Effect of a waste management intervention program on knowledge, attitude, and practice (KAP) of nurses and housekeepers: a quasi-experimental study, Egypt

Khashaba et al. Journal of the Egyptian Public Health Association https://doi.org/10.1186/s42506-023-00140-w (2023) 98:15 Journal of the Egyptian Public Health Association Open Access RESEARCH Effect of a waste management intervention program on knowledge, attitude, and practice (KAP) of nurses and housekeepers: a quasi‑experimental study, Egypt Eman Khashaba1* , Abdel Hady El‑Gilany1 and Khadija Denewar1 Abstract Background Improper healthcare waste management practice is alarming in developing countries because resources are inadequate and waste management is often delegated to poorly educated and untrained laborers. This study aimed to compare the pre-KAP versus post-KAP towards the waste management program for nurses and housekeepers. In addition, it aimed to explore possible factors affecting the pre- and post-KAP in Man‑ soura Emergency University Hospital, Egypt. Subjects and methods One hundred thirty-three newly employed nurses, housekeepers, and those who need refreshment training as nominated by head nurses and link occupational health and safety nurses in the hospital were recruited for the study. The study’s intervention included multiple training sessions using a PowerPoint presentation in Arabic with appropriate illustrations followed by an open discussion. An Arabic self-administered questionnaire containing demographic and occupational history, knowledge (27 questions), attitude (10 questions), and practice (9 questions) was used pre- and post-intervention. Results The overall KAP scores among the studied healthcare workers were significantly higher after the intervention. The pre- and post-knowledge scores were significantly different with respect to education, job description, and dura‑ tion of employment (p < 0.05). The post-attitude scores were significantly different with respect to education and job description only (p < 0.05). The total pre-practice scores were significantly different with respect to education and job description (p < 0.05). However, the post-practice scores were significantly different with respect to sex, age, educa‑ tion, and job description (p < 0.05). Conclusion There was a significant improvement in the KAP scores post-intervention. The post-knowledge and atti‑ tude scores were significantly better in nurses and participants with a higher education. The post-practice score was significantly better for females, participants with an age ≥ 30 years, higher education, and nursing jobs. The com‑ bination of training and supervision was crucial for the success of waste management programs. Higher education levels are required for housekeepers to be capable of gaining better knowledge, follow rules, and be ready for any challenges in the future. Keywords Waste management, Intervention, Training-healthcare workers, Healthcare waste *Correspondence: Eman Khashaba Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Khashaba et al. Journal of the Egyptian Public Health Association (2023) 98:15 1 Introduction Healthcare facilities such as hospitals, clinics, blood banks, and laboratories generate medical waste. Human or animal tissue, blood or other bodily fluids, excretions, medications or pharmaceutical items, swabs or dressings, syringes, and needles or other sharp tools may all be included. These represent biological, chemical, and multiple safety hazards to any person coming in contact with them [1]. Poor healthcare waste management (HCWM) practices may result in patients, staff, waste handlers, and the community being exposed to the unnecessary health risks of the waste [2]. Improper HCWM practice is alarming in developing countries because resources are inadequate to manage waste, and waste management is often delegated to poorly educated and untrained workers, who perform without proper guidance or adequate protection [3, 4]. Egypt, like many developing countries, is struggling to improve its hospital waste management standards. Despite the fact that the Environmental Law No. 4 of 1994 and lately the Waste Management Regulation Law No. 202 of 2020 and its executive regulations were enacted to organize the implementation of integrated hospital waste management, both healthcare staff and authorities are unable to create efficient mechanisms for the segregation, collection, transport, or treatment due to inadequate legislative compliance and enforcement. Because of mal-distribution and missing awareness of HCWM guidelines, healthcare personnel in Egypt are frequently uninformed of this regulation. The most common means of hazardous healthcare waste treatment are incineration or autoclaving. In Egypt, the majority of general hospitals utilize incineration, while the majority of teaching and university hospitals use autoclaving [5]. Healthcare workers (HCWs) play an important role in bio-medical waste management due to their expertise, attitude, and practices (KAP) [6]. The waste management program is an ongoing training since 2015 as a part of continuous training courses in the Mansoura University Emergency Hospital that is provided twice a year to nurses, housekeepers, and laboratory technicians. However, there are no previous studies assessing the effects of these training on KAP of the target population. The aim of this study is to compare the pre- with the post-intervention knowledge, attitude, and practice (KAP) of nurses and housekeepers towards waste management and factors associated with its variation. 2 Methods 2.1 Study design and setting This quasi-experimental study was done in Mansoura University Emergency Hospital from November 2021 to Page 2 of 9 March 2022. This is the only emergency hospital in the Delta region specialized in trauma and accidents and recently triage and isolation of COVID-19 patients. There is a high rate of flow of patients and also a considerable turnover rate for nurses and housekeepers due to excessive workload. 2.2 Study subjects All newly employed nurses and housekeepers as well as those who need refreshment training as nominated by head nurses were recruited in the study. These job categories par (...truncated)