ABSTRACT
Introduction: Biomedical waste (BMW) generated is a matter of great concern as it consists of high levels of hazardous waste. The lack of segregation and disposal policy in India leads to use of such infectious waste in day-to-day life [1]. Lack of awareness about segregation of Biomedical Waste (BMW) at source is a major cause for Hospital Acquired Infection (HAI) and increased risk of contamination of hospital and external environment. Materials & Methods: To address the problem, we decided to train interns and health care workers to increase their awareness about BMW segregation and thereby reduce HAI. The program was run in 3 phases. In the 1st phase need assessment was done as to how important and effective this program would be in controlling HAI. The 2nd phase comprised of identifying the stake holders in the program who will play the key role in implementing the program effectively. The 3rd phase of Biomedical Segregation Program BMWSP focused on the outcomes as enumerated in the Kirkpatrick model [2], viz., participants’ reaction, learning, change in behavior and results. Measuring the impact of the program on the learners at these four levels revealed the effectiveness of the program. Results: To overcome the shortfalls in the Kirkpatrick model we used Logic model which took care of the instructional design. Logic model is better suitable for evaluating BMWSP as it considers inter-relation between constituents in a sequence and their effect on the process as well as product providing the necessary roadmap from the planned work (inputs and activities) to the intended results (outputs, outcomes and impact). It is a sequence of events connecting each other starting with Resources / Inputs, Activities, Outputs, Outcomes and Impact. The model helped medical interns and dental students to understand the importance for BMWSP and also made a significant difference in its implementation. Conclusion: The program helped in making the health care staff more aware about BMWSP. It also increased their knowledge, and helped in implementation of the program. This will significantly reduce HAI and overall benefit the society.
ABSTRACT
Pulmonary tuberculosis is still a global public health threat. Despite all efforts at its containment; the scourge is still menacing especially in the rural communities and among HIV infected patients. This retrospective study was carried out to determine the case detection rate of pulmonary tuberculosis in a rural community hospital in Nigeria from 2001-2006. A total of 1219 suspected patients were tested for pulmonary tuberculosis by sputum smear stained by Ziehl-Neelsen technique. Out of this number; 350 (28.7) were positive for Acid-Fast Bacilli including 198 males and 152 females. Also 235 of the sputum-smear positive patients were tested for the human immunodeficiency virus (HIV) antibodies by Immunocomb 11 HIV 1 et 2 Bispot and confirmed by Immunocomb 11 HIV 1 et 2 Combfirm and HIV-1 Western Blot kit. Sixty three (26.8) of the sputum-smear positive patients were co-infected with HIV. Two hundred and seventy (77.1) of the AFB positive patients were treated under the Directly Observed Therapy-Short course; 201 of them (74.4) completed the treatment; 39 (14.4) defaulted; 30 (11.1) died before the completion of the treatment; 195 of the patients were declared cured and 6 were declared failed. Case detection rates could be improved upon by providing culture facilities at the DOTS centers. Also efforts should be made to ensure that all positive cases are followed to a logical conclusion and that anti-retroviral drugs are provided for patients co-infected with HIV to reduce the mortality rate of pulmonary tuberculosis