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KNOWLEDGE AND ATTITUDE OF NURSING STAFFS ABOUT MEDICAL WASTE MANAGEMENT IN PRIMARY HEALTH CARE CENTRES IN ERBIL CITY, IRAQ

Volume-9, Issue 2, 2017, Pages 58 - 63

Mustafa Mohammed Ameen 1; Salih Ahmed Abdullah 2 ;

1Ministry of Health, Directorate of Health, Erbil/Erbil, Iraq
2Department of Community Health Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq

Abstract :

Knowledge and attitude of nursing staffs about medical waste management show an essential role to decrease contagious diseases. This study aims to assess knowledge and attitude of nursing staffs about medical waste management in primary health care canters. Quantitative design, descriptive study was conducted in 23 primary health care canters in Erbil /City in the Kurdistan region of Iraq from September 2014 to August 2015. All nursing staffs were selected. Data were collected through the use of interview questionnaire forms. Results showed that majority of the nursing staffs’ age were between 40-49 years old, female, Secondary school nurses, most of them had 20-29 years of experience, working unit, most of them were minor surgery nurses and did not have training courses about medical waste management. The study showed that most of the nursing staffs had a medium level of knowledge about medical waste management. The study also showed that the majority of nursing staffs had high (positive) attitude regarding medical waste management. There was statistically significant association between level of education and nurses’ knowledge about medical waste management. Conducting training courses about medical waste management are necessary for all nursing staffs and preparation of educational programs to be implemented for developed knowledge and attitude of nursing staffs about medical waste management.

Keywords : Knowledge, Attitude, Nursing Staff, Medical Waste Management, Erbil

Introduction :

Medical waste denotes to hazardous waste materials produced by healthcare events, including a board range of materials, from used stickers and syringes to dirty dressing, body parts, diagnostic samples, blood, chemicals pharmaceuticals, medical procedures and radioactivity materials (Nie et al, 2014).

Healthcare activities like vaccination, diagnostic tests, medical treatments, and laboratory examinations protect and restore health and save lives (WHO, 2005).

Medical wastes are of considerable importance due to their possible as environmental threats and their dangers to human health. This kind of waste comprises infectious waste, toxic chemicals and heavy metals, and may have materials that are genotoxic or radioactive (Mbarki et al, 2013).

Medical and health-care wastes have suddenly enlarged in modern eras due to the enlarged population, number, and size of health care facilities, as well as the use of disposable medical products (Sarsour et al, 2014).

The data available from industrialized countries recommend that nearly 1-5 kg of discards are produced per bed per day, with significant inter country and inter specialty differences (Ajai and Nath, 2013).

World Health Organization (WHO) in 2002 carried out a survey on management of medical waste in 22 unindustrialized countries. Findings showed that the ratio of healthcare facilities that did not use appropriate waste disposal methods ranged from 18% to 64% (WHO 2004).

The several causes towards the poor waste management practices around the globe are: the lack of waste management, lack of consciousness about the health hazards, inadequate financial and human possessions and poor control of waste disposal, lack of strict and suitable rules, the clear attribution of accountability of appropriate management and disposal of waste and according to the 'polluter pays' principle, this responsibility lies with the waste producer, usually being the health-care provider, or the establishing involved in related activities (WHO, 2007).

There is great need to carry out a study that can evaluate the knowledge and attitude of medical waste management among the nursing staffs in Primary Health Care Centres (PHCC) .The current status of nursing staffs awareness regarding medical waste management will help the concerned authorities to manage medical waste effectively and to build up the plan for improving the condition in future.

Research Methodology :

A cross-sectional study was conducted during the period 1st September 2014 to1st August 2015.  Data was collected during the period 1st February 2015 to 1st of April 2015. The study was conducted in all (24) primary health care centres in Erbil city, but one of them (Azadi primary health care centers) was under the rebuilding status. The city is located in the North part of the Iraqi country. It has a population of over one million people. According to the lists obtained from the General Directorate of Health/Erbil a total of 215 nurses were present in primary health care centres. The entire population of the nursing staffs working in primary health care centres in Erbil city was considered for the study. The total numbers of nurses during data collection were 215 but 20 nurses excluded because of their participation in pilot study and 3 nurses refused to participate in the study and also 12 nurses were unavailable during data collection because of their obstetrical and sick leaves. Finally the sample size of the study became 180 nurses. A self-administered questionnaire was used for the data collection from nursing staffs in primary health care centres. The questionnaire has been validated through panel of 12 experts in different fields to investigate the content of the questionnaire for its clarity, relevancy and adequacy. The feasibility of the final study was determined by conducting a pilot study. Internal consistency reliability of the nursing staff’s knowledge and attitude questionnaire were examined through a pilot study with 20 nurses from Kurdistan and Sarwaran primary health care centres who had similar characteristics to the subjects in this current study. Determination of reliability was based on the test-retest method. Correlation coefficient was computed which revealed that the correlation coefficient was 0.80,so the tools used in assessing knowledge and attitude of nursing staffs were clear and comprehensive. The data were analyzed by using the Statistical Package for Social Sciences (SPSS, Version 19). Chi square test of association was used to compare between proportions. When the expected count of more than 20% of the cells of the table was less than 5, Fisher’s exact test was used. Pearson correlation was applied to test for the strong point of correlation between two numerical variables. A (p) value for = 0.05 was considered as statistically significant.

Results :

Table 1 shows the following characteristics of the samples regarding to the demographic data. Regarding the age of the samples, majority of the nursing staffs (51.7%) were in the age group 40-49 years. The mean age (M±SD) of the nurses was 44.05 years (SD=±7.9%). Concerning to the nursing staffs’ gender, the majority of the nursing staffs were females (61.1%). Regarding to nursing staffs’ educational levels, majority of them were secondary school nurses (42.2%).


Table 1: Frequency and percentage of the study samples regarding their age, gender and level of education (N=180)

Items
Frequency
Percentage
Age group/Years
=30
30-39
40-49
50-59
=60
 
4
43
93
30
10
 
2.2
23.9
51.7
16.7
5.6
Gender
Male
Female
 
70
110
 
38.9
61.1
Level of  education
Intermediate school nurses
Secondary school nurses
Technical institution nurses
Graduated of college of nursing
 
33
76
68
3
 
18.3
42.3
37.8
1.7
Total
180
100
 

Table 2 shows that more than half of the nursing staffs (51.67%) had a working experience between 20-29 years. The average working experience of the nurses was 20.61 (SD=±9.06). This table also shows that majority (33.3%) of the nurses was working in minor surgery units. Majority of the study samples were not trained regarding medical waste management which represents (92.8 %), while only 7.2% of them were trained.

 

Table 2: Frequency and percentage of the study samples regarding their years of working experience, working unit and training (N=180)


Items
Frequency
Percentage
Years of working experience
< 10
10-19
20-29
30-39
40+
 
4
43
93
30
10
 
2.22
23.88
51.67
16.67
5.56
Working unit
Dental health care
Minor surgery
Family planning
Vaccination unit
Laboratory
Maternal and child care
Pharmacy
School health services
 
22
60
4
41
6
19
15
10
 
12.2
33.3
2.2
22.8
3.3
10.6
8.3
5.6
Training
have trained
have not trained
 
13
167
 
7.2
92.8
Total
180
100
 
Figure 1 shows that there was significant association between nursing staff’s knowledge and attitude (P=0.001).


 
Figure 1: Relationship between knowledge and attitude scores
 

Table 3 shows the frequency and percentage of nurses who were in each category of knowledge level.  It was found that more than half (65.6%) of nursing staffs possessed medium levels of knowledge. Very few nurses (5.6%) had low levels of knowledge. Nearly one third of nurses (28.9%) had high levels of knowledge regarding medical waste management.


Table 3: Distribution of nursing staffs according to their knowledge level regarding medical waste management (N=180)

knowledge level
Frequency
Percentage
Low
Medium
High
10
118
52
5.6
65.6
28.9
Total
180
100
 
Table 4 shows that 56.7% of the samples had positive attitude, while less than 42.2% of them had neutral attitude and only (1.1%) of the samples had negative attitudes regarding medical waste management.

Table 4: Distribution of nursing staffs according to their attitude levels regarding medical waste management (N=180)

Nurse’s attitude
Frequency
Percentage
Low (Negative)
Medium (Neutral)
High (Positive)
2
76
102
1.1
42.2
56.7
Total
180
100
 

Table 5: A significant difference was found between nurses’ knowledge and their formal educational background at p value of < 0.001. Graduated nurses were more knowledgeable (100%) as compared to other educational background such as institutional graduated nurses, secondary school nurses and intermediate school nurses 48.5%, 17.1% and9.1% respectively.


Table 5: Association between nursing staff’s knowledge and their levels of education (N=180)

Level of education
No.
Low
knowledge
Medium
knowledge
High
knowledge
 
*P
No.
%
No.
%
No.
%
 
Intermediate school nurses
33
3
9.1
27
81.8
3
9.1
 
 
< 0.001
 
Secondary school nurses
76
6
7.9
57
75.0
13
17.1
Institutional graduated  nurses
68
1
1.5
34
50.0
33
48.5
College of nursing graduated nurses
3
0
0.0
0
0.0
3
100.0
Total
180
 
 
 
 
 
 










*This p- value was obtained by Fisher's exact Test

Table 6 shows that there was significant association between nursing staff’s attitude and levels of education (P=0.014).

Table 6: Association between nursing staff’s attitude and levels of education (N=180)

Working unit 
No.
Low or medium
attitude
High attitude
* p
 
No.
%
No.
%
Intermediate school nurses
33
17
51.5
16
48.5
 
0.014
 
Secondary school  nurses
76
40
52.6
36
47.4
Institutional graduated nurses
68
21
30.9
47
69.1
College of nursing graduated  nurses
3
0
0.0
3
100.








*This p- value was obtained by Fisher's Exact Test

Conclusion :

The knowledge and attitude of nursing staffs regarding medical waste management was varied and was not found to be satisfactory. There was a significant relationship between level of education and nurses' knowledge about medical waste management, and significant relationship between nurses’ knowledge and attitude. Knowledge regarding medical waste management was that more than half (65.6%) of nursing staffs possessed medium levels of knowledge. Nearly one third of nurses (28.9%) had high levels of knowledge. Attitude regarding medical waste management was 56.7% among the samples who had positive attitude.

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