TRAINING IN PUBLIC HEALTH CARE FACILITIES FOR HEALTH CARE WASTE MANAGEMENT

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TRAINING IN PUBLIC HEALTH CARE FACILITIES FOR
HEALTH CARE WASTE MANAGEMENT

• Dr. A Swart - TWR
• Ms. N Coulson HDA
• Ms. D Nteo - TWR

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OVERVIEW

• Introduction
• Identifying training needs
• Use of qualitative research methods
• Results from the qualitative research relevant to
  the design of the training intervention
• Design of the capacity building programme
• Evaluation results from the cascade training
  programme
• Training programme for health care waste officers
• Conclusion

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INTRODUCTION

• Training as an essential component of health care
  waste management (HCWM)
• Training in HCWM for public sector in Gauteng
• Gauteng Sustainable Health Care Waste Management
  project
• Research at two pilot sites
• Leratong Hospital
• Itireleng Clinic

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IDENTIFYING TRAINING NEEDS

• Performance discrepancy analysis
• Capacity in terms of performance
• For HCWM, three commonly areas of discrepancy
  (gaps) are
• knowledge gaps
• skills gaps and
• attitude gaps

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Training needs cont.

• Other areas to impact on the delivery of HCWM
  systems include
• inter-staff relations
• worst case scenarios
• technology gaps
• policy and procedures gaps and
• organisational, management and supervisory gaps.

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QUALITATIVE RESEARCH METHODS

• Focus group interviews at Leratong and Itireleng
• More than 90 health workers including
• two focus groups with senior and professional
  nurses
• two focus groups with auxiliary and enrolled
  nurses
• one focus group with doctors and
• three focus groups with general assistants and
  ward helpers.

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PURPOSE OF FOCUS GROUPS

• Explore the range of factors that impact on the
  behaviour and practices of staff
• Explore the knowledge of staff about HCWM
• Explore the attitudes to HCWM
• Understand the roles and responsibilities in HCWM

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RESULTS FROM QUALITATIVE COMPONENT

• Knowledge levels about HCWM improved down the
  traditional health worker hierarchy
• Knowledge levels about segregation and hazards
  appeared good re-enforcement required
• Health workers felt unappreciated in relation to
  HCWM

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• There is a level of poor practice in HCWM that is
  related to negligence, probably linked to low
  morale of health workers in the public sector
• Multidisciplinary training is important to
  overcome communication barriers
• Doctors believe that they do not have a role to
  play in HCWM

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DESIGN OF THE CAPACITY BUILDING PROGRAMME

• Approach to capacity building had seven elements
  of which training was one part
• Capacity programme complemented introduction of
  new equipment and addressed other important
  issues
• Training was an integrated component of broader
  strategy

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Capacity building programme involved

1. Code of Practice (new policy and procedures)
2. Improved monitoring and reporting through OHS
   committee
3. Introduction of dedicated Health Care Waste
   Officer and an Assistant
4. Knowledge, attitudes and skills training
5. Awareness activities
6. On the job skills coaching
7. Evaluation of capacity building activities

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CASCADE TRAINING PROGRAMME

• Primary approach to knowledge, attitudes and
  skills training at pilot sites was a train the
  trainer approach
• Cascade method of training reach maximum number
  of people within short period of time
• Supervisors trained to teach own staff
• Information largely generic multidisciplinary
  training where possible

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• Supervisors received teaching pack, including
• three teaching posters
• teaching notes to reinforce main information to
  be taught and
• two interactive teaching exercises, to be
  completed on the wards and in departments.

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• Key teaching topic reinforced - all health
  workers are members of the waste team, and has
  responsibility to teach and coach others
• Teaching topics organised into three teaching
  posters supported by teaching notes
• Supervisors introduced to teaching pack train
  the trainer session lasting 2.5 hours
• Supervisors to train multidisciplinary groups of
  staff, using one, maximum two teaching posters
  at a time

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Teaching topics to address the knowledge,
attitude and skill gaps for nurses, doctors and
general assistants at the pilot sites
Performance gap Nurses Doctors General Assistants
KNOW-LEDGE HCWM equipment system Segregation Recycling Procedures Monitoring and enforcement HCWM equipment system Segregation Recycling Procedures OHS reporting Monitoring and enforcement HCWM equipment system Segregation Recycling Procedures OHS reporting Monitoring and enforcement
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Performance gap Nurses Doctors General Assistants
ATTITUDES Protection of OHS Care of the environment Communica- tion with seniors about waste Part of a team Protection of OHS Care of the environment - Communica- tion with nurses and general assistants about waste Part of a team Protection of OHS Care of the environment Communica-tion with medical staff about waste - Part of a team

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Performance gap Nurses Doctors General Assistants
SKILLS Use of new sharp containers Seal liners Proper use and placing of coloured liners Segregate all waste correctly Coach other staff Use monitoring and reporting system Use of new sharp containers Segregate all waste correctly Use monitoring and reporting system Coach other staff Seal liners Use protective clothing correctly Proper use and placing of coloured liners Load internal trolley Unload internal trolley into 770 L bins Coach staff Use of chemicals
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CAPACITY BUILDING RESULTS

• LERATONG
• 65 supervisors trained as trainers
• 24 doctors
• 41 general assistants
• OHS committee 2.5 days of training

• ITIRELENG
• 7 supervisors trained as trainers
• 8 general assistants/ ward helpers
• 14 nursing staff
• 2 social workers/health promoter

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• 91 of sample in follow-on study had been trained
  about the new waste system
• 73 found training very useful 24 useful and 3
  not useful
• 51 would like further training 49 would not
  like further training

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KNOWLEDGE

• BASELINE
• 85 medical waste is put in red liners
• 55 general waste goes to landfill
• 54 cardboard boxes go for recycling

• FOLLOW ON
• 88 medical waste is put in red containers
• 77 general waste goes to landfill
• 73 cardboard boxes go for recycling

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SEGREGATION

• Always segregate waste correctly 68
• Sometimes segregate waste correctly 20
• Training helps segregation 80
• Well positioned containers 53
• Good supervision 46

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TRAINING PROGRAMME HEALTH CARE WASTE OFFICERS

• Designation of HCW officers a component of
  capacity building programme
• Recommended that HCW Officer and assistants be
  appointed at larger public health facilities
• Designated responsibility for nurse, infection
  control nurse or health and environment
  co-ordinator

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• Run over five days
• Five key outcomes for this training programme
• Understand key concepts and principles of HCWM
• Understand all aspects of cradle to grave
  management of all nine health care waste streams
• Understand the organisation and reporting for
  health care waste
• To plan training and awareness activities
• Able to conduct basic monitoring for
  non-conformances against the Code of Practice

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CONCLUSION

• Formative and evaluative research results
  consistently indicated the importance of an
  integrated approach to the development of
  training
• Two levels of training required
• Generic multi-disciplinary, taught by supervisors
  in wards and departments and
• Training for HCW Officers
• Reinforce skills, procedures and positive
  attitudes. Do not only address knowledge gaps.