Title: TRAINING%20IN%20PUBLIC%20HEALTH%20CARE%20FACILITIES%20FOR%20HEALTH%20CARE%20WASTE%20MANAGEMENT
1TRAINING IN PUBLIC HEALTH CARE FACILITIES FOR
HEALTH CARE WASTE MANAGEMENT
- Dr. A Swart - TWR
- Ms. N Coulson HDA
- Ms. D Nteo - TWR
2OVERVIEW
- 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
3INTRODUCTION
- 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
4IDENTIFYING 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
5Training 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.
6QUALITATIVE 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.
7 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
8RESULTS 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
9- 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
10DESIGN 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
11Capacity building programme involved
- Code of Practice (new policy and procedures)
- Improved monitoring and reporting through OHS
committee - Introduction of dedicated Health Care Waste
Officer and an Assistant - Knowledge, attitudes and skills training
- Awareness activities
- On the job skills coaching
- Evaluation of capacity building activities
12CASCADE 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
13- 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.
14- 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
15Teaching 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
16Performance 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
17Performance 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
18CAPACITY 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
19- 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
20KNOWLEDGE
- 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
21SEGREGATION
- Always segregate waste correctly 68
- Sometimes segregate waste correctly 20
- Training helps segregation 80
- Well positioned containers 53
- Good supervision 46
22TRAINING 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
23- 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
24CONCLUSION
- 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.