KNOWLEDGE ON SPILLAGE
MANAGEMENT AMONG
PARAMEDICS IN HOSPITAL BAHAGIA
ULU KINTA
AHMAD YUSOF BIN BADARUDIN
ADIP2/2024(07)-0002
CCRM 4024
SUPERVISOR: MARINA BINTI IDI
1
OUTLINE
Background Problem Research Research Literature Methodology Data
Of Study Statement Question Objectives Review Collection
Procedure
Research Demographic Knowledge Association Discussion Recommend Conclusion
Findings ation
Reference
2
BACKGROUND
Spillage management is crucial in healthcare settings, particularly in
southeast asia, as accidental releases of hazardous substances can pose
serious risks to patients, workers, and the environment, including
contamination and the spread of diseases (shi et al., 2020; musoke et al.,
2015).
In malaysia, rapid urban growth and more healthcare facilities have
increased hazardous spill risks, with paramedics and healthcare workers
often first to respond. These challenges, common across southeast asia,
highlight the need for effective spill management to prevent public health
risks (tadesse, 2020).
3
PROBLEM STATEMENT
Spillage management in healthcare Limited access to resources like PPE and
settings across malaysia and southeast Advanced disinfection methods,
asia faces challenges, as healthcare especially in rural areas, worsens
workers, including paramedics, often spillage management issues. Adriana
and maria henriqueta (2013) highlight
lack proper training, leading to the need to address systemic
inconsistent practices. The lack of weaknesses to reduce risks. Without
standardized guidelines increases the better training and interventions, poor
risk of errors that compromise safety spillage management could lead to
and compliance (vidhyashree et al., environmental damage, occupational
2022; aung et al., 2021). hazards, and a loss of public trust in
healthcare systems.
4
RESEARH QUESTION AND OBJECTIVES
Research Question Research Objectives:
examine the relationship between
1. What is the level of knowledge paramedics’ knowledge on spillage
regarding spillage management management among paramedics in
among paramedics? Hospital Bahagia Ulu Kinta
2. How are spillage management • To assess the level of knowledge on
practices implemented by spillage management among paramedics.
paramedics in clinical settings?
• To determine the practices of spillage
3. What is the relationship between management applied by paramedics in
paramedics’ knowledge and clinical settings.
practices of spillage management
and behavioural maladjustment? • To determine the relationship between
knowledge and practices of spillage
management and behavioral
maladjustment
5
CONCEPTUAL
FRAMEWORK
This framework emphasizes that
insufficient knowledge, poor
adherence to protocols, or lack of
access to training/resources may
increase the likelihood of behavioral
maladjustment. It draws on regional
and international literature, which
affirms that improving knowledge,
training, and resource allocation is
vital to ensuring safe and consistent
spill response behaviors
6
LITERATURE REVIEW
BODILY FLUID BLOODBORNE PATHOGEN
According to National Health Service Scotland Denault et al. (2023) highlight that bloodborne
(2020), the human body produces various fluids
pathogens, found in human blood, can cause
such as blood, urine, saliva, and others, which
can carry infectious microorganisms and should severe diseases and pose a major risk to
be handled carefully. Even though these fluids healthcare workers. These pathogens are mainly
aren't always classified as biohazards, they must spread through needle injuries, cuts, bites, or
be managed quickly to prevent the spread of
exposure to infected bodily fluids. Healthcare
pathogens. Biological hazards, or biohazardous
materials, are a major concern in occupational workers who perform invasive procedures or
health (Adriana & Maria Henriqueta, 2013). handle high blood volumes are particularly at
risk.
7
LITERATURE REVIEW
USE OF DISINFECTANT KNOWLEDGE ON SPILLAGE MANAGEMENT
In a study by aranke et al (2021), sodium
hypochlorite, commonly known as bleach, has The study found that registered nurses had
been used for many years due to its effective an average knowledge of 78.6% regarding
biomedical waste (BMW) protocols,
antimicrobial properties. Its mechanism of action showing a strong understanding of waste
involves the formation of the hypochlorite ion management, needle stick injury
when dissolved in water. Hypochlorite is effective
prevention, and spillage protocols. This
aligns with previous research in Mangalore,
against both viruses and bacteria, but has reduced where nurses had the highest awareness of
efficacy against endospore-forming bacteria and BMW practices, with 61.3% knowing safe
fungi. The acidity of the solution and the
collection, segregation, and disposal
methods, followed by doctors (46.6%), non-
concentration of hypochlorite are crucial factors teaching staff (37.7%), and lab technicians
influencing its germicidal activity and cleaning (27.9%).
efficiency
8
METHODOLOGY
RESEARCH SETTING:
HOSPITAL BAHAGIA ULU KINTA
TANJUNG RAMBUTAN
9
METHODOLOGY
SETTING
• HOSPITAL BAHAGIA ULU KINTA
STUDY DESIGN
• CROSS SECTIONAL SDUDY
POPULATION N: 200
• n:150
METHOD
• CONVINIENCE SAMPLING
TOOL
• GOOGLE FORM TOOL
10
DATA COLLECTION PROCEDURE
Type of Analysis Method Used Variables Analyzed
Age, gender,
Frequencies,
Descriptive Statistics education level, and
Percentages
NMRR training attendance
APPROVAL Knowledge scores,
Means, Standard
practice scores,
Deviations
confidence levels
DISTRIBUTE Knowledge ↔
QUESTIONAIRE Inferential Statistics Pearson Correlation Practice, Practice ↔
Confidence
Same variables as
OBTAIN Pearson, if
DATA Spearman’s Rho
assumptions are not
met
Training exposure vs.
ANALYSE
DATA IN Chi-square Test Behavioural
SPSS outcomes
Knowledge & Practice
Linear Regression → Behavioural
Maladjustment 11
RESEARCH FINDINGS
According to Field (2013), Cronbach’s Variable No. of items Cronbach’s Result
alpha value above 0.7 is considered alpha
acceptable for reliability, while
Knowledge 5 0.572 Quite
a value between 0.6 and 0.7 is deemed and practices Reliable
20 acceptable for exploratory research
Training and 4 0.617 Reliable
improvement
Total Distributed Total Completed Response rate
Questionnaire Questionnaire (%)
150 150 100
12
DEMOGRAPHIC DATA DEMOGRAPHIC DATA ON SPILLAGE MANAGEMENT
AMONG PARAMEDICS IN HBUK
100
• Participant who answered the 90
questionnaire is particularly nurses 80
who worked in HBUK for 1-5 years
70
compared to seniors who did not
answer. Souza et. al (2016) 60
• Assistant medical officer otherwise, 50
even with different job title, conducted 40
same responsibility as nurses in male
30
patient care.
20
• People with advanced diploma and
bachelor’s degree contributes a 10
significant role as in improving 0
knowledge on spillage management
13
RESEARCH FINDINGS
KNOWLEDGE AND PRACTICE ON 54% of the 150 paramedics reported regular training on
biohazardous spill management, while 46% did not. This nearly
SPILLAGE MANAGEMENT equal split suggests that training protocols at Hospital Bahagia
Ulu Kinta are not standardized. As a result, paramedics may
120
have different levels of knowledge, leading to inconsistent
96
spill responses. Regular, standardized training is essential to
100
ensure paramedics are equipped to handle hazardous spills
81 effectively (Goniewicz et al., 2021).
80
58 60
60 8.7% of respondents report daily exposure to biohazardous
spills, and 40% experience spills weekly. Only 7.3% face spills
40
monthly, while 14% encounter them occasionally. This high-
21 exposure environment calls for regular training and quick
20
11 access to PPE. According to Possas & Pérez-Rodríguez (2023),
0 routine access without proper training can increase cross-
Do you receive How often do you contamination and work-related risks. This emphasizes the
regular training on encounter
biohazardous spill biohazardous spills in
need for hands-on spill management training in high-risk
management your workplace departments.
14
RESEARCH FINDINGS
Which of the following steps do you take when managing a • 34% of respondents collected the right equipment
biohazardous spill? (Select all that apply.)
for spill management, 30% used PPE, and 18.7%
Frequency Percent Valid Cumulative
Percent Percent performed a spillage evaluation. However, only
Valid Cordon off the spill 9 6.0 6.0 6.0 6% removed the spill and 11.3% disinfected it.
Assess the type of spillage 28 18.7 18.7 24.7
These low numbers suggest poor adherence to
Gather the correct 51 34.0 34.0 58.7 proper spill management practices. Many
equipment
responses may reflect a lack of knowledge or
Wear personal protective 45 30.0 30.0 88.7
equipment (PPE) forgetfulness, leading to incomplete or improper
spill handling, which puts both staff and patients
Disinfect and clean the spill 17 11.3 11.3 100.0 at risk. A clear protocol and targeted training are
Total
needed to address this knowledge-action gap.
150 100.0 100.0 15
RESEARCH FINDINGS
Have you attended a training program on biohazardous Have you attended a training program on biohazardous spill
management within the past year?
spill management within the past year?
Frequency Percent Valid Percent Cumulative
Percent
VYes 84 56.0 56.0 56.0 44%
aNo 66 44.0 44.0 100.0 56%
lTotal 150 100.0 100.0
i
d
• The majority of respondents (56%) reported participating in a biohazardous spill training
program within the past year, while 44% had not.
• This indicates that while training is being offered, it has not reached all paramedics, leading to
concerns about inconsistent preparedness across the workforce.
• Aligina et al. (2022) recommended that, given the frequency of spills observed, annual training
should be mandatory for all paramedics to ensure consistent knowledge, enhance
16
competence, and mitigate risks.
RESEARCH FINDINGS
Good knowledge:
•This category was determined based on the paramedics' ability to
correctly identify and apply key protocols for biohazardous spill
management, such as using the correct PPE, following spill
containment steps, and knowing proper disinfection procedures.
Around 20% of the respondents demonstrated these high levels of
competence.
Moderate knowledge:
•The majority of the respondents (approximately 65%) fell into this
category. They are familiar with the general spill management
procedures but may struggle in high-pressure situations or fail to
consistently apply protocols. These respondents are likely to have
received some training but may need additional practical experience
or refresher courses.
Poor knowledge:
• A small group, about 15%, showed poor knowledge of spill
The bar chart above illustrates the distribution of management. This group either lacked awareness of the necessary
paramedics' knowledge levels on spillage management steps or failed to implement basic practices, such as proper
based on the data disinfection or spill containment. Their responses to the questionnaire
17
indicated significant gaps in their understanding and practices.
RESEARCH FINDINGS
Chi-Square Test Results for Demographics vs Knowledge and Practice
Gender vs Knowledge and Practice: The p-value of
Demographic Low (%) Moderate (%) High (%) X² p-value
0.000 suggests a significant relationship between
Gender 0 12 20 49.712 0.000
Female 0 12 20 gender and knowledge and practice.
Male 0 11.33 23.33
Age 0 8.66 7.33 0.000 0.624 Age vs Knowledge and Practice: The p-value of 0.624
25-30 years
31-35 years
0
0
8.66
10
7.33
8
indicates no significant relationship between age and
Above 35 years 0 7.33 5.33 knowledge and practice.
Below 25 years 0 6.66 13.33
Educational Qualification vs Knowledge and
Educational 0 10 8 0.000 0.398
Qualification Practice: The p-value of 0.398 indicates no significant
Advanced 0 10 8 association.
diploma
Degree
Diploma
0
0
7.33
6.66
5.33
13.33
Professional Designation vs Knowledge and
Professional 0 12 20 0.000 0.880 Practice: With a p-value of 0.880, there's no significant
Designation
Assistant 0 12 20
association.
Medical Officer
Nurse 0 11.33 23.33
Years of Experience vs Knowledge and Practice: The
Years of 0 10 8 0.000 0.402 p-value of 0.402 shows no significant relationship
Experience
1-5 years 0 10 8
between years of experience and knowledge.
6-10 years 0 7.33 5.33
Less than 1 0 6.66 13.33
.
year
18
More than 10 0 12 20
RESEARCH FINDINGS
Chi-Square Test Results for Demographics vs Training and Improvement
Demographic Low (%) Moderate (%) High (%) X² p-value
Gender 0 7.33 5.33 50.712 0.000
Female 0 7.33 5.33
Male 0 6.66 13.33
Age 0 7.33 5.33 0.000 0.572 The p-values suggest that none of the
25-30 years 0 7.33 5.33
31-35 years 0 6.66 13.33
demographic factors (gender, age,
Above 35 years 0 10 8 education, designation, or experience)
Below 25 years 0 7.33 5.33 are significantly associated with
Educational 0 10 8 0.000 0.398 training and improvement in spill
Qualification
Advanced diploma 0 10 8 management. This implies that the
Degree 0 7.33 5.33
training effectiveness may be
Diploma 0 6.66 13.33 influenced by other factors, such as
Professional 0 12 20 0.000 0.880
Designation
training quality or exposure, rather
Assistant Medical 0 12 20 than these demographic variables.
Officer
Nurse 0 11.33 23.33
Years of Experience 0 10 8 0.000 0.473
1-5 years 0 10 8
6-10 years 0 7.33 5.33
Less than 1 year 0 6.66 13.33 19
RECOMMENDATIONS
[Link] and Enhance Spill Management Training
•Develop clear training programs that combine theory and practical exercises to improve paramedics' readiness (Goniewicz et al.,
2021; Meltzer et al., 2024).
[Link] Clear, Updated Guidelines
•Create simple, standardized spill protocols and regularly update them based on new research (Kielar et al., 2021; Karin et al.,
2021).
[Link] Resource Availability
•Ensure that PPE and disinfectants are always available by conducting regular checks, and place spill kits in key areas (Tadesse,
2020; Aranke et al., 2021).
[Link] Confidence through Hands-On Training
•Increase hands-on training, including practical workshops and simulations, to build confidence in handling spills (Urban, 2023;
Meltzer et al., 2024).
[Link] Continuous Learning and Feedback
•Offer regular refresher courses and gather feedback to improve spill management training (Aligina et al., 2022; Possas & Pérez-
Rodríguez, 2023).
20
CONCLUSION
• Significant gaps in spill management knowledge among paramedics, with many showing moderate or poor understanding of
protocols. This indicates a lack of standardized and universally attended training programs, leading to inconsistent spill response
practices.
• Additionally, limited access to essential resources like ppe and disinfectants, especially in underserved areas, further exacerbates
the problem. The analysis also shows that age and years of experience do not strongly correlate with knowledge, highlighting the
need for better training rather than relying on demographic factors.
• To address these issues, it is crucial to develop standardized training programs that combine theoretical knowledge with practical
exercises to improve paramedics' preparedness. Spill management protocols should be regularly updated and enforced to ensure
all paramedics are equipped with the right knowledge.
• Ensuring resource availability through regular audits, providing hands-on training, and fostering continuous learning through
refresher courses are essential steps. Collecting feedback from paramedics will also help in refining training programs and
improving overall spill management practices (goniewicz et al., 2021; meltzer et al., 2024; kielar et al., 2021; karin et al., 2021;
tadesse, 2020; aranke et al., 2021; urban, 2023; aligina et al., 2022; possas & pérez-rodríguez, 2023).
21
REFERENCE
Aranke, et al. (2021). Antimicrobial properties and efficacy of sodium hypochlorite in hospital settings. Journal of Clinical Disinfection.
Aung, Y. N., Azizan, N., Carandang, R. R., & Guad, E. (2021). Different domains of dengue research in Malaysia: A systematic review and meta-analysis of questionnaire-based studies.
Denault, D., et al. (2023). Occupational exposure to bloodborne pathogens: Epidemiology and prevention. Infectious Disease Clinics of North America.
Goniewicz, K., Goniewicz, M., Włoszczak-Szubzda, A., Burkle, F. M., Hertelendy, A. J., Al-Wathinani, A., ... & Khorram-Manesh, A. (2021). The importance of pre-training gap analyses and
the identification of competencies and skill requirements of medical personnel for mass casualty incidents and disaster training. BMC Public Health, 21, 1-11.
Karin, et al. (2021). Factors influencing the efficacy of sodium hypochlorite as a disinfectant in healthcare settings. Journal of Disinfection Studies.
Mana, Z., & Tassi, A. (2024). Improving healthcare workers’ biohazardous spill safe handling skills. Unpublished study.
Meltzer, G. Y., Merdjanoff, A. A., Gershon, R. R., Fothergill, A., Peek, L., & Abramson, D. M. (2024). Adverse effects of the Deepwater Horizon oil spill amid cumulative disasters: A
qualitative analysis of the experiences of children and families. Journal of Child and Family Studies, 33(6), 1995-2011.
Musoke, D., et al. (2015). Occupational health hazards for healthcare workers. National Health Service Scotland.
Shi, X., et al. (2020). Healthcare workers' exposure to occupational hazards in Chinese hospitals. International Journal of Occupational Health.
Tadesse, M. L. (2020). Healthcare waste management and spillage handling practices in Addis Ababa. Public Health Facilities Review.
Vidhyashree, et al. (2022). Knowledge, attitude, and practice on blood and body fluid spill management among nursing students in Chennai, Tamil Nadu. Journal of Nursing Edu.
These sources are vital for enhancing knowledge on spill management, healthcare worker safety, and the prevention of exposure to hazardous biological and chemical materials.
22