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TRAINING IN PUBLIC HEALTH TRAINING IN PUBLIC HEALTH CARE FACILITIES FOR HEALTH CARE FACILITIES FOR HEALTH CARE WASTE MANAGEMENTCARE WASTE MANAGEMENT

Dr. A Swart - TWRDr. A Swart - TWR

Ms. N Coulson – HDAMs. N Coulson – HDA

Ms. D Nteo - TWRMs. D Nteo - TWR

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OVERVIEWOVERVIEW IntroductionIntroduction Identifying training needsIdentifying training needs Use of qualitative research methodsUse of qualitative research methods Results from the qualitative research relevant to the Results from the qualitative research relevant to the

design of the training interventiondesign of the training intervention Design of the capacity building programmeDesign of the capacity building programme Evaluation results from the cascade training Evaluation results from the cascade training

programmeprogramme Training programme for health care waste officersTraining programme for health care waste officers ConclusionConclusion

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INTRODUCTIONINTRODUCTION

Training as an essential component of Training as an essential component of health care waste management (HCWM)health care waste management (HCWM)

Training in HCWM for public sector in Training in HCWM for public sector in Gauteng Gauteng

Gauteng Sustainable Health Care Waste Gauteng Sustainable Health Care Waste Management projectManagement project

Research at two pilot sites:Research at two pilot sites:– Leratong HospitalLeratong Hospital– Itireleng ClinicItireleng Clinic

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IDENTIFYING TRAINING NEEDSIDENTIFYING TRAINING NEEDS

Performance discrepancy analysisPerformance discrepancy analysis ““Capacity” Capacity” in terms of in terms of “performance”“performance” For HCWM, three commonly areas of For HCWM, three commonly areas of

discrepancy (gaps) are:discrepancy (gaps) are:– knowledge gaps;knowledge gaps;– skills gaps; andskills gaps; and– attitude gapsattitude gaps

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Training needs cont.Training needs cont.

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

gaps.gaps.

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QUALITATIVE RESEARCH QUALITATIVE RESEARCH METHODSMETHODS

Focus group interviews at Leratong and Focus group interviews at Leratong and ItirelengItireleng

More than 90 health workers includingMore than 90 health workers including

– two focus groups with senior and professional two focus groups with senior and professional nurses;nurses;

– two focus groups with auxiliary and enrolled nurses; two focus groups with auxiliary and enrolled nurses; – one focus group with doctors; and one focus group with doctors; and – three focus groups with general assistants and three focus groups with general assistants and

ward helpers.ward helpers.

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PURPOSE OF FOCUS GROUPSPURPOSE OF FOCUS GROUPS

Explore the range of factors that impact on Explore the range of factors that impact on the behaviour and practices of staffthe behaviour and practices of staff

Explore the knowledge of staff about HCWMExplore the knowledge of staff about HCWM Explore the attitudes to HCWMExplore the attitudes to HCWM Understand the roles and responsibilities in Understand the roles and responsibilities in

HCWMHCWM

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RESULTS FROM QUALITATIVE RESULTS FROM QUALITATIVE COMPONENTCOMPONENT

Knowledge levels about HCWM improved Knowledge levels about HCWM improved down the traditional health worker hierarchydown the traditional health worker hierarchy

Knowledge levels about segregation and Knowledge levels about segregation and hazards appeared good; re-enforcement hazards appeared good; re-enforcement requiredrequired

Health workers felt unappreciated in relation Health workers felt unappreciated in relation to HCWMto HCWM

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There is a level of poor practice in HCWM There is a level of poor practice in HCWM that is related to negligence, probably that is related to negligence, probably linked to low morale of health workers in linked to low morale of health workers in the public sectorthe public sector

Multidisciplinary training is important to Multidisciplinary training is important to overcome communication barriersovercome communication barriers

Doctors believe that they do not have a Doctors believe that they do not have a role to play in HCWMrole to play in HCWM

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DESIGN OF THE CAPACITY DESIGN OF THE CAPACITY BUILDING PROGRAMMEBUILDING PROGRAMME

Approach to capacity building had seven Approach to capacity building had seven elements of which training was one partelements of which training was one part

Capacity programme complemented Capacity programme complemented introduction of new equipment and introduction of new equipment and addressed other important issuesaddressed other important issues

Training was an integrated component of Training was an integrated component of broader strategybroader strategy

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Capacity building programme involved:Capacity building programme involved:

1.1. Code of Practice (new policy and procedures)Code of Practice (new policy and procedures)

2.2. Improved monitoring and reporting through Improved monitoring and reporting through OHS committeeOHS committee

3.3. Introduction of dedicated Health Care Waste Introduction of dedicated Health Care Waste Officer and an AssistantOfficer and an Assistant

4.4. Knowledge, attitudes and skills trainingKnowledge, attitudes and skills training

5.5. Awareness activitiesAwareness activities

6.6. On the job skills coachingOn the job skills coaching

7.7. Evaluation of capacity building activitiesEvaluation of capacity building activities

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CASCADE TRAINING CASCADE TRAINING PROGRAMMEPROGRAMME

Primary approach to knowledge, attitudes Primary approach to knowledge, attitudes and skills training at pilot sites was a “and skills training at pilot sites was a “train train the trainer”the trainer” approach approach

Cascade method of training – reach Cascade method of training – reach maximum number of people within short maximum number of people within short period of timeperiod of time

Supervisors trained to teach own staffSupervisors trained to teach own staff Information largely generic; multidisciplinary Information largely generic; multidisciplinary

training where possibletraining where possible

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Supervisors received teaching pack, Supervisors received teaching pack, including:including:

– three teaching posters;three teaching posters;– teaching notes to reinforce main information to teaching notes to reinforce main information to

be taught; andbe taught; and– two interactive teaching exercises, to be two interactive teaching exercises, to be

completed on the wards and in departments.completed on the wards and in departments.

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Key teaching topic reinforced - all health Key teaching topic reinforced - all health workers are members of the workers are members of the “waste team”, “waste team”, and has responsibility to teach and coach and has responsibility to teach and coach othersothers

Teaching topics organised into three Teaching topics organised into three teaching posters supported by teaching teaching posters supported by teaching notesnotes

Supervisors introduced to teaching pack; Supervisors introduced to teaching pack; train the trainer session lasting 2.5 hourstrain the trainer session lasting 2.5 hours

Supervisors to train multidisciplinary groups Supervisors to train multidisciplinary groups of staff, using one, maximum two teaching of staff, using one, maximum two teaching posters at a timeposters at a time

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Performance Performance gapgap

NursesNurses DoctorsDoctors General General AssistantsAssistants

KNOW-KNOW-LEDGELEDGE

- HCWM HCWM equipment equipment systemsystem- SegregationSegregation- RecyclingRecycling- ProceduresProcedures- Monitoring and Monitoring and enforcementenforcement

- HCWM HCWM equipment equipment

systemsystem - SegregationSegregation

- RecyclingRecycling- ProceduresProcedures- OHS OHS reportingreporting

-Monitoring and Monitoring and

enforcementenforcement

- HCWM HCWM

equipment equipment systemsystem- Segregation Segregation - RecyclingRecycling- ProceduresProcedures- OHS OHS reportingreporting- Monitoring Monitoring and and enforcementenforcement

Teaching topics to address the knowledge, attitude and skill gaps for

nurses, doctors and general assistants at the pilot sites

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Performance Performance gapgap

NursesNurses DoctorsDoctors General General AssistantsAssistants

ATTITUDESATTITUDES

- Protection of Protection of OHSOHS- Care of the Care of the environmentenvironment- Communica-Communica-

tion with seniors tion with seniors about wasteabout waste- Part of a team Part of a team

- Protection of Protection of OHSOHS

- Care of the Care of the environmentenvironment

- Communica-- Communica-

tion with nurses tion with nurses and general and general assistants assistants about wasteabout waste- Part of a teamPart of a team

- Protection of Protection of OHSOHS- Care of the Care of the environment environment - Communica-Communica-tion with tion with medical staff medical staff about wasteabout waste

- Part of a - Part of a teamteam

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Performance Performance gapgap

NursesNurses DoctorsDoctors General General AssistantsAssistants

SKILLSSKILLS - Use of new Use of new sharp containers sharp containers - Seal linersSeal liners- Proper use Proper use and placing of and placing of coloured linerscoloured liners- Segregate all Segregate all waste correctlywaste correctly- Coach other Coach other staffstaff- Use monitoring Use monitoring and reporting and reporting systemsystem

- Use of new Use of new sharp sharp containerscontainers

- Segregate all Segregate all waste correctlywaste correctly- Use Use monitoring and monitoring and reporting reporting systemsystem- Coach other Coach other staffstaff

- Seal liners Seal liners - Use Use protective protective clothing clothing correctlycorrectly- Proper use Proper use and placing of and placing of coloured linerscoloured liners-Load internal Load internal trolleytrolley- Unload Unload internal trolley internal trolley into 770 L binsinto 770 L bins- Coach staffCoach staff- Use of Use of chemicalschemicals

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CAPACITY BUILDING RESULTSCAPACITY BUILDING RESULTS

LERATONGLERATONG

65 supervisors trained 65 supervisors trained as trainersas trainers

24 doctors24 doctors

41 general assistants41 general assistants

OHS committee – 2.5 OHS committee – 2.5 days of trainingdays of training

ITIRELENGITIRELENG7 supervisors trained as 7 supervisors trained as

trainerstrainers

8 general assistants/ ward 8 general assistants/ ward helpershelpers

14 nursing staff14 nursing staff

2 social workers/health 2 social workers/health promoterpromoter

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91% of sample in follow-on study had been 91% of sample in follow-on study had been trained about the new waste systemtrained about the new waste system

73% found training very useful; 24% useful 73% found training very useful; 24% useful and 3% not usefuland 3% not useful

51% would like further training; 49% would 51% would like further training; 49% would not like further trainingnot like further training

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KNOWLEDGEKNOWLEDGE

BASELINEBASELINE85% medical waste is put 85% medical waste is put

in red linersin red liners

55% general waste goes 55% general waste goes to landfillto landfill

54% cardboard boxes go 54% cardboard boxes go for recyclingfor recycling

FOLLOW ONFOLLOW ON88% medical waste is put 88% medical waste is put

in red containersin red containers

77% general waste goes 77% general waste goes to landfillto landfill

73% cardboard boxes go 73% cardboard boxes go for recyclingfor recycling

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SEGREGATIONSEGREGATION

Always segregate waste correctly – 68%Always segregate waste correctly – 68% Sometimes segregate waste correctly – Sometimes segregate waste correctly –

20%20% Training helps segregation – 80%Training helps segregation – 80% Well positioned containers – 53%Well positioned containers – 53% Good supervision – 46%Good supervision – 46%

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TRAINING PROGRAMME – TRAINING PROGRAMME – HEALTH CARE WASTE OFFICERSHEALTH CARE WASTE OFFICERS Designation of HCW officers a component of Designation of HCW officers a component of

capacity building programmecapacity building programme Recommended that HCW Officer and Recommended that HCW Officer and

assistants be appointed at larger public assistants be appointed at larger public health facilitieshealth facilities

Designated responsibility for nurse, infection Designated responsibility for nurse, infection control nurse or health and environment co-control nurse or health and environment co-ordinatorordinator

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Run over five daysRun over five days Five key outcomes for this training Five key outcomes for this training

programme:programme:– Understand key concepts and principles of HCWMUnderstand key concepts and principles of HCWM– Understand all aspects of cradle to grave management Understand all aspects of cradle to grave management

of all nine health care waste streamsof all nine health care waste streams– Understand the organisation and reporting for health Understand the organisation and reporting for health

care wastecare waste– To plan training and awareness activitiesTo plan training and awareness activities– Able to conduct basic monitoring for non-conformances Able to conduct basic monitoring for non-conformances

against the Code of Practiceagainst the Code of Practice

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CONCLUSIONCONCLUSION

Formative and evaluative research results Formative and evaluative research results consistently indicated the importance of an consistently indicated the importance of an integrated approach to the development of trainingintegrated approach to the development of training

Two levels of training required:Two levels of training required:– Generic multi-disciplinary, taught by supervisors in Generic multi-disciplinary, taught by supervisors in

wards and departments; andwards and departments; and– Training for HCW OfficersTraining for HCW Officers

Reinforce skills, procedures and positive attitudes. Do Reinforce skills, procedures and positive attitudes. Do not only address knowledge gaps.not only address knowledge gaps.