| Abstract|| |
Introduction: Waste is the most original important environmental contaminate. The most important point to be considered in hospital activities is waste management because of its importance. Objective: The aim of the study was to determine the level of knowledge, attitude, and performance among personnel of Doctor Mohammad Kermanshahi and Hazrat Masomeh Hospitals in terms of hospital waste management which this study was performed in 2015. Materials and Methods: This cross-sectional study was conducted as a descriptive analysis to evaluate the knowledge, attitude, and performance level of 229 personnel of Doctor Mohammad Kermanshahi (123 people) and Hazrat Masomeh (105 people) Hospitals in terms of hospital waste management. The data were collected by a questionnaire consisted of four parts as follows: demographic, knowledge, attitude, and performance characteristics. In order to analyze the data, SPSS software, Mann-Whitney, nonparametric Kruskal–Wallis, and independent t parametric tests were used. Results: The results showed that sex affects the personnel performance and attitude of Doctor Mohammad Kermanshahi Hospital. There was a significant effect between men and women of Hazrat Masomeh Hospital in the knowledge, attitude, and performance levels. In the personnel of Doctor Mohammad Kermanshahi Hospital, the attitude was different among different occupational groups, the highest rate was related to occupational condition, and the lowest was related to nurses' career status. However, in the personnel of Hazrat Masomeh Hospital, there were no significant results between knowledge, attitude, and performance. Conclusion: Based on the data for each variable in different job situations, it can be deduced that the average knowledge of personnel working in the supportive section was 15.97 which means that they had maximum knowledge and the average knowledge for nurses with 14.92 had the lowest knowledge. In the performance variable, the highest average (14.72) was related to the staffs who worked as supportive group and the physicians had the lowest performance with average score of 13. Finally for attitudes variable the highest average was for physician with 53 and the lowest for nurses with 50.07. According to these results, it can be recommended that training to the hospital staff as well as necessary regulation codification which emphasis on waste management and separation in hospitals.
Keywords: Attitude, hospitals, knowledge, performance, personnel, waste management
|How to cite this article:|
Mohammadi P, Rahimi S, Dashtaleh T, Sohrabi Y. Studying the level of knowledge, attitude, and performance among personnel of Doctor Mohammad Kermanshahi and Hazrat Masomeh Hospitals in terms of hospital waste management. Ann Trop Med Public Health 2017;10:612-7
|How to cite this URL:|
Mohammadi P, Rahimi S, Dashtaleh T, Sohrabi Y. Studying the level of knowledge, attitude, and performance among personnel of Doctor Mohammad Kermanshahi and Hazrat Masomeh Hospitals in terms of hospital waste management. Ann Trop Med Public Health [serial online] 2017 [cited 2020 Apr 1];10:612-7. Available from: http://www.atmph.org/text.asp?2017/10/3/612/213120
| Introduction|| |
The overall concept of waste management in hospitals including public education, reduce production, storage, collection, transportation, processing and disposal of such wastes in political, economic, social, cultural, and technical framework, and performing codified and efficient rules in society can also have a positive impact on reducing the production of such waste, increase national productivity, and reduce the adverse effects resulting from the inappropriate disposal of waste on public health and the environment.
The waste is the most original and important environmental contaminant. One of the most important points to be considered in hospital activities is waste management. In recent times, human activities and associated changes in life styles and consumption pattern lead to the production of a large volume of different types of waste. These wastes are considered as a serious threat for human survival and other organisms. As a result, waste management and problems associated with waste generation are considerably been considered. Among all sources of medical wastes, few number of hospitals produce the highest rate of medical wastes in any country. Infectious waste produced by hospitals was among the hazardous waste which based on the type of activity and regarding health standards consisted between at least 3% and maximum 90% of all medical wastes. The presence of a variety of chemical, radioactive, infectious, biological, and medical compounds in hospital waste on one hand and the risk of spreading dangerous diseases such as hepatitis and AIDS among hospital staff on the other hand requires serious management measures to be taken in this case.
Negligence in collection, preservation, transport, and disposal of the waste can create specific problems which reflects a serious health and environmental threat (water, soil, and air pollution).
The health risks from hospital waste are caused by occupational workers' exposures to the medical wastes, such as bags consist of blood contaminated with AIDS and hepatitis B, syringes, gauze and bandages, catheters and tubing used in the diagnosis and treatment of patients high levels of bacteria and parasites, and dangerous and infectious toxic materials, causing threat to human health and contamination of hospital's environment. The important point is that among various diseases which are produced by infectious waste, including hospitals' blood waste and health centers, blood bank products, medical laboratories, dialysis centers, and infectious waste, the AIDS and Hepatitis B present the greatest risk to medical staff and hospital's cleaners, which can only be controlled by implementing a coherent and efficient management. In many countries, especially developing countries, medical wastes have not received sufficient attention. In addition, there is no understanding of risks associated with wastes and its relation to appropriate waste management. Large amounts of hazardous wastes accompanied by domestic waste is disposed of without proper monitoring and control. This method, however, is low cost, but for human and the environment, the direct or indirect exposure to mixed waste would be very dangerous and can cause serious health problems such as damage to the reproductive system, mutation and carcinogenic effects, central nervous system disorder, and respiratory irritation. Of hospital wastes, 75–90% are safe and only 10–25% are hazardous wastes which contains 15–18% infectious waste and 5–7% other hazardous wastes, including radioactive wastes and chemical waste. In a study conducted by Akter and colleagues  in terms of hospital waste management in Bangladesh, it was found that physicians, nurses, and other hospital personnel did not have full knowledge about creation of hospital waste. In another study conducted by the Keene, it was found that the volume of medical waste is 1% of the total volume of municipal waste in the United States. Chiang et al.in their study found that over time of acute respiratory disease prevalence in Taiwan, the amount of infectious hospital waste from 0.58 kg per patient has increased to 7.2 kg per patient.
Considering the importance of hospital waste, this study aimed to determine the level of knowledge, attitude, and performance among personnel of Doctor Mohammad Kermanshahi and Hazrat Masomeh Hospitals in terms of hospital waste management which was performed and implemented in 2015.
| Materials and Methods|| |
This cross-sectional study was conducted as descriptive analysis to evaluate the knowledge, attitude, and performance levels of 229 personnel of Doctor Mohammad Kermanshahi (123 people) and Hazrat Masomeh (105 people) Hospitals in terms of hospital waste management. Doctor Mohammad Kermanshahi Hospital was affiliated to Kermanshah University of Medical Sciences, Special and Subspecialty of Pediatrics and Children's Hospital, and Hazrat Masomeh Hospital and Special Women's Hospital were affiliated to the Social Democrat. Research population consists of 229 personnel of above-mentioned hospitals (123 people of Doctor Mohammad Kermanshahi Hospital and 105 people of Hazrat Masomeh Hospital).
In order to carry out the study, a questionnaire survey has been conducted to collect data from 3 physicians, 48 nurses, 11 people in para-clinical sections, and 61 people in the administrative section, and the questionnaire was completed.
The first part of the questionnaire consisted of demographic information. The second part had 13 questions related to measure the knowledge regarding personal details about the person's amount of information in relation to medical waste management including policies and guidelines, stages, and characteristics of classification and types of waste, color coding, changing time of collection containers, waste transfer way, related diseases and health risks, proper disposal method and responsibility of transformation, and disposal transmitted disease by medical waste. The second part contains 13 questions about the measurement of attitudes in relation to medical wastes.
The third part contains 12 questions in relation to personnel performance about vaccination history against hepatitis B, separation of waste, and use of personal protective equipment when passing the waste. Each of the questions of knowledge, attitude, and performance questionnaire had five options, which were scored as follows: 1 = strongly disagree, 2 = disagree, 3 = no idea, 4 = agree, strongly agree = 5. In this research, descriptive and inferential statistic and SPSS software were used. In order to analyze the data, the statistical characteristics of the sample group (such as frequency, relative frequency, cumulative frequency, etc.) was calculated and described. In order to adjust the data, creating graph, calculating the attitudes indices to center and dispersion were used. In order to perform the normality test, the Kolmogorov–Smirnov test was used. The error is considered as 0.05 (α =0.05).
| Results|| |
Knowledge, attitude, and performance among personnel of Doctor Mohammad Kermanshahi Hospital
In this study, 123 staff members from Doctor Mohammad Kermanshahi Hospital and 105 from Hazrat Masomeh Hospital were enrolled. Of 123 participants from Doctor Mohammad Kermanshahi Hospital, 89 were (72.4%) women and 34 were (27.6%) men. Among the participants, 3 were (2.4%) physicians, 48 were (39%) nurses, 11 had (11.4%) para-occupational status, and 61 were (49.6%) in support and services position. Among the participants from Doctor Mohamed Kermanshahi Hospital, 26 (21.1%) had attended training courses on waste management and 97, that is, 78.9% participants had not enrolled in these courses. According to available data means, the null hypothesis has not approved and the data were not normally distributed. Therefore, non-parametric tests used in order to perform test related to hypotheses. The Mann–Whitney test results have shown that gender affects performance and attitude levels, but there was no statistically significant relationship between male and female. The results of Kruskal–Wallis test for knowledge (0.791) and performance (0.875) variables demonstrated that there is a similarity between knowledge and performance in different job positions. But according to the sig value related to attitude (less than 0.05), people have different attitudes in different job positions, so there is significant difference between attitude among the various occupational groups and the highest amount was related to the medical occupation condition and the lowest amount was related to the nurse occupation condition. The Mann–Whitney test result in people who have passed training courses and no passed these courses for knowledge and performance variable were significant, 0.16 and 0.436, respectively. But for attitude variable, the value was significant (less than 0.05) that shows the attitude of participants who were passed courses was better than the people who were not passed the courses.
According to the Spearman correlation coefficient, the relationship between knowledge, attitude, and performance has been investigated. The sig value related to relationship between knowledge and performance was 0.00 and knowledge and attitude was 0.012, which is less than 0.05; it means that there is a significant relationship between these both variables but the sig value related to the relationship between performance and attitude variables was 0.839 which is more than 0.05. This means that there is no significant relationship between them. The Spearman correlation coefficient between knowledge and performance is equal to 0.333, which is higher than that for correlation between knowledge and attitude, which is direct for these relations, but the intensity of the relationship was not high; it means that by changing the knowledge, the attitude and performance will change, but this change is not drastic.
Knowledge, attitude, and performance among personnel of Hazrat Masomeh Hospital
In this study, 105 staff members of Hazrat Masomeh Hospital were studied. Among studied persons, 80 were (76.2%) women and 25 were (23.8%) were men. Of the participants of Hazrat Masomeh Hospital, 2 were (1.9%) physicians, 51 were (48.6%) nurses, 12 had (11.4%) para-clinical status, and 40 were (38.1%) in support and services position. Also, 65 participants (61.9%) had attended training courses on waste management and 40, that is, 38.1% participants had not enrolled in these courses. Among the subjects, 15 persons (14.3%) introduced the AIDS as a transferable disease by wastes, 20 patients (19%) introduced Hepatitis and 70 patients (66.7%) introduced the infectious diseases as transferable diseases through the disposal of medical wastes. According to Kolmogorov–Smirnov, the attitude variable data were normally distributed, but two other variable data will not follow a normal distribution. So, in order to perform tests for attitude variable, parametric tests were used, and for the two other variables, corresponding nonparametric tests were used. The Mann–Whitney test results showed that there is statistically significant difference between women and men in terms of knowledge. The knowledge rate was significantly greater in men than in women. The Mann–Whitney test results showed that there is statistically significant difference between women and men in terms of performance. The performance rate was significantly greater in women than in men. The independent t-test showed that the attitude score in men is significantly higher than that in women. The Spearman correlation test results showed that in the men group, there is a significant correlation between the knowledge with performance variables (P = 0/005), knowledge with attitude (P = 0/000), and performance with attitude variables (P = 0/000). But in the women group, there was only a significant correlation variable between knowledge with performance variables (P = 0/005). According to Kolmogorov–Smirnov, the obtained sig value for knowledge variable (0.003), attitude (0.238), and performance variable (0.00). The sig value for knowledge and performance variables is less than 0.05, which means that the data of these two variables were normally distributed, but the attitude variable was normally distributed. According to the t-test results of two independent samples, the obtained sig value for the knowledge variable was 0.063 and performance variable was 0.237 which is more than 0.05; the gender had not affected the knowledge and performance. Considering the t-test results of two independent samples, the obtained sig value for the attitude variable is more than 0.05, which means that there is no significant relationship between attitude and sex. According to the results obtained by the Kruskal–Wallis test, the obtained sig value for knowledge variable was 0.362 and performance variable was 0.671, which is more than 0.05; job had not affected rate of performance and knowledge of subjects. According to the ANOVA test results, the obtained sig value for attitude variable is more than 0.05, which means there is no significant relationship between attitude and the job status.
| Discussion|| |
According to the obtained average for each variable in different job situations, it can be expressed that the knowledge average of personnel are working in the supportive section (15.97) had the maximum knowledge and the nurses with 14.92 had the lowest knowledge; for the performance variable, the working groups in the supportive section had highest performance which was 14.72 and the physicians had the lowest performance average of 13, and finally, for attitudes variable, the physician had the highest average which was 53 and the nurses were the lowest with 50.07 average [Table 1].
|Table 1: Three variables average in different working situation (Hazrat Masomeh hospital)|
Click here to view
According to the values obtained from the above table, for knowledge variable, women's average equals to 14.94 which is lower than the average of knowledge among men (16.68), women's performance variable equals to 14.6, but men's equals to 13.96, for the attitude variable, the average equals to 50.31 among women and among men it is 52 [Table 2].
|Table 2: Three average variable for men and women (Hazrat Masomeh hospital)|
Click here to view
The results of this research showed that the physician and the para-clinical groups had the highest (11.67) and the lowest (10.55) average knowledge, respectively; for the performance variable, the working groups in the supportive section had the highest performance average of 6.82 and the paraclinical section had the the lowest amount with a performance average of 6.45, and finally, for the attitude variable, the physician had highest average which was 54 and nurses had an average of 45.06, which was the lowest [Table 3].
|Table 3: Three variables average in different working situation (Mohammad Kermanshahi hospital)|
Click here to view
According to the values obtained from the above table, for the knowledge variable, women's average equals to 11.03 which is lower than the average of knowledge variable among men (11.47), women's performance variable equals to 7.06, but men's equals to 6, for the attitude variable, the average equals to 44.85 among women and among men, it was 50.62 [Table 4].
|Table 4: Three average variable for men and women (Mohammad Kermanshahi hospital)|
Click here to view
The results have shown that the gender had an impact on the performance and attitude of the Doctor Mohammad Kermanshah Hospital's staff. But in personnel of Hazrat Masomeh Hospital, there was a significant effect in the awareness, attitude, and performance between men and women. In personnel of Doctor Mohammed Kermanshahi Hospital, the attitude was different among different occupational groups, the highest amount belonged to the medical job status and the lowest amount was related to nurses' job status. But in Hazrat Masomeh Hospital's personnel, there were no significant relation between knowledge, attitude, and performance. Results showed that the attitude of people who participated at waste management periods was better compared with those who have not passed these courses. Knowledge of a need for strict control to manage waste generated in medical care services is increasing worldwide. Two major problems were managers and personnel's lack of knowledge about the problems of hospital waste and others and the lack of sufficient capital to develop the structure with no risk. According to a study conducted by 22 countries, it found that 18–64% of hospital wastes are not properly disposed. One of the major limiting factors to identify deficiencies in the management of hospital wastes is the lack of knowledge and education about this system. In Sharma's study, only 22% of the samples were trained about waste management. The results of Mokhtari and colleagues  showed that more than 36% of the hospital samples know their workplace with lack of specific policy about management of hospital wastes and 41% of them know the hospital waste management process poor or very poor.
The World Health Organization knows that the most important step in reducing the problems related to health care waste management is their separation and classification which is the task of producer. The best way to separate different groups of health centers wastes, separate them in bags or colored containers. For example, for general wastes (like home) use the black plastic bags and blue buckets, and for quite infectious wastes, the red and yellow bags are used. Considering that education is one of the most important sectors in waste management and staff training, policies boost hospital waste management procedures as well as make it possible that employees will always be aware of the infectious waste risks.
| Conclusion|| |
The aim of the study was to determine the level of knowledge, attitude, and performance among personnel of Mohammad Kermanshahi and Hazrat Masomeh Hospitals in terms of hospital waste management which was performed and implemented in 2015. The results showed that people who participated in waste management programs have better attitude compared with those who have not passed such programs. Considering that education is one of the most important sectors in waste management and staff training, policies boost hospital waste management procedures as well as make it possible that employees will always be aware of the infectious waste risks.
Financial support and sponsorship
Research Council of Kermanshah University of Medical Sciences (grant number: 95699).
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bazrafshan E, Kord-Mostafapoor F. Survey of quantity and quality of hospital wastes in Sistan and Balouchestan Province, 1387–1388. Zahedan J Res Med Sci 2010;12:1
Pirsaheb M, Khosravi T, Sharafi K. Domestic scale vermi composting for solid waste management. Int J Recy Org Waste Agri 2013; 2:1–5.
Liberti L, Tursi A, Costantino N, Ferrera L, Nuzzo G. Optimization of infectious hospital waste management in Italy. Waste Manage Res 1994;12:85–373.
Pirsaheb M, Yarmohammadi H, Rostami R, Sohrabi Y. The evaluation of safety, health, and environmental risks in waste unit of Imam Reza hospital in Kermanshah based on William Fine's method. IJPT 2016;8:10910–7.
Sabour MR, Mohamedifard A, Kamalan H. A mathematical model to predict the composition and generation of hospital wastes in Iran. Waste Manage 2007;27:7–584.
Diaz LF, Eggerth LL, Enkhtsetseg SH, Savage GM. Characteristics of healthcare wastes. Waste Manage 2008;28:26–1219.
Abdulla F, Qdais HA, Rabi A. Site investigation on medical waste management practices in northern Jordan. Waste Manage 2008;28:8–450.
Fazili A, Salehi E, Abdoli MA, Jafari HR, Shaikhpoor M. Evaluation of hospital waste management process in Karaj hospitals. J Environ Stud 2010;36:99–106.
Cheng YW, Sung FC, Yang Y, Lo YH, Chung YT, Li KC. Medical waste production at hospitals and associated factors. Waste Manag 2009;29:4–440.
Pirsaheb M, Sohrabi Y, Dabirian M, Abdollahzadeh D. Qualitative and quantitative survey of waste management system case study: Qods Hospital, Paveh-Iran (2015). J Eng Appl Sci 2016;11:1065–8.
Sharma S. Knowledge about bio-medical waste management among health care personnel of some important medical centers in Agra. Int J Environ Sci Develop 2010;1:5–251.
Al-Khatib IA, Sato C. Solid health care waste management status at health care centers in the West Bank-Palestinian Territory. Waste Manag 2009;29:398–403.
Ferreira V, Teixeira MR. Healthcare waste management practices and risk perceptions: Findings from hospitals in the Algarve region, Portugal. Waste Manag 2010;30:63–2657.
Ruoyan G, Lingzhong X, Huijuan L, Chengchao Z, Jiangjiang H, Yoshihisa S, et al
. Investigation of health care waste management in Binzhou District, China. Waste Manag 2010;30:50–246.
Marinkovic N, Vitale K, Holcer NJ, Džakula A, Pavic T. Management of hazardous medical waste in Croatia. J Waste Manage 2008;28:1049–56.
Akter N, Hussain Z, Trankler J, Parkpian P. Hospital waste management and its probable health effect: A lesson learned from Bangladesh. Indian J Environ Health 2002;44:37–124.
Keene JH. Medical waste: A minimal hazard. Infect Control Hosp Epidemiol 1991;12:682–5.
Chiang CF, Sung FC, Chang FH, Tsai CT. Hospital waste generation during an outbreak of severe acute respiratory syndrome in Taiwan. Infect Control Hosp Epidemiol 2006;27:22–519.
Hossain MS, Santhanam A, NikNorulaini NA, Omar AK. Clinical solid waste management practices and its impact on human health and environment–A review. Waste Manag 2011;31:66–754.
Ibrion M, Mohammad M, Farrokh N. Earthquake disaster risk reduction in Iran: Lessons and “lessons learned” from three large earthquake disasters—Tabas 1978, Rudbar 1990, and Bam 2003. Int J Disas Risk Sci 2015;6:415–27.
Oker A, Sangodoyin A, Sridhar M, Booth C, Olomolaiye P, Hammond F. Medical waste management in Ibadan, Nigeria: Obstacles and prospects. Waste Manag 2009;29:11–804.
Mehdi M, Hasan S, Salman Z, Ensiehshariati, Issa KT. Health personnel's knowledge of Yazd hospitals in the management of hospital wastes in 2011. Univ Med Sci J 2012;12:137–48.
Allhoff F. On the autonomy and justification of nanoethics. Nanoethics 2007;1:185–210.
Research Committee, Kermanshah University of Medical Sciences, Kermanshah
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]