1 Indian Journal of Medical Microbiology, (2015) 33(Supplement 1): S119-21
Brief Communication
On the path of continual improvement: An evaluation of biomedical waste management training *K Usha Krishnan, T Sheila Doris Devamani, G Jayalakshmi
Abstract Microbiologists play a pivotal role in the prevention of infection both at hospital and community level. Biomedical waste management (BMWM) is one of the aspects of infection control. For the effective implementation of this, various training programmes have been conducted at our regional training centre. This study evaluates the impact of the BMWM training programme. Knowledge on all parameters was significantly better at post-course evaluation for all the participants (P value 0.001). Evaluation of training is recommended to improve the effectiveness of training method. Key words: Biomedical waste management, evaluation of training, pre- and post-test
Introduction In the era of collaboration and in the model of multispecialty coordination, the clinical microbiologist is seen as a key interface between clinical and laboratory sciences. With the incorporation of preventive aspect and the extension of the field of microbiology to embrace biomedical waste management (BMWM), hospital infection control and infectious disease surveillance, the role of a microbiologist has evolved from a laboratory person to a clinical microbiologist to a community microbiologist. Training, evaluation and surveillance have become their integral role. The Government of India has enacted the BMW (Management and Handling) Rules 1998 in July 1998,[1] under which it is mandatory for all health care facilities to ensure that the BMW be handled and managed without any harm to human health and environment. Health care personnel are expected to have proper knowledge, practice and capacity to guide others for waste management. *Corresponding author (email: ) Department of Microbiology (KUK, TSDD, GJ) Institute of Microbiology, Madras Medical College, Chennai, India Received: 10-01-2014 Accepted: 5-07-2014 Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.150911
Thus, in the state of Tamilnadu, it was planned to educate all the health care workers (HCWs) on BMW (Management and Handling) Rules, 1998 through extensive training programmes. Ours is one of the regional training centres which organises the training and reorientation sessions on BMWM. Hence, the present study was considered to understand the effectiveness of the training. Objectives The aim of the study is to estimate the effectiveness of the BMWM training based on level 1 (reaction) and level 2 (learning) of Kirkpatrick’s model of evaluation of the training programme.[2] The research objectives are to study the impact of training, and to suggest suitable measures for improving the efficiency of the training. Materials and Methods A training module was designed based on recommendations by an expert group. One hundred and twenty-five doctors and 444 staff nurses were trained as Group I on every Wednesday. In Group II, 514 paramedical staffs were included and for them, training was conducted in regional language on every Monday. Forty participants per session were fixed as maximum. The core elements of the training workshops remained unchanged throughout the training with judicious mix of lecture, peer discussions, exercises, games, video films and demonstrations. The level of knowledge was measured by a questionnaire prepared on the basis of various training-related factors. It consisted of a total of 20 multiple
S120
Indian Journal of Medical Microbiology
vol. 33, Supplement 1
choice questions printed in English and in regional language side by side on the same page.
and are more responsible in implementation of BMWM practices than medical professionals.[4]
Knowledge level of trainees was evaluated before and after the course. Trainees were also asked to evaluate the sessions using a five-point scale on various presentation modalities. Results were analysed statistically using percentages, proportions and Student’s paired t-test.
Mohd Shafee et al. are also of the opinion that the nurses have better knowledge and attitude and also practice BMWM better than other paramedical staff.[5]
Results Table 1 shows the analysis of pre-test and post-test marks obtained. Statistical difference between the performance of Group I and II participants is tabulated in Table 2. Knowledge on all parameters was significantly better at post-course evaluation for both the groups (P value 0.001). Also, 85.2% of respondents felt excellent about the session, 6.8% felt good, and another 7.8% felt average. Sessions recording high scores included short video film and ball game. Interactive sessions were appreciated more. Participants graded most of the sessions as excellent in terms of presentation, except the session on transport and storage of BMW. Discussion It is a fact that the training given to the employee has direct relation with the performance of the organisation. Verma et al., in their study, found an improvement in practices after involvement of the service provider training in terms of management and disposal of health care waste.[3] While analysing the effectiveness of training programme, Don Kirkpatrick opined that training would lead to learning, which would then transcend into the job application and thus the desired results. In relation with the effectiveness of training programme, Saini et al. pointed out that nurses have better understanding
Participants Group I Group II
In this study, the basic level knowledge on BMWM of paramedical staffs was significantly higher than doctors and staff nurse group as reflected by their pre-test mean. Pre-test mean was 8.36 and 13.49 for Group I and II, respectively. The knowledge gain was 25% for Group I and 15% for Group II. Percentage of gain score was calculated; benefit was 53% and 25% for Group I and II, respectively. As the basic level knowledge of paramedical group was significantly higher, their knowledge gain and benefit was lesser than Group I. This is in contrary to the above-mentioned studies. This may also be due to the greater interest and commitment shown by paramedical group in filling up the questionnaire than their counterparts. Hospital waste management has major attitudinal and behavioral components.[6] It was planned to project the results of this study in the forthcoming training sessions to motivate the participants to spend enough time in filling up the questionnaire and encourage them for enthusiastic participation. Based upon the participants’ feedback, necessary modification of the content, presentation, time allocation, etc. can be made to improve the effectiveness of the session. The major limitation is that the study has not been designed to perform evaluation of the level 3 (application) and level 4 (impact) aspects of the Kirkpatrick’s model. The study needs to be extended to assess whether what is learnt is being applied and such application is achieving desired results.
Table 1: Comparison of pre-test and post-test responses of participants Test Minimum mark Maximum mark Range Median Pre-test 3 15 12 8.5 Post-test 7 17 10 13.01 Pre-test 12 16 4 13.5 Post-test 15 18 3 16.94
Std error of mean 0.138 0.098 0.045 0.035
Table 2: Statistical difference of marks obtained by Group I and Group II participants Participants Pre-test mean Post-test mean Pre-test standard deviation Post-test standard deviation Student’s paired t-test Group I 8.36 12.83 3.14 2.24 T=8.98 P=0.001 Group II 13.49 16.91 1.09 0.84 T=11.48 P=0.001 www.ijmm.org
February
Krishnan et al: An evaluation of biomedical waste management training
Conclusion
4.
Conducting training workshops on BMWM for health care providers has shown promising results. Evaluation of training is recommended to improve the effectiveness of training method.
5. 6.
References 1. 2. 3.
Notification on Bio-Medical Waste (Management and Handling) Rules. New Delhi: The Gazette of India; 1998. Kirkpatrick DL. Evaluating Training Programs. San Francisco: Berrett-Koehler Publishers, Inc; 1994. Verma LK, Mani S, Sinha N, Rana S. Biomedical waste management in nursing homes and smaller hospitals in Delhi. Waste Manag 2008;28:2723-34.
S121
Saini S, Nagarajan SS, Sarma RK. Knowledge attitude and practices of bio-medical waste management amongst staff of a tertiary level hospital in India. J Hosp Adm 2005;17:2. Shafee M, Kasturwar N, Nirupama N. Study of knowledge, attitude and practices regarding biomedical waste among paramedical workers. Indian J Community Med 2010;35:369-70. Rasheed S, Iqbal S, Big LA, Mufti K. Hospital waste management in the teaching hospitals of Karachi. J Pak Med Assoc 2005;55:192-5.
How to cite this article: Krishnan KU, Doris Devamani TS, Jayalakshmi G. On the path of continual improvement: An evaluation of biomedical waste management training. Indian J Med Microbiol 2015;33:S119-21. Source of Support: Nill, Conflict of Interest: None declared.
www.ijmm.org
Copyright of Indian Journal of Medical Microbiology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Brief Communication
On the path of continual improvement: An evaluation of biomedical waste management training *K Usha Krishnan, T Sheila Doris Devamani, G Jayalakshmi
Abstract Microbiologists play a pivotal role in the prevention of infection both at hospital and community level. Biomedical waste management (BMWM) is one of the aspects of infection control. For the effective implementation of this, various training programmes have been conducted at our regional training centre. This study evaluates the impact of the BMWM training programme. Knowledge on all parameters was significantly better at post-course evaluation for all the participants (P value 0.001). Evaluation of training is recommended to improve the effectiveness of training method. Key words: Biomedical waste management, evaluation of training, pre- and post-test
Introduction In the era of collaboration and in the model of multispecialty coordination, the clinical microbiologist is seen as a key interface between clinical and laboratory sciences. With the incorporation of preventive aspect and the extension of the field of microbiology to embrace biomedical waste management (BMWM), hospital infection control and infectious disease surveillance, the role of a microbiologist has evolved from a laboratory person to a clinical microbiologist to a community microbiologist. Training, evaluation and surveillance have become their integral role. The Government of India has enacted the BMW (Management and Handling) Rules 1998 in July 1998,[1] under which it is mandatory for all health care facilities to ensure that the BMW be handled and managed without any harm to human health and environment. Health care personnel are expected to have proper knowledge, practice and capacity to guide others for waste management. *Corresponding author (email: ) Department of Microbiology (KUK, TSDD, GJ) Institute of Microbiology, Madras Medical College, Chennai, India Received: 10-01-2014 Accepted: 5-07-2014 Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.150911
Thus, in the state of Tamilnadu, it was planned to educate all the health care workers (HCWs) on BMW (Management and Handling) Rules, 1998 through extensive training programmes. Ours is one of the regional training centres which organises the training and reorientation sessions on BMWM. Hence, the present study was considered to understand the effectiveness of the training. Objectives The aim of the study is to estimate the effectiveness of the BMWM training based on level 1 (reaction) and level 2 (learning) of Kirkpatrick’s model of evaluation of the training programme.[2] The research objectives are to study the impact of training, and to suggest suitable measures for improving the efficiency of the training. Materials and Methods A training module was designed based on recommendations by an expert group. One hundred and twenty-five doctors and 444 staff nurses were trained as Group I on every Wednesday. In Group II, 514 paramedical staffs were included and for them, training was conducted in regional language on every Monday. Forty participants per session were fixed as maximum. The core elements of the training workshops remained unchanged throughout the training with judicious mix of lecture, peer discussions, exercises, games, video films and demonstrations. The level of knowledge was measured by a questionnaire prepared on the basis of various training-related factors. It consisted of a total of 20 multiple
S120
Indian Journal of Medical Microbiology
vol. 33, Supplement 1
choice questions printed in English and in regional language side by side on the same page.
and are more responsible in implementation of BMWM practices than medical professionals.[4]
Knowledge level of trainees was evaluated before and after the course. Trainees were also asked to evaluate the sessions using a five-point scale on various presentation modalities. Results were analysed statistically using percentages, proportions and Student’s paired t-test.
Mohd Shafee et al. are also of the opinion that the nurses have better knowledge and attitude and also practice BMWM better than other paramedical staff.[5]
Results Table 1 shows the analysis of pre-test and post-test marks obtained. Statistical difference between the performance of Group I and II participants is tabulated in Table 2. Knowledge on all parameters was significantly better at post-course evaluation for both the groups (P value 0.001). Also, 85.2% of respondents felt excellent about the session, 6.8% felt good, and another 7.8% felt average. Sessions recording high scores included short video film and ball game. Interactive sessions were appreciated more. Participants graded most of the sessions as excellent in terms of presentation, except the session on transport and storage of BMW. Discussion It is a fact that the training given to the employee has direct relation with the performance of the organisation. Verma et al., in their study, found an improvement in practices after involvement of the service provider training in terms of management and disposal of health care waste.[3] While analysing the effectiveness of training programme, Don Kirkpatrick opined that training would lead to learning, which would then transcend into the job application and thus the desired results. In relation with the effectiveness of training programme, Saini et al. pointed out that nurses have better understanding
Participants Group I Group II
In this study, the basic level knowledge on BMWM of paramedical staffs was significantly higher than doctors and staff nurse group as reflected by their pre-test mean. Pre-test mean was 8.36 and 13.49 for Group I and II, respectively. The knowledge gain was 25% for Group I and 15% for Group II. Percentage of gain score was calculated; benefit was 53% and 25% for Group I and II, respectively. As the basic level knowledge of paramedical group was significantly higher, their knowledge gain and benefit was lesser than Group I. This is in contrary to the above-mentioned studies. This may also be due to the greater interest and commitment shown by paramedical group in filling up the questionnaire than their counterparts. Hospital waste management has major attitudinal and behavioral components.[6] It was planned to project the results of this study in the forthcoming training sessions to motivate the participants to spend enough time in filling up the questionnaire and encourage them for enthusiastic participation. Based upon the participants’ feedback, necessary modification of the content, presentation, time allocation, etc. can be made to improve the effectiveness of the session. The major limitation is that the study has not been designed to perform evaluation of the level 3 (application) and level 4 (impact) aspects of the Kirkpatrick’s model. The study needs to be extended to assess whether what is learnt is being applied and such application is achieving desired results.
Table 1: Comparison of pre-test and post-test responses of participants Test Minimum mark Maximum mark Range Median Pre-test 3 15 12 8.5 Post-test 7 17 10 13.01 Pre-test 12 16 4 13.5 Post-test 15 18 3 16.94
Std error of mean 0.138 0.098 0.045 0.035
Table 2: Statistical difference of marks obtained by Group I and Group II participants Participants Pre-test mean Post-test mean Pre-test standard deviation Post-test standard deviation Student’s paired t-test Group I 8.36 12.83 3.14 2.24 T=8.98 P=0.001 Group II 13.49 16.91 1.09 0.84 T=11.48 P=0.001 www.ijmm.org
February
Krishnan et al: An evaluation of biomedical waste management training
Conclusion
4.
Conducting training workshops on BMWM for health care providers has shown promising results. Evaluation of training is recommended to improve the effectiveness of training method.
5. 6.
References 1. 2. 3.
Notification on Bio-Medical Waste (Management and Handling) Rules. New Delhi: The Gazette of India; 1998. Kirkpatrick DL. Evaluating Training Programs. San Francisco: Berrett-Koehler Publishers, Inc; 1994. Verma LK, Mani S, Sinha N, Rana S. Biomedical waste management in nursing homes and smaller hospitals in Delhi. Waste Manag 2008;28:2723-34.
S121
Saini S, Nagarajan SS, Sarma RK. Knowledge attitude and practices of bio-medical waste management amongst staff of a tertiary level hospital in India. J Hosp Adm 2005;17:2. Shafee M, Kasturwar N, Nirupama N. Study of knowledge, attitude and practices regarding biomedical waste among paramedical workers. Indian J Community Med 2010;35:369-70. Rasheed S, Iqbal S, Big LA, Mufti K. Hospital waste management in the teaching hospitals of Karachi. J Pak Med Assoc 2005;55:192-5.
How to cite this article: Krishnan KU, Doris Devamani TS, Jayalakshmi G. On the path of continual improvement: An evaluation of biomedical waste management training. Indian J Med Microbiol 2015;33:S119-21. Source of Support: Nill, Conflict of Interest: None declared.
www.ijmm.org
Copyright of Indian Journal of Medical Microbiology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
