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Biomedical waste management has recently emerged as an issue of major concern not only to
hospitals, nursing home authorities but also to the environment. the bio-medical wastes
generated from health care units depend upon a number of factors such as waste management
methods, type of health care units, occupancy of healthcare units, specialization of healthcare
units, ratio of reusable items in use etc.
A hospital is an institution visited by people of any age, sex, race and religion when they are
medically unfit. In addition to patients, hospitals also consist of doctors and medical staff
personals. Any human activity produces waste that is dangerous requiring proper disposal
techniques. If these wastes are not disposed of in a safe manner they may pollute the
surrounding air, water and soil. Hospital waste (Biomedical waste) is a kind of waste that is
dangerous due to its hazardous and infectious nature in comparison to the other wastes.
Although, almost 75-90% of waste produced by hospitals, nursing homes etc. is non- risk in
natures as they are generated from administrative and general housekeeping, the remaining
10-25% of waste is regarded as ‘hazardous’ and may create variety of health risks due to their
infectious nature . It has been observed that people dealing with biomedical wastes are often
themselves subjected to infectious diseases like HIV, Hepatitis and tetanus. To prevent such
adverse health effects on personals handling biomedical wastes and for general health and
safety of the population The Ministry of Environment And Forest (MOEF) has notified
biomedical waste (management and handling) rules in 1998 that issues guidelines to all
hospitals, clinics, nursing homes and laboratories to ensure safe and environmentally sound
management of waste produced by them . In general, biomedical wastes are generated during
diagnosis, treatment or immunization of human being or animals. It was expected that with
tremendous advancement in global health care facilities adequate attention will be given to
the disposal and management of biomedical wastes however the ground reality suggests that
often the healthcare facility themselves have posed a huge health risk due to poor waste
management by professionals and have become a huge threat to environment. This has been
acknowledged globally and different countries have ensured legislations for proper
biomedical waste management. The purview of these regulations caters to both the public and
the private healthcare facilities. Improper biomedical waste practices lead to microbial
ecology change and spread of antibiotic resistance hence the most suitable method for
disposal involves prevention or minimization of toxic substances from hospital to
environment.
The recent developments in healthcare units are precisely made for the prevention and
protection of community health. Sophisticated instruments have come into existence in
various operations for disease treatment. Such improvement and advances in scientific
knowledge has resulted in per capita per patient generation of wastes in health care units.
Waste generated in the process of health care are composed of variety of wastes including
hypodermic needles, scalpels, blades, surgical cottons, gloves, bandages, clothes, discarded
medicine and body fluids, human tissues and organs, chemicals etc., Other wastes generated
in healthcare settings include radioactive wastes, mercury containing instruments, PVC
plastics etc., World Health Organization states that 85% of hospital wastes are actually non-
hazardous, whereas 10% are infectious and 5% are non-infectious but they are included in
hazardous wastes. About 15% to 35% of Hospital waste is regulated as infectious waste.
These wastes now threatens the public since, the health care foundations are situated in heart
of city and therefore medical waste, if not properly managed can cause dangerous infection
and posses a potential threat to the surrounding environment, persons handling it and to the
public.. Globally this issue has been seriously considered and appropriate waste management
systems are being developed and installed. A number of difficulties are being faced at many
places in implementation of this plan in practice. The waste disposal is governed by the
Government agencies and regulations including private organizations. At present, there is no
available information that describes the actual practice of handling the health care waste
products. The proposed hospital waste management plan is consistent with the biomedical
waste (management and handling) (second Amendment) Rules, 2000, Ministry of
environment and forests. As a result this study aims to assess the biomedical waste handling
and treatment in different health care settings.
Health-care waste refers to all the waste generated by a health care establishment. It is
estimated that 10-25% of health care waste is hazardous, with the potential for creating a
variety of health problems. The waste produced in the course of healthcare activities carries a
higher potential for infection than any other type of wastes. Bio-medical waste collection and
proper disposal has become a significant concern for both the medical and the general
community. Since the implementation of the biomedical Waste Management Rules 1998,
every concerned health personnel is expected to have proper knowledge, practice and
capacity to guide others for waste collection and management, and proper handling
techniques. Dental offices generate a number of hazardous wastes that can be detrimental to
the environment if not properly managed. This includes sharps, used disposable items,
infectious wastes (blood-soaked cotton, gauze etc.), mercury containing waste (mercury,
amalgam scrap), lead containing waste (lead foil packets, lead aprons) and chemical waste
(such as spent film developers, fixers and disinfectants). Studies have shown that waste water
from dental offices typically contains elevated concentrations of metals such as mercury,
silver, copper, tin and zinc. Sources of these metals include placement and removal of
amalgam fillings (mercury, silver, copper, tin and zinc) and disposal of the spent X-ray fixer
solution. The biomedical waste management and handling rules have been notified in 1998.
The rules were amended twice in 2000, primarily to address administrative matters. The rule
makes it mandatory for the health care establishments to segregate, disinfect and dispose their
waste in an ecofriendly manner. An important pre-requisite and key to successful waste
management program is segregation which is the separation of different types of waste as per
treatment and disposal option. Segregation and collection of various categories of waste
should be done at the source, in separate containers so that each category is treated in a
suitable manner to render it harmless. For waste management to be effective, the waste
should be managed at every step, from acquisition to disposal.
The proper management of biomedical waste has become a worldwide humanitarian topic
today. Although hazards of poor management of biomedical waste have aroused the concern
world over, especially in the light of its far-reaching effects on human, health and the
environment. Now it is a well established fact that there are many adverse and harmful effects
to the environment including human beings which are caused by the “Hospital waste”
generated during the patient care. Hospital waste is a potential health hazard to the health care
workers, public and flora and fauna of the area. The problems of the waste disposal in the
hospitals and other health-care institutions have become issues of increasing concern.
CHAPTER 2: LITERATURE REVIEW
2.1 Review of Literature
Lots of research has already been done on Bio medical waste management system. Some of
review of related literature on the present study is given in this chapter.
Gupta, V, K., & et al (2017) Researchers aim of the survey was to provide awareness of
biomedical waste management among the interns in developing countries medical waste has
not received much attention and it is diposed together. This is a cross sectional study
comprises of randomly selected sample from each of the categories with 142 respondents.
Study finds that only 55.8% of dental intern and 79.1% of medical staff thought that if waste
is not treated then there were chance of infection knowledge about the bmw management
practices in the staff of hospitals were satisfactory.
Vasistha, P., and Ganauly, R, (2015) Researchers aim of the survey was assessing
biomedical waste management in Shimla city realizing the significance of bmw management
.the research was done through a questionnaire which was circulated in the city of Shimla’s
private and government hospitals it was done for 90 hospitals. The public hospital released
16.65kg/day waste and private hospital released 1.26kg/day waste. The above survey helped
to design a waste disaster to dispose of biomedical waste of a hospital.
Saranya, R (1998) Author focus of survey was to handle the biomedical waste essentially
and properly and it also aimed at evaluating the knowledge of biomedical management
among the health care providers. The research was done through periodic visit to the health
care provider to analyse their knowledge about bmw management data was also collected
through question. Finding presented that there was law of knowledge about bmw
management which led to the poor practice of bio medical handling.
Babu, R., and Parande, S. (2008) Authors aim to to summarize the rules of management
and handling of bmw and also the effects of biomedical waste on environment. The data
mostly was secondary from the other surveys. The solid waste generation rates ranges from
0.5 to 2.0 kg bed day and other general waste including food(40-45%)several survey works
carried out by the various research organizations has been also discussed and reviewed in this
paper.
Sharma, A., and Sharma, V., (1992) Researchers aimed to determine the following among
the workforce of the Jaipur dental college India waste management policy and practices
attitude towards the biomedical waste across sectional study conducted using a questionnaire.
140 were written and answered. The result show there was poor level of awareness and
knowledge about bmw management. It can be concluded that the levels of knowledge about
bmw were low in Jaipur.
Acharya, A., and Joshi, D. (2014) Researchers evaluate the disposal of bmw and also
evaluate the threats caused by it were analyzed in this survey. The parameters which affect
the quality of environment to explore the effect of bmw in the city. The research was done in
Pune. Hospitals and clinics in are becoming a major treats as they are not following the bmw
management rules. The identity of the chemicals showed be clearly marked and the best
disposing method is incretion.
Pandey, V., and Sahar, A. (2018) Researchers main objective of the study was to assess the
awareness towards dental waste including mercury management. An epidemiologic survey
was conducted among 109 dental students. The survey composed of 21 self administered
questions. The results showed 43.11 of dental student were aware about more than 50% of
questions. It was concluded not all the dental student were aware of the BMW.
Tippat, S, K., and Pachkhade, A, U (year) Researchers focused on bio medical disposal
system in some hospital of Omnavati city. The survey was done by providers randomly
questionnaire to the staff of the hospitals. As per the observation and report of six hospital of
Amravati city .it is concluded that all the hospital generating bio medical waste. It includes
hazardous waste in the form of solid and liquid not a single hospital has its own disposal
mechanism.
Barar, M (2013) Author aims to survey was about bio waste management in the modern
hospitals. The survey was done with personally visiting the hospitals and health care
providers. The problem of bio- medical waste disposal in the hospital and other healthcare
establishment has become an issue of increasing concern prompting hospital administration
to seven new wastes of scientific safe and cost effective management of waste.
Verma, k (2016) aims to survey the waste disposal system of the hospital of the city of Surat.
The survey was done in 25 hospitals of both sectors. The research state that here was increase
in knowledge of BMW management in the hospital and waste was disposed efficiently. The
date mostly secondary and was generated from new spaces and other surveys.
Observation
As stated above the surveys mentioned in the literature review are very large as
compared to survey done for the topic of the project the sample size are very
less as compared to other survey there are only 50 interns who were provided
with questionnaire and instead of many hospitals which is trl hospital belpahar
and through which the survey is completed.
CHAPTER 4: RESEARCH METHODOLOGY
One of the most important aspects of research is the statistics associated with it conclusion or
result it is about the thought that goes behind the research. Research is conducted with a
purpose to understand. Research is based on logical reasoning and involves both inductive
and deductive methods. The data or knowledge that is derived is in real time actual
observation in the natural settings.
Problem oriented research as the name suggests problem- oriented research is conducted to
understand the exact nature of the problem to find out relevant solution. The term “problem”
refers to having issue or to thoughts while making any decision. Problem solving research:
this type of research is conducted by companies to understand and resolve their own
problems. The problem solving research applied research to find solution to the existing
problems.
Bio medical waste management is an integral part of traditional and contemporary system of
health care the paper focuses on the identification and classification of biomedical waste in
ayurvedic hospitals current practice of the management in ayurveda hospital and the future
respective database like pub med we made a attempt to categories the biomedical waste from
the hospital as the available data about its grouping is very scarce incarnation and landfills.
But these methods are having some methods are having some merits as well as some demerits
our review has identified a number of interesting area for further research such as the logical
application of bioremediations techniques in biomedical waste management. Biomedical
waste management has recently emerged as an issue of major concern not only to hospitals,
nursing home authorities but also to the environment. The bio medical waste generated from
health care units depend upon a number of factors such as waste management methods, types
of health care units , occupancy of healthcare units, specialization of healthcare units, ratio of
reusable items in use availability of infrastructure resources.
The proper management of bio medical waste has become a worldwide humanitarian topic
today although hazards of poor management bio medical waste have aroused the concern
world over especially in the light of its far reaching effects on human, health and
environment.
The scope of the study is confined to Biomedical waste Management of TRL hospital,
Belpahar
To calculate the biomedical waste management process carried out inside the TRL hospital.
To know the knowledge about bio medical management among the staff and nurses of the
hospital.
Suggesting new method of biomedical waste handling to the hospital.
To calculate the effectiveness of bio medical waste management system in the private sector
hospitals.
To assist the staff of the hospital in handling the biomedical waste properly.
To reduce the amount of infliction caused by poor handling of bio medical waste.
4.6 Sources of Data Collection
The data are generally collected from primary and secondary means. In present study also
data are collected from both sources. Primary data are collected with help of structured
questionnaire targeting 70 respondents, out of which 50 respondents are taken for study.
Target respondent are staff and nurses of the TRL hospital and Secondary data are collected
from the internet and different journals and newspaper and from the surveys done by other
researchers.
The sum totals of 50 respondents were taken for the survey and the technique applied was
convenience sampling method. The sample unit considered in study is TRL hospital of
Belpahar town.
H01 : There is no significant relation between safe management of health care waste
and age groups of individual.
H02 : There is no significant relation between bio medical waste disposal policy and
marital status of individual.
H03 : There is no significant relation between programs which enhance knowledge
about waste management and age groups.
H04 : There is no significant relation between colour coding for bio medical waste
and age groups..
4.9. Tools Employed
The Methods which were applied to make this survey is average method and chi square test.
The method helps to describe a relationship between two independent variables and also
derive findings and suggestion about the survey and research. In chi test we have derived four
null hypothesis to determine the relationship between the variables. The average method was
used to arrange data and convert them into various charts. The tools were very important in
completing the survey.
5.1.1 -Introduction:
The chi-square test is a statistical test that can be used to determine whether observed
frequencies are significantly different from expected frequencies. For example, after we
calculated expected frequencies for different allozymes in the HARDY-WEINBERG module
we would use a chi-square test to compare the observed and expected frequencies and
determine whether there is a statistically significant difference between the two. As in other
statistical tests, we begin by stating a null hypothesis (H0: there is no significant difference
between observed and expected frequencies) and an alternative hypothesis (H1: there is a
significant difference). Based on the outcome of the chi-square test we will
either reject or fail to reject the null hypothesis.
Chi-square tests enable us to compare observed and expected frequencies objectively, since it
is not always possible to tell just by looking at them whether they are different enough" to be
considered statistically significant.
The Chi-square test is intended to test how likely it is that an observed distribution is due to
chance. It is also called a "goodness of fit" statistic, because it measures how well the
observed distribution of data fits with the distribution that is expected if the variables are
independent.
5.2-Conditions:
A Chi-square test is designed to analyze categorical data. That means that the
data has been counted and divided into categories. It will not work with
parametric or continuous data (such as height in inches). For example, if you
want to test whether attending class influences how students perform on an
exam, using test scores (from 0-100) as data would not be appropriate for a Chi-
square test. However, arranging students into the categories "Pass" and "Fail"
would. Additionally, the data in a Chi-square grid should not be in the form of
percentages, or anything other than frequency (count) data. Thus, by dividing a
class of 54 into groups according to whether they attended class and whether
they passed the exam, you might construct a data set like this:
Pass Fail
Attended 25 6
Skipped 8 15
5.3-IMPORTANT:
Be very careful when constructing your categories! A Chi-square test can tell
you information based on how you divide up the data. However, it cannot tell
you whether the categories you constructed are meaningful. For example, if you
are working with data on groups of people, you can divide them into age groups
(18-25, 26-40, 41-60...) or income level, but the Chi-square test will treat the
divisions between those categories exactly the sameas the divisions between
male and female, or alive and dead! It's up to you to assess whether your
categories make sense, and whether the difference (for example) between age
25 and age 26 is enough to make the categories 18-25 and 26-40 meaningful.
This does not mean that categories based on age are a bad idea, but only that
you need to be aware of the control you have over organizing data of that sort.
Another way to describe the Chi-square test is that it tests the null
hypothesis that the variables are independent. The test compares the observed
data to a model that distributes the data according to the expectation that the
variables are independent. Wherever the observed data doesn't fit the model, the
likelihood that the variables are dependent becomes stronger, thus proving the
null hypothesis incorrect!
The following table would represent a possible input to the Chi-square test,
using 2 variables to divide the data: gender and party affiliation. 2x2 grids like
this one are often the basic example for the Chi-square test, but in actuality any
size grid would work as well: 3x3, 4x2, etc.
Democrat Republican
Male 20 30
Female 30 20
This shows the basic 2x2 grid. However, this is actually incomplete, in a sense;
generally, the data table should include "marginal" information giving the total
counts for each column and row, as well as for the whole data set:
We now have a complete data set on the distribution of 100 individuals into
categories of gender (Male/Female) and party affiliation
(Democrat/Republican). A Chi-square test would allow you to test how likely it
is that gender and party affiliation are completely independent; or in other
words, how likely it is that the distribution of males and females in each party is
due to chance.
So, as implied, the null hypothesis in this case would be that gender and party
affiliation are independent of one another. To test this hypothesis, we need to
construct a model which estimates how the data should be distributed if our
hypothesis of independence is correct. This is where the totals we put in the
margins will become handy: later on, I'll show how you can calculate your
estimated data using the marginals.
5.4-Procedure:
Suppose that Variable A has r levels, and Variable B has clevels. The null
hypothesis states that knowing the level of Variable A does not help you predict
the level of Variable B. That is, the variables are independent.
The alternative hypothesis is that knowing the level of Variable A can help you
predict the level of Variable B.
Note: Support for the alternative hypothesis suggests that the variables are
related; but the relationship is not necessarily causal, in the sense that one
variable "causes" the other.
Formulate an Analysis Plan
The analysis plan describes how to use sample data to accept or reject the null
hypothesis. The plan should specify the following elements.
Using sample data, find the degrees of freedom, expected frequencies, test
statistic, and the P-value associated with the test statistic. The approach
described in this section is illustrated in the sample problem at the end of this
lesson.
DF = (r - 1) * (c - 1)
where r is the number of levels for one catagorical variable, and c is the
number of levels for the other categorical variable.
where Er,c is the expected frequency count for level r of Variable A and
level c of Variable B, nr is the total number of sample observations at
level r of Variable A, nc is the total number of sample observations at
level c of Variable B, and n is the total sample size.
Interpret Results
If the sample findings are unlikely, given the null hypothesis, the researcher
rejects the null hypothesis. Typically, this involves comparing the P-value to
the significance level, and rejecting the null hypothesis when the P-value is less
than the significance level.
Problem
Is there a gender gap? Do the men's voting preferences differ significantly from
the women's preferences? Use a 0.05 level of significance.
Solution
The solution to this problem takes four steps: (1) state the hypotheses, (2)
formulate an analysis plan, (3) analyze sample data, and (4) interpret results.
We work through those steps below:
State the hypotheses. The first step is to state the null hypothesis and an
alternative hypothesis.
DF = (r - 1) * (c - 1) = (2 - 1) * (3 - 1) = 2
Interpret results. Since the P-value (0.0003) is less than the significance
level (0.05), we cannot accept the null hypothesis. Thus, we conclude that
there is a relationship between gender and voting preference.
5.5-Advantages
The Chi-square statistic is a non-parametric (distribution free) tool designed to
analyze group differences when the dependent variable is measured at a
nominal level. Like all non-parametric statistics, the Chi-square is robust with
respect to the distribution of the data. Specifically, it does not require equality
of variances among the study groups or homoscedasticity in the data. It permits
evaluation of both dichotomous independent variables, and of multiple group
studies. Unlike many other non-parametric and some parametric statistics, the
calculations needed to compute the Chi-square provide considerable
information about how each of the groups performed in the study. This richness
of detail allows the researcher to understand the results and thus to derive more
detailed information from this statistic than from many others. The Chi-square
is a significance statistic, and should be followed with a strength statistic. The
Cramer's V is the most common strength test used to test the data when a
significant Chi-square result has been obtained. Advantages of the Chi-square
include its robustness with respect to distribution of the data, its ease of
computation, the detailed information that can be derived from the test, its use
in studies for which parametric assumptions cannot be met, and its flexibility in
handling data from both two group and multiple group studies. Limitations
include its sample size requirements, difficulty of interpretation when there are
large numbers of categories (20 or more) in the independent or dependent
variables, and tendency of the Cramer's V to produce relative low correlation
measures, even for highly significant results.
5.7-Disadvantages
First, chi-square is highly sensitive to sample size. As sample size increases,
absolute differences become a smaller and smaller proportion of the expected
value. What this means is that a reasonably strong association may not come up
as significant if the sample size is small, and conversely, in large samples, we
may find statistical significance when the findings are small and uninteresting.,
i.e., the findings are not substantively significant, although they are statistically
significant.
Chi-square is also sensitive to small frequencies in the cells of tables. Generally
when the expected frequency in a cell of a table is less than 5, chi-square can
lead to erroneous conclusions. The rule of thumb here is that if either (i) an
expected value in a cell is less than 5 or (ii) more than 20% of the expected
values in cells are less than 5, then chi-square should not and usually is not
computed.
5.7-APPLICATION OF CHI SQUARE TEST
TABLE NO. 1 :–
DEMOGRAPHIC PROFILE
DEMOGRAPHIC PROFILE NO. OF RESPONDENTS PERCENTAGE %
SEX:
MALE 31 62%
FEMALE 19 38%
MARITAL STATUS:
MARRIED 30 60%
UNMARRIED 20 40%
DESIGNATION:
OFFICERS 46 92%
G.M. 4 8%
AGE:
25 - 35 Yrs 34 68%
ABOVE 35 16 32%
Interpretation1:
Q No 1 :
VARIABLES OBSERVATION PERCENTAGE
STRONGLY AGREE 35 70
SOMEWHAT AGREE 10 20
NEUTRAL 4 8
SOMEWHAT DISAGREE 1 2
STRONGLY DISAGREE 0 0
Graph 1:
PERCENTAGE
2% 0%
8%
STRONGLY AGREE
20% SOMEWHAT AGREE
NEUTRAL
SOMEWHAT DISAGREE
70% STRONGLY DISAGREE
Interpretation 1:
TABLE NO. 2
QUESTIONNARE NO. 2
H01:
H11:
NO. OF
RESPONDENTS
VARIABLES N = 50 PERCENTAGE % STATISTICAL INFERENCE :
TABULATED VALUE AT
NEUTRAL 7 14%
5%SIGNIFICANCE LEVEL =9.48
SOMEWHAT DISAGREE 2 4%
H0 = IS ACCEPTED
Interpretation 2 :
QUESTIONNARE NO. 3
DEGREE OF FREEDOM = 4
SOMEWHAT AGREE 23 46%
TABULATED VALUE AT 5%
H0 = IS ACCEPTED
SOMEWHAT DISAGREE 2 4%
H1 = REJECTED
STRONGLY DISAGREE 0 0%
Interpretation 3 :
QUESTIONNARE NO. 8
NO. OF
RESPONDENTS N = STATISTICAL INFERENCE :
VARIABLES 50 PERCENTAGE % X2 =18.6
STRONGLY AGREE 6 68% DEGREE OF FREEDOM = 4
QUES 4:
VARIABLES OBSERVATION PERCENTAGE
STRONGLY AGREE 10 20%
SOMEWHAT AGREE 22 44%
NEUTRAL 13 26%
SOMEWHAT DISAGREE 5 10%
STRONGLY DISAGREE 0 0%
percentage
0%
10%
20%
STRONGLY AGREE
SOMEWHAT AGREE
26%
NEUTRAL
SOMEWHAT DISAGREE
STRONGLY DISAGREE
44%
QUES 5:
VARIABLES OBSERVATION PERCENTAGE
STRONGLY AGREE 12 24%
SOMEWHAT AGREE 24 48%
NEUTRAL 8 16%
SOMEWHAT DISAGREE 6 12%
STRONGLY DISAGREE 0 0%
percentage
0%
12%
24% STRONGLY AGREE
QUES 6:
16%
24%
STRONGLY AGREE
SOMEWHAT AGREE
NEUTRAL
18%
SOMEWHAT DISAGREE
STRONGLY DISAGREE
40%
QUES 7:
VARIABLES OBSERVATION PERCENTAGE
STRONGLY AGREE 6 12%
SOMEWHAT AGREE 26 52%
NEUTRAL 12 24%
SOMEWHAT DISAGREE 4 8%
STRONGLY DISAGREE 2 4%
percentage
4%
8% 12%
STRONGLY AGREE
SOMEWHAT AGREE
24% NEUTRAL
SOMEWHAT DISAGREE
52% STRONGLY DISAGREE
QUES 9:
VARIABLES OBSERVATION PERCENTAGE
STRONGLY AGREE 6 12%
SOMEWHAT AGREE 24 48%
NEUTRAL 11 22%
SOMEWHAT DISAGREE 8 16%
STRONGLY DISAGREE 1 2%
percentage
STRONGLY AGREE
SOMEWHAT AGREE
NEUTRAL
SOMEWHAT DISAGREE
STRONGLY DISAGREE
QUES 10:
VARIABLES OBSERVATION PERCENTAGE
STRONGLY AGREE 10 20%
SOMEWHAT AGREE 15 30%
NEUTRAL 11 22%
SOMEWHAT DISAGREE 10 20%
STRONGLY DISAGREE 4 8%