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.