Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-12-01T10:30:58Z No. of bitstreams: 2 Tese - Sergiane Bisinoto Alves - 2015.pdf: 5232968 bytes, checksum: c022677e17e8e462562f6cc1099eaced (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-12-01T11:51:31Z (GMT) No. of bitstreams: 2 Tese - Sergiane Bisinoto Alves - 2015.pdf: 5232968 bytes, checksum: c022677e17e8e462562f6cc1099eaced (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-12-01T11:51:31Z (GMT). No. of bitstreams: 2 Tese - Sergiane Bisinoto Alves - 2015.pdf: 5232968 bytes, checksum: c022677e17e8e462562f6cc1099eaced (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-03-13 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The waste management is still deficient in many healthcare services. Those healthcare services smaller, as the primary healthcare offices, this problem becomes greater. Also important the destination for healthcare waste management generated by professionals and users in households. Faced with the expansion of the number and specificities of units in primary healthcare of occupational, environmental and social risks represent by healthcare waste generated in these environments, if not correctly managed, interventions in these realities are necessary and urgent. The objective was to evaluate the impact of the implementation of a healthcare waste management plan in primary healthcare unit and to check the approaches adopted by healthcare workers on the management of piercing and cutting waste generated by insulin users at households. This is a comparative and intervention study, pre and post, in a non-hospital unit to emergency care and also in a family healthcare unit, in the period from 2011 to 2014. The intervention performed consisted of: design and implementation of healthcare waste management plan using the situational strategic planning, educational and illustrative activities for users and multimodal permanent education, collective and individualized, for professionals for both healthcare units. A year after the intervention, all waste generated during a week in each healthcare unit were weighed and analyzed about the segregation. The values obtained were compared to those in the pre-intervention phase (Alves, 2010) that made the diagnosis in the same units and used the same methodology for the quantification and segregation analysis of the healthcare waste. The results show that the development and implementation of the waste management plan, using the situational strategic planning reduced healthcare waste generation and the inadequacies found about segregation in both units studied. It was also observed that there isn´t a management plan about management of piercing and cutting waste generated by users in households and that management is not assimilated in professional practice or in institutional procedures. The proposed intervention proved to be easy to apply and to involve all professionals and managers in prepare and implementation of a healthcare waste management plan in primary healthcare unit. The professionals and managers actively participated since the diagnosis of the healthcare waste management situation, discussion of alternatives to solve the problems listed until the decision making, resulting in a collective commitment to implement the healthcare waste management plan of healthcare services. / O manejo de resíduos ainda se mostra deficiente em vários estabelecimentos de saúde. Naqueles de pequeno porte, como as unidades de saúde da atenção básica, essa questão é ainda maior. Importante também destacar a destinação dada aos resíduos de serviços de saúde gerados por profissionais e usuários nos domicílios. Diante da expansão no número e especificidades dos estabelecimentos de saúde da atenção básica, dos riscos ocupacionais, ambientais e sociais representados pelos resíduos gerados nesses ambientes, se não gerenciados adequadamente, intervenções nessas realidades se mostram necessárias e urgentes. Assim, objetivou-se verificar a existência de plano de gerenciamento de resíduos e as condutas adotadas pelos profissionais de saúde da atenção básica sobre o manejo de resíduos perfurocortantes gerados por usuários de insulina nos domicílios e avaliar o impacto da implementação de um plano de gerenciamento de resíduos de serviços de saúde na atenção básica. Trata-se de um estudo comparativo e de intervenção, do tipo antes e após, realizado em uma unidade não hospitalar de atendimento as urgências e emergências e também em uma unidade de atenção básica à saúde da família, no período de 2011 a 2014. A intervenção realizada consistiu em: elaboração e implementação de um plano de gerenciamento de resíduos de serviços de saúde utilizando como ferramenta o planejamento estratégico situacional, atividades educativas e ilustrativas para conscientização dos profissionais e usuários e educação permanente multimodal coletiva e individualizada destinadas aos profissionais das duas unidades. Um ano após a intervenção, todos os resíduos gerados durante uma semana em cada unidade de saúde foram pesados e analisados quanto à segregação. Os valores obtidos foram comparados aos encontrados na etapa pré-intervenção (Alves, 2010), em que foi realizado o mesmo diagnóstico nessas unidades, utilizando metodologia idêntica para quantificação e análise da segregação. Os resultados mostram que a elaboração e implementação do plano de gerenciamento de resíduos, utilizando o planejamento estratégico situacional, reduziram a geração de resíduos e as inadequações encontradas em relação à segregação dos resíduos de serviços de saúde nas duas unidades estudadas. Observou-se também que não há um plano de gerenciamento que contemple o manejo dos resíduos perfurocortantes gerados pelos usuários nos domicílios e que esse manejo, não está assimilado na prática profissional, nem nos procedimentos institucionais. A intervenção proposta mostrou-se de fácil aplicabilidade e possibilitou o envolvimento de todos os profissionais e dos gestores na elaboração e implementação do plano. Os profissionais e gestores participaram ativamente desde o diagnóstico situacional do manejo de resíduos de serviços de saúde, discussão de alternativas para solucionar os problemas elencados até a tomada de decisão, resultando em um comprometimento coletivo para implementação do plano de gerenciamento de resíduos de serviços de saúde.

MPH / Department of Public Health / See the attached abstract below

PhD (Public Health) / Department of Public Health / Medical waste is a special type of hazardous waste generated from healthcare facilities. Mismanagement of this waste has a negative impact on healthcare workers, patients and their relatives, medical waste handlers and the community. South Africa, like many other developing countries, is resource-constrained in the management of medical waste and poor practices have been reported across the country, especially in the urban health facilities that have received more attention from researchers. This study was conducted to explore the practices and challenges of medical waste management in Vhembe District, a largely rural district in Limpopo province and develop intervention strategies for better management of the waste in the District. A convergent parallel approach of mixed method design was adopted to achieve the objectives of this study. The target population included the main stakeholders of medical waste management in the district: the Department of Health, healthcare facilities and the waste management company responsible for the treatment and disposal of medical waste in Limpopo Province. The study population from the Department of Health included representatives from the medical waste management section while the waste management company was represented by the manager of the company in Limpopo Province. The samples for the healthcare facilities were drawn from fifteen randomly selected healthcare facilities in the district and included the administrative heads, medical waste generators and medical waste handlers. The study was conducted in three phases. Phase 1 was a qualitative study during which the administrative heads of the selected healthcare facilities, personnel directly involved in medical waste management at the healthcare facilities as well as the representatives from the Department of Health and waste management company were engaged in in-depth interviews. This phase also involved voice recording, observations, field documentation and taking of relevant pictures. Thematic content analysis was used to analyze the data obtained. During phase 2 (quantitative study), a semi-structured questionnaire was employed for data collection from medical waste generators and handlers at the healthcare facilities. A total of 229 questionnaires were retrieved from the participants and were analyzed with the Statistical Package for Social Sciences version 25.0. Descriptive statistical analyses were performed; Chi-square and Cramer’s V tests were used to determine the associations between dependent and independent variables, as well as the strength of association where significant relationships exist. Statistical significant level was set at p<0.05 and the results are presented in tables and graphs. The results from both phases were interpreted and discussed simultaneously. Respondents and participants were assured of anonymity of their identities and confidentiality of the information they provided. They were given adequate information about the study and only those who volunteered participated in the study after appending their signatures on the informed consent form. In phase 3, the Medical Research Council Framework was used to develop intervention strategies for improved medical waste management in Vhembe District based on the Strength, Weakness, Opportunity and Threat (SWOT) and Political, Economic, Social, Technological, Environmental and Legal (PESTEL) analysis techniques. The study revealed inefficient practices of medical waste management in all the healthcare facilities. Rate of medical waste generation was 338.15kg/day, 19.2kg/day and 15.5kg/day of HCRW from the hospitals, community health centers and clinics respectively. Segregation practices were poor, and only 28.4% of respondents rated their healthcare institutions as being excellent with medical waste segregation. The type of occupation was found to be significantly associated with exposure to training (p=0.000) and the level of knowledge about medical waste management (p=0.000). Also, the use of personal protective equipment was found to be significantly associated with training (p=0.011). Transportation and temporary storage were not done according to the recommendation in the guidelines and incineration was the main means of treatment of the waste. The final product of waste treatment is being disposed into an hazardous waste landfill. The challenges encountered in the process of managing medical waste include lack of adequate funding and budget for medical waste management, ineffective and irregular training of healthcare workers, non-compliance to medical waste management guidelines, insufficient bins, substandard central storage rooms, insufficient personal protective equipment and unavailability of Hepatitis B vaccine. The strength, weakness, opportunities and threats of medical waste management in Vhembe District were analyzed and specific intervention strategies were developed to improve on the strength, minimize the weakness, take advantage of the opportunity and combat the threats. The developed strategies were validated. This study provides the evidences of poor management of medical waste in Vhembe District, and shows the need for urgent intervention measures to be put in place. We therefore recommend that the intervention strategies proposed here be evaluated and implemented to mitigate the untoward effects of poor medical waste management among healthcare workers and the community as a whole. / NRF