowledge and attitude items were administered
twice with the gap of one week between the first and second
administration. Karl Pearson’s correlation ‘r’ was computed for finding
out the reliability.

It was found that reliability of knowledge items were 0.90, attitude

were 0.95 and practice items were 0.91which was highly positively
correlated. So the tool was found to be highly reliable for final study.

Data collection procedure

A written permission was obtained from the Medical
Superintendents and Nursing Superintendents of selected hospitals.
Nursing superintendent was introduced the nursing staff to the
Investigator. The Investigator informed the sample about the purpose of
the study and requested for cooperation of the staff during the study.

An informed consent was taken from the respondents and

confidentiality was assured (Annexure-V). Data were collected from
01.02.05 to 05.03.05. The time schedule was planned from 8 am to 10 pm
according to the availability of the sample.

Totally 120 nurses were selected from Government Hospital,

OPEC Hospital, Navodaya Diagnostic Centre, Bhandari Hospital and
Nandini Hospital. Participation of the nurses was fully depends upon their
interest and convenience.

47
 It was ensured that the routine of the hospital would not be
disturbed. The Investigator interviewed the sample by using structured
interview schedule and observed their activities to assess the practices
without any bias.

Plan for analysis

The data was planned and analyzed based on objectives and
hypotheses of the study. The data analyzed by using descriptive and
inferential statistics.

The planned analysis of the raw data is as follows:

Section 1 : Demographic data
Demographic data would be analyzed by using percentages.

Section 2 : Knowledge items

The knowledge of the nurses would be analyzed in terms of
percentage, mean and standard deviation

Section 3 : Attitude scale

The attitude of the nurses would be analyzed in terms of
percentage, mean and standard deviation.

Section 4 : Practice items

The practices of the nurses would be analyzed in terms of
percentage, mean and standard deviation.

48
Section 5 : Relationship between the knowledge, attitude and
practices of nurses with selected variables.
χ2 Test was used to find out the significance between the
knowledge, attitude and practices with the selected demographic
variables.

Section 6 : Relationship between the knowledge, attitude and

practices.
The relationship between knowledge, attitude and practices of
nurses regarding biomedical waste management would be tested by using
Pearson’s correlation coefficient.

The level of significance would be set of 0.05 levels to test the

significance of difference. This level is often used as a standard for
testing the difference.

49
 4. RESULTS

Analysis is the categorizing, ordering, manipulating and

summarizing of the data to obtain answer to the research questions52.

The term analysis refers to, “the number of closely related

operations, which are performed with the purpose of summarizing the
collected data and organizing the data in such a manner that they answer
to the research questions.”

This section presents the analysis and interpretation of data

collected from 120 nurses in order to assess the knowledge, attitude and
practices of the nurses regarding biomedical waste management. The data
collected were tabulated, analyzed and interpreted by using descriptive
and inferential statistics53.

The analysis and interpretation of data presented under following

sections:

Section A : Sample characteristics

Section B : Knowledge, attitude and practices of nurses regarding

biomedical waste management

Section C : Association between the knowledge, attitude and

practices regarding biomedical waste management
with selected variables.
Section D : Data on correlation between the knowledge, attitude
and practices of nurses regarding biomedical waste
management.

50
 Section A

Sample characteristics included in the study were; age, sex,

professional qualification, experience, previous orientation training, type
of hospital, working area and available facilities.

Table 1

Percentage distribution of nurses by their age and sex

Variables Frequency Percentage

• Age in years
20-25 years 49 40.8
26-30 years 42 35.0
31-35 years 16 13.3
36-40 years 10 8.3
Above 41 years 3 2.5
• Sex
Male 14 11.6
Female 106 88.33

Table 1 narrates the Percentage distribution of nurses by their age

and sex. 40.8 percentage of nurses were between the age group of 20-25
years, more than one third of nurses (35%) were in the age group of 26-
30 years. Above one tenth of the nurses were in the age group of 31-35
years (13.3%). Less than one tenth of the nurses were belonging to 35-40
years (8.3%). Very few percentage of samples were fallen in the age
group of 41 years and above (2.5%)

51
 Majority of the nurses were females (88.3%). Above one tenth of
the nurses were males (11.6%). It may be due to in previous years
government & Indian nursing council permitted only females in certain
states of the country; In recent years the rule was changed, co-education
was offered in the field of nursing and approved by the INC and the
government.

52
53
54
 Table 2

Percentage distribution of nurses by their professional background

Professional back ground Frequency Percentage

• Professional qualification
General nursing and midwifery 109 90.83
[Link] (Nursing) 11 9.16
• Experience
Below 5 years 64 53.33
6-10 years 31 25.83
11-15 years 14 11.66
16-20 years 10 8.3
More than 21 years 1 0.83
• Designation
Staff nurse 92 76.66
Head Nurse / Incharge nurse 28 23.33

• Previous Orientation Training

Programme on BMWM 19 15.83

Attended 101 84.16

Not attended
• Source for Attending Previous
Orientation Training
Programme
Professional education 5 4.1

In-service education 12 10

Mass media 2 1.6

55
 Table 2 describes the sample by their professional background
majority of the nurses were diploma nurses (90.83%) and followed by
very few percentage of the nurses were graduates (9.16%).

More than half of the nurses were having less than 5 years of
experience (53.3%). One fourth of the nurses were having 6-10 years of
experience (25.83%). Above one tenth of the nurses were having 11-15
years of experience (11.6%). Below one tenth of the nurses were having
16-20 years of experience (8.33%). Only one nurse among the sample
had more than 21 years of experience (0.83%).

More than three fourth of the nurses were working as staff nurses
(76.6%). Nearly one fourth of the nurses were working as incharge nurse
or head nurses (23.3%)

Majority of the nurses didn’t attend any orientation-training

programme on BMWM (84.16%). Only 15.83 percentage of the nurses
were attended orientation training programme. In that 10 percentage of
the nurses gained knowledge through in service education 4.1 percentage
of the nurses were gained knowledge by professional education followed
by mass media (1.6%)

56
57
58
59
60
 Table 3

Percentage distribution of nurses by their working back ground

Working background Frequency Percentage

Type of hospital
Government 25 20.8
Semi government 70 58.3
Private 25 20.8
Working area
Intensive care unit 22 18.33
Wards 65 54.16
Out patient department 12 10.0
Casualty and emergency 9 7.5
department
Operation theatre 12 10.0

Table 3 describes the percentage distribution of nurses by their

working background. More than half of the nurses were working in semi
government hospital (58.3%) followed by government (20.8%) and
private hospital (20.8%).

More than half of the nurses were working in wards (54.16%).

Nearly one fifth of the nurses were working in ICU (18.33%) followed by
OPD (10%), OT (10%). Less than one tenth of the nurses were working
in casualty and emergency department (7.5%)

61
62
63
 Table 4

Percentage distribution of nurses with their

working facilities related to BMWM

Available facilities Frequency Percentage

Colour coding system 110 91.66
Puncture proof transparent container 90 75.0
Chemical disinfection facilities 120 100.0
Needle cutter or destroyer 90 75.0
Autoclave 120 100.0
Incinerator 70 58.3
Co-ordination with pollution 120 100
control board

Table 4 describes the working facility of sample where presently

they are working. All the nurses were working in the hospital where the
facilities like chemical disinfection facilities, autoclave, co-ordination
with pollution control board are available. Majority of the nurses were
working with the facility of colour coding system (91.6%). Three fourth
of the nurses were working with the facilities like puncture proof
transport container (75%) and needle cutter (75%). More than half of the
nurses were working with the facility of incinerator (58.3%). No hospital
was having the facilities like shredder and microwave.

64
65
 Section –B
Table 5

Percentage distribution of the nurses based on

their knowledge on BMWM.

Knowledge Standard
Frequency Percentage Mean
scores deviation
Low 0-50% 94 78.3
Average
24 20.0
51-75% 11.08 5.27
High
2 1.7
Above 76%

Table 5 shows the percentage distribution of the nurse’s knowledge

on biomedical waste management. Totally 30 items was prepared to
assess the knowledge. Each item with correct response was carried one
mark. According to the scores, nurses were divided into high (above
76%), average (51-75%) and low (0-50%).

Very negligible nurses had high knowledge (1.7%). One fifth of

the nurses had average knowledge (20%). More than three fourth of the
nurses had low knowledge (78.3%). The knowledge score mean was
11.08 with the standard deviation 5.27.

The nurses were having low knowledge regarding biomedical

waste management. The effects of improper waste management must be
explained and the nurses must be motivated towards proper BMWM.

66
 Table 6

“Percentage distribution of nurses based on their knowledge

regarding definition, and classification of biomedical waste”

Items Frequency %
• Biomedical waste is produced 86 71.6
during the procedures in hospital.
• The symbol of biohazard is 39 32.5
• The major classification of waste 53 44.1
is infectious & non infectious.
• Cytotoxic waste is generated from 45 37.5
anti neoplastic drugs.

Table 6 determines the percentage distribution of nurses based on

their knowledge regarding definition and classification of biomedical
waste.

Above two third of the nurses defined correctly regarding

biomedical waste i.e. produced during the procedures in hospital (71.6%).
Nearly one third of the nurses identified the appropriate symbol of
biohazard (32.5%). Less than half of the nurses were able to classify the
waste as infectious and non infectious (44.1%). Above one third of the
nurses had responded cytotoxic waste is generated from anti neoplastic
drugs. (37.5%)

67
 Table 7

Percentage distribution of nurses based on their knowledge

regarding waste segregation

Items Frequency %
• Segregation of waste is to avoid mixing of 62 51.6
infectious and non infectious waste.
• Water proof colour coded bin with lid 55 45.8
closure is ideal bin to dispose the waste.
• Red container with biohazard symbol is used 41 34.1
for infected plastics.
• Anatomical & pathological waste is disposed 44 36.6
into yellow container with biohazard symbol.
• Blue colour coded bin with bio hazard 44 36.6
symbol is used for disposal of glass items.
• Official type of waste is discarded in white 36 30.8
container.
• Kitchen waste is discarded in green container 24 20
with biohazard symbol.
• Puncture proof container with sodium 51 42.5
hypochlorite solution is used for disposal of
sharp items.
• Mixing of waste from other container with 51 42.5
yellow container the whole waste has to be
treated as infectious waste.
• The cover should be tied when it is filled ¾ 54 45

68
 Table 7 depicts the percentage distribution of nurses based on their
knowledge regarding waste segregation.

More than half of the nurses responded segregation of waste is to

avoid mixing of infectious and noninfectious waste (51.6%). 45.8
percentage of the nurses answered correctly to use the water proof colour
coded bin with lid closure is the ideal bin to dispose the waste. More than
one third of the nurses identified correctly the usage of colour coded bins;
Red (34.1%), Yellow (36.6%), Blue (36.6%) in disposal of waste.

Nearly one third of the nurses identified correctly the usage of

white container with biohazard symbol is for disposal of official type of
waste (30.8%) one fifth of the nurses responded correctly to discard the
kitchen waste in green container with biohazard symbol (20%).

42.5 percentage of nurses knew puncture proof container with

sodium hydro chloride solution is used for disposal of sharp items and the
same percentage (42.5%) of the nurses answered to treat the whole waste
as infectious in case of mixing of waste. 45 percentage of the nurses told
that they have to tie the cover in the waste container when it is filled three
fourth.

69
 Table 8

Percentage distribution of nurses based on their knowledge

on storage and transportation of waste

Items Frequency Percentage

• The waste can be stored in hospital is 47 39.1
for 48 hours.
• The route is preferred for transport of 40 34.1
waste in side the hospital is least used
by public.
• Symbol of biohazard should be seen 50 41.6
in the waste transport vehicle.

The Table 8 enumerates the percentage distribution of nurses based

on their knowledge on storage and transportation of waste.

More than one third of the nurses knew the storage time of waste in
the hospital is for 48 hours (39.1%). 34.1 percentage of the nurses
responded to prefer the transport inside the hospital should be least used
by the public. 41.6 percentage of the nurses were aware that the symbol
of biohazard should be labelled over the transport vehicle.

70
 Table 9

Percentage distribution of nurses based on their knowledge about

treatment facilities in biomedical waste management

Items f %
• Shredding helps to cut the waste into small pieces. 29 24.1
• Autoclaving of syringes, tubes and gloves etc before 51 42.5
disposal will helps to avoid reuse.
• Pulverization helps to reduce the waste volume. 51 42.5
• Placenta is disposed by incineration. 46 38.3
• Chlorinated plastics should not be incinerated. 52 43.3
• Incinerated ash is stored in closed storage container. 36 30.0
• Cytotoxic waste should not discarded in sewers. 43 35.8
• Soakage pits are the useful method for final disposal 30 25.0
of liquid waste in rural and small health care
institutions.
• The garbage is disposed off by land filling. 39 32.5

The Table 9 clearly describes the percentage distribution of nurses

based on their knowledge about treatment facilities in bio medical waste
management.

Nearly one fourth of the nurses were responded shredding helps to

cut the waste into small pieces (24.1%). 42.5 percentage of the nurses
knew autoclaving of syringes, tubes and gloves etc before disposal will
helps to avoid reuse. Similar percentage the nurses knew about
pulverization (42.5%).

71
 Above one third of the nurses aware of disposal of placenta by
incineration (38.3%). 43.3 percentage of nurses identified correctly that
chlorinated plastics should not be incinerated. Nearly one third of the
nurses knew that closed storage container for storage of incinerated ash
(30%).

Above one third of the nurses responded that cytotoxic waste

should not discarded in sewers (35.8%). One fourth of the nurses
responded correctly the soakge pits is the useful method for final disposal
of liquid waste in small health care institutions (25%). Nearly one third of
the nurses identified land filling is the suitable method for disposal of
garbage (32.5%).

72
 Table 10

Percentage distribution of nurses based on their knowledge

regarding administrative aspects of BMWM

Items f %
• Air pollution control system should be seen while 54 45
purchasing the incinerator.
• State pollution control board is the prescribed 40 33.3
authority for biomedical waste management.
• Punishment for violation of biomedical waste 32 26.6
management is Rs. 1 lakh/imprisonment for 5 years
• Insisting the nurses to write the ward name and date 58 48.3
on the covers will reduce the wrong way of disposal.

Table 10 describes the percentage distribution of nurses based on

their knowledge regarding administrative aspects of bio medical waste
management.

45 percentage of the nurses were stated that, it is necessary to

check the air pollution control system while purchasing the incinerator.
One third of the nurses were pointed correctly that the state pollution
control board is the prescribed authority for biomedical waste
management (33.3%).

Above one fourth of the nurses were answered the punishment for
violation of bio medical waste management is Rs 1 lakh/imprisonment for
5 years (26.6%). Nearly half of the nurses suggested that insisting the
nurses to write ward name and date on the covers will reduce the wrong
way of disposal (48.3%).

73
 Table 11

Percentage distribution of the nurses based on

their attitude on BMWM.

Standard
Attitude score Frequency Percentage Mean
deviation
Unfavourable
10 8.3
0-40%
Moderately
favourable 78 65.0 42.34 10.50
41-70%
Favourable
32 26.7
Above 71%

Table 11 shows the percentage distribution of the nurses attitude on

biomedical waste management. Totally 14 items was constructed to
assess the attitude level of the nurses. The nurses were categorized based
on the scores as favourable (Above 71%), moderately favourable
(41-70%) and unfavourable (0-40%).

More than one fourth of the nurses had favourable attitude (26.7%).
More than two third of the nurses had moderately favourable attitude
(65%) and less than one tenth of the nurses had unfavourable attitude
(8.3%). The mean score of the attitude level was 42.34 with the standard
deviation 10.50.

74
 Table 12

Percentage distribution of nurses based on their attitude towards

biomedical waste management related to positive items.

Sl SA A U D SD
Items
No % % % % %
1. If the health team members are effectively
implementing necessary measures in bio
45 40 5.8 4.1 5
medical waste management, the incidence of
illness will be reduced.
2. The nurses and other health team members
should be given training on bio medical 35.8 46.6 7.5 5 5
waste management.
3. Single person cannot regulate proper waste 12.
36.6 36.6 6.6 7.5
management. 5

4. Periodical classes and demonstration of bio

medical waste management is necessary for 32.5 50 8.3 5 4.1
upgrading the knowledge of nursing staffs.
5. Introducing biomedical waste management
into the nursing curriculum will bring out
23.3 41.6 20 2.4 12.5
effective management of biomedical waste
management in working areas in future.
6. To safeguard the rag pickers government
must formulate and regulate necessary rules
31.6 45 11.6 5.8 14.1
and regulations and implement the steps
effectively.
7. Labeling over the waste reduces confusion. 31.6 45 11.6 5.8 14.1
SA= strongly agree, A= agree, U=undecided, D=disagree, SD=strongly
disagree

75
 Table 12 determines the percentage distribution of nurses based on
their attitude towards the positive statements. In the present study the
Investigator used 7 positive and 7 negative items. Positive items were
scored i.e. SA=5, A=4, U=3, D=2, SD=1 and for the negative items the
scores were reversed.

45 percentage of the nurses strongly agreed and 40 percentage of

the nurses were agreed to implement the necessary bio medical waste
management measures to reduce the illness.

More than one third of the nurses were strongly agreed (35.8%)
and 46.6 percentage of the nurses were agreed for the necessity of
training on biomedical waste management.

More than one third of the nurses (36.6%) strongly agreed and
same percentage of nurses agreed that, single person couldn’t regulate
proper waste management (36.6.%).
Nearly one third of the nurses were strongly agreed (32.5%) and
half of the nurses agreed (50%) for upgrading the knowledge, periodical
classes and demonstration classes are necessary.

More than one fifth of the nurses were strongly agreed (23.3%) and
41.6 percentage of the nurses were agreed to introduce bio medical waste
management into the nursing curriculum.

Nearly one third of the nurses (31.6%) were strongly agreed and 45
percentage of the nurses were agreed to safe guard the rag pickers,
government must formulate and regulate the necessary rules and
regulations and implement the steps effectively.

Nearly one third of the nurses (31.6%) were strongly agreed and 45
percentage of the nurses were agreed by for labelling over the waste will
reduce confusion.

76
 Table 13

Percentage distribution of nurses based on their attitude towards

biomedical waste management related to negative items

S.
Items SA A U D SD
No
1. It is difficult to reduce the waste, produced in 45.8 28.3 17.5 11.6 1.6
the hospital.
2. More colour containers may lead to 40.8 26.6 21.6 9.1 1.6
mismanagement.
3. It is difficult to identity and categories the 39.1 21.6 27.5 10.8 0.83
waste.
4. Busy schedule may interfere with the 43.3 34.1 10 20 0.83
disposal of waste.
5. Bio medical waste management is time 42.5 20.8 12.5 19.1 5
consuming process.
6. Bio medical waste management needs more 43.3 20 15 20.8 0.83
expenditure.
7. It is difficult for the nurse to co-ordinate with 44.1 26.6 13.3 15.8 0
other health team members in bio medical
waste management because of positional
hierarchy.

SA-Strongly agree, A-agree, U-undecided, D-disagree, SD-strongly agree.

77
 Table 13 clearly indicates the percentage distribution of nurses
based on their attitude towards the negative statements on biomedical
waste management.

Above one tenth of the nurses were disagreed (11.6%) and very
negligible percentage of the nurses were strongly disagreed (1.6%) that it
is very difficult to reduce the waste produced in hospital.

Nearly one tenth of the nurses were disagreed (9.1) and very
negligible percentage of the nurses were strongly disagreed (1.6%) that,
more colour containers may lead to mismanagement.

Above one tenth of the nurses were disagreed (10.8%) and 0.83
percentage of the nurses were strongly disagreed to identify and
categories the waste is difficult.

One fifth of the nurses were disagreed (20%) and 0.83 percentage
of nurses were strongly disagreed that, busy schedule may interfere with
the disposal of waste.

Nearly one fifth of the nurses were disagreed (19.1%) and 5

percentage of the nurses were strongly disagreed for bio medical waste
management is time consuming process.

Above one fifth of the nurses were disagreed (20.8%) and 0.83
percentage strongly disagreed for biomedical waste management needs
more expenditure.

15.8 percentage nurses were disagreed and no one was strongly

disagreed, to co-ordinate with other health team members in bio medical
waste management is difficult because of positional hierarchy.

Nurses were having negative attitude in these aspects. The nurses

in the study area must be educated in these aspects.

78
 Table 14

Percentage distribution of the nurses based on their

practices on BMWM.

Perce Standard
Practice scores Frequency Mean
ntage deviation
Inadequate
88 73.3
0-40%
Moderate adequate 5.49 2.09
30 25.0
41-70%
Adequate above 71% 2 1.7

Table 14 describes the percentage distribution of the nurses based

on their practices on biomedical waste management. Totally 14 items
were constructed to assess the practices on biomedical waste management
the nurses were categorized in to adequate (Above 71%), Moderately
adequate (41-70%) and inadequate (0-40%).

It was very pathetic to note that very negligible percentage of

nurses had adequate practices (1.7%). One fourth of the nurses had
moderately adequate practices (25%) and nearly three fourth of the nurses
had inadequate practices (73.3%). The mean score of the practices on
biomedical waste management is 5.49 with the standard deviation
of 2.09.

79
 Table 15

Percentage distribution of nurses based on their practices regarding

identification and segregation of waste.

Items f %
• Identifying and labelling of infectious and 55 45.8
noninfectious waste.
Usage of colour containers with biohazard
symbol
• Yellow container is used for glass items 63 52.5
• Red container is used for infected plastics 28 23.3
• Blue container is used for glass items 22 18.3
• Green container is used for kitchen waste 29 24.1
• White colour container is used for general 19 15.8
waste and non infected plastics
• Disposal of sharp items
o Disinfect with chemicals 69 57.5
o Stored in puncture proof 69 57.5
container
• Closing the container after putting waste 77 64.1

80
 Table 15 describes the percentage distribution of nurses based on
their practices regarding identification and segregation of waste.

45.8 percentage of the nurses identified and labelled the infectious

and non infectious waste. More than half of the nurses used correctly, the
yellow container for anatomical and pathological waste (52.5%). Nearly
one fourth of the nurses used correctly the red container with biohazard
symbol is for infected plastics (23.3%).

Below one fifth of the nurses used correctly blue container for
disposal of glass items (18.3%). Nearly one fourth of the nurses disposed
kitchen waste in green container (24.1%) 15.8 percentage of the nurses
disposed non infected plastics and general waste in white container.

More than half of the nurses disposed correctly the sharp items
(57.5%). Nearly two third of the nurses were closed the waste container
after putting the waste (64.1%). In the study area non of the hospital was
using the black container for expired medicines, disposal of
chemotherapy drugs and radio active substances.

81
 Table 16

Percentage distribution of nurses based on their practices regarding

protective measures, monitoring and maintenance role

Items f %

• Using protective devices like gloves, gown, 78 65

mask, cap, boot while handling of waste.
• Monitoring the package of waste when it is 56 46.6
filled ¾ of the cover.
• Monitoring the internal transportation 89 74.1
without spillage of waste materials.
• Involves in giving education on bio medical 5 4.1
waste management.
• Maintaining proper records and reports 5 4.1
related to biomedical waste management.

Table 16 explains the percentage distribution of nurses based on

their practices regarding protective measures, monitoring and
maintenance role.

Nearly two third of the nurses were using protective devices while
handling the waste (65%). 46.6 percentage of the nurses were monitoring
the package of waste when it is filled three fourth of the cover. Nearly
three fourth of the nurses were monitoring the internal transportation
without any spillage (74.1%). Equal percentage of nurses were involved
in giving education (4.1%) and record and report maintenance on
biomedical waste management (4.1%).

82
 Section C

Table 17

Association between the knowledge of nurses regarding

biomedical waste management with their age
N = 120

Level of knowledge
Age in
Years
Low Average High Total
f % f % f %
20-25
44 36.7 4 3.3 1 0.8 49
years
26-30
30 25 12 10.0 - - 42
years
31-35
9 7.5 6 5.0 1 0.8 16
years
36-40
8 6.7 2 1.7 - - 10
years
Above
41 3 2.5 - - - - 3
years
Total 94 78.3 24 20.0 2 1.7 120

(χ2 value = 13.257;d.f =8)

Table 17 shows the association between the knowledge of nurses

with their age. Among the total nurses, 49 nurses who were falling

83
between 20-25 years of age, only one nurse had high knowledge, 4 nurses
had average knowledge and 44 nurses had low knowledge.

42 nurses were belongs to the age group of 26-30 years. In that 12

nurses had average knowledge and 30 nurses had low knowledge.

16 nurses were belongs to 31-35 years age group. In that one nurse
had high knowledge, 6 nurses had average knowledge and 9 nurses had
low knowledge.

10 nurses were belongs to the age group of 36-40 years. In that 2

nurses had average knowledge and remaining 8 nurses had low
knowledge.

Only 3 nurses were belongs to the age group of above 41 years and
they had low knowledge.

Chi square value (χ2) was computed for knowledge on biomedical

waste management and age, at 5% level of significance with degree of
freedom 8. Table value is (15.51) and the calculated chi square was
13.257. It was less than the Table value. Hence there was no significant
association was found between the knowledge of nurses on bio medical
waste management with their age.

84
 Table 18

Association between knowledge of nurses regarding

biomedical waste management with their sex
N = 120

Level of knowledge
Sex
Low Average High Tot
f % F % f % al
Male 10 8.3 4 3.3 - - 14
Female 84 70.0 20 16.7 2 1.7 106
Total 94 78.3 24 20.0 2 1.7 120

(χ2 = 0.943; d.f =2)

Table 18 shows the association between the knowledge of nurses

on biomedical waste management and sex of the nurses. Among 106
female nurses, only 2 nurses had high knowledge, 20 nurses had average
knowledge and 84 nurses had low knowledge. 14 nurses were males. In
that only 4 nurses had average knowledge and 10 nurses had low
knowledge.
Chi square value (χ2) was computed to find out the relation
between the knowledge on biomedical waste management and sex at 5%
level of significance with degree of freedom 2. Calculated value was
0.943. It was less than the Table value (5.99). Hence there was no
significant association was observed between the knowledge on
bio medical waste management and sex.

85
 Table 19

Association between the knowledge of nurses regarding

BMWM with their professional background
N = 120

Professional Low Average High

Tot Chi square value
background
al
f % f % f %
G.N. 1. χ2= 2.157 df=2
87 72.5 20 16.7 2 109
Professional M 7 and at 5%
qualification [Link] significant
7 5.8 4 3.3 - - 11
(N) NS
Below
0.
5 55 45.8 8 6.7 1 64
8
years
6-10
23 19.2 8 6.7 - - 31
years
χ2= 11.441 df=8
11-15 0.
7 5.8 6 5.0 1 14 and at 5%
Experience years 8
significant level
16-20
8 6.7 2 1.7 - - 10 NS
years
More
than
1 0.8 - - - - 1
20
years
Staff 0.
75 62.5 16 13.3 1 92
nurse 8 χ2= 2.648 df=2
Inchar and at 5%
Designation
ge/hea 0. significant level
19 15.8 8 6.7 1 28
d 8 NS
nurse
Atten 0.
8 6.7 10 8.3 1 19 χ2= 17.553 df=2
Previous ded 8
and at 5%
orientation Not
0. significant level
training attend 86 71.7 14 11.7 1 101
8 S
ed

(S: Significant, NS-not significant)

86
 Table 19 narrates the association between the knowledge of sample
related to BMWM with their professional background.

Among 109 Diploma nurses, 2 nurses had high knowledge, 20

nurses had average knowledge and 87 nurses had low knowledge.
Among the 11 graduate nurses, 4 nurses had average knowledge and
7nurses had low knowledge. It is very interesting to note that diploma
nurses who were specifically trained towards institutional care were
having high knowledge than graduate nurses which indicates the need for
BMWM in nursing curriculum is compulsorily required in all the training
programmes.

Chi square (χ2) value was computed. It was (2.157) less than the
Table value (5.99), df=2 and at 5% significant level. So there was no
significant association was found between the knowledge on BMWM and
professional qualification.

With related to experience, only 2 nurses had high knowledge who

were having below 5 years of experience (1) and 11-15 years of
experience (1). 24 nurses had average knowledge, whose experience was
as follows: nurses who had below 5 years of experience –8; 6-10 years -
8; 11-15 years -6; and 16-20 years –2; and majority of the nurses had low
knowledge (94), whose experience was as follows : below 5 years –55;
6-10 years –23; 16-20 years –8; 11-15 years -7; and more than 20 years of
experience –1;. It indicates intensive inservice training programme is
very much required in the study area and management of hospital
authority has to provide opportunity and permission for their staff to
enrich their knowledge and automatically which will enhance the quality
of services.

87
 The computed chi square (χ2) value was (11.441) less than the
Table value (15.51), df=8 and at 5% level of significance. So there was
no significant association was found between the nurses knowledge on
BMWM with their experience.

Based on designation, only 2 sample had high knowledge, they

belongs to both categories of staff nurses –1; and head nurse/incharge –1;.
24 nurses had average knowledge in that staff nurses –16; head
nurse/incharge –8;. Low knowledge was observed more (94) (staff nurse
-75; head nurses/incharge –19;.

Chi square (χ2) value was computed to see the association between
the knowledge on BMWM with their designation. The computed value
was (2.648) less than the Table value (5.99), df=2 and at 5% significant
level. So there was no significant association was found between the
knowledge on BMWM with their designation.

Among the 120 nurses, only 19 nurses had attended orientation

training programme. Their scores were as follows; high –1; average –10;
and low –8; where as 101 nurses were not attended any orientation
training programmes. Their knowledge scores were as follows: High –1;,
average –14; and low –86;.

Chi- square (χ2) value was computed to find the association

between the knowledge on BMWM with their previous orientation
training. Computed value (17.553) was higher than the Table value
(5.99) df=2 and at 5% significant level. So the knowledge of nurses on
BMWM and previous orientation training was found to be significant.

88
 Table 20

Association between the knowledge of nurses regarding

BMWM with their working background.
N = 120

High Chi
Low Average Tota
Working background square
l
f % f % f % value
Semi χ2=4.387
57 47.5 12 10.0 1 0.8 70
government df=2 and
Type of
Government 16 13.3 8 6.7 1 0.3 25 at 5%
hospital
sig. level
Private 21 17.5 4 3.3 - - 25
NS
ICU 17 14.2 4 3.3 1 0.8 22
χ2=3.286
Wards 49 40.8 15 12.5 1 0.8 65
df=8 and
OPD 11 9.2 1 0.8 - - 12
Working at 5%
Casualty &
area sig. level
emergency 7 5.8 2 1.7 - - 9
NS
Dept.
OT 10 8.3 2 1.7 - - 12

(S= Significant; NS= Not Significant)

Table 20 identifies the association between the knowledge of

sample with their working background.

Among 70 nurses who were working in semi government hospital

the knowledge scores were as follows: high –1; average –12; and low

89
knowledge –57; more than one fifth of the nurses who were working in
government hospital shows knowledge pattern was as follows: high –1;
average –8; low –16; and more than one fifth of the nurses who were
working in private hospitals knowledge level were as follows: average –
4; and low –21;.

Chi-square (χ2) was computed to find the association between the

knowledge of nurses with their type of hospital where they are working.
It was (4.387) less than the Table value (9.488). So the association
between knowledge of sample and type of hospital where they were
presently working was not significant.

The knowledge level of nurses on BMWM and the area of working

was as follows: 2 nurses had high knowledge (ICU –1; wards –1;). 24
nurses had average knowledge (wards –15; ICU –4; casualty and
emergency dept –2; OT –2; and OPD–1;) and 94 nurses had low
knowledge (wards –49; ICU –17; OPD –11; OT –10; and casualty and
emergency department –7;).

Chi square (χ2) value was computed to find the association

between the knowledge on BMWM with their working area. It was (3.28)
less than the Table value (15.51). No significant relationship was found
between knowledge on BMWM and working area.

90
 Table 21

Association between the attitude level of nurses regarding

biomedical waste management with their age
N = 120
Moderately
Unfavourable Favourable
favourable
Age in years Total

f % f % f %
20-25 years 1 0.8 40 33.3 8 6.7 49
26-30 years 9 7.5 15 12.5 18 15.0 42
31-35 years - - 13 10.8 3 2.5 16
36-40 years - - 9 7.5 1 0.8 10
Above 419
- - 1 0.8 2 1.7 3
years
Total 10 8.3 78 65.0 32 26.7 120

(χ2= 32.400 ; df=8)

Table 21 shows, the association between the nurses attitude on

BMWM with their age. 32 nurses had favourable attitude. Their age was
as follows: 20-25 years –8; 26-30 years –18; 31 -35 years –3; 26-40 years
–1; and above 41 years –2;. 78 nurses had moderately favourable
attitude. Their age was as follows: 20-25 years -40; 26-30 years –15; 31-
35 years –13; 36-40 years –9; and above 41 years –1;.

91
 10 nurses had unfavourable attitude. Their age was as follows : 20-
25 years –1; 26-30 years –9;.

Chi- square test (χ2) was computed to see the association between
the attitude level on BMWM with their age. Calculated value was 32.400,
df=8 and at 5% significant level, Calculated value was greater than the
Table value (15.51), so there was significant association between the
attitude level on BMWM with their age.

92
 Table 22

Association between the attitude level of nurses regarding

biomedical waste management with their sex.
N = 120
Level of attitude
Unfavourable Modera Favourable
Sex tely favouable
Total

f % f % f %
Male 4 3.3 6 5.0 4 3.3 14
Female 6 5.0 72 60.0 28 23.3 106
Total 10 8.3 78 65.0 32 26.7 120

(χ2= 9.007; df=2)

Table 22 shows the association between the attitude level of nurses

regarding BMWM with their sex. Maximum number of nurses was
females. Their attitude was as follows: favourable –28; moderately
favourable –72; and unfavourable –10;

Among the male nurses (14), 4 nurses had favourable attitude, 6

nurses had moderately favourable attitude, 4 nurses had unfavourable
attitude.

Chi square test (χ2) was computed to find out the association
between the attitude level on BMWM with their sex. Calculated value
was =9.007, df =2 and at 5% significant level. Calculated value was
( 9.007) greater than the Table value (5.99). So there was significant
relationship between the attitude level on BMWM with their sex.

93
 Table 23

Association between the attitude level of nurses regarding BMWM

with their professional background
N = 120
Unfavou Moderately Chi square
Favourable
Professional rable favourable value
Total
background
f % f % f %
G.N.M 10 8.3 74 61.7 25 20.8 109 χ2=8.744
Professional df=2 and at
5% level of
qualification [Link](N) - - 4 3.3 7 5.8 11
sig.
S
Below5
3 2.5 46 38.3 15 12.5 64
years
6-10
7 5.8 13 10.8 11 9.2 31
years χ2=18.532
11-15 df=8 and at
- - 11 9.2 3 2.5 14
Experience years 5% sig
16-20 level.
- - 8 6.7 2 1.7 10
years S
More
than 20 - - - - 1 0.8 1
years
Staff χ2=0.115
8 6.7 60 50.0 24 20.0 92
nurse df=2 and at
Designation Incha 5% sig
rge/hea 2 1.7 18 15.0 8 6.7 28 level.
d nurse NS
Attende χ =2.769
2
- - 12 10.0 7 5.8 19
Previous d df=2 and at
orientation Not 5% sig
training attende 10 8.3 66 55.0 25 20.8 101 level.
d NS

(S=significant; NS=not significant)

94
 Table 23 depicts clearly the association between the attitude level
on BMWM and professional background.

Under the variable i.e. professional qualification majority of the

nurses were G.N.M nurses (109). Their attitude towards BMWM as
follows: favourable attitude –25; moderately favourable attitude –74; and
unfavourable attitude -10; Nearly one tenth of the nurses were graduate
nurses. Their attitude scores were follows: favourable attitude –7; and
moderately favourable attitude-4;

Chi square (χ2) value was computed to see the association between
the attitude level on BMWM with their professional qualification. It was
(8.744) above than the Table value (5.99), df=2 and at 5% significant
level. So significant association was found between the attitude level on
BMWM with their professional qualification.

Among 120 nurses nearly two third of the nurses had moderately
favourable attitude (78). Their experience was as follows: below 5 years
–46; 6-10 years –13; 11-15 years –11; and 10-20 years –8; More than
one fourth of the nurses (32) had favourable attitude. Their experience
was as follows: below 5 years –15; 6-10 years –11; 11-15 years –3; 16-20
years –2; and more than 20 years –1; and only 10 nurses had
unfavourable attitude. Their experience was as follows: below 5 years –
3; 6-10 years -7;.

Chi square χ2 value was computed to find the association between

the attitude level on BMWM with their experience. It was (18.532) more
than the Table value (15.51) df=8 and at 5% significant level. So there
was significant association between the attitude level of nurses with their
experience.

95
 The attitude level of nurses on BMWM and their designation was
as follows: 78 nurses had moderately favourable attitude. Their
designation was as follows: staff nurses –60; and head nurse/incharge –
18; 32nurses had favourable attitude. Their designation was as follows:
staff nurse –24; and head nurse/incharge –8; and only 10 nurses had
unfavourable attitude. Their designation was as follows: staff nurse –8;
and head nurse/incharge –2;.

Chi square (χ2) value was computed to see the association between
attitude level on BMWM with their designation. It was (0.115) less than
the Table value (5.99) df=2 and at 5% significant level. So there was no
significant association was observed between attitude level on BMWM
with their designation.

Among 120 nurses, 19 nurses had previous orientation training

related to BMWM. In that 7 nurses were having favourable attitude and
12 nurses were having moderately favourable attitude. No one was
having unfavourable attitude towards BMWM. 101 nurses did not attend
any orientation training related to BMWM. In that 25 nurses had
favourable attitude, 66 nurses had moderately favourable attitude and 10
nurses had unfavourable attitude.

Chi square (χ2) value was computed to see the association between
the attitude level on BMWM with their previous orientation training.
Computed value (2.769) was less than the Table value (5.99), df =2 and at
5% significant level. The relationship between attitude level of nurses on
BMWM with their previous orientation was found to be not significant.

96
 Table 24

Association between the attitude level of nurses regarding

BMWM with their working background.
N = 120
Unfavou Moderately
Professional Favourable Chi square
rable favourable Total
background value
f % f % f %
Type of Semi χ2 22.826
5 4.2 52 43.3 13 10.8 70
hospital government df =4 and
Government - - 10 8.3 15 12.5 25 at 5%
Private 5 4.2 16 13.3 4 3.3 25 significant
level.
S
Present ICU 2 1.7 12 10.0 8 6.7 22 χ2=6.808
working Wards 6 5.0 41 34.2 18 15.0 65 df =8 and
area OPD 2 1.7 7 5.8 3 2.5 12 at 5%
Casualty and - - 8 6.7 1 0.8 9 significant
emergency level.
Dept. NS
OT - - 10 8.3 2 1.7 12

(S= significant ; NS= not significant )

Table 24 depicts the association between the attitude level on

BMWM of nurses regarding biomedical waste management with their
working background.

97
 More than one third of nurses had favourable attitude (32). Their
working hospital was as follows: semi government –13; government –15;
and private–4;. Nearly two third of the nurses had moderately favourable
attitude (78). Their working hospital was as follows : semi government –
52; government –10; and private –16; and only 10 nurses had
unfavourable attitude. Their working hospital was as follows : semi
Government –5; and private –5;.

Chi- square (χ2) value was computed to find the association

between the attitude level on BMWM and type of hospital. It was 22.826,
df=4 and at 5% level of significance. Table value was 9.488. Calculated
value was above than the Table value, so there was a significant
relationship between attitude level on BMWM with their type of hospital.
The attitude level of nurses on BMWM and the area of working
was as follows: more number of nurses (65) was working in wards. Their
attitude score was as follows: favourable –18; moderately favourable –41;
unfavourable –6; followed by ICU (22 nurses). Their attitude score was
as follows: favourable –8; moderately favourable –12; unfavourable –2;
followed by OPD (12 nurses). Their attitude score was as follows:
favourable –3; moderately favourable –7; and unfavouorable –2; casualty
and emergency dept (9 nurses). Their attitude score was as follows:
favourable –1; moderately favourable –8; and OT (12 nurses). Their
attitude score was as follows: favourable –2; moderately favourable –10;.
In casualty and emergency dept no one had unfavourable attitude.

Chi square (χ2) value was computed to find the association

between the attitude level on BMWM with their working area. It was
6.808, df=8 and at 5% significant level. Table value was 15.51,
computed value was less than the Table value. Significant association
was not found between the attitude level on BMWM with their working
area.

98
 Table 25

Association between the practices of nurses regarding

biomedical waste management with their age.
N = 120
Level of practice
Moderately
Age in years Inadequate Adequate
adequate Total
f % f % f %
20-25 years 34 28.3 14 11.7 1 0.8 49
26-30 years 31 25.8 10 8.3 1 0.8 42
31-35 years 12 10.0 4 3.3 - - 16
36-40 years 8 6.7 2 1.7 - - 10
Above 41 years 3 2.5 - - - - 3
Total 88 73.3 30 25.0 2 1.7 120

(χ2 =2.240; df=8)

Table 25 shows the association between the practices of nurses on

biomedical waste management with their age, among 120 nurses, only 2
nurses had adequate practices. Their age was as follows: 20-25 years –1;
26-30 years –1; 30 nurses falls in moderate level of practices. Their age
was as follows: 20-25 years –14; 26-30 years –10; 31-35 years –4; 36-40
years –2; and 88 nurses falls in inadequate practices. Their age was as
follows: 20-25 years –34; 26-30 years –31; 31-35 years –12; 36-40
years–8; above 41 years –3;

Chi square test (χ2) was computed to find out the association
between the practices with their age. Computed value was 2.240, which
was less than the Table value 15.51, with df=8 and at 5% significant
level. Hence there was no significant association between practices on
BMWM with their age.

99
 Table 26

Association between the practices of nurses regarding

biomedical waste management with their sex.
N=120
Level of practice
Moderately
Sex Inadequate Adequate Tot
adequate
al
f % f % f %
Male 12 10.0 1 0.8 1 0.8 14
Female 76 63.3 29 24.2 1 0.8 106
Total 88 73.3 30 25.0 2 1.7 120

(χ2 =5.205 ; df=2)

Table 26 shows the association between the practices of nurses

regarding BMWM with their sex, more number of female nurses were
participated in the study area (106). In that 1 nurse had adequate
practices. 29 nurses had moderately adequate practices and 76 nurses had
inadequate practices. Among the 14 male nurses 1 nurse had adequate
practices, 1 nurse had moderately adequate practice and 12 nurses had
inadequate practices.

Chi square text (χ2) was computed to find the significant

association between the practices and sex, calculated χ2 value was 5.205
which was less than the Table value 5.99, with df =2 and at 5%
significant level. Hence it is clear that there was no significant
association between practices on BMWM with their sex.

100
 Table 27

Association between the practices of nurses regarding

BMWM with their professional background
N= 120
Inade Moderately
Professional Adequate Chi square
quate adequate Total
background value
f % f % f %
G.N.M 83 63.2 26 21.7 - - 109 χ2=21.727
df=2 and at
Professional
5% level of
qualification [Link](N) 5 4.2 4 3.3 2 1.7 11
significance.
S
Below 5
45 37.5 17 14.2 2 1.7 64
years
6-10
23 19.2 8 6.7 - - 31
years χ2=3.607
11-15 df=8 and at
10 8.3 4 3.3 - - 14
Experience years 5% level of
16-20 significance
9 7.5 1 0.8 - - 10
years NS
More
than 20 1 0.8 - - - - 1
years
Staff
68 56.7 22 18.3 2 1.7 92 χ2=.813 df
nurse
=2, and at 5%
Head
Designation level of
nurse/In
20 16.7 8 6.7 - - 28 significance
charge
NS
nurse
Attended 10 8.3 8 6.7 1 0.8 19 χ2=5.713
df=2 and at
Previous
5%
orientation Not
78 65.0 22 18.3 1 0.8 101 significant
training attended
level
S

(Sig= significant ; NS= not significant)

101
 Table 27 describes the association between the practices on
BMWM and professional background.

Among the Diploma nurses no one had adequate practices. 26

nurses had moderately adequate practices and 83 nurses had inadequate
practices. Among the graduate nurses, 2 nurses had adequate practices, 4
nurses had moderately adequate practices and 5 nurses had inadequate
practices.

Chi square χ2 was computed to find the association between the

practices and professional qualification. The calculated value (21.727)
was more than the Table value (5.99), df=2 and at 5% significant level.
Significant association was found between the practices on BMWM with
their professional qualification.

Under experience wise, only 2 nurses had adequate practices who

had below 5 years of experience. 30 nurses had moderately adequate
practices, whose experience was as follows: below 5 years –17; 6-10
years –8; 11-15 years –4; 16-20 years –1; and 88 nurses had inadequate
practices, whose experience was as follows: Below 5 years –45; 6-10
years –23; 11-15 years –10; 16-20 years –9; and more than 20 years –1;.

Chi square (χ2) value was computed to find the association

between the practices on BMWM with their professional experience.
Calculated value (3.607) was less than the Table value (15.51), df=8, and
at 5% significant level. Hence there was no significant association was
found between the practices on BMWM with their professional
experience.

102
 19 nurses had attended orientation training programme on
biomedical waste management. In that one nurse had adequate practices,
8 nurses had moderately adequate practices and 10 nurses had inadequate
practices. Among the nurses who did not attended orientation programme
scored as follows: only one nurse had adequate practices.
22 nurses had moderately adequate practices and 78 nurses had
inadequate practices.

Chi square (χ2) test was computed to find the association between
the practices on BMWM and previous orientation training programme.
The calculated value (5.713) was lower than the Table value (5.99).
No significant association was found between the practices on BMWM
and previous orientation.

Among the 92 staff nurses 2 nurses had adequate practices,

22 nurses had moderately adequate practices and 68 nurses had
inadequate practices. Totally 28 nurses were head nurses/incharge nurses
in that 8 nurses had moderately adequate practices and 20 nurses had
inadequate practices.

Chi square (χ2) value was computed to find the association

between the practices with their designation. The computed value was
(0.813) less than the Table value (5.99), df =2 and at 5% significant level.
There was no significant association was observed between practices on
BMWM with their designation.

103
 Table 28

Association between the practices of nurses regarding BMWM

with their working background.
N =120

Level of practice
Chi
Inadeq Moderately
Working background Adequate Total square
uate adequate
value
f % f % f %
Semi Govt. 50 41.7 19 15.8 1 0.8 70 χ2 =
Type of Govern 4.085
17 14.2 8 6.7 - - 25
hospital ment d.f= 4
Private 21 17.5 3 2.5 1 0.8 25 NS
ICU 13 10.8 8 6.7 1 0.8 22
Wards 50 41.7 15 12.5 - - 65
OPD 9 7.5 3 2.5 - - 12 χ2 =
Working Casualty 8.077
area and d.f= 8
7 5.8 2 1.7 - - 9
emergency NS
dept
OT 9 7.5 2 1.7 1 0.8 12

(S=Significant; NS= Not Significant) at 5% significant level.

Table 28 describes the association between the practices on

BMWM with their working background.

70 nurses were working in semi government hospital. Among

them only one nurse had adequate practices, 19 nurses had moderately
adequate practices and 50 nurses were having inadequate practices.

104
25 nurses among the sample were working in private hospitals. Among
them only one nurse had adequate practices, 3 nurses had moderately
adequate practices and 21 nurses had inadequate practices. Among the
sample 25 nurses were working in government hospitals. Among them 8
nurses had moderately adequate practices and remaining 17 nurses had
inadequate practices. In government hospital no one had adequate
practices.

Chi square (χ2) value was computed to find the association

between the practices on BMWM and type of hospital. Calculated was
(4.085) less than the Table value (9.488) df=4 and at 5% significant level.
Significant association was not found between the practices on BMWM
and type of hospital.

The sample was described by their area of working area, adequate

practices was followed by 2 nurses. Their working area was as follows :
ICU –1; and OT –1; moderately adequate practices was followed by 30
nurses. Their working area was as follows: wards –15; ICU –8; OPD –3;
casualty and emergency dept –2; and OT –2; and more nurses were
following inadequate practices. Their working area was as follows: wards
–50; ICU –13; OPD –9; OT –9; and casualty and emergency dept –7;

Chi square χ2 value was computed to find the association between

the practices on BMWM and working area. Calculated value was (8.077)
less than the Table value (15.51). So there was no significant association
was found between the practices on BMWM and working area.

105
 Table 29

Association between knowledge, attitude and practices on BMWM

and available facilities in the hospitals.

Available facilities Knowledge Attitude Practices

χ2 value χ2 value χ2 value
Colour coding system 0.917 7.324* 1.577
Puncture proof container 1.017 2.471 2.323
Needle cutter 1.017 2.471 2.323
Incinerator 0.948 6.643* 0.449

(*= significant at 5% level ; df=2)

Table 29 describes the relationship between the knowledge,

attitude, and practices on biomedical waste management with available
facilities in the hospitals. Significant relationship was found between the
attitude level on biomedical waste management and colour coding system
(χ2=7.324), incinerator (χ2=6.643), df=2 and at 5% significant level.

All the hospitals were having the facility of autoclave and

coordination with pollution control board. None of the hospitals were
having the facilities like shredder and microwave.

106
 Section D

Data on correlation between the knowledge, attitude and practices.

Table 30

Correlation between the nurses knowledge and attitude, attitude and

practices and knowledge and practices.

Correlation
Paired correlation
value (r)

Pair 1 Knowledge and attitude 0.610 P <0.001

Pair 2 Knowledge and practices 0.501

Pair 3 Attitude and practices 0.297

Table 30 shows the correlation between the knowledge, attitude

and practices. The knowledge and attitude correlation value was r=
0.610. It shows that statistically highly positive correlation between the
nurses knowledge and attitude on biomedical waste management. The
knowledge and practices correlation value was r=0.501. It shows
statistically moderately positive correlation between the nurses’
knowledge and practices on biomedical waste management. The attitude
and practices correlation value was r=0.297. It shows that statistically
less positive correlation was observed between the attitude and practices
on biomedical waste management. Hence the H2, H3 and H4 were
accepted.

107
H2 - Significant relationship was found between the knowledge
level of nurses and the attitude level of nurses regarding
biomedical waste management.

H3 - Significant relationship was found between the knowledge

level and the practices of nurses about biomedical waste
management.

H4 - Significant association was found between the attitude level

and practices of nurses regarding biomedical waste
management.

108
 5. DISCUSSION

Nurses are playing vital role in the health care setting. Nurses are
involving in several aspects like preventive, promotive, curative and
rehabilitative in client care. Compare to all the aspects, preventive role is
very important than the curative role.

The study was designed to assess the knowledge, attitude and

practices of nurses regarding biomedical waste management. This study
was descriptive in nature, conducted from 1.02.05 to 5.03.05. Data were
collected from 120 nurses working in selected hospitals in Raichur. The
instrument consists of four sections.

Section A: Demographic data

Section B: Structured interview schedule to assess the knowledge level
on bio medical waste management.
Section C: Likert scale to assess the attitude on biomedical waste
management
Section D: Observational check list to assess the practices on bio
medical waste management.

The findings of the study have been discussed in relation to the

objectives and hypotheses.

Sample characteristics
40.8 percentage of the nurses were between the age group of 20-25
years, 35 percentage of the nurses were between the age group 26-30
years. 13.3 percentage of the nurses were in the age group of 31-35 years.
Less than one tenth (8.3%) of the nurses were 36-40 years. Only 2.5
percentage of nurses were above 41 years.

109
 Majority of the nurses were females (88.3%). Only 11.6 percentage
of nurses were males.

Majority of the nurses had undergone general nursing and

midwifery (90.83%) and less than one tenth of nurses were undergone
[Link] Nursing (9.16%). More than half of the nurses were having less than
5 years of experience (53.3%) other nurses experience was as follows. 6-
10 years (25.83%), 11-15 years (11.6%), 16-20 years (8.33%) and above
21 years (0.83%). More than three fourth of nurses were working as staff
nurses (76.6%). 23.3 percentage of the nurses were working as head
nurses/incharge nurses.

Majority of the nurses were not attended any orientation training

programmes (84.16%). Only 15.83 percentage of respondents were
attended orientation training programme. Among them ten per cent of
nurses were gained knowledge through inservice education and 4.1
per cent had through professional education and remaining 1.6 percentage
of nurses were obtained through mass media.

More than one fifth of the nurses were working in government

hospital (20.8%). 58.3 per cent of the nurses were working in semi
government hospital and more than one fifth of the nurses were working
in private hospitals (20.8%). More than half of the nurses (54.16%) were
working in wards. 18.3 percentage of nurses were working in ICU. Equal
number of nurses were working in out patient department (10%) and
operation theatre (10%). Only 7.5 percentage of nurses were working in
casualty and emergency department.

110
 The samples were working in the hospitals with the following
facilities: colour coding system (91.66%); puncture proof container and
needle cutter for sharp disposal (75%). All the hospitals, which was
included in the study, was having the facility of autoclave and co-
ordination with the pollution control board. More than half of the nurses
were working with the facility of incineration (58.3%). None of the
hospitals were having other facilities like shredder and microwave etc for
biomedical waste management.

The level of knowledge, attitude, practices regarding

biomedical waste management

Out of 120 nurses very negligible percentage of nurses had high

knowledge (1.7%) one fifth of the nurses had average knowledge (20%)
and more than three fourth of the nurses had low knowledge (78.3%). The
overall mean value of the nurses regarding knowledge on biomedical
waste management was 11.08 with standard deviation 5.27. These
findings inferred that most of the staff nurses had low knowledge on
biomedical waste management.

In the attitude scores, above one fourth of nurses had favourable

attitude (26.7%), nearly two third of nurses had moderately favourable
attitude(65%) and more than one tenth of the nurses had unfavourable
attitude (10%). The mean value of the attitude level of biomedical waste
management was 42.34, with standard deviation of 10.50. These findings
show that most of the staff nurses had moderately favourable attitude.

111
 In the practices scores, only 1.7 per cent had adequate practices.
One fourth of the nurses had moderately adequate practices (25.0%) and
nearly three fourth of the nurses had inadequate practices (73.3%).The
mean value of the practices regarding biomedical waste management was
5.49 with standard deviation 2.09. So the practices were not satisfactory.

Massroje HT was conducted a study in Palestine on medical waste

management. It was conducted among 400 healthcare workers. Data were
collected through questionnaire, checklist, interview. The results shows,
segregation was not done properly. Inadequate knowledge and practices
were observed. Attitude score was moderately positive.

The relationship of the nurses knowledge, attitude and

practices on biomedical waste management with the selected
variables

Significant association was found between knowledge on BMWM

and previous orientation training programme at 5% level of significance
(χ2= 17.553).

Significant association was found between the attitude on BMWM

and age (χ2= 32.400), sex (χ2=9.007), professional qualification
(χ2=8.744), experience (χ2=18.532) and type of hospital (χ2=22.826) and
available facilities (colour coding system (7.324), and incinerator (6.643))
and at 5% level of significance.

112
 Significant relationship was found between the practices on
BMWM and professional qualification at 5% level of significance
(χ2=21.727).

The relationship between the knowledge and attitude,

knowledge and practices and attitude and practices

Highly positive correlation was observed between the knowledge

and attitude (r=0.610) at 5% significant level.

Moderately positive correlation was observed between the

knowledge and practice (r=0.501) at 5% significant level.

Less positive correlation was observed between the attitude and

practices (r=0.297) at 5% significant level. Hence the H2, H3, H4 was
accepted.

So knowledge, attitude and practices are depends upon each other.

After assessing the knowledge, attitude and practices regarding

biomedical waste management, it was as clear that nurses were deficient
in all three areas. So information module was prepared and distributed
which will be helpful for them to improve their knowledge, attitude and
practices on biomedical waste management and the Investigator
conducted training programme in the selected hospitals with the request
of hospital authorities in the study area.

113
 6. SUMMARY

The purpose of the study was to assess the knowledge, attitude and
practices regarding biomedical waste management. The study was
descriptive in nature.

The objectives of the study were,

• To assess the knowledge, attitude and practices of nurses
regarding biomedical waste management.
• To analyze the relationship between knowledge, attitude and
practices of nurses related to biomedical waste management
with selected variables.
• To describe the relationship among the knowledge, attitude and
practices of nurses with regard to biomedical waste
management.
• To prepare information module for the nurses on biomedical
waste management.

Based on the objectives of the study the following hypotheses were

formulated.
H1 - There will be significant association between the
knowledge attitude and practices of the nurses and with
selected demographic variables.
H2 - There will be significant relationship between the knowledge
level of nurses and the attitude level of nurses regarding
biomedical waste management.

114
H3 - There will be significant relationship between the knowledge
level and the practices of nurses about biomedical waste
management.
H4 - There will be significant association between the attitude
level and practices of nurses regarding biomedical waste
management.

The variables under the study were: dependent variable-knowledge,

attitude and practices regarding biomedical waste management and
independent variables were: age, sex, Professional qualification,
experience, designation, previous orientation training, type of hospital,
present working area, and available facilities in the hospital.

The main study was conducted from 1.02.05 to 5.03.05 in selected

hospitals of Raichur. (Govt. district hospital, Opec hospital, Bandari
hospital, Nandini hospital and Navodaya diagnostic centre).

A total of 120 nurses who met all inclusion criteria were selected
from the hospitals as sample by using simple random sampling technique
by complete enumeration method. The Investigator first introduced
himself to the sample and explained the purpose of study. The
conceptual framework of the study was based on general systems theory
by Ludwig Vonbertalanftly. It was helped for the Investigator to assess
the knowledge, attitude and practices of biomedical waste management.

115
The tool consists of following sections.
Section A: Demographic data
Section B: Structured interview schedule to assess the knowledge level
on biomedical waste management.
Section C: Likert scale to assess the attitude on biomedical waste
Management
Section D: Observational check list to assess the practices on bio
medical waste management.

Knowledge items were divided into following areas.

• Definition, Classification of biomedical wastes.
• Segregation of waste.
• Storage and transport.
• Treatment facilities.
• Administrative and legal aspects in BMWM.

A five point likert scale was used for the study to assess the attitude
with 14 items. (7 positive items and 7 negative items).

An observational checklist was made with 14 items and used to

assess the practices.

The tool was sent for the validity to the 20 experts (Nurse
educators (11), Doctors (4), Psychologist (2), Bio statistician (1), and
clinical nurse (2)). The pilot study was conducted from 22.01.05 to
28.01.05. In order to establish the reliability of knowledge and attitude
items test retest method was used (knowledge items. 0.90 and attitude
items 0.95). For the practice items interrater reliability method was used
(0.91). The tool was found highly reliable.

116
 The data were analysed and interpreted in terms of the objectives
and hypotheses of the study. Descriptive and inferential statistics was
used for data anaysis. The level of significance was set 0.05 level.

Major findings of the study were:

• The nurses were categorized based on age were as follows 20-25
years (40.8%), 26-30 years (35%), 31-35 years (13.3%), 36-40
years (8.3%) and above 41 years (2.5%).
• Majority of the nurses were females (88.3%). Only 11.6 per cent
of the nurses were males.
• Majority of the nurses (90.83%) had undergone general nursing
and midwifery training and 9.16 per cent of the nurses had
undergone [Link] nursing training.
• Categorization of the nurses by experience were as follows: Less
than 5 years (53.3%), 6-10 years (25.33%), 11-15 years (11.6%),
16-20 years of experience (8.33%) and 25 years and above
(0.83%).
• More than one third of the nurses were working at staff nurses
(76.6%), less than one fourth of the nurses were working as
incharge/head nurses (23.3%).
• 15.83 per cent of the nurses had previous orientation training of
BMWM 84.16 per cent of nurses did not had any orientation
training on BMWM. Source for previous orientation was by in-
service education (10%), professional education (4.1%) and mass
media (1.6%).
• More than half of the samples were working in semi government
hospital (58.3%), one fifth of the nurses were working in
government hospital (20.8%) and also sample were chosen from
private hospitals (20.8%).

117
 • Nurses were working in different areas in the institutions was as
follows. ICU (18.3%), wards (54.16%), OPD (10%), OT (10%)
and casualty emergency department (7.5%).
• The hospitals which were considered under the study were having
following facilities like colour coding system (91.66%) puncture
proof container and needle cutter for sharp disposal (75%) and
incinerator (58.3%). All the hospitals were having the facility of
autoclave and co-ordination with pollution control board. None of
the hospitals had other facilities like shredder and microwave etc
for biomedical waste management.

II. Findings related to the knowledge level of nurses on BMWM.

Among 120 nurses very negligible percentage of the nurses had
high knowledge (1.7%). One fifth of the nurses had average knowledge
(20%) and more than three fourth of the nurses had low knowledge
(78.3%). The over all mean value of the nurses regarding knowledge of
biomedical waste management was 11.08 with the standard deviation
5.27.

III. Findings related to the association between the knowledge

regarding biomedical waste management and demographic variables
and other variables.
Significant association was found between the knowledge
regarding biomedical waste management and previous orientation
training. The calculated chi-square (χ2) value (17.553) was higher than
the Table value (5.99).

No association was found between the knowledge regarding

biomedical waste management and other variables such as age, sex,
professional qualification, experience, designation, type of hospital,
working area and available facilities.

118
IV. Findings related to the attitude level of nurses on BMWM.
In the attitude scores, above one fourth of nurses had favourable
attitude (26.7%). Nearly two third of nurses had moderately favourable
attitude (65%) and more than one tenth of the nurses had unfavourable
attitude (10%). The mean value of the attitude of biomedical waste
management was 42.34 with the standard deviation 10.50.

V. Findings related to the association between the attitude

regarding biomedical waste management and demographic variables
and other variables.
The calculated chi square χ2 value of nurses age (χ2=32.400), sex
(χ2=9.007), professional qualification (χ2=8.744), experience
(χ2=18.532), type of hospital (χ2=22.826) and available facilities (colour
coding system (χ2=7.324) and incinerator (χ2=6.643)) was higher than the
Table value. So significant association was found between the attitude
regarding biomedical waste management and age, sex, professional
qualification, experience, type of hospital and available facilities (colour
coding system and incinerator).

Insignificant association was found between the attitude regarding

biomedical waste management with their designation, previous
orientation training and working area.

VI. Findings related to practices of nurses on BMWM.

In the practices scores, only 1.7 percentage of the nurses had
adequate practices. One fourth of the nurses had moderately adequate
practices (25.0%) and nearly three fourth of the nurses had inadequate
practices (73.3%). The mean value of the practices of biomedical waste
management was 5.49 with standard deviation 2.09.

119
VII. Findings related to the association between the practices
regarding biomedical waste management and demographic variables
and other variables.
The calculated chi square value of professional qualification
(χ2=21.727) was higher than the Table value. So there was significant
association was found between the practices of found between the
practices of nurses regarding biomedical waste management and
professional qualification.

Insignificant association was found between the attitude regarding

biomedical waste management with their age, sex, experience,
designation, previous orientation training, type of hospital, working area
and available facilities.

VIII. Findings on the relationship between the knowledge, attitude

and practices regarding biomedical waste management.
There was high positive correlation was found between the
knowledge and attitude (0.610).
There was moderately positive correlation was found between
knowledge and practices (0.501).

Less positive correlation was found between attitude and practices

(0.297).

IX. Preparation of information module.

Information module was prepared and distributed to the nurses. It
will be helpful for the health care professional to improve their
knowledge, attitude and practices on BMWM.

120
 7. CONCLUSION

The following conclusions were made on the basis

of findings of the study.
• Among 120 nurses, very negligible percentage of the nurses had
high knowledge (1.7%). One fifth of the nurses had average
knowledge (20%) and more than three fourth of the nurses had low
knowledge (78.3%).
• In the attitude scores, above one fourth of nurses had favourable
attitude (26.7%). Nearly two third of nurses had moderately
favourable attitude (65%) and more than one tenth of the nurses
had unfavourable attitude (10%).
• In the practices scores only 1.7 percentage of the nurses had
adequate practices. One fourth of the nurses had moderately
adequate practices (25.0%) and nearly three fourth of the nurses
had inadequate practices (73.3%).
• Continuing education would help the nurses to keep the upto date
knowledge and which will be helpful for them to follow good
practices.
• Significant association was found between the knowledge and
previous orientation training programme.
• Significant association was found between the attitude and age,
sex, professional qualification, experience, type of hospital and
available facilities (colour coding system & incinerator).
• Significant association was found between the practices and
professional qualification.

121
• Significant relationship was identified between the knowledge and
attitude.
• Significant relationship was identified between the knowledge and
practices.
• Significant association was identified between the practices and
attitude.
• Knowledge, attitude and practices regarding biomedical waste
management depend upon each other.

122
 8. NURSING IMPLICATIONS AND
RECOMMENDATIONS

Implications:

The findings of the study have several implications for nursing

education, nursing practice, nursing administration and nursing research.
The implications, which have been made in the present study are very
essential to the nurse practitioners, nurse educators and nurse
administrators.

Nursing education

• The curriculum of different nursing programmes should

incorporate the topic on biomedical waste management to make
them to learn the methods of safe disposal of waste and protect
them from hazards.
• Inservice and continuing education programmes may be conducted
for the staff to enhance the knowledge on biomedical waste
management.
• Motivate the staff and student nurses to implement safe disposal of
waste procedures in their clinical area.
• Audio visual aids regarding biomedical waste management should
be prepared.

123
Nursing practice

1. Nursing superintendent / Head nurse

• Should involve in planning of biomedical waste management.
• Should plan and conduct orientation training programme on
biomedical waste management.
• Should recommend and provide adequate facilities to the health
care personnel for biomedical waste management.
• Supervised handling procedures should carried out for biomedical
waste management.
• Plan for incidental as well as planned health awareness campaign.
• Insisting the health care providers for labelling and keeping
pictures at the segregation point regarding colour coding.

2. Staff nurse should

• Monitor the proper segregation at the point of generation.
• Involves in orientation training programmes.
• Follows the hospital protocols in waste management.
• Informs the higher authority in case of any needle pricks.

Nursing administration

• Educating the nursing personnel on biomedical waste management

• Should provide adequate facilities and needed supplies.
• Nurse administrator should emphasize on prevention of
occupational hazards by recommending periodic health checkups
and vaccination.
• Develops standard protocols for proper waste management.
• Develops policies on safe handling of waste from the point of
waste generation to internal transportation.
• Should monitor for healthy practices in waste management.

124
Nursing research

• A study may be conducted on safe practices of nursing personnel

regarding waste management at periodic intervals.
• A similar study can be conducted on a larger sample covering the
entire nursing personnel in Raichur district.
• A study may be done on problem faced, acceptance of technique of
treatment and disposal of hospital waste.
• A study on nurses role in prevention of occupational hazards can
be conducted.

Recommendations

Based on the findings, the following recommendations are proposed

for future research:

• A comparative study may be undertaken in all types of health care

settings.
• A similar study can be carried out for other health care
professionals who are involved in BMWM in the hospital settings.
• A study may be undertaken to evaluate the practices of final
disposal treatment of hospitals.
• A comparative study may be conducted between the doctors and
nurses and other high health care personnel.
• An experimental studies may be conducted in treatment facilities.
• A comparative study may be conducted to assess the learning needs
of class iv employees on hospital management.

125
Projected outcome

An information module prepared by the Investigator will be

distributed to the sample. It can be used by any health professional to give

education and carryout the safe practices in the hospital on biomedical

waste management. By request of medical and nursing superintendents

the Investigator has conducted orientation training programme for the

nurses on biomedical waste management in all the selected hospitals.

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163
 ABSTRACT

A descriptive survey was carried out to assess the knowledge,

attitude and practices of nurses regarding biomedical waste management
in selected hospitals of Raichur, (Govt. District hospital, Opec Hospital,
Bandari Hospital, Nandini Hospital and Navodaya diagnostic centre) by
Mr. Mathar Mohideen, in Navodaya College of Nursing, Raichur. The
study was conducted in Partial fulfillment of the requirement for the
degree of Master of Science in Nursing of Rajiv Gandhi University of
Health sciences, Bangalore.

The objectives of the study were,

• To assess the knowledge, attitude and practices of nurses
regarding biomedical waste management.
• To analyze the relationship between the knowledge, attitude and
practices of nurses related to biomedical waste management
with selected variables.
• To describe the relationship among the knowledge, attitude and
practices of nurses with regard to biomedical waste
management.
• To prepare information module for the nurses on biomedical
waste management.

Methodology
The study was based on general systems theory by Ludwig
Vonbertalanftly. The data was collected by descriptive survey method.
120 nurses were selected as sample from the hospitals by complete
enumeration method of simple random sampling technique. Data were

164
collected by using structured interview schedule and observational
checklist. Both descriptive and inferential statistics were used for
analysis of data.

Major findings of the study were:

• The nurses were categorized based on age were as follows 20-25
years (40.8%), 26-30 years (35%), 31-35 years (13.3%), 36-40
years (8.3%) and above 41 years (2.5%).
• Majority of the nurses were females (88.3%). Only 11.6 per cent
of the nurses were males.
• Majority of the nurses (90.83%) were undergone General Nursing
and Midwifery and 9.16 per cent of the nurses were undergone
[Link] Nursing training.
• Categorization of the nurses by experience were as follows: Less
than 5 years (53.3%), 6-10 years (25.33%), 11-15 years (11.6%),
16-20 years (8.33%) and above 20 years of experience were only
0.83 per cent.
• More than one third of the nurses were working as staff nurses
(76.6%), less than one fourth of the nurses were working as
incharge /head nurses (23.3%)
• 15.83 per cent of the nurses had previous orientation of BMWM
84.16 per cent of nurses did not had any orientation training on
BMWM. Source for previous orientation was by inservice
education (10%), professional education (4.1%) and mass media
(1.6%).
• More than half of the sample were from semi government hospital
(58.3%). More than one fifth of the nurses from government
hospital (20.8%) and also from private hospitals (20.8%).

165
• Nurses were working in different areas in the institutions was as
follows. ICU (18.3%), wards (54.16%), OPD (10%), OT (10%)
and casualty and emergency department (7.5%).
• The hospitals which have considered under the study were having
following facilities like colour coding system (91.66%) puncture
proof container, and needle cutter for sharp disposal (75%),
incinerator (58.3%). All the hospitals were having the facility of
autoclave and co-ordination with pollution control board. None of
the hospitals had other facilities like shredder and microwave etc
for biomedical waste management.
• More than three fourth of the nurses had low knowledge (78.3%).
Mean knowledge score was [Link] the knowledge level on
BMWM was found low.
• Above one fourth of nurses had favourable attitude (26.7%) and
nearly two third of nurses had moderately favourable attitude
(65%). Mean attitude score was 42.34. So the attitude level on
BMWM was moderately favourable.
• Nearly three fourth of the nurses had inadequate practices (73.3%).
Mean score was 5.49. So the practices on BMWM were
inadequate.
• Significant association was found between the knowledge and
previous orientation.
• Significant association was found between the attitude and age,
sex, professional qualification, experience, type of hospital and
available facilities (colour coding system and incinerator).
• Significant association was found between the practices and
professional qualification.

166
 • There was high positive correlation was found between the
knowledge and attitude (0.610). Moderately positive correlation
was found between knowledge and practices (0.501) and less
positive correlation was found between the attitude and practices
(0.297).

Conclusion
The nurses knowledge, attitude and practices on biomedical waste
management depend upon each other. Nurses’ knowledge, attitude and
practices scores were not satisfactory. So they need to be educated on
BMWM and their knowledge, attitude and practices should be improved
to achieve better care.

167
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172
 Annexure I
Letter requesting for conducting the main study
From
The Principal,
Navodaya College of Nursing,
RAICHUR.

To

Sir/ Madam,

Sub : Seeking permission for conducting study about Biomedical

waste management among nursing staff of your hospital,
Raichur by Mr. N. Mathar Mohidden 2nd year [Link].
(Nursing) course.

This is for your kind information that Mr. N. Mathur Mohideen, 2nd
year [Link]. (Nursing) student of this college has selected following
problem for his research work / thesis as required by university in partial
fulfillment of his [Link]. (Nursing) course.

Topic : “A study to assess the knowledge, Attitude, Practices of

nurses regarding biomedical waste management in selected hospitals
of Raichur.” He would like to conduct research study in your hospital. I
request you to grant permission for his study and extend your guidance
and cooperation in this matter.

Thanking you,
Yours Faithfully,

PRINCIPAL
Sd/-
173
 Annexure II

Letter seeking Acceptance From The Content Validators

From
Mr. Mathar Mohideen.N
IInd Year [Link] Nursing Student
Navodaya College of Nursing
Raichur

To

Through the proper channel

Respected Sir/Madam,

Sub: Letter for opinion and suggestions of experts for establishing

content Validity of the research tool requested regarding.

I am, Mr. Mathar Mohideen.N doing my final year [Link] Nursing at Navodaya
College of Nursing in Raichur, have selected the following topic for the dissertation,
to be submitted to RGUHS, as partial fulfillment of university requirement for
awarding Master of Nursing Degree.

Topic:
“A Study to Assess the Knowledge, attitude and practices of Nurses
regarding Bio-Medical Waste Management in selected hospitals of Raichur.”

In this behalf, I have developed a tool, which is organized in the following

headings.
Section A : Demographic data Section C : Attitude Scale
Section B : Knowledge questionnaire Section D : Observational Check list

I will be very thankful to you if you could kindly go through the tool and give
your valuable suggestions on content validity. I am herewith enclosing the study
objectives, variables and certificate of validation.
Thanking you,
Yours faithfully
(Mr. Mathar Mohideen.N)

Signature of Principal Signature of Guide

174
 Annexure III

CONTENT VALIDITY CERTIFICATE

This is to certify that Mr. Mathar Mohideen.N. II Year [Link](N)

student in Navodaya College of Nursing, Raichur, who has selected the
Topic “A Study to Assess the Knowledge, attitude and practices of
Nurses regarding Bio-Medical Waste Management in selected
hospitals of Raichur.” The tool was validated by me. The suggestions/
advices are here with enclosed.

Sd/-

Expert’s name

175
 Annexure IV

List of experts consulted for the content validity.

Mrs. A. Ganalakshmi Principal

Govt. college of Nursing
Hyderabad.

Mrs. K. Draksayani Devi Principal

NIMs College of Nursing
Hyderabad.

Sr. Anne Principal

Vijay marry college of nursing,
Hyderabad.

Dr. Manjunath Professor & HOD of Paediatrics

N.M.C.H & R.C
Raichur.

Dr. Ram Mohan Consultant

Care Hospital
Hyderabad

Dr. Johan Consultant

Care Hospital
Hyderabad

176
Dr. Ravi Raju Consultant
Care Hospital
Hyderabad.

Mrs. S. Rafath Razia Professor

Govt. College of Nursing
Hyderabad.

Mrs. Shakunthala Professor

NIMS College of Nursing
Hyderabad.

Mrs. C.R. shamshad Begum Asst. Professor

Govt. College of Nursing
Hyderabad.

Mrs. T. Vasundhara Tulasi Lecturer

NIMS College of Nursing
Hyderabad.

Mrs. Geetha Srinivas Lecturer

NIMS College of Nursing
Hyderabad.

Mrs. Valli Lecturer

Govt. College of Nursing
Hyderabad.

177
Mrs. Jayaprada Lecturer
Govt. College of Nursing
Hyderabad.

Mrs. T. Vijayalakshmi Lecturer

NIMS College of Nursing
Hyderabad.

Dr. [Link] Lecturer in Psychology

Nizams Arts and Science College
Hyderabad.

Mr. Chandra Mouli Psychologist

Ambedkar University
Hyderabad.

Mr. Porchalean Biostatistician

Ramachandra Medical College
Chennai.

Ms. Archana Head Nurse

Infection control Unit
Care hospital
Hyderabad.

Ms. Anbarasi Head Nurse

Infection control Unit
Care hospital
Hyderabad.

178
 Annexure V
Consent Form

Dear participant,

I would like to get some information regarding your knowledge

and attitude about Biomedical waste management. The information will
be used only for the partial fulfillment of the [Link]. Nursing programme
and information will be kept confidential. This is for information and
kind participation.

Signature of the
Investigator

I ………………………….. here by consent to participate and undergo

the study.

Signature of the
Participant

179
 Annexure VI
Part – A

Demographic Data
Sample No:
1. Age: ( )
a) 20-25 years
b) 26-30 years
c) 31-35 years
d) 36-40 years
e) Above 41 years
2. Sex: ( )
a) Male
b) Female
3. Total years of experience ( )
a) Below 5 years
b) 6-10 years
c) 11-15 years
d) 16-20 years
e) More than 20 years
4. Professional qualification ( )
a) General nursing and midwifery
b) [Link] (Nursing)
5. Designation ( )
a) Staff nurse
b) Incharge nurse /Head nurse

180
 6. (i) Have you attended any orientation training programme on
biomedical waste management ? ( )
a) Yes
b) No
6. (ii) If yes what was the source for attending the orientation
training programme? ( )
a) Professional education
b) Inservice education
c) Mass Media
d) Any other
7. Working area ( )
a) Intensive care unit (all the specialty intensive care units)
b) Wards (it includes medical, surgical, opthalmology, ENT,
labour room, antenatal, postnatal, special rooms,
paediatrics),
c) Out patient department
d) Casualty and emergency department
e) Operation theatre (all the specialty operation theatre) ( )
8. What facilities are available at your hospital? ( )
a) Colour coding system Yes/No
b) Puncture proof transparent container Yes/No
c) Incinerator Yes/No
d) Autoclave Yes/No
e) Microwave Yes/No
f) Shredder Yes/No
g) Needle cutter or destroyer Yes/No
h) Coordination with pollution control board. Yes/No
i) Chemical disinfect ion facilities Yes/No

181
 Part –B

Interview Schedule to assess the knowledge regarding biomedical

waste management among the nurses

1. What is biomedical waste? 1 Mark

a) Produced during boiling ( )
b) Produced during the procedures in hospitals
c) Produced in factories
d) Produced in polluted areas
2. What is the symbol of biohazard? 1 Mark

a) ( )
b)
c)
d) ⌫
3. What is the major classification of waste? 1 Mark
a) Chemical, toxic ( )
b) Infectious, non infectious
c) Physical, chemical
d) Biological, physical
4. How the cytotoxic waste is generated? 1 Mark
a) Generated from anti neoplastic drug ( )
b) Generated from antiemetic drugs
c) Generated from anti pyretic drugs
d) Generated from anti inflammatory drugs

182
5. Why segregation of the waste is important? 1 Mark
a) To reduce the workload ( )
b) To avoid mixing of infectious and non-infectious waste
c) Easy to dispose
d) To save time
6. What is the ideal bin to dispose the waste? 1 Mark
a) Water proof colour coded bin with lid closure ( )
b) Metal bin
c) Plastic bags
d) Card board boxes
7. Which type of waste is collected in Red container with biohazard
symbol? 1 Mark
a) Soiled dressings ( )
b) Contaminated cotton
c) Infected plastics
d) Laboratory waste
8. Which colour coded bin with biohazard symbol is used for
anatomical and pathological waste? 1 Mark
a) Yellow ( )
b) Blue
c) White
d) Red or black
9. Which colour coded bin with biohazard symbol is used for disposal
of glass items? 1 Mark
a) Yellow ( )
b) Blue
c) White
d) Orange

183
10. Which colour coded bin with biohazard symbol is used for official
type of waste? 1 Mark
a) Yellow ( )
b) Green
c) Blue
d) White ( )
11. Which type of waste is discarded in green container with biohazard
symbol? 1 Mark
a) Kitchen waste ( )
b) Ward waste
c) Laundry waste
d) OT waste
12. How will you discard the sharp materials? 1 Mark
a) All purpose metal bin ( )
b) Plastic bin
c) Yellow container
d) Puncture proof transparent container with sodium hypo chlorite
solution
13. What is your responsibility if mixing of waste with yellow
container? 1 Mark
a) It is not a serious issue ( )
b) Whole waste, has to be treated as infectious waste
c) Replace the waste into its containers
d) Put it into the red bag
14. When the cover in the waste colour container has to be tied? 1Mark
a) When it is filled fully ( )
b) When it is filled ½
c) When it is filled ¾
d) When it is filled ¼

184
15. How long the waste can be stored in hospital? 1 Mark
a) For 7 days ( )
b) For 72 hours
c) For 48 hours
d) For 4 days
16. Which route is preferred for transport of waste inside the hospital?
a) Back way 1 Mark
b) Least used by public ( )
c) Entrance
d) Through Lift
17. What is the important aspect to be seen in the waste transport
vehicle? 1 Mark
a) Symbol of infection ( )
b) Symbol of pollution control
c) Symbol of WHO
d) Symbol of biohazard
18. What is the importance of shredding in waste disposal? 1 Mark
a) It helps to burn the waste ( )
b) It helps to reduce the volume of waste
c) It helps to cut the waste into small pieces
d) It helps to boil the waste
19. Why autoclaving is important before disposal of syringes, tubes
and gloves? 1 Mark
a) Reduce the size ( )
b) Increase the size
c) Avoid reuse
d) Reduce the weight

185
20. What is pulverization? 1 Mark
a) Heating ( )
b) Boiling
c) It is the process by the waste is reduced by one tenth in volume
d) Dumping
21. How the placenta is disposed? 1 Mark
a) Dumping ( )
b) Incineration
c) Drain
d) Municipal bin
22. Which one should not be incinerated? 1 Mark
a) Cotton ( )
b) Bandages
c) Anatomical waste
d) Chlorinated plastics ( )
23. How the incinerated ash is stored? 1 Mark
a) Closed storage container ( )
b) Opened container
c) Colour coded bin
d) Plastic bags
24. Which type of waste should not be discharged into sewers? 1 Mark
a) Laundry waste ( )
b) Cyto toxic waste
c) Kitchen waste
d) Office waste

186
25. Which is the useful method for final disposal of liquid waste in
rural and small health care institutions? 1 Mark
a) Soakage pits ( )
b) Municipal drain
c) Septic tank
d) Large drain
26. Which is the most satisfactory method for disposal of garbage?
a) Land filling 1 Mark
b) Municipal drain ( )
c) Septic tank
d) Incineration
27. What is the important aspect to be considered while purchasing
incinerator? 1 Mark
a) Less cost ( )
b) Air pollution control system
c) Less work load
d) Small size
28. Which is the prescribed authority for Biomedical waste
management? 1 Mark
a) WHO ( )
b) Central Government
c) Government Hospital
d) State Pollution control Board

187
29. If biomedical waste management rules are violated, what
punishment will be given? 1 Mark
a) Rs. 1 lakh/imprisonment for 5 years ( )
b) Rs. 2 lakh/imprisonment for 5 years
c) Rs 3 lakh/imprisonment for 5 years
d) Rs 4 lakh/imprisonment for 5 years
30. How does the biomedical waste management committee can reduce
the wrong way of disposal in colour containers? 1 Mark
a) Keeping security near by the colour containers ( )
b) Insisting the nurses to write ward name and date on the covers
c) Asking the nurses for mixing of waste
d) Punishing the nurses

188
 Part-C

Assessment of attitudes regarding biomedical waste management

among nurses

Undecided

Disagree
Strongly
Strongly

disagree
Agree
agree
Sl
Items
No

1. If health team members are effectively

implementing necessary measures in
biomedical waste management, the
incidence of illness will be reduced.
2. The nurses and other health team
members should be given training on
biomedical waste management.
3. Single person cannot regulate the proper
waste management.
4. Periodical classes and demonstration of
biomedical waste management is
necessary for upgrading the knowledge
of nursing staffs.
5. Introducing biomedical waste
management unit in to the nursing
curriculum will bring out effective
management of biomedical waste
management in the working areas in
future.

189
 Undecided
Disagree
Strongly
Strongly

disagree
Agree
agree
Sl
Items
No

6. To safeguard the rag pickers, government must

formulate and regulate necessary rules &
regulations and implement steps effectively.
7. Labelling over the waste will reduce confusion.
8. It is difficult to reduce the amount of waste
produced in the hospital.
9. More colour containers, may leads to
mismanagement.
10. It is difficult to identify and categorize the
waste.
11. Busy schedule may interfere with the disposal
of waste.
12. Biomedical waste management is time
consuming process.
13. Biomedical waste management needs more of
expenditure.
14. It is difficult for the nurse to co-ordinate with
other health team members in biomedical waste
management because of positional hierarchy.

190
 Part –D
Assessment of practices regarding biomedical waste management

[Link] Observational check list YES NO

1. Identifying and labelling infectious and non-
infectious waste
2. Using yellow colour container with biohazard
symbol is for anatomical and pathological waste.
3. Using red colour container with biohazard symbol
is for infected plastics.
4. Using blue colour container with biohazard symbol
is for infected glass items.
5. Using black colour container with biohazard
symbol is for Cyto toxic waste, Expired medicines
& Chemical waste.
6. Using green colour container with biohazard
symbol is for kitchen waste.
7. Using white colour container with biohazard
symbol is for non infected plastics and general
waste.
8. Using protective devices like gloves, gown, mask,
cap, boot while handling waste.
9. Closing the container soon after putting the waste
10. Disposal of sharps items
a) Disinfect with chemicals
b) Strong in puncture proof container/cutting by
needle destroyer

191
[Link] Observational check list YES NO
11. Monitoring the package the waste when it is filled
¾ of the cover in the colour coded bin.
12. Monitoring the internal transportation without
spillage of waste materials.
13. Involves in giving education on biomedical waste
management.
14. Maintaining record and reports related to
biomedical waste management.

192
 Annexure VII
Scoring key

Assessment of knowledge regarding biomedical waste management

among nurses
[Link] Key Score
1. b 1
2. a 1
3. b 1
4. a 1
5. b 1
6. a 1
7. c 1
8. a 1
9. b 1
10. d 1
11. a 1
12. d 1
13. b 1
14. c 1
15. c 1
16. b 1
17. d 1
18. c 1
19. c 1
20. c 1
21. b 1

193
22. d 1
23. a 1
24. b 1
25. a 1
26. a 1
27. b 1
28. d 1
29. a 1
30. b 1
Total 30

194
 Scoring Key

Assessment of attitude regarding BMWM among the nurses

Item No Nature of the item

1-7 Positive Items
8-14 Negative Items

The response for each item was measured as a five point scale as
follows:

Options Positive Statements Negative statements

Strongly agree 5 1
Agree 4 2
Undecided 3 3
Disagree 2 4
Strongly disagree 1 5

The maximum score is 70.

195
 Scoring key

Assessment of practices regarding biomedical waste management

among nurses

[Link] Key Score

1. Yes 1
2. Yes 1
3. Yes 1
4. Yes 1
5. Yes 1
6. Yes 1
7. Yes 1
8. Yes 1
9. Yes 1
10. a Yes 1
10.b Yes 1
11. Yes 1
12. Yes 1
13. Yes 1
14. Yes 1
TOTAL 15

196
 Output
Adequate practices

High knowledge,
Input Throughput favourable attitude

Nurses age, sex, professional Knowledge, attitude and practices

background, designation, regarding BMWM
previous orientation, type of
hospital, working area and Average
available facilities. knowledge
Structured interview schedule, Moderately
likert attitude scale, favourable attitude
observational checklist Moderate or
Poor practices
Low knowledge
unfavourable
Information attitude
Feed back module

Under the study

Not under the study

Fig No: 1 Conceptual Frame Work of Ludwig vonbertalanftly’s –General Systems Theory

21
HEALTH CARE WASTE MANAGEMENT CONCERNS US ALL, LET’S WORK TOGETHER

FOR A HEALTHY ENVIRONMENT

Information Module

127
 Information Module

Topic : Biomedical waste management

Group : Staff Nurses, Incharge/Head Nurses

Places : Civil Hospital, Navodaya Medical College Hospital and research centre

Opec hospital, Nandini hospital, Bandari hospital and Navodaya diagnostic centre

Duration : 60 minutes

Method of teaching: Lecture cum discussion

AV aids : Flash cards, Black board, pamphlet, Leaflet, Transparencies and posters.

General objective : The nurses in selected hospitals will be able to acquire knowledge about biomedical waste

management and able to implement the correct practices in their working area.

128
Specific objectives:

The nurses will be able to

• Define bio-medical waste.

• List the hazards of biomedical waste management.

• Differentiate the types of waste.

• Practices the universal principles in handling waste.

• Identifies the method of segregation.

• Follows the correct storage methods.

• Select the transport facilities.

• Categorizes the treatment technologies.

• Identifies the final disposal of hospital waste.

• Follows the recommendations in handling of waste.

• Recognizes the administrative aspects of biomedical waste management.

129
 Audio
Specific Teacher
Duration Content visual Evaluation
objectives activity
aids
2 To introduce Introduction Introduces Black Enumerate
Minutes the topic on Healthcare personnel including doctors, nurses and the topic to board the concept
BMWM paramedical staff, who will be the guardians of the health of the nurses of
the community. Healthcare is highly critical and essential healthcare.
service, extra attention is needed specifically to the issues
concerning infrastructure and training. The whole concept of
‘health care’ is paying attention to the minute problems of the
patient, nursing, comforting and helping the patient till he/she
is well again. It is the duty of the entire healthcare
establishment to ensure speedy recovery of their patient’s by
maintaining clean and infection free environments.

While basic sanitation and cleanliness have always been

mandatory requirements in healthcare establishments, there

130
 are other issues such as biomedical waste which is often
ignored that it can be directly responsible for the spread of
diseases in the general community and specifically among
health care persons.

5 minutes The nurses Definition: Define Transp What is

will be able to Bio medical waste: Bio medical aren biomedical
define bio Bio medical waste is, “any waste, which is generated waste. cies waste?
medical waste during diagnosis, treatment or immunization of human beings
or animals.”13

Health care waste is extremely hazardous if it is not

managed properly, it can lead to serious health and
environmental problems. Healthcare waste is different from
our domestic waste and must be segregated, collected, stored,
transported and disposed properly.

131
5 minutes The nurses Health care personnel constantly face health hazards such Explaining Charts What are
will be able to as: about the the hazards
list the hazards • Pricks/ cuts from sharps like needles, blades, broken health of improper
of biomedical glasses, scalpels etc. hazards waste
waste • Infections due to contact with patients, their blood, related to manage
management sputum, urine, stool and other body fluids. BMWM. ment?
• Allergies due to dust, smoke fumes and chemicals.2

Healthcare personnel and the general community face

hazards from:
Radioactive and cytotoxic medicines generally given to
cancer patients. These, if left exposed can cause death or
disability to any one.
• Highly infectious diseases can spread in the
community unless proper precautions are taken.
• Disposable items can be repacked and resold causing
spread of infections.

132
 • The indiscriminate dumping of untreated hospital
waste in municipal bin increasing the possibility of
epidemic.

Chances of vectors like cats, rats, mosquitoes, flies and stray

dogs getting infected and becoming carriers which also
spread diseases in the community.2

5 minutes The nurses Types Lecture Flash What are

will be able to General waste cum cards the different
differentiate Although there is so much hazard from hospital waste, discussion types of
the types of 65-70 per cent of the waste generated in a hospital is non hospital
waste infectious and non-hazardous. These are general waste and waste?
can be managed easily, if segregated properly at source.

General waste includes items like paper, cardboard boxes,

plastic packaging, metal boxes and kitchen waste is also
another kind of general waste.

133
 Generally dry waste can be sold for recycling while
kitchen waste can be composed at convenient site inside the
hospital.
General waste though easy to handle, needs to be managed
with care. It must be segregated from infected waste.
Infectious waste
“Portion of biomedical waste which may transmit viral,
bacterial or parasitic diseases, if concentration and virulence
of pathogenic organisms is more”.
• This category includes cultures and stocks of infectious
agents from laboratory waste from surgeries and
autopsies.
• Wastes originating from infectious patients in isolation
wards.
• Waste that has been in contact with infected patients
undergoing hemodialysis.
• Waste that has been in contact with animals inoculated
with an infectious disease.6

134
Pathological waste:
Consists of tissues, organs, body parts, human fetuses
animal carcasses; and mostly blood and body fluids. Apart
from the infectious nature of this waste, its appropriate
disposal it required on ethical grounds.2

Infected plastics:
Disposable items like syringes, tubes, gloves etc is
segregated in red liners, autoclaved or microwaved and then
shredded and washed before disposal.
Such treatment prevents their value and renders their
reuse and renders them sterile and useless. It is advisable that
such waste is treated at site to avoid any risk of repacking and
reuse. Chlorinated plastics should never be incinerated as
their incineration can emit dioxin, furans, and other
hydrocarbons in the air.2

135
Sharps:
Sharps are the most dangerous components of healthcare
waste, which can injure the healthcare personnel and all those
coming into contact with this waste. Sharp items include
needles, blade scalpel and metal sharps, broken and unbroken
glass material.2

Chemical waste
The hospital may generate chemical waste like
disinfectant, insecticides, pesticides etc. furthermore,
chemically contaminated containers are also generated. The
containers should be cleaned and mutilate but never reused or
recycled for making containers, for storing substances, for
human and animal use.2

Radio active waste:

Radioactive chemical dyes and isotopes of various
elements are frequency used for diagnosis and treatment.

136
 Radioactive waste is therefore generated at the site of
diagnosis and treatment. Radioactive waste may be solid or
liquid form.2

5 minutes The nurses Universal principles in handling of waste Explaining Leaflet What are
will be able to • There is a need for reduction in the amount of waste the the
practice the generated in hospitals and other healthcare and universal principles
universal research institutions. principles in of handling
principles. • Use of reusable items like stainless steel trays, ceramic handlings of of waste?
mugs etc. in place of disposable items need to be waste
encouraged. Proper cleaning after use should be
ensured.
• Segregation and treatment of waste at the site of
generation must be promoted since it general and
infectious waste get mixed then the whole waste has to
be treated as infectious.

137
 • Treatment and disposal of waste should take place as
for as possible to the point of production as it is
technically and environmentally possible or pretreated,
it should transported to a common facility away from
the hospital, dispensary, clinic, research institution etc.
• Attention to be focused on disposal of ash left after
incineration in secured land fills.6

5 minutes The nurses Segregation Lecture Show List out the

will be able to Segregation is defined as separation of different types of cum ing the advantages
identifies the waste by sorting. discussion colour of
advantages of coded segregation
Advantages of segregation
segregation bins
• Waste minimization
methods and
• Effective waste management
posters
• Decrease in expenses incurred in managing wastes

138
 • Reduced risk of infection ensuring better health care
• Prevention of infection to communities living in the
vicinity of the hospital who may be exposed to the
infectious hospital waste.
The waste has to be segregated in colour coded liners
placed in appropriate sized lidded bins.

White: Used for segregating office/non infected dry waste.

Green: Used for kitchen waste.

Red: used for infected plastics that have to be autoclaved.

Red bags should never incinerated.
Yellow: used for highly infectious items like anatomical
waste pathological waste, blood/body fluid soaked cotton.
Anatomical wastes in yellow labeled liners are sent for
incineration/deep burial.

139
 Blue: used for glass items and preferably should be puncture
proof.
Translucent puncture proof or stainless steel: used for
needle, blades etc and should be puncture proof. Jerry cans,
cardboard boxes or stainless steel containers are often used to
collect metal sharps.
Lead containers: used for storing radioactive waste until the
ten half life period.
Black: used for storing chemicals and chemical containers.
Cytotoxic waste and incinerator ash etc.
Sturdy card board boxes: cytotoxic waste can be stored.2
5 minutes The nurses Storage:
will be able to Storage means “the holding of biomedical waste for such Explaining Charts How will
follows the period of time. At the end of which waste is treated and about you store
correct storage disposed of. In another words it means the duration of time storage the hospital
methods the wastes are kept in the areas of generation, transit, till the methods waste ?
point of disposal.

140
 Authorized person handling biomedical waste shall
ensure that:
• The packaging of all wastes is done in sturdy leak
proof containers conforming to specification.
• All containers used for storage of such wastes shall be
provided with a lid/cover and covered properly.
• The container in which such wastes are stored shall
display prominently and label in red colour with details
of biomedical wastes.
• Such containers shall be inaccessible to scavengers and
protected against insects, birds and animals. The waste
has to be protected from rain.
• No spillage during handling or transit of such waste.
• Infectious waste should not be stored beyond 48 hours
during this period itself it should be treated and made
noninfectious.

141
 • The name of the radio active given day, period of
storage should be mentioned on the label clearly and
radio active hazard” should be in bold.
Storage of sharps should have following characteristics.
• Sturdy, puncture proof container made up of
plastic/metal.
• The container’s should contain appropriate
disinfectants like polar bleach, sodium hypochlorite
etc.
• It should have a mechanism to show when it is filling
three fourth, so that it can be replaced.
• It should have handle so that it can be transported
easily.
Waste collection area/centre should have the following
characteristics:

142
 • Area should be marked.
• Waste should be covered and protected from animals.
• There should be the facility of locking.
• It should be away from the public places and food
preparation areas.
• Area size should be adequate for storage.2
5 minutes The nurses Transport: Explaining Transp What
will be able to The movement and transport of waste is essentially a part about the arenc precautions
select the of comprehensive waste management system in small health transport ies should be
appropriate institutions. There are two types of transport.1. Intramural facilities taken while
transport (internal) transport. The transport of waste from the point of transporting
facilities generation, collection and storage in the wards to the point the waste?
out side the building premises, where it is kept pending for
the transport to the actual site of disposal. 2. Extramural
(external) transport. The transport of wastes from central
collection point outside building premises to the site of final
disposal.

143
 • Internal transport is by pushcart, garbage trolley and
wheel barrow.
• External transport is by cycle rickshaw and garbage
van/lorry.

Operational aspects
• Route of transport inside the hospital should be chosen
which are least used by the public.
• Transportation timings should not clash with peak
working hours and meal distribution findings.
• There should be a documentation system, which should
be recorded, the type of waste taken by whom for
which type of disposal on specific day/shift.
• Vehicles used for clinical waste collection and
transport should be thoroughly cleaned and disinfected
immediately.

144
 • General/non hazardous waste should be taken by
municipal/civil authority from the dumping site in the
hospitals and regular monitoring of the same should be
done.
• The vehicle should have refrigerator facility in case of
ambient temperatures are high as in the summers.
• Always tie the waste bag when it fills three fourth.6

10 minutes The nurses Treatment technologies Explains the Flash What are
will be able to Autoclave treatment card the pre
categorize the In an autoclave, waste is treated under high temperature and techno treatment
treatment pressure for 1 hour or 45 minutes respectively. This results in logies precautions
technologies sterilization of waste, sterilization is the destruction of all should be
form of microbial life including viruses, fungal or bacterial
taken before
endospores. Plastic, metal and glass items can be autoclaved.
the final
Autoclave waste is then shredded and washed. After being
disposal?
processed the waste which is sterile, should be shredded and
safest place for recycling.2

145
Hydroclave
This is a low heat thermal process which is an
innovation of the autoclave designed to apply steam an
indirect heating source, allowing total dehydration of waste.

In addition the waste is also internally agitated and

fragmented to attain high degree of sterilization of all waste
components and particles.

The treatment time is 15 minutes at 1320C or 30

minutes at 1210C achieve level 6.8 sterilization.

This is a low heat thermal process with the difference

in the sense that unlike other low heat processes which heat
the waste from outside, this heating occurs inside the waste
material.6

146
Microwaves
Microwaves are electromagnetic waves that enter into
or penetrate materials. It is the portion of electromagnetic
spectrum, lying between 300mega hertz and.300,000mega
herz. Here high frequency microwave causes molecules
within the wave to vibrate, generating heat from within.
Plastics and glass items can be treated by microwave,
cytotoxic, radio active material, metal sharps cannot be
treated by this method.
Microwavable wastes are introduced in a special
treatment chamber, which heats the waste to 970C and 1000C.

Chemical disinfection
Hospital waste e.g. infected plastics, rubber and metal
items can be treated by using various chemicals like bleach,
sodium hypochlorite etc. disinfection should ensure correct
concentration, exposure, time and penetration. This method

147
of treatment is most effective and it is not require large
investments, but if not properly done can be ineffective and
cause infection. For instance blood or organic material
activates hypochorite and hence this method would be
ineffective for treating the waste with high organic.2

Incineration
Incineration is the process by which combustible
materials are burned, producing combustion gases and non-
combustible residues and ash. They use high temperature
combustion under controlled conditions to convert waste
containing infectious waste and pathological material into
inert mineral residues and gases.

Conventional incinerator: It is single chambered and it

functions with the help of wood.

148
Electrical incinerator:
It is also single chambered. It functions with the help
of electricity. For 40 kg/hour burning required 93-kW/Hr
electricity.

Oil fired incinerator

It is multiple chambered. It functions with the help of
some electricity and oil.

The following categories of the hospital waste can be

incinerated.
• Surgical, autopsy and obstetrical waste like placenta.
• Human and animal tissue containing pathogens which
are infectious.
• Dialysis and ward waste which have had contact with
blood and body fluid.
• Isolation room wastes
• Blood and blood products

149
Compaction
Compaction techniques are used to reduce the waste
volume and affect waste identity generally a hydraulic ram is
used to compress the waste against a rigid surface, so that it
gets compressed or compacted. It will not affect the nature of
the waste by it will destroy the containers.

Grinding and shredding

These are used to convert medical wastes into a more
homogenous form so that they are easily handled. There the
wastes are physically broken down by primary and secondary
shredding in one pass into smaller particles and the
equipments are maintained at negative pressure to ensure that
no material escape from outside.

Pulverization
This is a process by which waste is reduced by one tenth
in volume. The system consists of wastes and the container

150
 being placed on a large enclosed incline conveyor and carried
to a feed hopper where a large volume of water and sodium
hypoclorite (bleach solution) are introduced.
The waste is torn into small shreds and fed along with
chorine solution into an ultra high speed hammer mill
consisting of closed chamber in which large steel blades spin
at approximately 3,600 revolutions per minute.
By the action of this, cloth items are reduced to fibrous
pulp, glass is reduced to sand, sharps and other metal objects
are reduced to small safe particles, soft tubing and dialyser
filters are completely powdered.10

5 minutes The nurses Final disposal methods Lecture Pamphl What is

will be able to (i) Land filling : cum et land filling?
identifies the This is the most satisfactory method of garbage is by land discussion
final disposal filling. However the site of landfill has to chosen.
of waste - Away from the sensitive aquifers and scores of water.

151
 - Away from public view
- Sign boards should be put at these sites.
Land filling is done by any of the following methods
a) Trench method – Long trench 2-3 meters deep and 3-
10 meters wide depending upon local condition, is
made. The treated waste is ideally compacted upto 2
meters, covered with excavated earth.
b) Ramp method- This is well suited where the terrain is
moderately slopping and some excavation is done to
secure covering material.
c) Area method- The treated waste is deposited packed
and consolidates in uniform layers up to 2-2.5 meters
deep. Each layer is seated on its exposed surface with a
mud cover at least 12” thick to prevent infestation of
files and rodents etc.

152
(ii) Pit burial
This is suitable for small camps or institutions, where in a
small pit of size 2 Mts. by 2 Mts. is dug and the waste are put
there with 10cm soft between each layer of waste, when the
level is almost full. It is closed with thick layer of soil.
Contents get decomposed 4-6 months time.
(iii) Composting
Composting is a method of combined disposal of refuse
and night soil or sludge. It is a process of nature where by
organic matter breaks down under bacterial action resulting
in the formation of a relatively stable material called compost
which has considerable manorial value as it contains nitrates
and phosphates.

Disposal of waste water

Waste waters and liquid wastes from the kitchen,
cafeteria and laundry should be drained into the

153
municipal/civic drains. In case no sewer connections are
available in the hospital, they should develop their own
sewerage treatment plants.

Soak pits can be a useful method for final disposal of

liquid wastes in rural or small healthcare institutions, as they
were cheap, simple to build and require only tools for
digging. The drawback is that it is not effective in rainy
season.

Disposal of anatomical and pathological waste:

This must be incinerated, the ash can be sent for
specialized landfills, as it is sterile.
Disposal of sharps
All sharps need to be disinfected or sterilized through
microwaving, autoclaving or dry heating and then sent for
final disposal.

154
 Disposal of radioactive waste
Radioactive waste must be stored in special containers
until ten times their half-life period before the waste
transported. It should then disposed in secured landfills.
Liquid radioactive waste should be discharged into drains
only after its ten half life period is over.
Disposal of cytotoxic waste
Small amounts of cytotoxic waste can be buried at site or
incinerated. Larger quantities, it produced should be send for
secured landfilling through proper system.6
5 minutes The nurses Recommendation in handling of waste Lecture Transp Why plastic
will be able to • Never put plastics in yellow bags. cum arenc articles
follow the • Plastics should not be incinerated. discussion ies should not
recommendati • Waste should never transferred from one bag to be
ons in another. incinerated?
handling of • Trolley should be used for transportation inside the

waste hospital.2

155
3 minutes The nurses Administrative aspects
will be able to Service charges:
recognize the The service charge collected ranges from Rs. 2.50-
administrative 4/bed/day in most places in the country when the services
aspects in provided.

BMWM Prescribed authority:

The state pollution control board is the prescribed Lecture Charts
authority at the state level. cum
• Every authorized person has to maintain records discussion
related to generation, collection, reception, storage,
transportation, treatment etc
• It any accident occurs in any institution it has to be
reported.
• In case of violating biomedical waste management
rules, the administrator is punishable with
imprisonment for 5 years or fine of 1 lakh rupee.13

156
Conclusion
The management of biomedical waste requires diligence and
care from a chain of people, starting with the nurse or doctor
who use the equipment, supplies that become waste,
continuing through to the hospital attendant, or ancillary staff
who provides clean bags or containers and carriers should be
away from the waste, on to the mechanics and technicians
who keep the vehicles and equipments in good condition and
finishing with the person responsible for ensuring that waste
is disposed of in the correct way. If any of these are careless
in their work, or allow scavengers access to the waste, the
chain is broken and dangers. Hence it is the responsibility of
health care personnel to dispose the biomedical waste in an
efficient manner in order to promote the clients health
specifically and community health at large.

157
Improper waste management will affect

The health of the human being

158
Do’s and Don’t Dos in Biomedical Waste Management

159
Segregation of Waste

160
Segregate The Waste at Source

161
162
 Treatment Technologies in Biomedical Waste Management

Hydroclave

Microwave
Autoclave
163
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