an-najah national university attitude_ knowledge... · human blood and blood products human blood...

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An-Najah National University

FACULTY OF NURSING

NURSING ATTITUDE, KNOWLEDGE AND PRACTICE TOWARD MEDICAL WASTE MANAGEMENT: A STYDY CONDUCTED IN THE

NORTHERN AREA OF THE PALESTINIAN WEST BANK

Prepared by

Amjad Malayshi Nidal Hashem

Jamilah Salamah Tariq Al-khateeb

Supervised by

Dr. Adnan Sarhan Miss. Mahdia Al-kony

2010-2009

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Content

I. Introduction

I.I Types of medical waste

I.II Waste Segregation

I.III Background

I.IV Significance of the study

I.V Question of the study

I.VI Aims of the study

I.VII Demographic data

II. Literature review

III. Methodology

III.I Introduction

III.II Study population

III.III Study design

III.IV Sampling

III.V Instrument

III.VI Setting of the study

III.VII Inclusion criteria for the sample and Exclusion criteria for the sample

III.IIX Period of the study

III.IX Data collection

III.X Piloting

III.XI Validity of the tool

III.XII Stability of the tool

III.XIII Statistical processing

III.XIV Reliability

IV. Results

IV.I Introduction of results

IV.II Analysis

IV.III Demographic data analysis

IV.IV Knowledge data analysis

IV.V Attitude data analysis

IV.VI Practice data analysis

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V. Discussion

VI. Conclusion

VII. Recommendation

IIX. References

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List of tables

Table (1): Distribution of the sample of the study as a variable of the city.

Table (2): Distribution of the sample of the study as a variable of the sex.

Table (3): Distribution of the sample of the study as a variable of the age.

Table (4): Distribution of the sample of the study as a variable of the marital status.

Table (5): Distribution of the sample of the study as a variable of the address.

Table (6): Distribution of the sample of the study as a variable of the education level.

Table (7): Distribution of the sample of the study as a variable of the experience .

Table No (8): Averages and standard deviations for the degree of knowledge, attitude of nursing

staff in government hospitals in the cities of Nablus and Jenin in the management of medical

waste.

Table No (9): Averages and standard deviations for the degree of knowledge, attitude of nursing


waste.

Table No. (10): Test results (T) to signify the differences in knowledge and attitude of nursing


waste by changing the city.

Table No. (11): Test results (T) to signify the differences in knowledge and attitude of nursing


waste by changing the sex.

Table No. (12) :The results of anova of the degree of knowledge and behavior and the practice of

nursing staff in government hospitals in the cities of Nablus and Jenin in the management of

medical waste due to the variable age.

Table No. (13): he results of anova of the degree of knowledge and behavior and the practice of


medical waste due to the variable Social status.

Table No. (14): The results of anova of the degree of knowledge and behavior and the practice of


medical waste due to the variable address.



medical waste due to the variable level of education.

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medical waste due to the variable experience.

Table No. (17): Shows the a posteriori LSD test comparisons to determine differences to the

variable level of education.

Table (18): show the answers of the assay question.

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I. INTRODUCTION The Medical Waste Management Act defines “medical waste” as biohazardous or sharps

waste,which is generated or produced as a result of the diagnosis, treatment, or immunization of

human beings, research pertaining to the diagnosis, treatment, or immunization of human beings,

production/testing of biological or the accumulation of properly contained hospital-generated

sharps waste. (Handling biohazardous and medical waste, Biosafety Handbook, chapter 20).

Infectious medical wastes represent an increasing problem everywhere in the world due to

sanitary safety and costs involvement. (Chemother, 1999).

Good healthcare waste management in a hospital depends on a dedicated waste management

team, good administration, careful planning, sound organization, underpinning legislation,

adequate financing, and full participation by trained staff. Hence, waste management protocols

must be convenient and sensible. (Gehan M.A. Mostafa, et al, 2009). Sanitary staff has very poor

knowledge about the Biomedical waste management (BMW) Act and rules, but a good

percentage of this category has positive attitude and practice habits. (S. Saini, S.S. Nagarajan,

R.K. Sarma, 2005).

In 2002, the results of a WHO assessment conducted in 22 developing countries showed that

the proportion of health-care facilities that do not use proper waste disposal methods ranges from

18% to 64 %.( WHO, 2004).

Health care waste (HCW) is a by-product of health care that includes sharps, non-sharps,

blood, body parts, chemicals, pharmaceuticals, medical devices and radioactive materials. Poor

management of HCW exposes health care workers, waste handlers and the community to

infections, toxic effects and injuries.

(KH. Dhalfullah, nor)

I.I TYPES OF MEDICAL WASTE

Human Blood and Blood Products

Human blood and blood products are classified and managed as medical waste because of the

possible presence of infectious agents that cause blood-borne disease. Wastes in this category

include bulk blood and blood products as well as smaller quantities of blood samples drawn for

testing or research. Waste human blood must be treated by steam sterilization. After sterilization,

the liquid portion may be safely poured off into a sanitary sewer drain.

(Department of Risk Management and Safety Hazardous Materials Management, 2006).

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Cultures and Stocks of Infectious Agents

Cultures and stocks of human infectious agents, regardless of storage method, must be

managed as medical waste. Cultures and stocks of zoonotic disease are not regulated as medical

waste if they have neither been intentionally exposed to a human infectious agent nor capable of

transmitting that disease to humans.


Sharps

All hypodermic needles and syringes, intravenous needles and tubing, scalpel blades, lances,

and other such devices are regulated as medical waste. Even if these materials are unused they

are still regulated. All sharps must be placed in an approved sharps container. Sharps that have

been exposed to human disease agents must be autoclaved prior to pickup by Risk Management

and Safety.


Glassware

Glassware exposed to a human infectious agent must be managed as a sharp until it

has been autoclaved. This includes pipettes, capillary tubes, test tubes, stir rods, and other

laboratory equipment. All glassware that has been exposed to human infectious agents must be

autoclaved prior to disposal. After the glassware has been autoclaved it can be thrown in the

trash. Glassware that has not been exposed to a human disease agent is not regulated as a sharp.

Broken glassware should be placed into a container designed for such materials and

either recycled or disposed. At a minimum, broken glassware should be disposed of in small

double lined cardboard boxes and clearly labeled as broken glassware. Small double lined boxes

minimize the potential for injury and excessive accumulation in the laboratory.


Contaminated Equipment

This includes any equipment not mentioned above which may come into contact with human

infectious agents. Equipment that has been contaminated with human disease agents must be

treated as a medical waste and either autoclaved or shipped off-site for treatment.


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The concern regarding the medical waste is mainly due to the presence of pathogenic organisms

and organic substances in hospital solid wastes in significantly high concentrations. The

substantial number of organisms of human origin in solid waste suggests the presence of virulent

strains of viruses and pathogenic bacteria in undetected numbers. (Wallace L.P., Zaltzman R. and

Burchinal lC. 1972).

I.II WASTE SEGREGATION

Different color coding has to be assigned to various waste for effective segregation, as: Black:

Non-Risk waste, Red: Risk waste with Sharps, Blue: Risk Waste without sharps, Yellow:

Radioactive waste, Green: Chemicals like Mercury & Cadmium

All this segregation should be done by the individual user (WHO, 2006)

I.III BACKGROUND

Jenin and Nablus cities considered as large area and contain large amounts of medical wastes

in there hospitals, these wastes considered an important session of huge problem that health care

provider and who expose to these wastes may suffer and become with direct contact with these

contaminated wastes.

Large numbers of health care provider could lose there work or may there life as a result of

poor managing medical waste.

hospitals as jenin governmental hospital, Rafidia and Al-watane governmental hospitals do

not have a specific criteria from Palestinian ministry of health for managing medical wastes.

The study concentrates on the attitude, knowledge and practice of nurses in these governmental

hospitals for separating and managing medical waste.

I.IV SIGNIFICANCE OF THE STUDY

Its be observed As a result of lack of waste separation practices in jenin, Rafidia and Al-

watane governmental hospitals, many of these hazardous materials are represent a serious health

hazard to health workers and the public.

Regulated medical waste is a new designation for wastes that may contain pathogenic

microorganisms which can termed “infectious waste”, these waste must be managed in order to

minimize the potential of personal exposures.

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Therefore improper handling of solid waste in the hospital may increase the airborne

pathogenic bacteria, which could adversely effect the hospital environment and community at

large. (NIOSH /Health Care Workers guidelines / Chap 6).

I.V QUESTIONS OF THE STUDY

1. What is the nursing knowledge and attitude regarding medical waste managment?

2. Is nurses practice separation of medical wastes?

I.VI AIMS OF THE STUDY

- To evaluate the practice of separating hospital medical wastes.

- To evaluate the knowledge and attitude about the importance of managing medical wastes.

I.VII DEMOGRAPHIC DATA

According to a 2007 census, Jenin city has a population of 256,000 Palestinian peoples. The

Jenin refugee camp housed approximately 20,000 refugees, according to United Nations Relief

and Works Agency (UNRWA) on 373 dunams. Some 42.3% of the population of the camp is

under the age of fifteen.

Jenin city contains four hospitals, one of them is governmental hospital and the others are

private hospitals. Jenin governmental hospital located at the center of jenin city, this hospital is

centralized for all people who came from all areas around jenin city, and this includes all

villages.

According to a 2007 census, Nablus city has a population of 321,000 Palestinian peoples, 56

villages and tow camps. Nablus contains tow governmental hospitals, Rafidia, Al-watane. And

four special hospitals.

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II. LITRETURE REVIEW World Health Organization (WHO, 2000) sure that the unsafe disposal of health-care waste

(for example, contaminated syringes and needles) poses public health risks. Contaminated

needles and syringes represent a particular threat as the failure to dispose of them safely may

lead to dangerous recycling and repackaging which lead to unsafe reuse. Contaminated injection

equipment may be scavenged from waste areas and dumpsites and either be reused or sold to be

used again.

WHO estimated that contaminated injections with contaminated syringes caused 21 million

hepatitis B virus (HBV) infections (32% of all new infections), and two million hepatitis C virus

(HCV) infections (40% of all new infections), and at least 260 000 HIV infections (5% of all

new infections). (WHO, 2000)

In addition to the public health risks, if not managed, direct reuse of contaminated injection

equipment results in occupational hazards to health workers, waste handlers and scavengers.

Where waste is dumped into areas without restricted access, children may come into contact with

contaminated waste and play with used needles and syringes. Epidemiological studies indicate

that a person who experiences one needle stick injury from a needle used on an infected source

patient has risks of 30%, 1.8%, and 0.3% respectively of becoming infected with HBV, HCV and

HIV. (WHO,2004).

The majority of community nurses reported compliance with universal precautions, although

a small number of nurses stated that they re-sheathed needles, inappropriately stored sharps

containers, inadequately wore gloves and experienced difficulties in hand washing.

(Bennett G. & Mansell I, 2004).

Forty questionnaires were distributed to nurses with emergency department experience in

Botswana, with a response rate of 55% (n = 22). Quantitative data were analyzed using

descriptive statistics while qualitative data were subjected to thematic and content analysis. The

majority of respondents reported compliance with universal precautions at the hospital

emergency department. However, qualitative data highlighted resource constraints that may

hinder compliance with universal precautions such as a lack of appropriate facilities, a shortage

of equipment and materials, inadequate staffing and absence of sustainable in-service education

programs. (Chelenyane M, Endacott R. 2006).

In addition, Nurses at the 437-bed University Hospital handled more needles and experienced

more needle stick injuries than did nurses at the 300-bed Community Hospital. Needle-handling

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and needle stick injuries among personnel at the two hospitals were similar, although University

Hospital interns and residents and University Hospital fourth-year students handled more needles

than did the staff at either hospital. A total of 164 (33.6%) respondents reported receiving one or

more needle stick injuries during 1983. A large proportion of respondents in each group reported

that they did nothing about the needle stick injuries they experienced. Carelessness was

perceived by all groups to be the most common reason for needle stick injuries. Most

respondents reported some knowledge of proper needle disposal techniques and perceived lack

of knowledge as the least important reason for needle stick injuries. (Marguerite M. Jackson,

Douglas C. Dechairo, Dianne F. Gardner, 1986).

The Objectives and rationale of bio-medical wastes (BMW) management are mainly to

reduce waste generation, efficient collection, handling and disposal in such a way that it controls

infection and provides safety to employees working in the system and ensure cost effectiveness

by avoiding penalties and fines imposed by regulatory authorities. Accordingly, waste is required

to be treated and disposed of in accordance with schedules prescribed. The basic elements is to

recognize the waste, identify where waste is generated and determine the cause of generation,

plan disposal of the waste in a scientific manner so as to render it environmentally non-

hazardous and eliminate the source of infection. (S. Saini, S.S. Nagarajan, R.K. Sarma, 2005)

Medical waste contains highly toxic metals, toxic chemicals, pathogenic viruses and bacteria,

which can lead to pathological dysfunction of the human body. Medical waste presents a high

risk to doctors, nurses, technicians, sweepers, hospital visitors and patients due to arbitrary

management. It is a common observation in Dhaka City that poor scavengers, women and

children collect some of the medical wastes (e.g. syringe-needles, saline bags, blood bags etc.)

for reselling despite the deadly health risks. It has long been known that the re-use of syringes

can cause the spread of infections such as AIDS and hepatitis. The collection of disposable

medical items (particularly syringes), its re-sale and potential re-use without sterilization could

cause a serious disease burden. (BMC Public Health, 2008).

The safe disposal and subsequent destruction of medical waste is a key step in the reduction

of illness or injury through contact with this potentially hazardous material, and in the prevention

of environmental contamination. The transmission of blood-borne viruses and respiratory, enteric

and soft tissue infections through improper medical waste disposal is not well described. The

management of medical waste therefore, has been of major concern due to potentially high risks

to human health and the environment. (BMC Public Health,2008).

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III. METHODOLOGY III.I Introduction to methodology

This study was conducted in jenin, Rafedia and al-watane governmental hospital, northern area

of the Palestinian west bank. These hospitals involve deferent departments that contain nurse’s

workers and produce large amounts of medical wastes.

The tool was contributed in all department that contains nurses in these hospitals

III.II Study population The study targeted to the nurses whom work in these hospitals, and this includes all levels of

nurses.

III.III Study design The design of our study was cross-sectional descriptive design. The researcher use a semi-

constructed design for the tool of the study, and the sample taken at one time.

III.IV Sampling Our sample had chosen through heterogeneous convenient method, and we collect 198 samples.

III.V Instrument The tool was used for collection of data was a questionnaire which has semi-structured format

with a set of 30 Items, concerning the knowledge, attitude and practice on the subject. This was

further categorized in four sets, demographic data, knowledge, attitude and practice, and we use

a scale for answering the questions.

III.VI Setting of the study The study was conducted in Jenin, Rafedia and Al-watne governmental hospitals. Northern area

of the Palestinian west bank.

III.VII Inclusion criteria for the sample and Exclusion criteria for the sample

The inclusion group was all departments that contain nurse’s worker.

The exclusion group was all departments that dose not contain nurses.

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III.IIX PERIOD OF THE STUDY

The study started in 1/2/2010, and continuo for 3 month, the study ended in 1/5/2010, the tools

was contributed in the department within three shift (A,B,C ) and collected in tow days.

III.IX DATA COLLECTION

Tow hundred samples collected from the three hospitals, the data filled through face to face

interview.

III.X PILOTING Pilot sample was taken in the three hospitals, the nurse’s opinion about the tool was good and

they give us a constructive background for our study.

III.XI VALIDITY OF THE TOOL

Verified the authenticity of the tool by offering a range of arbitrators with competence and

experience in statistical studies, and were asked to express an opinion on the paragraphs of

resolution and the deletion and amendment and propose new paragraphs and appropriate tool for

study, based on observations of the arbitrators has been modified instrument of the study became

finalized constituent of four parts (21) paragraph.

III.XII STABILITY OF THE TOOL

in order to extract the stability coefficient of the tool, the equation was used Cronbach alpha to

determine internal consistency of the paragraphs of resolution amounted to (0.826) and this value

indicates that the tool has an appropriate degree of stability and fulfill the purposes of this study.

III.XIII STATISTICAL PROCESSING

After data collection, coding, and processing of statistical methods appropriate, using the

program packages of statistical SPSS, the researchers used frequencies, averages, standard

deviations, percentages, and test (T) for independent samples, analysis of variance, and the

equation of Cronbach alpha.

III.XIV RELIABILITY

Method 1 (space saver) will be used for this analysis

R E L I A B I L I T Y A N A L Y S I S - S C A L E (A L P H A)

Statistics for Mean Variance Std Dev N of Variables

SCALE 70.0729 77.4716 8.8018 32

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Reliability Coefficients

N of Cases = 198.0 N of Items = 32

Alpha = .8262

15

City

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IV. RESULTS

IV.I INTRODUCTION TO RESULTS

Researchers follow the descriptive analytical method to suitability for the purposes of this study,

an approach that deals with the phenomenon as it is in fact, works to describe, analyze, and

ant to where the researchers depends on the sources of information relevlinked to other events,

which has been prepared on ,the study, analysis, and then collecting data through questionnaire

the basis of the theoretical framework and previous studies.

IV.II ANALYSIS The study population consisted of all nurses in government hospitals in the cities of Nablus and

Jenin, where the researcher selected a heterogeneous convenient sample consisting of (198)

nurses in government hospitals in the cities mentioned, with the following description of the

characteristics of the study sample according to variables:

IV.III DEMOGRAPHIC DATA ANALYSIS

Table (1): Distribution of the sample according to the city

Valid Frequency Percent Valid

Percent Cumulative

Percent 1 Nablus 134 67.7 67.7 67.7 2 Jenin 64 32.3 32.3 100.0 Total 198 100.0 100.0

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Table (2): Distribution of the sample according to the sex


Percent Cumulative

Percent 1 Male 88 44.4 44.4 44.4 2 Female 110 55.6 55.6 100.0 Total 198 100.0 100.0

Table (3): Distribution of the sample according to the age

Valid Frequenc

y Percent

Valid Percent

Cumulative Percent

1 20-29 95 48.0 48.0 48.0 2 30-39 66 33.3 33.3 81.3

3 more than

40 37 18.7 18.7 100.0

Total 198 100.0 100.0

Table (4): Distribution of the sample according to the martial status


Percent Cumulative

Percent 1 Single 61 30.8 30.8 30.8 2 Married 129 65.2 65.2 96.0 3 Divorced 8 4.0 4.0 100.0 Total 198 100.0 100.0

1 2 3

Sex

21

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Table (5): Distribution of the sample according to the address


Percent

Cumulative

Percent 1 City 69 34.8 34.8 34.8 2 Village 95 48.0 48.0 82.8 3 Camp 34 17.2 17.2 100.0 Total 198 100.0 100.0

Table (6): Distribution of the sample according to the education level


Percent Cumulative

Percent

1 Diploma 121 61.1 61.1 61.1 2 Bachelors 66 33.3 33.3 94.4

3 High

education level

11 5.6 5.6 100.0

Total 198 100.0 100.0

123

123

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Table (7): Distribution of the sample according to the experience


Percent Cumulative

Percent

1 less than 6

months 13 6.6 6.6 6.6

2 7-11

months 19 9.6 9.6 16.2

3 1-5 years 65 32.8 32.8 49.0

4 more than 5

years 101 51.0 51.0 100.0

Total 198 100.0 100.0

IV.IV KNOWLADGE DATA ANALYSIS

Q1: Frequency Percent

Valid Strongly agree 10 5.1 agree 28 14.1 disagree 122 61.6 Strongly disagree 37 18.7 5.00 1 .5 Total 198 100.0

1 2 3 4

123

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Q2:

Frequency Percent

Valid Strongly agree 8 4.0 agree 66 33.3 disagree 90 45.5 Strongly disagree 34 17.2 Total 198 100.0

Q3:

Frequency Percent


Q4:

Frequency Percent Valid Strongly agree 16 8.1

agree 42 21.2 disagree 72 36.4 Strongly disagree 68 34.3 Total 198 100.0

Q5:



Q6:



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Q7:

Frequency Percent


IV.V ATTITUDE DATA ANALYSIS

Q8:

Frequency Percent


Q9:



Q10:

Frequency Percent


Q11:

Frequency Percent


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Q13:


agree 71 35.9 disagree 47 23.7 Strongly disagree 33 16.7 5.00 1 .5 Total 198 100.0

IV.VI PRACTICE DATA ANALYSIS Q14:

Frequency Percent Valid Yes 96 48.5

No 102 51.5 Total 198 100.0

Q15:


No 119 60.1 Total 198 100.0


Valid Yes 88 44.4 No 110 55.6 Total 198 100.0

Q17:


No 113 57.1

Total 198 100.0

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Valid Yes 68 34.3 No 130 65.7 Total 198 100.0

Q19:


No 132 66.7 Total 198 100.0

Q20:


No 61 30.8 Total 198 100.0

Q21:


No 61 30.8 Total 198 100.0

To interpret the results of the study, the researchers used the following percentages:

From 80 – 100 % very high

From 60 - 79.9 % high

From 40 – 59.9 % medium

Less than 39.9 % low

The following presentation is the results of the study:

What are the knowledge, attitude and practice of nursing staff in government hospitals in the

cities of Nablus and Jenin in the management of medical waste?

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Table No (8): Averages and standard deviations for the degree of knowledge, attitude of nursing staff in government hospitals in the cities of Nablus and Jenin in the management of medical waste.

Paragraph

No. Paragraph Mean

standard

deviations

Percentag

es

Response

Degree

1. Medical waste is well defined in my

hospital 2.95 0.74 73.75 High

2. knowledge of medical waste management

is gained through hospital policy 2.75 0.78 68.75 High

3. Medical waste separated according to

colored bags 2.49 0.95 7375 High

4. Sharp boxes and plastic bags are available

in the department 2.96. .93 74.0 High

5. Sharps container approved model

specifications in terms of protection 3.08 0.85 77.0 High

6. Sharps container should be impervious,

rigid puncture resistance 3.57 0.70 89.25 Very High

7.

lectures, seminars or courses for medical

waste management is presented in the

hospital

2.73 0.95 68.25 High

8. medical waste management program is an

important issue in the hospital 3.35 0.78 83.75 Very High

9. My health care setting has medical waste

plan 2.55 0.82 63.75 High

10. Medical waste management is a nursing

responsibility in the hospital 2.46 0.92 61.5 High

11.

There is a clear policy describes the

mechanism to deal with hospital medical

waste

2.49 0.82 62.25 High

12. There is a full supervision for medical

waste management in the hospital 2.25 0.88 56.25 Medium

13. I'm satisfied about the process of collecting

and isolating medical waste 2.35 1.03 58.75 Medium

Total 2.73 0.49 68.25 High

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For the areas of study, the results were as follows:

NO. Area mean S.D percentage degree

1 knowledge 2.88 0.53 72.0 high

2 Attitude 2.58 0.57 64.50 high

Table No (9): Averages and standard deviations for the degree of knowledge, attitude of nursing staff in

government hospitals in the cities of Nablus and Jenin in the management of medical waste.

(T) TEST AND THE SIGNIFICANCE LEVEL (α = 0.05)

area city N mean S.D T test Sig (2-tailed)*

knowledge nablus 134 2.98 0.51

4.023 0.000* jenin 64 2.67 0.51

attitude nablus 134 2.63 0.59

2.008 0.046* jenin 64 2.46 0.50

total nablus 134 2.81 0.49

3.316 0.001* jenin 64 2.56 0.49

Table No. (10) Test results (T) to signify the differences in knowledge and attitude of nursing staff in government hospitals in the cities of Nablus and Jenin in the management of medical

waste by changing the city. (Statistically significant at the significance level α = 0.05)

area city N mean S.D T test Sig (2-tailed)*

knowledge male 88 2.83 0.58

1.31- 0.191 female 110 2.93 0.48

attitude male 88 2.56 0.58

0.319- 0.750 female 110 2.59 0.56

total male 88 2.69 0.52

0.889- 0.375 female 110 2.76 0.46

Table No. (11) Test results (T) to signify the differences in knowledge and attitude of nursing staff in

government hospitals in the cities of Nablus and Jenin in the management of medical waste by changing the sex.

(Statistically significant at the significance level α = 0.05)

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ANOVA TEST

Table No. (12) The results of anova of the degree of knowledge and behavior and the practice of nursing staff in government hospitals in the cities of Nablus and Jenin in the management of medical waste due

to the variable age. (Statistically significant at the significance level α = 0.05)

Table No. (13) The results of anova of the degree of knowledge and behavior and the practice of nursing staff in government hospitals in the cities of Nablus and Jenin in the management of medical waste due to

the variable Social status. (Statistically significant at the significance level α = 0.05)

area

Source of variation

Sum of squares

DF

Mean-Square

F sig

knowledge

Between groups

0.0976 2 0.0488

0.170 0.844 Within groups

55.954 195 0.287

total 56.051 197

attitude

Between groups

0.493 2 0.246


63.992 195 0.328

total 64.485 197

total

Between groups

0.111 2 0.0555


48.322 195 0.248

total 48.433 197

area

Source of variation

Sum of squares

DF

Mean-Square

F sig

knowledge

Between groups

0291 2 0.146


55.760 195 0.286

total 56.051 197

Attitude

Between groups

0.777 2 0.388


63.708 195 0.327

total 64.485 197

Total

Between groups

0.494 2 0.247


47.939 195 0.246

total 48.433 197

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area

Source of variation

Sum of squares

DF

Mean-Square

F Sig

knowledge

Between groups

1.305 2 0.652


54.746 195 0.281

total 56.051 197

attitude

Between groups

1.465 2 0.733


63.020 195 0.323

total 64.485 197

total

Between groups

1.292 2 0.646


47.141 195 0.242

total 48.433 197


the variable address. (Statistically significant at the significance level α = 0.05)

area

Source of variation

Sum of squares

DF

Mean-Square

F Sig

knowledge

Between groups

1.598 2 0.799


54.453 195 0.279

total 56.051 197

attitude

Between groups

1.582 2 0.791


62.903 195 0.323

total 64.485 197

total

Between groups

1.557 2 0.779

3.239 0.041* Within groups

46.876 195 0.240

total 48.433 197


the variable level of education. (Statistically significant at the significance level α = 0.05)

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area

Source of variation

Sum of squares

DF

Mean-Square

F sig

knowledge

Between groups

1.322 3 0.441


54.729 194 0.282

total 56.051 197

attitude

Between groups

2.054 3 0.685


62.430 194 0.322

total 64.485 197

total

Between groups

1.466 3 0.489


46.967 194 0.242

total 48.433 197 Table No. (16) The results of anova of the degree of knowledge and behavior and the practice of nursing staff in government hospitals in the cities of Nablus and Jenin in the management of medical waste due to

the variable experience. (Statistically significant at the significance level α = 0.05)

LSD TEST

Level of education

Diploma Bachelor High

education level

Diploma *** 0.1828* 0.1768 Bachelor *** *** 0.00559

High education level

*** *** ***

Table No. (17) Shows the a posteriori LSD test comparisons to determine differences to the variable

level of education

Question from collage from hospital Experience

My knowledge about medical waste management acquired from?

119 38 42

total 198

Table (18): show the answers of the a say question

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V. DISCUSSION The study sample was 132 samples from Nablus and 64 samples from jenin, the sample from

Nablus taken from tow hospitals.

Our sample had shown that the number of male nurses is closed to female nurses number and

48% of our sample was from 20-29 years old of nurses (table 2,3), the researcher attribute that

result to Tendencies of young people, especially males to the nursing profession.

The study shows that 61.1% of our sample had a diploma level of education, 33.3% had bachelor

and 5.6% had a high level of education (table 6). The researcher attributes that result to the

orientation of carrying graduate degrees to the academic edifices.

The results of questionnaire analysis show that the percentage of knowledge for nurses in our

study area is 72.0 %, the attitude percentage is 64.50 %

In the field of practice 51.25% of nurses practices there medical waste professionally

And this percentage considered as medium level of practice, for this, the researcher attribute the

high percentage of suffering between nurses from direct contact with medical waste ( sticks,

injurys) which was 48,5% (Q14).

The researcher attributes other reasons for decreased level of practice between nurses in clinical

area, first, the lack of a suitable place to dispose of medical waste. Secondary, Working Pressure.

Tertiary, Shortage of nursing staff.

In another study was done in India, the knowledge component among the nurses have shown to

be 60%, the attitude was 98.3%, and the practice was 100 %.( S. Saini, S.S. Nagarajan, R.K.

Sarma . 2005).

29

VI. CONCLUSION

The knowledge of nurses in jenin and Nablus governmental hospitals was in good level and

the attitude also in good level, but the researcher found there is a lack of practice skills in these

areas, so the practice level take an estimation medium level, with taking into account the reasons

that led up to it. The responsibility for this lack rests on the ministry of health and the hospital

and the nurse it self.

The lack of practice in the hospital leads to many problems and expose the health team and the

patients to harm, so the practice skills must be managed and improved.

30

VII. RECOMMENDATION

The researcher recommendation involve many aspects and several other institutions, for the

ministry of health (MOH), the researcher recommend that must provide the governmental

hospitals with the updated equipments that insure the safety of the nurses and the patients and

avoid them the direct contact with medical wastes, this involve the colored plastic bags and sharp

boxes with standard criteria

Also the MOH must provide the hospitals with specific protocols that describe the dealing with

medical wastes, and providing sufficient numbers of nurses for each department, and arranging

for lectures and seminars that provide the nurses with the precautions that they must followed as

considered.

For the hospital it self, the managers must keep closed supervision on the nurses through

specialized Commissions for medical waste management.

The hospital must provide a specific place for gathering medical wastes and to eliminate it in

proper way.

For the nurses, the nurse must practice his work professionally and to be a critical thinker and

creative and to be knowledge updated.

31

IIX. REFERENCES

1. Handling biohazardous and medical waste, Biosafety Handbook, chapter 20 Available at: www.ehs.uci.edu/programs/biosafety/medwasteguide.pdf . 2. KH. Dhalfullah,(nor), Healthcare waste management (HCWM); WHO Available at: http://www.healthcarewaste.org/en/115_overview.html .

3. Wallace L.P., Zaltzman R. and Burchinal lC. Where solid waste comes from; where it goes.

Modem hospitals 1972; 121(3): 92-5.

4. Guidelines for protecting the safety and health of health workers. NIOSH /Health Care Workers guidelines / Chap 6.

5. Department of Risk Management and Safety Hazardous Materials Management . Auburn University, October 2006.

Available at: http://www.auburn.edu/administration/rms/pdf/medical-waste-disposal.pdf.

6. Eleven Recommendations for Improving Medical Waste Management. The Nightingale Institute for Health and the Environment, 1997 – 2006.

Available at: http://www.nihe.org/elevreng.html .

7. Chemother. 1999 Sep 26-29; 39: 633 (abstract no. 1693).

Available at: http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102246161.html.

8. WHO Media centre.

Available at: http://www.who.int/mediacentre/factsheets/fs281/en/index.html. 9. UNDP and Ministry of Health Seminar concludes to establish a national body to manage

medical waste. Ramallah, June 10, 2009. Available at: http://www.undp.ps/en/newsroom/pressreleasespdf/2009/15.pdf .

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10. K. V. Radha, K. Kalaivani, R. Lavanya.2009, Case Study of Biomedical Waste Management in

Hospitals.Global Journal of Health Science, Vol 1, No 1.

11. Da Silva, A.E. Hoppe, M.M. Ravanello and N. Mello, Department of Hydraulic and Sanitation, Federal University of Santa Maria, UFSM/CT/HDS, Campus Universitário, Rua Vicente do Prado Lima, 355/201, 97105-390 Santa Maria, RS, Brazil.

12. Bennett G. & Mansell I. (2004) Universal precautions: a survey of community nurses' experience and practice. Journal of Clinical Nursing 13, 413-421. J Clin Nurs. 2004

13. Chelenyane M, Endacott R. 2006, Self-reported infection control practices and perceptions of HIV/AIDS risk amongst emergency department nurses in Botswana. Accid Emerg Nurs.

14. El-Shafie IF, Mokabel FM, Helmy FE 1995, the relationship between the knowledge of nursing

staff and their compliance to universal precautions for prevention of hepatitis B viral infection. J Egypt Public Health Assoc.

15. Marguerite M. Jackson, Douglas C. Dechairo, Dianne F. Gardner. February 1986, American Journal of Infection Control, Volume 14, Issue 1, Pages 1-10

16. Gehan M.A. Mostafa, Mona M. Shazly, Wafaa I. Sherief, January 2009, Waste Management. Pages 430-439, Volume 29, Issue 1.

17. S. Saini, S.S. Nagarajan, R.K. Sarma, (2005-01 - 2005-12) Knowledge, Attitude and Practices of Bio-Medical Waste Management amongst Staff of a Tertiary Level Hospital in India, Vol. 17, No. 2

18. BMC Public Health 2008.

Available at:

http://www.biomedcentral.com/1471 2458/8/36

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