title: Impact of intervention on healthcare waste management practices in a tertiary care governmental hospital of Nepal.
abstract: BACKGROUND
  Healthcare waste is produced from various therapeutic procedures performed in hospitals, such as chemotherapy, dialysis, surgery, delivery, resection of gangrenous organs, autopsy, biopsy, injections, etc. These result in the production of non-hazardous waste (75-95%) and hazardous waste (10-25%), such as sharps, infectious, chemical, pharmaceutical, radioactive waste, and pressurized containers (e.g., inhaler cans). Improper healthcare waste management may lead to the transmission of hepatitis B, Staphylococcus aureus and Pseudomonas aeruginosa.
  
  
  METHODS
  This evaluation of waste management practices was carried out at gynaecology, obstetrics, paediatrics, medicine and orthopaedics wards at Government of Nepal Civil Service Hospital, Kathmandu from February 12 to October 15, 2013, with the permission from healthcare waste management committee at the hospital. The Individualized Rapid Assessment tool (IRAT), developed by the United Nations Development Program Global Environment Facility project, was used to collect pre-interventional and post-interventional performance scores concerning waste management. The healthcare waste management committee was formed of representing various departments. The study included responses from focal nurses and physicians from the gynaecology, obstetrics, paediatrics, medicine and orthopaedics wards, and waste handlers during the study period. Data included average scores from 40 responders. Scores were based on compliance with the IRAT.
  
  
  RESULTS
  The waste management policy and standard operating procedure were developed after interventions, and they were consistent with the national and international laws and regulations. The committee developed a plan for recycling or waste minimization. Health professionals, such as doctors, nurses and waste handlers, were trained on waste management practices. The programs included segregation, collection, handling, transportation, treatment and disposal of waste, as well as occupational health and safety issues. The committee developed a plan for treatment and disposal of chemical and pharmaceutical waste. Pretest and posttest evaluation scores were 26% and 86% respectively.
  
  
  CONCLUSIONS
  During the pre-intervention period, the hospital had no HCWM Committee, policy, standard operating procedure or proper color coding system for waste segregation, collection, transportation and storage and the specific well-trained waste handlers. Doctors, nurses and waste handlers were trained on HCWM practices, after interventions. Significant improvements were observed between the pre- and post-intervention periods.
authors.affiliation: Government of Nepal Civil Service Hospital, Minbhawan, Kathmandu, Nepal. sapkota.binaya@gmail.com.
authors.forename: Binaya
authors.initials: B
authors.lastname: Sapkota
authors.forename: Gopal Kumar
authors.initials: GK
authors.lastname: Gupta
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Mainali
mesh_terms: D019983:Guideline Adherence; D017408:Guidelines as Topic; D006256:Hazardous Waste; D006748:Hospital Departments / Q000458:organization & administration; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D017744:Medical Waste Disposal / Q000191:economics / Q000379:methods*; D009390:Nepal; D016272:Occupational Health; D010564:Personnel, Hospital; D057766:Policy; D062606:Tertiary Care Centers / Q000191:economics / Q000458:organization & administration*
chemical_list: D006256:Hazardous Waste; D017744:Medical Waste Disposal