Integrated Sanitation and Hygiene Management in Residential Institutes in Medak District  

Ms. Vanitha Kommu and Ms Indira Prakash work in CEE Andhra Pradesh office. Their experience in water and sanitation, natural resource management, nature education and awareness generation has played a key role in this programme. 

Hygiene and Sanitation Facilities in Student Hostels

The Govt of Andhra Pradesh has started a large number of social welfare hostels for stay and studies of children of economically weaker section. At present there are 2356 Social Welfare Hostels (1691 for Boys and 665 for Girls) functioning in the State with a sanctioned strength of 2,36,600 including Ananda Nilayams and Children Homes etc1. Each hostel has one Hostel Welfare Officer (HWO), Cook, Kamati (cleaner) and Watchmen. The sanctioned strength of each hostel is 100. Health care and healthy environment at these hostels is of utmost importance as the children are in a period of physical growth and need an optimum health and nutrition care. However provision of adequate water and sanitation facilities has been a problem due to various reasons like lack of space, water scarcity, inadequate cooperation from local governing bodies, vandalism, no operation and maintenance staff, no funding etc.

These problems occur in schools as well. This means that these studentsare constantly exposed to unhygienic environment during their formative years. A survey among school children in India revealed that about half ofthe ailments are related to unsanitary conditions and lack of personal hygiene. Childhood is the best time for a person to acquire hygiene behavior. However lack of education on Water and Sanitation and the sanitary condition of many rural schools is a major stumbling block to formation of hygiene practices among children. 

An Initiative for Improvement

The Integrated Sanitation and Hygiene Management (ISHM) programme in Residential Institutions (RI) was initiated by the District Administration, Medak with support from UNICEF, considering the general status and importance of these aspects in the hostels. CEE Andhra Pradesh office provided the implementation support in coordination with Medak District Voluntary Agencies Network (MEDVAN).The programme had the following components:

• Assessment of the status of WATSAN facilities in 230 RIs and development of action plans along with budget estimation.
• Training residential institution (RI) staff on hygiene, water, sanitationoperation and maintenance (O&M) and conducting educational activities with the students for behavioral changes.
•  Facilitating the implementation of action plans through UNICEF with concerned line departments
• Identification of 6 RI in each category to establish model sanitation complexes.

Participatory Survey of Hygiene and Sanitation Facilities in Hostels

Participatory surveys were conducted to identify infrastructural gaps in water and sanitation facilities and behavioral aspects among children pertaining to personal hygiene. The survey was carried out in all 230 hostels while they were closed for summer holidays. 46 Mandal Coordinators (MCs) (working with MEDVAN) having more than one year experience in water and sanitation field were selected and further trained by CEE on the concept on Integrated Sanitation and Hygiene Management in RIs. 

The provision of water and sanitation facilities 

have been inadequate in social welfare hostels 

due to various reasons like lack of space, 

water scarcity, lack of cooperation from local 

governing bodies, vandalism, theft, funding etc.

Out of 230 hostels, 146 were boys’ hostel and 84 were girls’ hostels. In girls RIs women MCs conducted the participatory assessment. Each RI was visited by two MCs, one interacted with the warden while the other interacted with the students. Followed by interactions, the HWOs, students and Mandal Co-ordinators together visited the facilities in RIs. Each assessment took about 3 hrs in each RI. 

Assessment for identifying the issues and facilitating actions

The survey was conducted in a participatory way involving the children and hostel staff (warden, cook, kamati, watchmen etc). While provision of WATSAN infrastructure in the hostels is one main objective, it is also important to understand the child friendly/unfriendly nature of existing facilities or the facilities that are planned to provide. For this reasons children were involved in identifying the issues and needs. This happened in the form of discussions and visits to the facilities with children. Many of these children in hostels are first generation toilet users and hence it is important to make them understand first what are basic facilities required and what kind of improvement is possible. These inputs are provided by MCs to the children during the assessment itself. 

The investigation revealed that the infrastructure facilities for water and sanitation are insufficient and there are several functional problems associated with these like running water inside the bathroom, electrification inside the toilets, repairs of taps, bathrooms, floors, doors, septic tanks, proper ventilation, periodic cleaning of septic tanks etc. 

It was also found that hostels had to depend on water supply from outside sources. So there was a need to provide water facilities/storage tanks where absent or inadequate. A few places required repair of bore well motors and water purifiers for safe drinking water.

  

Once these gaps were found and findings analyzed, hostel-wise action plans were developed. The overall status and the infrastructure gaps and needs were presented to UNICEF and the District Administration.

District Administration Fills Infrastructure Gaps 

The District Administration responded by following two strategies to address the infrastructural issues. 

•  It invited local industries to provide the facilities as part of their CSR by adopting the hostels or through monetary contributions.
• Pooling the fund from the Government Departments, and addressing some of the issues with their help. 

It is important to understand whether 

existing or planned facilities are child  friendly

or not. Trained mandal coorindinators

interacted with children to identify their 

concerns and needs.

As part of CSR contributions an amount of Rs 1.2 crore was collected from industries. The funds were channelized to the respective executing agencies like DE Tribal Welfare, EE Social Welfare, PD Housing etc. for necessary actions. Some industries also came forward and adopted 15 hostels for direct interventions. The concerned departments estimated and shared information about the budget needs for each hostel, which were directly addressed by the industries.

Workshops for Students and Staff on Personal Hygiene and Sanitation Management: In addition to provision of infrastructure, it was also essential to ensure the continued use and maintenance of the provided facilities. Bimonthly awareness workshops were designed and 16 MCs were trained to conduct these, preferably in the evening times or during holidays. Each workshop had a specific theme with a set of activities and games. These were 

Workshop 1: Personal Hygiene 
Workshop II: Hand washing, making soap 
Workshop III: Water and Sanitation 
Workshop IV: Waste management and Operation and Maintenance

Relevant resource material was made available to each MC based on the activities/ games developed in the manual. The workshops were designed interactively and followed by visits to capture the impact among the children.

Review and Monitoring 

CEE monitored 105 hostels (45%) to check the impact of the awareness programmes and provision of facilities. Every month 20 to 25 hostels were visited to

• Interact with the children to understand their awareness levels and observing the best practices in sanitation and hygiene
• Interact with Kamaties/cook/watch women etc on changes in operation and maintenance
• Interact with the HWOs on overall improvement of facilities and management 


Besides this, review meetings were organized by CEE at regular intervals to check the progress, provide feedback to MCs and to understand the need to improve, include new aspects etc.

Rank cards 

A rank card system was introduced to help the hostels, MCs and departments understand the progress made in terms of infrastructure provision and sustainable use. Rank cards consisted of baseline information about different aspects like facilities available, usage, facilities maintenance and personal hygiene practices among the children etc. Against these, marks were expected to be given every month based on improvement of the situation. Based on the marks, grading was done as Green (100-80 Marks), Organe (80-60 Marks) and Red (60-10 Marks). Mostly the hotels were found to be in Orange colour.

Bio intensive vegetable gardens 

Keeping in mind the nutrition needs of 
students in welfare hostels, organic 
vegetable gardens were promoted in the 
hostels and schools where land
and other facilities were available.

Along with Water, Sanitation and hygiene management, bio intensive vegetable gardens were also promoted in the hotels to provide green, organic food and meet the micro nutrient requirements of growing children.

All 230 hostels were provided with a garden kit to facilitate farming in the hostel premises. The kit contained 13 varieties of vegetable seeds, one spray bottle, vermicompost and neem oil. Children were involved right from the garden initiation stage and they participated actively in watering, weeding, providing fencing, etc. Depending on the various factors like rented hostels, insufficient water supply, heavy rains, no guard against cattle etc gardens could be maintained in 53 hostels.

Best hostel award 

Every month marks on rank card (placed in the hostels) based on the actions taken in addressing infrastructural issues in the hostels, O&M of the facilities and best practices followed by the students (behavioral change) by the MCs and HWO. The hostel with maximum score at end of a year gets the ‘Best Hostel Award’, that includes a Trophy and certificate along with cash prize of Rs 5000/-. This cash award money is planned to be spent for repair of leaking taps, tanks, pipes, etc, purchase of bolts, doors repairs or replacement, electric wiring repairs, window mesh, etc or purchase like storage facilities, toilets cleaning material.

For more information contact: 

CEE Andhra Pradesh

Door No 6-3-348/2

Dwarakapuri Colony, Panjagutta

Hyderabad – 500082

Ph: 040 – 23352596, 65883100

Email: ceeandhrapradesh@ceeindia.org

  

Materials developed under the programme: 

A manual was developed with basic information of each topic with activities for easy understanding of the personal Hygiene, Water, Sanitation and Menstrual hygiene was developed for the mandal coordinators.

Neeru paarishyuddam vyaktigatha parisubratha: Activities based manual is developed on themes ‘personal hygiene, water and sanitation for trainers.

The following existing materials by UNICEF are distributed to hostels:

Take it easy: Hand out on hygiene habits during menstrual cycle developed for girl children and distributed to all girls.

Sharing simple facts: Myths and facts about menstrual cycle and hygiene practices developed for girl child.

Hayeega Arogyamuga: Comic book developed on personal hygiene and sanitation for both boys and girls.

1 Right to Information, sourced at http://tinyurl.com/Social-Welfare-Hostels, accessed on 20th November 2010.

All photograph Courtesy: CEE Andhra Pradesh

Education for Health Care
Mrs. Yogini Dolke, SRUJAN, Mangurda

Nirutta Atram, a mother of two resides on one of the Kolam Poad (hamlets) in the Zari-Jamni block of Yavatmal district. Educated up to fourth standard in an ashram school, she was the only literate women from the Kolam community ready to take up the responsibility of being a village health worker from her hamlet. As the VHW, she would have to cater to the health needs of people in her hamlet as well as in two neighboring hamlets.

In the early years, Nirutta was often not informed about baby deliveries nor did anyone come on their own to seek her services. The elderly men and women in her community did not believe that any human efforts could help in saving a new born baby’s life or cure an ailment. Gaining the confidence of her own community members and changing their beliefs and practices has been an uphill task for Nirutta.

Regular visits to the hamlets to distribute medicines to those with various minor ailments, diagnosis and treatment of pneumonia for children under five years of age, regular visits to new-born infants in the neo-natal period has made her one of the most sought after persons now. But regular visits and service provision alone weren’t the key to the changed faith and practices of the community members. The most important part has been the continuous health education on different issues undertaken by Niruttta at the community , family and individual levels.

Nirutta is one of the 32 village health workers volunteering their services under the guidance of the local NGO, Srujan, that has been working in the tribal belt of Yavatmal district since 1998. Srujan’s work is concentrated in the 5 tribal blocks of Yavatmal district particularly amongst the Gond, Kolam, Andh and Pardhan communities that reside in this region. Amongst them Kolam is a member of Particularly Vulnerable Tribal Group (PTG) as categorized by the Planning commission of India in 1961. The PTGs are vulnerable as their population is stagnant or is declining with high infant and maternal mortality rates, and with literacy rates tending towards zero. They are in a pre-agricultural stage of technology, with hunting and food gathering as their primary source of livelihood.

A survey done by Srujan in 1998-2000 on child deaths showed that 96% of the babies were delivered at home in the presence of the traditional birth attendants. The child mortality rate in this area was 110 child deaths per 1000 live births per year. The neo-natal mortality rate was 61. Child survival is one of the most sensitive indicators of human welfare and the effectiveness of public policies. It helps to understand the socio-economic, cultural and political situation, the ineffectiveness of the long list of welfare programmes for the tribal in Yavatmal district. The health care system along with other systems like the education system and other governance systems seemed to have been equally ineffective and inaccessible to the most marginalized section of the society here. Strengthening the local communities to make these systems effective and workable was the best way to make change sustainable.

Community involvement – a key to success
For the Kolam community a new born child’s death was a common phenomenon. So when the Srujan volunteers started sharing the child death survey results with the community members, nothing seemed strange to them. It was only when the linkages of these high mortalities with non-accessible health care services and most of the basic amenities, inadequate nutrition to mothers, the traditional believes and practices regarding child bearing and child rearing were pointed out that people began to look at it as a systemic failure and not just as a divine curse.

However, providing health care is believed to be a doctor’s job. Srujan wanted to introduce the idea that the village need not depend on a professional doctor for basic services and preventive health care, but that women from the village itself could be trained to work as a primary health care provider. It was essential that the community accept the person and the services she was to provide to the villagers.

At each stage of this experiment the villagers were taken into confidence. Though reluctantly, they gave their consent to the concept of a village woman to be trained as a health worker. A visit of the village heads and community leaders to SEARCH, Gadchiroli also helped in building their confidence. SEARCH has been working on community health care to the tribes of the Gadchiroli district in Maharashtra, since 1985. Since its inception it has been involved training village health workers and traditional birth attendants to manage reproductive and child health related issues. It has also worked on alcoholism and alcohol policy, deforestation, and tribal development in the region.

After two years of initiating the experiment, now these elders and villagers use the data of the six monthly bi-annual child death surveys to question the local authorities and the political leaders about inactions to improve the health situation in their villages and hamlets.

Empowering the women
A strategy for sustainable development is to seek local solutions. Selecting a village woman as health service provider was one step towards the goal of finding local and sustainable solutions.

Married women with basic reading and writing abilities were selected as health workers and continuous training for one year was imparted to them in a step-ladder manner.

The first phase of training was rather difficult as the VHWs were out of touch with books, reading and writing skills. Thus their primary abilities of reading and writing had to be updated and sharpened. The training phase was spread over a year. An assessment of learning was done as part of every training event. After each training the VHWs would go back to their villages, practice the skills taught and come back for the next training with her experiences, problems and triumphs.

As the training and experiment progressed, the VHWs (village health worker) flowered from being ‘common village women’ to confident, committed, more respected and sought after persons in their villages. Most of them are now members of village committees for health, Jalswarajya, the NREGA. The VHW is the new role model for the young girls in the village.

Empowering the Community
Acceptance of the concept that the lives of new-born babies could be saved by trained village health workers has been successfully done. This is all the more important for the Particularly Vulnerable Tribal Groups (PTGs) as their population is already stagnant and declining. Every new-baby’s life saved is like saving a community from extinction.

But saving a new born life is not just a matter of diagnosis and treatment at the village level and referral services offered by the VHW. The community also has to look at its own knowledge, beliefs and practices critically and consider the need for changes in practices and beliefs that are hundreds of year old, if they are not relevant in the current context. An equally critical look is needed at the various developmental schemes available for tribal development, with utilization of those that are relevant and rejection of non-relevant ones.

Another important aspect is the ability to see the interrelation of the high incidence of child deaths with local social and physical conditions - like low literacy, lack of potable drinking water, unhygienic conditions in the village, lack of sanitation facilities, lack of employment opportunities through out the year, the processes of planning, monitoring, management and conservation of the natural resources - being able to see all these aspects as the visible signs of food and nutrition security culminating into the high child morbidity and mortality rates.

One way of increasing community participation in the local development process is regular sharing of information. This often triggers discussions and debates in the village for alternative solutions to the problems. As solutions are locally sought and decisions taken after thorough discussions there is a sense of ownership.

To address the issue of food and nutrition security, the villages have started to consider local nutritious vegetables and fruits, one step processing of non-timber forest produces like honey, and a number of nutritious preparations using the Mahua flower.

Changed Scenario

A survey of the knowledge and practices at the initial period helped in understanding the health education needs of these communities.

Based on the findings, the work patterns of the VHWs were drawn up. The VHW is regularly in touch with the families as she goes from house to house initially to make a list of pregnant women in the community and latter on to update it. She also occasionally conducts group activities for health education such as film or slide shows and discussions. Home visits to meet the mother and her family member - thrice during pregnancy and once on the second day after delivery - have helped in slowly changing the knowledge and practices in new-born health care.

The impact of services provided by the VHW on the health seeking behavior and change in beliefs and practices are:

• The number of pregnant women to receive all three health education has gone up from 42% in the first year of intervention to 91% after five years.


• The number of women taking iron folic acid tablets in pregnancy has gone up from 27% to 81%.


• Presence of VHW during delivery went up from 42% to 68% and examination of babies within first six hours went up from 58% to 87%. The presence of village health worker at the time of delivery assures clean and hygienic practices followed by the traditional birth attendant during the delivery of the baby; it also implies that the family members are seeking the health workers services.


• A new-born life was never a matter of joy, nor its death a matter of sorrow in the Kolam community. The mother was not supposed to eat a full meal as it was thought that the fetus would gain weight and the mother would face difficulty in delivering the baby. Now, after sustained health education of community members, elderly women in the villages, and family members, all the pregnant women eat full meals whenever they are hungry.


• Making a pit inside the room where the women delivered her baby was a common practice amongst the Gond community in this region. The placenta and the umbilical cord were buried in this pit. The pit was also used as a bathroom for the new mother as she was not supposed to go outside her house for 40 days after the baby was delivery. Elder family members and the traditional Jat panchayat members were educated about the danger this practice causes to the life of the new-born and the mother. Now the number of families following this practice has gradually gone down to 3% from 67% in 5 years.


• Due to the raised awareness and information the number of pregnant women getting benefits of the Janani Surksha Yojana, has gone up from a meager 3% to 31%.


• The percentage of young women’s participation in the village affairs has noticeably gone up in all the villages due to the changed attitude of the village elders.

Lessons learnt
Since independence, India has created a vast public health infrastructure of Sub-centers, Public Health Centers (PHCs) and Community Health Centers (CHCs). There is also a large cadre of health care providers (Auxiliary Nurse Midwives, Male Health workers, Lady Health Visitors and Health Assistant Male).

Yet, this vast infrastructure is able to cater to only 20% of the population. Rural India still suffers from a long-standing healthcare problem. A critical part of enabling health services is education of health service seekers.

Educating people about the importance of a disease-free and healthy life, and making space for people to slowly change their behaviors and practices leads to empowering an individual as well as a community. Knowledgeable service seekers are not helpless at the hands of the service provider; instead they are in a position to demand and ascertain their rights. People in the Zhari-Jamnni block of Yavatmal district hold the Government health care providers accountable and demand that they do they duty towards the tribal population.

For more information contact:
Yogini Dolke
At “Srujan Pod”, Village: Mangurda,
Post Box No-1, Pandharkawada – 445 302
Ph: 9326585234
Email: kolamian@gmail.com

Education for Hospital Waste Management

Dr Shyamala Mani, Centre for Environment Education

“This work is sapping”. Deepak points to one among them, ‘When he joined, he was very healthy. Now look at him’.

Vijay says,” This work of clearing the hospital’s garbage is exhausting and dirty. Sometimes, I don’t even feel like eating when I go back home. I just sleep. But what to do? In spite of being educated, didn’t get any job”. … ‘This is not work for men but for machines’ … ‘this is not even our work, but that of others. They are permanent, so they have paid the ‘afsar’, they get to keep drawing their salaries without ever coming for work. We are put in their places instead.’

The situation in other dumps catering to hospitals across the country is probably no different, if not worse. … irresponsible methods of waste management by the hospitals lead to not just environmental and public health hazards but also has the potential to severely affect the health of an unsuspecting population that handles hospital waste for a livelihood. Hence is it not the hospitals responsibility to take care of waste generated in their premises? Are there no binding rules on hospital which take care of this? This is important because health is linked to amenities like clean drinking water, sewerage systems, poverty, literacy levels and infrastructure. Higher government spending on healthcare can result in lower incidence of diseases especially communicable ailments.

According to ‘Healthcare in India’ published by the Foundation for Research in Community Health, among the leading causes of deaths in India, communicable diseases especially infectious, parasitic, gastrointestinal and respiratory diseases make up 43.3%. Similarly, prevalence of HIV infection has been on the rise in practically all states and all population groups in India. Nearly one in every 150 adults in India is infected.

New health problems such as drug resistant forms of several communicable diseases have emerged, including malaria, filariasis and multi-drug resistant TB.
Besides the known pathways or spread of communicable diseases, untreated waste-biomedical and others, also act as carriers or vehicles for microorganisms and cause injury to the people handling these wastes thus creating a portal of entry for these pathogens. The environment is also the reservoir for many unwanted chemicals which are genotoxins and these contribute to the decline of immunity amongst humans, animals and even damage the ecosystem’s ability to control or stabilize pathogenic microorganisms.

Labels for waste containers, developed by CEE. Colour-codes for waste containers for different categories of waste are specified by law. Segregation and treatment of waste at the site of generation must be promoted since if general and infectious wastes get mixed, then the whole waste has to be treated as infectious waste.

Growth of healthcare industry
The poor health status and high demand for services has led to a phenomenal growth of private healthcare establishments in the country.

Delhi has nearly 9000 establishments of which more than 50% are in the private sector. 99% of these healthcare establishments are small that includes nursing homes, private dispensaries, clinics and laboratories etc.

Although larger hospitals especially those providing secondary and tertiary care generate large amounts of infectious wastes, the scattered smaller establishments contribute to half of the infected biomedical wastes produced in Delhi. Many do not segregate their wastes or disinfect them before giving to common facility operators / service providers. At least parts of these wastes are deposited in municipal bins, making the entire municipal waste infectious. Thus the total quantity of infectious wastes increases, which can contribute to the increased morbidity in the city.

To address this problem, an integrated waste management plan involving the coordinated working of several departments in a health-care establishment such as housekeeping, engineering, laundry, kitchen, security, yard supervisor besides nursing, medical, surgical, laboratory and administrative departments, needs to be put in place.

Many health-care settings may have had incinerators for incinerating pathological waste and body parts earlier. These can no longer be used since most cities in India have banned their use except in common facilities located several kilometers away from the city.

There is a need to set up more model common facilities in each state and systems for collecting and storing separated waste and safely transporting the waste. Autoclaving and shredding which is not there in many of the healthcare establishments, needs to be set up either in-house or at common facilities.

The most important component of all is the education and training aspect of the integrated waste management plan which involves not only training of several medical, para-medical and non-medical employees of the establishments for source reduction, segregation, disinfection, transport, treatment and disposal, but also creation of awareness among public, public servants, professionals and the government for taking serious note of the consequences of improper management of hospital waste.

Provisions for protective gear for healthcare staff are part of an integrated healthcare waste management system.

The Biomedical Waste (Handling and Management) Rules 1998 have categorised the various types of wastes generated in healthcare establishments methods that can be used to treat and dispose these. The subsequent amendments also suggest how large and small hospitals can manage their wastes and make use of common facilities to treat wastes. These Rules and their implementation have brought about a degree of awareness and concern among those managing healthcare establishments.

Way Ahead
Formation of professional associations like National, State and District Hospital Waste Management Associations, Infection Control Committees and cells and special groups among the Municipal Solid Waste Associations, Municipalities and Corporations and other relevant bodies for carrying out advocacy through them and through various national and international conferences on various issues of Hospital Waste Management and developing plans through them for awareness among public, establishing model waste management in hospitals, common facilities, monitoring and evaluation helps greatly in taking the movement forward and achieving tangible results. This is what the Indian Society for Hospital Waste Management and the Hospital Infection Society of India; NGOs like CEE and Toxics Link have been doing in India.

Management of Hospital Waste involves not only the medical fraternity but several other professional groups, NGOs and the common people.

Without their conscious effort not only at hospitals and clinics but even their homes, where a lot of treatment occurs these days, the spread of infection from the hospital waste cannot be contained. Their awareness and education through the media and other means like door-to-door motivation is all important. College students, youth, women’s groups and service clubs play a vital role in spreading awareness and can combine these with programmes they are already involved with like AIDS awareness. Even school children need to be conscientisized towards this immense problem and from a young age should adopt practices, which along with personal hygiene habits helps them demonstrate responsible behaviour for their safeguard and those of others as well.

CEE’s Health-Care Establishment Waste Management and Education Programme (HEWMEP)
STEP 1: Waste reduction
STEP 2: Segregation at Source
STEP 3: Separation of glass sharps
STEP 4: Disinfection by dipping IN 10% bleach or sodium hypochlorite for 6-8 hours
STEP 5: Transport and routing of Hospital Wastes from different zones and wards to the place of treatment
STEP 6: Autoclaving/Microwaving of waste and shredding (for plastics, and metal sharps)
STEP 7: Incineration/Deep burial (for pathological and anatomical waste)
STEP 8: Radioactive waste must be stored in lead containers according to BARC Regulations for ten half life period for radioactive decay of the wastes
STEP 9: Cytotoxic waste — Deep burial/ land filling in hazardous waste site
STEP 10: General waste
• Composting of kitchen waste
• Recycling for Office and packaging waste, confidential paper to be Shredded zand then sent for recycling
STEP 11: Hazardous chemical plastics should not be shredded. Separate collection for these should be organized for making into structurals such as girders for buildings, culverts, lamp posts and telephone poles etc. or for burying in hazardous waste landfills
STEP 12: Training and education at all levels within the healthcare establishment/s and outside for achieving the above steps

As an NGO and a part of the concerned public, CEE tried to assess whether the wastes actually being managed in the healthcare establishments led to reduction in infection levels and whether the knowledge, attitudes and practices of the healthcare staff had any relation with the changed infection status in a healthcare setting.

This was studied by evaluating the infection status in several healthcare establishments of different sizes in Delhi, Pune, Kannur, Gulbarga and Bhubaneswar and is being continuously checked in other places too. The knowledge, awareness/ attitudes and practices (KAP) of doctors, nurses and housekeeping staff of these establishments who are primarily concerned with waste generation and management were assessed using carefully designed KAP questionnaires. This was followed by a cross sectional study of biomedical wastes generated in all healthcare establishments, research institutions in Delhi and many other states throughout the country. The profile status of all these institutions towards handling and management of wastes was assessed using interview schedules and observation tables. Standard methods were used to check the infection status in correlation with KPA and profile scores in all the locations. A practical and ongoing training schedule for the staff was evolved, conducted and several educational material in different languages were developed for training and reinforcement.

The KAP and profile tests were repeated. Scoring of the KAP and profile scores and the actual infection status after training showed that the awareness and best practices status of the HCEs directly impacted their infection status. We have found that in addition to development of safe transport, treatment and disposal facilities, a customized awareness and training programme is essential to control the spread of infections from biomedical waste.

For more information contact:
Dr Shyamala Mani
Waste and Resource Management (WaRM)
Centre for Environment EducationC-40, Ground Floor, South Extension Part 2
New Delhi 110049
Ph: 011-26262878/81; Fax: 011-26262880
E-mail: shyamala.mani@ceeindia.org

Healthcare waste is different from our domestic waste and must be segregated, collected, stored, transported and disposed properly. If it is not managed in accordance with set guidelines, it can get mixed with general waste within the hospital and subsequently with solid and liquid municipal waste outside. This can expose the entire community to highly infectious diseases like HIV, Hepatitis B, C, Tuberculosis and other skin and respiratory aliments.

In order to enhance awareness about biomedical waste management, CEE has created a variety of general awareness materials such as cinema slides and a website. More detailed educational material have been developed as a kit for healthcare professionals including a booklet on the legislation, FAQs, sample stickers for waste containers, poster on pre-treatment processes etc.