Impact of an intervention programme on knowledge, attitude and practice of healthcare staff regarding pharmaceutical waste management, Gaza, Palestine

doi:10.1016/j.puhe.2016.04.001

Public Health

Volume 138, September 2016, Pages 127-137

https://doi.org/10.1016/j.puhe.2016.04.001 Get rights and content

Abstract

Objectives

To assess knowledge, attitude and practice (KAP) of healthcare staff regarding pharmaceutical waste management; and to determine the impact of an educational programme on the KAP survey items.

Design

Pre–post-test intervention study.

Methods

The pre-intervention phase was performed using a sample of 530 out of 1500 healthcare workers. A predesigned interview questionnaire was used to assess KAP. Next, an educational programme was designed and offered to a subsample of 69 healthcare workers. KAP were re-assessed for the programme attendees using the same interview questionnaire, both immediately (post-test) and six months after the end of the programme (follow-up test). The parametric paired sample t-test was used to assess the difference between pre-test and follow-up test results.

Results

Poor knowledge and poor practice levels (scores 50%) detected in the pre-intervention phase were found to improve to satisfactory levels (scores ≥75%) in the follow-up phase. Attitude was found to be positive (score ≥75%) in all phases of the study.

Conclusion

The educational programme led to a significant improvement in KAP of healthcare staff regarding pharmaceutical waste management (P < 0.001).

Introduction

Pharmaceutical waste (PW) consists of expired, unused, spilt, and contaminated pharmaceutical products, drugs, vaccines, and sera that are no longer required and need to be disposed of appropriately. This also includes discarded items used in the handling of pharmaceuticals, such as bottles, boxes, gloves, masks, connecting tubing, and drug vials’.¹ In a healthcare facility, PW is generated for various reasons including cessation of patient medication, spills/breakages and expiration of drugs before use.² Generally, PW is discharged down the drain or sent to landfill. This may take place due to poor knowledge about the potential negative impacts of PW on human health and the environment. These impacts could occur directly through contact with healthcare staff or indirectly through contamination of soil, ground water and surface water.³

Concerning the impacts of PW on human health, many cytotoxic drugs used in chemotherapy are known to be carcinogens, mutagens or teratogens. Nurses, pharmacists, waste handlers, storehouse employees and laundry workers could be at risk of exposure to these hazardous drugs.4, 5 In 1979, a hospital-based study reported signs of mutagenicity in the urine of oncology nurses.⁶ Other side-effects were also reported, including an increase in spontaneous abortion, child malformation and abnormal menstrual cycles.⁷ In a study conducted in 14 German hospitals, the urinary concentrations of certain cytotoxic drugs (cyclophosphamide, ifosfamide, doxorubicin, epirubicin and platinum) were monitored. The study results revealed that 40% of pharmacists and oncology workers had one of the tested drugs in their urine. The same study also documented the existence of drugs in the urine of workers who did not handle these hazardous drugs but were potentially exposed through contamination of work surfaces, clothing or drug containers.⁸ Furthermore, platinum was detected in the air of the antineoplastic drug preparation room, and in the blood and urine of nursing staff who helped patients to administer cisplatin.⁹

Regarding the impacts of PW on the environment, a variety of pharmaceuticals have been discovered in surface, ground and drinking waters in the USA.¹⁰ Pharmaceutical residues detected included pain killers, cholesterol regulators, antiseptics, chemotherapeutic agents, antibiotics and hormones.¹¹ Chemical residues discharged into the sewerage system may have adverse effects on the operation of biological sewage treatment plants, or toxic effects on the natural ecosystems of receiving waters.¹ Similar problems may be caused by pharmaceutical residues.¹²

Knowledge, attitude and practice (KAP) studies aim to collect information on what is known, believed and done by a particular population in relation to a specific topic.¹³ Some KAP studies have been undertaken on the management of biomedical waste in general.14, 15, 16, 17, 18 Pharmacists and nurses do not acquire information on hazardous waste management during their academic studies. In addition, safety personnel and heads of environmental services may not recognise the active ingredients present in pharmaceutical products. It is thus recommended that they should be given in-service education regarding proper handling of PW, especially that resulting from chemotherapy.³

In Gaza, rapid population growth (annual growth of 4.8%) has been associated with public service expansion, including healthcare services.¹⁹ According to the Ministry of Health, 317.6 m³ of PW was disposed of in 2011.²⁰

This study had two objectives: (1) to assess the KAP of healthcare staff in five major governmental hospitals in Gaza with regard to PW management (PWM) using a KAP survey; and (2) to determine the impact of an intervention programme on the KAP survey items.

Section snippets

Methods

This pre–post-test intervention study was conducted in 2014. It consisted of three phases: pre-intervention phase; intervention phase; and post-intervention phase.

Demographic data

Age, sex, qualifications, profession and years of experience of the participants in the pre-intervention phase are presented in Table 1. The majority of respondents were aged <40 years, with a mean age of 32.4 years (standard deviation [SD] eight years). There were more male subjects than females (56.2%), probably due to the fact that the majority of administrators and waste workers in Gaza hospitals are males. In terms of qualifications, 7% of employees were found to have postgraduate degrees,

Discussion

To the best of the authors' knowledge, this is the first study to tackle KAP regarding PW.

Ethical approval

This study was approved by the Ethics Committee, High Institute of Public Health, Alexandria University. Approval for conducting the study was also obtained from the Ministry of Health in Gaza, as well as from all hospital managers. Before data collection, each respondent was notified about the objective of the study, and was informed that collected data would be confidential as all questionnaires would remain anonymous.

Funding

None.

Competing interests

None declared.

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Original ResearchImpact of an intervention programme on knowledge, attitude and practice of healthcare staff regarding pharmaceutical waste management, Gaza, Palestine

Abstract

Objectives

Design

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Demographic data

Discussion

Ethical approval

Funding

Competing interests

Lancet

Waste Manag

Safe management of wastes from health-care activities

Guidance document. Best management practices for unused pharmaceuticals at health care facilities

Managing pharmaceutical waste: a 10-step blueprint for health care facilities in the United States

Workplace Health and Safety Queensland. Guide for handling cytotoxic drugs and related waste

Cytotoxic drug spillages among nursing personnel working in the chemotherapy administration areas

Nurs Midwif Res J

Health issues related to the management of antineoplastic drugs

Uptake of antineoplastic agents in pharmacy and hospital personnel. Part I: monitoring of urinary concentrations

Int Arch Occup Environ Health

Determination of platinum in workroom air and in blood and urine from nursing staff attending patients receiving cisplatin chemotherapy

Int Arch Occup Environ Health

Lessons from endocrine disruption and their application to other issues concerning trace organics in the aquatic environment: critical review

Environ Sci Technol

Drug residues in ambient water: initial surveillance in New Mexico, USA

Impact of residual pharmaceutical agents and their metabolites in wastewater effluents on downstream drinking water treatment facilities: final report

A guide to developing knowledge, attitude and practice surveys

Knowledge, attitude and practices of biomedical waste management amongst staff of institutional trauma center level II

Int J Res Health Sci

Knowledge, attitudes and practices of health care personnel towards waste disposal management at Ain-Shams University Hospitals, Cairo

EMHJ

Knowledge, attitude and practice of health care waste management and associated health risks in the two teaching and referral hospital in Kenya

J Community Health

Knowledge, attitude and practice of health care waste management amongst staff of nursing homes of Gulbarga city

JPBMS

Substantial changes in the size, structure, growth rate, and type of housing in the Gaza Strip between 1997 and 2007 Censuses

Hospitals annual report

Original Research
Impact of an intervention programme on knowledge, attitude and practice of healthcare staff regarding pharmaceutical waste management, Gaza, Palestine