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Running head: SAFETY IMPROVEMENT
Safety Improvement Need Assessment and Plan Paper
Tammy Virginia Selleck
Ferris State University
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Abstract
Biomedical wastes include infectious, pathological, genotoxic, radioactive, and heavy metals wastes that can
negatively impact communities, risking punctures, cuts, inhalations, or dermal contacts affecting patients, staff,
and families with microorganism caused drug-resistant diseases and illnesses (CDC, 2010, Salkin et al., 2009;
WHO, 2011). This paper will explore the implications of the unethical and unsafe healthcare waste
management and practices, as well as how creating a health system that fosters a just culture and utilizes high
reliability standards can create a plan to continue staff and public learning on proper waste handling, storage,
and care can reduce the risk of contracting infections and injuries. Nurses need to participate in interdisciplinary
teams that address the ethical risks and benefits of decreasing exposure to and harm from improper healthcare
waste management (Mathur et al., 2012). Studies on healthcare wastes revealed the presence of opportunistic
pathogenic bacteria, which threatens patient and staff safety, urging for the development of a plan from these
teams that supports color coded waste contains for proper waste disposal and staff/patient training on the types
of healthcare wastes (Mathur et al., 2012; Polovich & Clark, 2013).
Keywords: safety, quality, waste, infectious, management
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Safety Improvement Need Assessment and Plan Paper
Biomedical, or healthcare, wastes carries a higher potential for infection and injury to healthcare staff
and patients than any other type of waste, putting emphasis on implementing effective control and safe handling
of these hazardous, healthcare materials (WHO, 2011). These wastes can include infectious, pathological,
genotoxic, radioactive, chemical, and heavy metals wastes, which inadequate and inappropriate knowledge of
safe handling of healthcare waste can have serious health consequences for both patients and healthcare staff
(Salkin et al., 2009, p.56). Diseases, such as cholera, tuberculosis, hepatitis, acquired immunodeficiency
syndrome (AIDS), skin infections, food poising, etc., can ensue (CDC, 2010).
Ultimately, improper management of healthcare and biomedical waste can negatively impact
communities, risking punctures, cuts, inhalations, or dermal contacts affecting patients, staff, and families with
microorganism caused drug-resistant diseases and illnesses (WHO, 2011). Therefore, nursing leaders need to
develop a safety improvement plan can help to better education healthcare staff and the public on healthcare
wastes, to decrease the incidences of unnecessary injuries and harm from improper disposal occurring. This
paper will explore the implications of the unethical and unsafe healthcare waste management and practices, as
well as how creating a health system that fosters a just culture and utilizes high reliability standards can create a
plan to continue staff and public learning on proper waste handling, storage, and care can reduce the risk of
contracting infections and injuries.
Need Assessment of the Safety Issue
Even though there are five federal agencies, such as the United States Environmental Protection
Agency, Occupational Health and Safety Administration, and the United States Public Health Service, that have
established healthcare waste definitions, there is no uniform, national waste protocol (CDC, 2010). Therefore, it
is imperative for nursing leaders to tailor this safety intervention to a specific unit, so plans can be implemented
that are specific and will support change (Mathur et al., 2012; Polovich & Clark, 2013). The desired result is to
bring a successful, positive impact on the unit and throughout the hospital. In a 300-bed regional hospital, 30bed medical-surgical unit, there is a need to have a universal infection waste protocol, specifying how to
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properly handle and store infectious biomedical waste that is consistently educated on and followed by
healthcare workers on the unit.
Healthcare waste contains dangerous microorganisms that have the potential for infecting hospital
patients, healthcare workers, and the general public (CDC, 2010; WHO, 2011). With sixteen million injections
being administered worldwide, 35% of needles and syringes are not properly disposed of afterwards due to
confusion on how to properly dispose of such waste (WHO, 2011, para.2). Twenty percent of healthcare waste
is considered hazardous due to it containing infectious, toxic, or radioactive components, where 42% of this
waste is not disposed of nor stored properly (WHO, 2011, para.4). Not appropriately handling and disposing of
healthcare waste can lead to an increased chance of injuries and infections (CDC, 2010; WHO, 2011). In 2010,
there were approximately 400,000 to 550,000 needle stick injuries due to inappropriate handling and disposal of
needles after they were utilized for patients (WHO, 2011, para.2). AIDS and hepatitis B are a few of the longterm diseases that can be acquired by such an injury (CDC, 2010; WHO, 2011). Some other injuries include
poisoning and pollution through pharmaceutical products and radiation burns.
Therefore, there is a need for healthcare workers to be properly trained in a universal strategy that
reduces the rate of injuries and infection by urging the importance of proper healthcare waste disposal.
According to Hinkin and Cutter (2014), nurses were assessed on the quantity and applicability of the education
they received on infection control and waste management, as compared to how much they learned in their own
clinical experience. About 68% reported that they did not have a set protocol on their unit to guide them on
appropriate infectious waste disposal (Hinkin & Cutter, 2014, p.200). Instead, they learned waste management
while practicing on the floor. Hence, nursing leaders in this healthcare institution need to advocate that for this
medical-surgical unit, proper training and waste management systems need to be the same throughout the unit
and hospital, so there is a decrease prevalence in injuries and infections (CDC, 2010; Ho & Liao, 2011; Polovich
& Clark, 2013; Salkin et al., 2009).
The hazardous impact of medical waste on the healthcare workers is enhanced when adequate and
appropriate handling is not adopted (Ho & Liao, 2011). Due to there not being a universal standard of proper
waste containment, a protocol needs to be implemented on this unit that defines the appropriate measures that
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need to be taken for waste management. Improper waste management, lack of awareness about the health
hazards from biomedical wastes, and poor control of waste disposal are the critical issues connected with
improper disposal of wastes and is linked to compromising patient and healthcare staff safety (Ho & Liao, 2011,
p.2635).
Evaluation of the Safety Issue
In order to create change on this medical-surgical unit, planning on how to properly manage biomedical
waste can be explored by integrating high reliability standards, just culture principles, and quality improvement
models. When exploring each of these terms, high reliability standard is criteria set that demands consistent,
dependable performances that result in quality and safe care that is delivered to patients (Barnsteiner, 2012;
Graban 2012). The just culture principle denotes a created atmosphere of trust, encouragement and reward for
staff providing essential safety information to better improve care. Quality improvement models incorporate
data used to monitor the outcomes of care, so that improvement methods can be designed to continuously
improve the excellence in and safety of healthcare.
High Reliability Standards
The concept of high reliability standards can be applied to this unit by reviewing infection and injury
rates for healthcare staff and patients related to other units in the hospital and from other medical-surgical units
from area hospitals (Barnsteiner, 2012). This can be completed in order to create an average benchmark and
criteria. This can assist staff in understanding the principles they need to employ in order to meet the
benchmark or criteria set and to continually improve proper healthcare waste management tactics staff
implements. Thereby, this has the potential of decreasing rates of infection and injuries. Allowing staff to
compare their results to the average rates and being persistent in following through with appropriate waste
management, will result in quality and safe care.
Just Culture Principle
By implementing an online system where anonymous data can be entered when injuries occur and
unsafe practices are used, can help form different strategies to be utilize that prevent further safety issues from
occurring (Barnsteiner, 2012). The just culture principle is allowing the staff to enter data into a system
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anonymously, so they may feel welcomed to share concerns; thusly, the information that is shared is collected
and educational materials and strategies are formed and implemented. By management taking the concerns of
proper healthcare waste management seriously, staff can feel trust in leadership and rewarded for making the
decision to report unsafe activities.
Quality Improvement Models
Collecting data and making quality improvement models for the unit can help to better monitor or
visualize the areas of improvement and advancements, so safety from improper disposal of healthcare wastes
can be better maintained for the patients and staff (Barnsteiner, 2012). For example, data on needle stick
injuries due to improper disposal of needles can be collected and represented on pie charts or line graphs,
depicting the data from the unit throughout the months and where/when occurred. In so doing, specific
education pieces for the unit can be formulated and addressed. After education is implemented, more data on
the needle stick injuries needs to be collected to evaluate or monitor the outcomes of the education and care
provided.
Safety Improvement Plan
Regarding biomedical waste management, healthcare workers, especially nurses, need to ensure that
patient safety is maintained by creating and following a plan of action that can be implemented and followed,
resulting in quality and safe patient care is promoted (Ho & Liao, 2011; Hossain et al., 2013). Nurses have a
direct role to play in maintaining not only staff safety, but patient safety, as the care nurses provide patients
produce outcomes that are measurable and are determined to be nursing sensitive if they improve due to a
greater quantity or quality of nursing care. In this proper healthcare waste management case, nursing leaders
need to implement a plan that will incorporate how the staff will maintain their own safety but will decrease the
rate of patient hospital-acquired infections due to inappropriate waste management, which can be considered
nursing sensitive.
A plan to be implemented on a 30-bed medical-surgical unit can involve training staff on waste
segregation and color coded healthcare waste containers, as well as educating the patients by printing material
on the types of healthcare wastes and the importance of its proper disposal due to the negative implications
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associated with increased injury and infection rates (Ho & Liao, 2011; Hossain et al., 2013). An
interdisciplinary team, governed by nursing leadership, needs to be formed that involves different professions’
perspectives on how to improve staff and patient safety regarding proper waste disposal. They need to focus on
how if improperly completed by nursing, healthcare waste can cause an increase in hospital-acquired infection
rates and poor patient outcomes.
Color coded waste containers can be kept in dirty utility rooms, specific to a particular type of waste,
supporting for its proper disposal (Mathur et al., 2012; Polovich & Clark, 2013). Red biohazard waste
containers can be kept and easily found in each patient room for sharps and needles. Training the staff on how
and why to segregate biomedical wastes is imperative to ensure compliance with the new plan implementation.
Posters can be kept in dirty utility rooms to remind staff what types of wastes correspond with each color waste
bin. Posters for patients and families can also be in each patient room and near nursing stations reminding them
about the types of biomedical wastes, the negative implications for contact, and what to do in case waste is
observed or if they are exposed to waste. The goal needs to be kept in mind to limit the patient and families
from waste exposure; hence, there is a decrease in the occurrence of injuries and infections from ensuing.
Ethical Implications
In order to improve healthcare waste management, there are several ethical responsibilities required of
the professional nurse. Nurses need to participate in interdisciplinary teams that address the ethical risks and
benefits of decreasing exposure to and harm from improper healthcare waste management, in order to improve
safety outcomes for patients and staff by implementing and evaluating plans (Mathur et al., 2012). Recognizing
and advocating for necessary safety and quality improvement on proper disposal of biomedical waste allows for
goals of decrease infection and injuries rates to be achievable.
By changing how biomedical waste is handled, brings on ethical implications for both the nursing
profession and healthcare practices (Mathur et al., 2012). For the nursing profession, the ethical effects of
change can increase the validity of the profession by nurses observing and collecting evidence and creating new
tactics to implement that will result in improved waste management and reduce exposure to possible waste
infections. Disseminating and educating staff and patient on new evidence-based strategies can help to identify
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the risk and how to avoid them for current and future recipients of care and generations of healthcare staff. In
regards to healthcare practices, change will benefit the staff and patients by decreasing infection and injury
rates; thereby, increasing the safety and quality of the care provided. Healthcare practices will be current and
efficient by limiting exposure to potential waste hazards.
Conclusion
Past studies from Mathur et al. (2012) and Polovich and Clark (2013) revealed the presence of
opportunistic pathogenic bacteria, which threatens patient and staff safety, urging for the development of a plan
that supports color coded waste contains for proper waste disposal and staff/patient training on the types of
healthcare wastes (Mathur et al., 2012; Polovich & Clark, 2013). Accentuating the importance of proper waste
management can lead to implementing and disseminating knowledge about biomedical waste management,
impacting practices on appropriate waste disposal. Reviewing the ethical implications surrounding nursing and
healthcare practices in regards to proper infectious wastes management assists to explain the concerns, so better
methods can better explored and implemented to improve nursing and healthcare outcomes.
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