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PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
DISSERTATION PROPOSAL
“ A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF BIO
MEDICAL WASTE MANEGEMENT AMONG STAFF NURSES
IN SELECTED HOSPITALS AT TUMKUR WITH A VIEW TO
DEVELOP AN INFORMATION BOOKLET ”
SUBMITTED BY;
MISS. ASHA V SAMUEL
FIRST YEAR M.Sc. NURSING
MEDICAL SURGICAL NURSING
SHRI DEVI COLLEGE OF NURSING
TUMKUR, KARNATAKA.
RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCES KARNATAKA
BANGALOREPROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.
1. NAME OF THE CANDIDATE
AND ADDRESS (IN
BLOCK LETTER)
MISS.ASHA V SAMUEL
SHRI DEVI COLLEGE OF NURSING,
TUMKUR.
2. NAME OF THE
INSTITUTION.
SHRI DEVI COLLEGE OF NURSING,
TUMKUR.
3. COURSE OF STUDY AND
SUBJECT.
MSC NURSING 1st YEAR
MEDICAL SURGICAL NURSING.
4. DATE OF ADMISSION TO
COURSE
01.10.2012
5. TITLE OF THE TOPIC. “ A DESCRIPTIVE STUDY TO
ASSESS THE KNOWLEDGE OF
BIO MEDICAL WASTE
MANEGEMENT AMONG STAFF
NURSES IN SELECTED
HOSPITALS AT TUMKUR WITH
A VIEW TO DEVELOP AN
INFORMATION BOOKLET ”
6.0 INTRODUCTION
All human activities and living thing on earth produce waste in some form or the
other. Normally, aerobic and anaerobic process in the environment degrades such products.
These waste, both biodegradable and non-biodegradable hardly had any impact on the
environment until the invention of plastics by the modern man. The process of natural
degradation could not keep pace with the increase in waste generated by the over increasing
population of mankind and its necessities. The air, water, and land are today becoming
disposal sinks for the waste.1
Waste is a useful to first user but with its transportation after use, some of the waste
items are useful to subsequent users. If subsequent utilization is harmful, waste should be
removed with such precautionary measure keeping it out of reach for others but, the trouble
comes throw away society.2
Hospitals produce a verity of wastes that can be utilized as a resource after recycling
it properly. Comprehensive recycling and waste minimization programme can decrease, the
financial burden on facilities and at the same time systematic waste management practices
can helpful to save the environment.3
Waste reduction strategies go beyond recycling which comes into play only at the end
of a products of lifecycle. Good strategies have first place. This involves switching to less
wasteful practice & using products that are non polluting. All waste can be used as resources
through recycling or composing. A good segregation system in the hospital, therefore, helps
in generating extra resources3.
The hospital medical waste is responsible for serious health hazards. Though the
persons involved in this aspect the existing status of biomedical waste management cannot be
said satisfactory due to many shortcomings and constrains. No specific guidelines and
parameters are being followed or implemented by the staff concerned. They are poorly
educated guidance and supervision is poor2.
Some hospital waste generated are too hazardous to be treated negligently and if any
carelessness is followed by the management of these wastes it is a hospital that tends to
spread infection and contamination of the entire living environment prevailing in the hospital.
The delay in the recovery and overburden for weak patients. It affect the most of the
patient’s survival and also generate health hazards to working personnel in & around the
hospital environment.4
Now today nursing is considered as a professional discipline that includes the art of
applying scientific knowledge to practice.
BACK GROUND OF THE STUDY
The hospital generated waste is concerned by the growing problem of the disposal of
waste. Though generate large amount of medical wastes each year. Surprisingly until recent
days not enough very much of attention. Was paid to the disposal of hospital waste. Proper
disposal of health care waste is of paramount importance because of its infections and
hazardous characteristics. Some of the specific problems of improper waste management.5
Organic portion, of health care waste ferments and attracts fly breeding, which may
increase the risk of infection of waste handlers, and (eventually) the general public.
Poor management can increase risk of infections to medical, nursing and other hospital
staff.
Injuries from sharps can results to all categories of hospital personnel and waste
handlers.
Poor waste management and poor infection control can lead to noscomical infections
in patients.
Increase in risks associated with hazardous chemicals & drugs being handled by
persons handling waste at all levels.
Poor hospital waste management encourages disposable being repacked and sold
without proper disinfection.
Poor management practices can lead to disposed drugs being repacked and sold6.
The Government of India has promulgated the Bio-chemical waste management &
handlings rules, 1998. These are a welcome step towards improving the overall waste
management of health care units in India. These waste management of health care units in
India. These rules are applicable to all persons who generate, receive, store, transport, treat,
dispose or handle bio-medical waste. These rules are also applicable to any institution
generating bio-medical waste including hospitals, nursing homes, clinics, dispensaries
veterinary institution, animal houses, pathological laboratories and blood bank, or authorities
in charge of these institutions6.
6.1 NEED FOR THE STUDY:
Nursing as a profession is now accountable of staff and students nurses for competence and
performance. The nurses spend maximum time with patients in the ward than any other
member of the health team, increases their exposure and risk to the hazards present in
hospital environment, mainly biomedical waste they need to be well equipped with latest
information, skills and practice in managing this waste besides reducing hospital acquired
infections to protect their own health they are also responsible for preventing risk due to
waste to the other members of health team and community at large7.
Nursing as a profession is now accountability of staffs and students, nurses, for
competence and performance this has seen the birth of the language of “outcomes” outcomes
is a mechanism to evaluate quality, improve effectiveness and risk practice to professional
accountability7.
Many health care wastes poses a serious public health problems. The main causes are
improper disposal of health care waste aesthetically damages the environment and however
the transmission modes of agents associated with blood born diseases are still not understand
therefore the disposal of health care waste and their potential health care impact are important
public health issue. In the past 10 years, due to the increased numbers and size of health care
facilities, medical services and use of medical disposable products, the generation rate of
health care wastes has increased rapidly. So now it has become important to provide
information on the hazards and practices of management of health wastes for formulating
policies, enacting legislation and developing technical guideline8.
So many our hospitals have neither a satisfactory waste disposal system nor a waste
management and disposal policy. The disposal of waste is entrusted to junior most staff from
the housekeeping department without any supervision. Even pathological waste are observed
to be disposed off in the available open ground around hospitals with scanty regards to
aesthetic and hygienic considerations7.
In the study pattern of waste in India cities, the equinity of refuge varied from 0.48 to
0.06 kg/capital/day. On an average the volume of total solid waste generated is Indian
hospitals is estimated to range between 1 kg to 3 kg7.
Health care waste management is India is receiving greater attention due to recent
regulations of BMW management and handling rules,1998. The prevailing situation is
analyzed covering various issues like quantities and preparation of different constituents of
waste, handling treatment and disposal methods in various health care units (HCVS). The
waste generation rate ranges between 0.5 and 2.0 kg/bed/day. It is estimated that annually
about 0.33 million tones of waste are generated in India. The solid waste from the hospitals
consist of bandages, linens and other infectious waste 30-35 % plastics, 7-10% disposable
syringes 0.3-0.5 % glass 3-5 % of other general waste including food of 40-45 %. In general
the waste are collected in a mixed form transported and disposed of along municipal solid
waste. At many places authorities are failing to install appropriate system for a verity of
reasons, because of non availability of appropriate technologies, inadequate financial
resources and absence of professional training on waste management and one of the reasons
is lack of staff educational programme7.
The WHO study was conducted on health care waste has estimated that, the total
waste generated in health care facilities, about 85% of the hospital waste are actually non
hazardous, 10% are infective hence, hazardous and the remaining 5% are non-infectious but
hazardous. In the use for example, about 15 % of hospital waste are regulated as infectious
waste. In India this could range from 15 to 35% depending on the total amount of waste
generated BAN and HCWH. 1999. Based on these estimates the total health care waste
generated as per 1993 date can be taken as 544040 tones/ annum and hazardous waste can be
taken as 27,202 tons/annum. A proper waste segregation scheme for separating hospital waste
into infectious and noninfectious categories is thus desired9.
The biomedical waste has become a serious health hazard in many hospitals. The
waste has been disposed off illegally in to the garbage and into the severs in most of the parts
of the world including India. In many places, the waste is disposed carelessly and
indiscriminate disposal of this waste by healthcare. So many hospitals waste spread serious
disease such as hospitals and AIDS(HIV) among though who handle it and also among the
general public the waste disposal is at generator site and nurses are highly responsible for
biomedical waste management they play a leading role in managing and supervising hospital
waste10.
Nurses are the largest occupational group in any health care agency. By virtue of their
job responsibilities they are frequently exposed to biomedical waste. The nurse’s risk of
exposure to health hazard and the nurses as a cause of cats organic infection to the patients
are equally challenging issues to the nurses all over the world of only the Nurses are aware of
the risks and proper management techniques they can effectively handle the same challenge.
Early recovery of patents and health of hospital staff depends on clean healthy and safe
hospital atmosphere. Thus the researcher felt it as a need to educate the staff nurses
regarding bio-medical waste management as an effective strategy to improve the prevailing
health care.
Health and safety of the nursing staff is cardinal feature of biomedical waste
management. The medical superintendent or head of institute must provide training to
strengthen their skills for safety. Although biomedical waste management can’t be achieved
without the co-operation of each and every worker and patient, however, nursing personnel
play a significant role is this whole process. They need to be informed about current available
technology and safe practices among all health care staff need to be strengthened.
My need for the study of the waste management also found that the present awareness
among health personnel is poor regarding biomedical waste management and imparting
training do improve their attitude knowledge practices. The waste management is needed to
be well equipped with latest information skill and practices in managing this waste besides
reducing hospital acquired infections to protect.
Staff nurses are thus challenge to assimilate knowledge and develop critical thinking
skills necessary to apply that knowledge on self protection practices, the knowledge of the
current prevention and control measure can assist the staff nurses in educating the patients
and family, students nursing, regarding the mode of waste management they can apply self
protection and prevention measure in the daily working in hospital the biomedical waste
cross infection can be prevented by careful self-protection attitude practices. So the
researcher felt that is need to assess the self-protection attitude knowledge and practices
followed by the staff nurses in daily working hospital.
6.2 REVIEW OF LITERATURE.
Review of literature refers to the extensive, exhaustive and systemic examination of
publication relevant to research project.
The literature review provides readers with a back ground for understanding current
knowledge on a topic and illuminates the significance of the new study.
The investigator carried an extensive review of literature relevant to the research topic to gain
insight and collected maximum information for laying the foundation of the study.
1 Massrouje HT 2011 November
A study was conducted on medical waste and health workers in Gaza governorates.
This study the author was conducted by the another among health workers in Gaza to
identify and highlight so many problems of medical waste management. Data collected
through a questionnaires (given to 400 health workers) a check list and interviews 16 decision
makers results show that these is no systems for medical waste management in Gaza.
Segregation is done only for sharps and there are no colour coded bags. Medical waste is
stored disposed of domestic waste in primary health care clinics and is incinerated in
hospitals but there are no emission control or safety measures the same gaps in knowledge of
health care workers and current practices are inadequate. However there is generally a
positive attitude to improving medical wastes management among those surveyed and
interviewed. A national progamme for medical waste management is essential in falsetime11
Danchaivijitramd S. Etal
A study conducted on problems in the management of medical waste in Thailand. In
this study I will identify some problems in the management of medical waste. The study was
done in 39 hospitals during June and July 2002 by interviewing medical personnel on
knowledge and attitude in management of medical waste, observation of practice revealed
that the amount of medical waste was 0.41 kilograms per bed per day. Problems identified
were inadequate knowledge in management, improper practices, and high incidence of sharp
injury at work. Laboratory tests in dust men showed evidence of pulmonary tuberculosis in
3.4%, parasites and intestinal pathogens in stouts 5.1% and positive for HBSAG in 8.5% for
improper management infection related to the management were at concerned level education
and practice guidelines are needed12.
3. Saini. S. etal (2005)
A Study was done by MS.S Saini & group on knowledge, attitude and practices of
bio-medical waste management among staff of tertiary level hospital in India. The study has
shown a definite apathy of intellectuals towards the operational aspects of the system. In
which they found to have had on edge in the attitude and understanding in the subject and
nurse were maintaining the guidelines and paramedical staff and lab, house keeping staff
have relatively less understanding in the subject and it is found that they are practicing the
guidelines in more responsible manner may be due to their accountability and commitment in
the patient welfare. Paramedical staff including laboratory staff and high attitude and more
practical habits which may be because of strict, instructions by authorities and fear for
punitive action13.
Ben-Ami.S. etal
The purpose of this study was to examine the influence of the nurse’s knowledge,
attitudes, and health beliefs on their behavior and their actual usage of safety measures while
handling cytotomxic drugs in their daily work surroundings. The Health Belief Model (HBM)
and its extensive form, the Protection Motivation Theory (PMT), were used as the theoretical
frameworks. Sixty one nurses participated in the study, 31 hospital based nurses daily
exposed to cytotoxic drugs for the last 5 years, and 30 non-exposed community nurses. An
occupational questionnaire was used to test the nurse’s actual safe behviour and compliance
with the recommended guidelines. A randomly selected group of exposed nurses were
observed to validate their compliant behaviour. A gap was found between the nurses
knowledge and their actual behaviour concerning the potential risks of cytotoxic drugs and
their use of protective measures (p<500). Significant correlations were found among the
components of he extensive HBM (perceived susceptibility barriers, benefits and self-
efficacy). The observational finding supported the above results. The study’s findings support
the need to promote primary prevention by providing a safe environment for the employee by
means of education, training with regard to safety measures, clear policy, written guidelines
and their enforcement.
According to Ben Amis El al 2001 health care worker are at increated of occupation a
questions of hepatitis B virus HBV infection to data of the study suggest that prevalence of
HBV infection is more efficiently transmition Health care personnel14.
A cross sections survey was conducted on incidence of needle sticks injuries and
factors associated with it among medical students in Malaysia. The aims of the study were to
determine the incidence of cases and associated factors such as socio demographic factors.
Level of knowledge related to blood borne diseases and practices of universal precaution four
hundred and seventeen medical students were selected as the study subjects. The study
finding suggested that the incidence of needle sticks injury among the medical students was
14.1% further it was also found that the students who had needle sticks injury had low scores
in practice of universal precautions then these did not sustain needle stick injury (P<0.05) the
study conducted that medical students are at risk of needle injury and blood borne infections.
There fore preventive measures must be taken to avoid the occurrence of these injuries15.
Turk M. Davas A et al 2004
A Study was done by Turk M Davas a & Group on Knowledge, attitude and safe
behavior of nurses handling Cytotoxic anticancer drugs in Ege University Hospital Many
antineoplastic drugs are known to be carcinogenic, teratogenic and mutagenic to humans.
There is thus a potential risk due to occupational exposure to cytotoxic drugs (CDs). Nurses
and pharmacists study was here carried out in order to evaluate the level of knowledge of
nurses on the health effects and the routes of exposure to CDs, to clarify the protective
measures while handling these agents and to determine the influence of this knowledge on
clinical attitudes, behavior and actual usage of safety measures. The level of knowledge of
the nurses concerning antineoplastics was not satisfactory. Findings for nurses safety
behavior and usage of recommended health safety measures showed that, notwithstanding the
rules and regulations pertaining to CDs, nurses did not comply with them fully. In service
training is a very effective tool to increase the level of knowledge. This study also revealed
the necessity for improvement of the working environment and the availability of appropriate
protective equipment16
Ritu Sing Jugal Kishor et al 2002 December.
A study was done on the role of an information booklet on bio-medical waste
management for nurses. In this study first role out the subject matter the staff nurses will have
there knowledge about how to handling rules and how to manage safeguard their own health,
nursing staff must have knowledge and perform their duties that should ensure safe handling,
collection, storage treatment & disposal of bio-medical waste17.
Askarian M et al 2004 this is pubmed
This study was conducted on hospital waste management status in university hospital
of fars province Iran country. In this contains a very large quantities of hospital waste
hazardous materials in Iran, as is many developing countries, not much more attention has
been paid to this matters. Lack of separation between hazardous and non hazardous waste. An
absence of necessary rules and regulations applying to the collection of waste from the
hospital, wards and the onsite transport to a temporary storage location a lack of proper
waste treatment, disposal of hospital waste along municipal garbage, insufficient training of
personnel, insufficient personal protective equipment and lack of knowledge regarding the
proper use of such equipment, were the main findings for a rapid improvement of existing
conditions performing extensive research for the assessment of present situation in the
hospitals of this country18.
Patil A.D etal 2001 oct.
A study was conducted on health care waste management in India.
In this study has shown several operational plans and is receiving greater attention to
recent regulation rules 1998. The waste generation rate ranges between 0.5 & 2.0 kg bed-
one-day-one. It is estimated that annually about 0.33 million tones of waster are generated in
India. The solid waste from the hospitals consist of bandages, liner and other infections waste
30-35% plastics 7-10 % disposal syringes 0.3-0.5% glass (3.5%) and other general waste
including food 40-45% in general the waste are collected in a mixed from transported and
disposal of along municipal solid wastes. The rules for management and handling of bio-
medical waste are summarized giving the categories of different waste suggested storage
containers including colour coding and treatment options existing and proposed system of
health care waste management are described waste management plan for health care
establishment is also proposed appropriate technologies, appropriate staff training
programmes19.
Kishor J et al 2000 October.
The study was conducted on awareness about bio-medical waste management and
infection control among dentists of a teaching hospital in New Delhi, India. In this study I see
that there is so many dentists working in a teaching hospital of New Delhi participated in
survey. A per-tested self administered questionnaires was used to assess knowledge and
practice of bio-medical waste management and infection control among these dentists. The
results show that to and only half of them observed infection control practices in addition to
this majority of them were not aware of proper hospital waste management. The dentists need
to be educated on bio-medical waste management and handling rules 1998 through extensive
training programme20.
Tearle P 2001 September
A study conducted on clinical waste management. We studied in this content every
producer of controlled waste in the UK has a duty of care under the environmental protection
act 1990 to dispose of the waste in a manner which takes appropriate care and consideration
to ensure that it doses not cause harm to human health or pollute the environment. This article
looks at what is meat by duty of care to ensure clinical waste produced by laboratories or in a
health care setting is disposal of in the correct manner21.
Jahnvi G. et al Indian J public health 2006.
A study conducted on awareness and training need of bio-medical waste management
among undergraduate student. Here in this study I have seen that 463 undergraduate students
216 males and 247 females of ASRAM medical waste management. Most of the students
have heard about biomedical waste. Some of them were aware that it causes health hazards.
But knowledge about category of wastes duration of waste storage responsibilities of waste
type of bags used for collection identification of bio hazard symbol was poor. Awareness of
biomedical waste management and handling rule 1998 was also poor. These were gaps in
various aspects of BMW management among medical students appropriate training or
inclusion of a topic in undergraduate medical curriculum can fulfill this22.
6.3 STATEMENT OF THE PROBLEM
“ a descriptive study to assess the knowledge of bio medical waste
manegement among staff nurses in selected hospitals at tumkur with
a view to develop an information booklet .”
6.4 OBJECTIVES OF THE STUDY:
1. To assess the staff nurse knowledge of bio medical waste manegement among staff nurses in
selected hospitals.
2. To find out the association between the level of knowledge of bio medical waste
manegement and selected demographic variables of staff nurses.
3. To develop and administer an information booklet on bio medical waste management to
staff nurse in selected hospital.
6.5 OPERATIONAL DEFINITIONS:
1. BMW knowledge: - In this study Bio-medical waste knowledge refers to information
in understanding acquired through experience.
2. Bio-medical Waste :- In this study Bio-medical waste refers to the any solid or
liquid waste that is generated during the process of diagnosis treatment or
immunization of human beings.
3. Biomedical waste management: - In this study biomedical waste management means
a good technique of dealing a biomedical waste, from the point of generation of the
disposal of waste. The management is a co-ordination allocation and management of
human, fiscal, material, support, information and system resources needed to deliver
care to patient and to faster healthy, productive working relationships.
4. Staff Nurses:- In this study staff nurses refer to nursing personnel who have
undergone GNM ,B.SC(N) and PC.BSC(N) course prescribed by the INC. Nurse is a
most directly concerned with giving health education and care to patient’s individuals
and families in the community.
6.5 RESEARCH HYPOTHESIS
H1 :There will be significant association between level of knowledge of staff nurses in
selected hospitals with selected demographic variables .
6.6 ASSUMPTIONS
The study assumed the staff nursed will be practicing bio-medical waste management to some
extent.
1) Staff Nurses are working in a selected hospital have some knowledge about bio-medical
waste management.
2) Nurses have knowledge of self protection regarding bio medical waste management in
hospital.
3) In this study it is assumed that the practice is being influenced by the extraneous variables
such as age qualification experience in bio medical waste exposure
4) Knowledge on bio medical waste measurable.
5) Nurses have potential to learn about bio medical waste management.
6.7 VARIABLES UNDER STUDY
1.Demographic variables: age, religion, education qualification, year of expirience,
etc.
2.Dependent variable: level of knowledge regarding biomedical waste management
among staff nurses.
6.8 DELIMITATIONS OF THE STUDY:
The study is delaminated to the hospital, which is selected conveniently for
data collection were including in the study.
The staff nurses who were willing to participate were including in this study.
The staff nurses working in the selected hospital.
Assessment of knowledge will be done through written responses by
structured knowledge questionnaires.
6.9 PILOT STUDY
The pilot study will be conducted with 10% of the total sample size of antenatal
mothers and they will be excluded in the main study. The purpose of pilot study is to
find out the feasibility of conducting study and design on plan of statistical analysis.
The findings of the pilot study samples will not be included in main study
7.0 RESEARCH METHODOLOGY
7.1 SOURCES OF DATA
Staff nurses in selected hospitals at Tumkur.
RESEARCH DESIGN
The design selected for the present studyis descriptive design.
RESEARCH APPROACH
The non-experimental survey approach will be considered appropriate for this study.
RESEARCH SETTING
The study will be conducted in selected hospital at Tumkur.
POPULATION
Population in the study consists of staff nurses working in selected hospitals at
Tumkur.
SAMPLE SIZE
Total sample of the study will consist of 60 staff nurses in selected hospitals at
Tumkur.
SAMPLING TECHNIQUE
Purposive samplingtechnique will be used for the study.
SAMPLING CRITERIA
INCLUSION CRITERIA
The inclusion criteria for the sampling were:
Registered staff nurses with diploma/degree in nursing.
Registered staff nurses with GNM,BSc or PCBSc In nursing.
Staff nurses who are willing to participate in the study.
Staff nurses who are present during the study.
EXCLUSION CRITERIA:
The exclusion criteria for the sampling were:
Staff nurses who are not willing to participate in the study.
Nurses who are already attended any related seminors or work shops on biomedical
waste manegement.
7.2 METHOD OF DATA COLLECTION:
1.Investigator introduce herself to subject.
2.Administer the demographic Performa to assess the demographic variables of staff
nurses.
3.Administer structured questionnaire to assess the level of knowledge regarding
biomedical waste managementge among the staff nurses.
.
7.2 METHOD OF DATA ANALYSIS AND INTERPRETATIONS:
The data will be organized, tabulated and analysed by using descriptive and inferential
statistics
Descriptive statistics
frequency and percentage : used to analyze the demographic variables, the level of
knowledge regarding biomedical waste management .
Inferential statistics
chi-square:Used to find the association between the level of knowledge and selected
demographic variables.
TIME AND DURATION OF THE STUDY:
The time and duration of the study will be limited to 6 weeks as per the guidelines of
the university.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMAN OR ANIMAL?
-No, since the study is descriptive, study interventions are not required
7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM
YOUR INSTITUTION?
-Yes,the pilot study and the main study will be conducted after the approval from the
research committee of shridevi college of nursing, Tumkur. Permission will be
obtained from the concerned head of the hospital. The purpose and details of the
study will be explained to the study subjects and an informed consent will be obtained
from them. Assurance will be given to the study subjects on the confidentiality and
anonymity of the data collected from them.
8.0 LIST OF REFERENCE
1. Saini S.S. Nagrajan RK Sarma Vol 17 No.2 2005-01 2005-12 Journal of the Academy of
Hospital Administration KAP of Bio-Medical Waste Management amongst staff of
territory level Hospital in India.
2. Rahman H Ahmed N.S.Ullah S.M. Sundy on Hospital Waste management in Dhaka city.
Proceeding of 26th WEDC Conference : Ethiopia 1999 P 342-44.
3. Glance ATA Bio-medical Toxics link Fact sheet Number 24/Dec 2004 1996 Beth Israel
Medical Centre in New York City going Green HCWH October 15, 2001.
4. Gupta S Kant S Hospital and Health Care Administration 1st Edition New Delhi J.P
Publishers 1998.
5. Centre for Disease control and prevention safe management of waste from Health care
activities USA 1999.
6. Gopichandan R etal towards better Management of Hospital Waste CEE centre for
Environment education materials from this book 2000.
7. Shakharkar B.M. Principals of Hospital Administration 1st Ed. New Delhi: Jaypee
Publishers 1998.
8. Khairun nessa MA Quaiyeem Barkat-e-Khuda Waste management in Health Care
Facilities : A Review 2001.
9. Indian Nursing Year Book: Implementation of various technologies for treatment and
disposal of Bio-medical waste New Delhi: 2000-2001.
10. Central Pollution Control Board Manual on Hospital Waste Management New Delhi:
Ministry of Environment and Forest: 1999 .
11. Massrouje HT Medical Waste and health workers in GAZA Governorates. Eastern
Mediterranean Health Journal Volume 7, No.6 November 2001, 1017-1024.
12. Danchaivijitrarnd S. etal Problems in the management of Medical waste in Thailand. J med
Association Thai Vol.88, Suppl 10, 2005.
13. Saini S etal Knowledge, Attitude and Practice of Bio-Medical waste Management
among staff of tertiary level hospital in India.
14. Ben-Ami-S Shaham J Rabins etal The influence of nurses Entrez pubmed links
2001Noorsayani Y.M.,
15. Noorhassim I, Study on incidence of Needle stick injury and factors associated with this
problem among medical students journal of occupational health. June 2003. : 45(3) :
172-78.
16. Turk M Davas A etal knowledge, attitude and safe behavior of nurses handling
cytotaxic anticancer drugs in Ege University Hospital Enterer pubmed Links 2004.
17. .Ritu singh R. Kishore J Mattur G etal Role of Information Booklet on Bio-medical
Waste Management Nursing Journal of India 2002 Dec.
18. . Askarian M etal Hospital Waste Management status in University Hospital for Province
Iran Country Pub med 2004.
19. Patil AD etal National Enviroment Engineering Research Institute Nehru Marg, Nagpur-
440 020. India Oct 2001: 63(2): 211-20.
20. Kishor J etal awareness about Bio-medical Waste Management and Injection control
among dentist of a teaching hospital in New Delhi, India October 2000.
21. Jearle P Clinical Waste Management September 2001.
22.Jahnvi G etal Awareness and training need of Bio- medical Waste Management among
undergraduate students. Indian J Public Health 2006.
Signature of the candidate.
10. Remark of the guide.
11. Name designation of
11.1 Guide.
PROF.SHEEBA.K
11.2 Signature.
11.3 Co-Guide
11.4 Signature.
11.5Head of the department.
11.6 Signature.
12. Remark of the chairman and
the principal.
12.1 Signature.