CHAPTER I INTRODUCTION

Hospital is one of the complex institution which is frequently by people from every walk of life in society without any distinction between age, sex, race and religion for the health care setting, which restore and maintain community health are also threatening there well being. Poor waste management practice cause a huge risk to health of public, patient, professionals and contribute to environment degradation (Joseph & Krishanan, 2004). It is reported that for the first time the bio-medical waste management issue was discussed at meeting convinced by WHO regional office at Bergen Narway, 1983. Environmental Protection Agency Act, 1986 of USA in this regard culminated in passing of Medical Waste Tracking Act (MWTA). Bio-medical waste management handling rule 1998 lay down clear method of disposal bio-medical waste. Bio-medical defined as any waste generated by heath care setting laboratories, home care, diagnoses treatment or immunization of human being, of animals or research activities used in the production or resting of biological. Pollution control board of every state has been given the task of authorizing and implementing rules.

The waste generated has been increasing due to the use of disposable material and development in medicine production. Hazardous and toxic material office board of public work Los Angles 1995 estimated that around 15% of hospital waste is with infectious agent potentially hazardous to human health such as Hepatitis-B, C, HIV, T.B., Typhoid etc. As these changes have been gradual and waste disposal was not previously perceived as a major concerned the response of hospital fields has been largely piecemeal and uncoordinated (Wangsaatmaja S., 1997). Not only solid waste is considered as major problem in many developing countries but other waste such as water waste due to lack of investment and infrastructure in some cases, waste water discharge from hospital often runs directly into near water bodies (Nelson et. al., 1993). Improperly discharge waste to sewerages will generate waste water potentially dangerous handler. Moreover, most hospital incinerators were never designed for disposable of large quantities of waste. The most appropriate way of identifying categories of bio-medical waste is by storing waste in colour coded plastic bags or containers. Biomedical waste should segregated in to containers/bags at the point of generation in according with schedule II of bio-medical waste management handling rule 1998 according to as given in table two in booklet.

With the passage of time the problem has evolved as a global humanitarian issue. In our country this issue has attracted the attention of Honble Supreme Court of India and guidelines has been issued the biomedical waste management and handling rule 1998 lay down clear method for disposable of bio-medical waste management. In the present study an attempts is made to determine awareness about bio-medical waste management policy, practices and to access about biomedical waste management knowledge level towards it and develop by medical waste management plan for health care environment setting special focus on selected hospital of Rohtak. NEED FOR THE STUDY: A man who committed a mistake and does not correct it is committing another mistake. Human existence produces waste as the need are elaborated day by day, the type of waste and quantum of waste also increased, whether it may be at home, office, industries, hotels and in health care setting. The bio-medical waste, it means all waste generated by health care setting, research centers and laboratories. In addition including health care waste originated from (home care, home deliveries and bed ridden patients).

According to bio-medical waste management and handling rule under Environmental Protection Agency Act, 1986. Bio-medical waste is the major health hazardous to community. Increase the generation of waste from health care setting and its improper disposable have drawn attention of environmentalist, media and general public. From the time of Florence Nightingale environment is the key concept of health, so we started providing the conducive environment to the client but a forgetting or neglecting waste generated from client care. The report of WHO consultation on medical waste in developing countries reveals that health care waste management is an important subject that needs urgent attention in most circumstances. It is appropriate to consider an incremental approach, realizing that is knowledge regarding biomedical waste management among all health care member 91% of staff nurses were not trained so their poor level knowledge regarding colour code used for different categories and their method of disposal 23% were not aware of precaution for preventing of HIV/AIDS, 55% were not using protecting devices even study reveals that there is need for improvement can

be started from the basic level of periodic training of staff nurses by strengthening their knowledge and attitude. The indiscriminate and unregulated dumping of health care waste sharp exposes the most under privileged and informal sector like rag pickers to avoidable health risk. According to WHO study incidents of hospital acquired infection is 10%. It can be said to be that the hospital have become reservoir of infection. According to bio-medical waste management and handling rule (under Environmental Protection Agency Act, 1986) rule -4 explains, it shall be the duty of every occupier of an institution generating bio-medical waste which includes a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathology laboratory, blood bank by whichever name called to take all steps to insure that such waste is handled without any adversed effect to human health and environment. WHO estimated that unsafe injection causes worldwide every year as given: HIV infection 30000 new cases, HBV 8 million

 HCV 1.2 million Needle stick injuries are very common and an occupational hazard for all health care workers the problem is much more common in our country due to lack of proper education on this problem. The exact extent of this

problem is not estimated in our country, a look at some Western, estimate will help us to understand the magnitude of this problem. Data from USA indicate that 600000 to 800000 such injuries occur annually. Data suggested that at average for health care worker approximately 30 needle stick injuries per hundred bed in a year. About half of these injuries go unreported. The awareness regarding bio-medical waste management is very less among staff nurses of selected hospital of Rohtak due to lack of guidance and resources to manage at hospital level. Hence, they need proper knowledge to practice which protect self and environment. A clear and safe environment will attract client by building up public confidence. With the support of literature, researcher, assumed the staff nurses of selected hospital of Rohtak certain amount of awareness on bio-medical waste management but due to lack of availability of complete information and guidance proper equipments and other facilities to practice. Better waste management will not be possible and policy regarding bio-medical waste

management is not existing hence the staff nurses of selected hospital Rohtak practice ineffectively. Health care associated infections are preventable as per finding of hygiene standard 2007 improve the status of hygiene has been shown to reduce infection with good hand hygiene remain universally low 40% to 50%. The study concludes the bio-medical waste management practices in majority of staff nurses of selected hospital Rohtak is unscientific. However, there are smaller majority of staff nurses in these institutes which practice the more sound on bio-medical waste management training and awareness program are lacking. The need which generating, collecting, receiving, storing, transporting, treating, disposing and handling the bio-medical waste improvement. STATEMENT OF PROBLEM: A study to evaluate the effectiveness of structured teaching program on knowledge regarding bio-medical waste management among staff nurses of selected hospitals Rohtak OBJECTIVES: 1. To access the knowledge level of the staff nurses on bio-medical waste management using pre-test knowledge questionnaire.

2. To determine the effectiveness of structured teaching program regarding bio-medical waste management. 3. To find the association between post-test knowledge score and selected demographic variables. OPERATIONAL DEFINITIONS: B.M.W. It refers to bio-medical waste or any waste which is generated during the diagnosis, treatment or immunization of human being or animal or research activities in the production or testing there of bio-medical waste management handling rule 1998. EFFECTIVENESS It refers to gain knowledge regarding bio-medical waste management among staff nurses as determined by significant different between pre-test or post-test knowledge score. INFORMATION BOOKLET It is written information booklet intended to enhance knowledge and practice of bio-medical waste management handling rule under

Environmental Protection Agency Act 1986.

KNOWLEDGE It refers to ability of bio-medical waste management staff nurses to question regarding hazardous, toxic and bio-medical waste through questionnaire. SAFETY MEASURE It refers to staff nurse protection during bio-medical waste management by using of hospital and health care facilities to ensure that personal protective equipment e.g. gloves, mask, apron, goggles, etc. HYGIENE It generally refers to whole range of measure which protects health and health being and improve the quality of life (through hygiene standard 2007) to give the guidance to staff nurses HYPOTHESIS: 1. Only a very few staff nurses have proper awareness regarding biomedical waste management policy and practice. 2. Staff nurses will show positive attitude towards bio-medical waste management.

3. The development and implementation of a bio-medical waste management plan for health care setting. 4. Environment setting will reduce the rate of spread of health care associated infections. DELIMITATIONS: 1. The study is delimited to bio-medical waste management to assessment of knowledge is limited to written response obtained through a structured knowledge questionnaire. 2. Assessment of attitude is limited to response obtained through interview schedule. 3. The subject present at the time of data collection willing to participate in the research study. EXCLUSION AND INCLUSION CRITERIA: EXCLUSION CRITERIA: 1. No any staff nurses involved from the outside (outdoor) for the present study. 2. Staff nurses who were not willing in participate in the present study. 3. Staff nurses who did not have time of data collection.

INCLUSION CRITERIA: 1. For the present study selected the 100 staff nurses randomly. 2. Selected area from different selected hospital Rohtak from the indoor place such as medical, surgical, ENT, eye, orthopedic, pediatric, gyane and obst. And emergency department. CONCEPTUAL FRAMEWORK OF THE STUDY: 1. The conceptual model provide a certain frame of sequence for clinical practice research and education. The utility of conceptual model comes from the organization. 2. They provide thinking, judgment, observation, perception for interpreting the topic. 3. The present study aims at accessing the knowledge of the staff nurses regarding with view to developing/prepare information booklet on bio-medical waste management as mention below: a. Policy on hospital waste management b. Definition of bio-medical waste management c. Category of bio-medical waste management d. Segregation of waste e. Collection of bio-medical waste table

f. Storage of waste g. Transportation of waste within a hospital h. Treatment of hospital waste i. Safety measures j. Training k. Management and administration l. Coordination between hospital and outside agency Conceptual framework based on modified Kings Goel attainment theory: 1. Investigator 2. Staff nurses 3. Perception