title: Effectiveness of intensive healthcare waste management training model among health professionals at teaching hospitals of Pakistan: a quasi-experimental study.
abstract: BACKGROUND
  Infectious waste management has always remained a neglected public health problem in the developing countries, resulting in high burden of environmental pollution affecting general masses. Health workers are the key personnel who are responsible for the management of infectious waste at any hospital, however, their proper training and education is must for an optimal performance. This interventional study was conducted to assess the effectiveness of Intensive healthcare waste management (IHWM) training model at two tertiary care hospitals of Rawalpindi city, Pakistan.
  
  
  METHODS
  This study was quasi-experimental pre and post design with control and intervention groups. Out of 275 health care workers enrolled for the study, 138 workers were assigned for intervention group for 3 months trainings, hands-on practicum and reminders on infectious waste management; whereas 137 workers were assigned to the control hospital where routine activities on infectious health care waste management were performed. Pre and post intervention assessment was done for knowledge, attitude and practices (KAP); and was statistically analyzed. Bivariate and multivariate analysis, independent, paired and unpaired t-test, chi-square with p values, and mean of the responses were calculated. Overall the response rate was 92% at the end of intervention.
  
  
  RESULTS
  During the baseline survey, 275 healthcare workers (HCW) included doctors, nurses, paramedics and sanitary workers, and after 3 months of intervention, 255 were reached out to complete the questionnaire. With regard to KAP at baseline, there were no significant differences between two groups at baseline, except for gender and department. However, in the post intervention survey, statistically significance difference (<0.05) between intervention and control group's knowledge, attitude and practices was found. Moreover, within the control group no statistically significant difference was reported (>0.05) after 3 months.
  
  
  CONCLUSIONS
  Study results suggest that IHWM training could be an effective intervention for improving knowledge, attitudes and practices among health workers regarding infectious waste management. Such training should become a regular feature of all hospitals for reducing the hazards attached with infectious wastes.
authors.affiliation: Fellow at College of Public Health Sciences, Chulalongkorn University Thailand, Bangkok, Thailand. ramesh@hsa.edu.pk.|Department of Health Systems and Policy, Health Services Academy, Islamabad, Pakistan. ramesh@hsa.edu.pk.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand. ratana.so@chula.ac.th.
authors.forename: Ratana
authors.initials: R
authors.lastname: Somrongthong
authors.affiliation: Department of Health Systems and Policy, Health Services Academy, Islamabad, Pakistan. shaikh.babar@gmail.com.
authors.forename: Babar Tasneem
authors.initials: BT
authors.lastname: Shaikh
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D005260:Female; D006282:Health Personnel / Q000193:education*; D006784:Hospitals, Teaching; D006801:Humans; D007318:Inservice Training; D008297:Male; D017146:Models, Organizational; D010154:Pakistan; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D018505:Waste Management; D055815:Young Adult