TO EVALUATE EXISTING PROBLEMS
AND TRAINING NEEDS IN WESTTALLINN CENTRAL HOSPITAL
Questionnaire for head nurses
Qestrain task no 1
K.Linsmann
June 2003
1
INTRODUCTION
•
Aims:
• To survey of the existing situation, problems and needs of
improvement
• To get information about nursing stuff consciousness from health
care waste management, enviromental and safety things
2
•
The interview was carried out in June 2003.
•
Questionnaire consisted of 31 questions related to: quality,
environment and safety issues. Answers were possible from selection
of choices and open ended form.
•
Data were processed with EXCEL software program.
•
Questionnaires were sent to all departments of WTCH (54), target
group were head nurses who answered to the questions with nursing
and helping staff. 39 (72%) correctly filled questionnaires were
returned.
STUDY RESULTS
I LEGISLATION 1


3
As a legal basis that regulate the waste
management at the health care institution
the 24 different legal acts were mentioned by
the head nurses.
Most frequently were named Tallinn City
Council regulation no 9 10.02.2000 “Waste
management rules”, Waste management
rules of Tallinn health care and nursing
institutions and Waste Act no 52.
LEGISLATION 2

Legal basis that regulate the work safety at the
health care institution
–
–
4
the Occupational Health and Safety Act was named most
frequently by head nurses.
In two cases were named the Procedure of selecting and
using the personal protective equipment; Procedure for
training in occupational health and occupational safety;
Instructions of occupational safety for all employees;,
Internal work procedure rules and WTCH safety
instructions.
LEGISLATION 3

Legal basis that regulate the quality of the
work at the health care institution
–

5
Most frequently was named internal work
procedure rules, Occupational Health and Safety
Act and Quality Requirements for Health Services
(SM 20.12.01 regulation no 144).
32 head nurses had opportunity to read
aforementioned documents and 6 head
nurses did not had that opportunity.
Head nurses need addition information in
following areas







6
Quality of work at the health care institutions (3)
Risks of working environment influenced by the
biological hazards (1)
All sections of Occupational Health and Safety Act
(1)
Occupational Accident and Disease Insurance Act
(1)
Occupational Safety Act 1992 – 1999 (1)
Waste Act 1998 (1)
What equipment is used in countries of European
Union (1)
II ENVIRONMENTAL PROTECTION

7
As a most hazardous waste to the
environment: the most frequently were
named by the head nurses a radioactive
waste, mercury, biological waste, chemical
waste, infectious waste, and sharp objects
(Figure 1).
Figure 1. Most hazardous waste for the
environment according to head nurses
Total number of responders
33
Sharp objects
6
Infectious waste
8
Chemical waste
8
Biological waste
10
Mercury
17
Radioactive waste
20
0
8
5
10
15
20
25
Number of responders
30
35
Hospital waste generated at the
departments


9
In the opinion of all head nurses the most
prevalent hospital waste generated at the
departments were sharp objects.
Biological waste was most prevalent
according to 35, infectious waste according
to 22 and laboratory waste according to 10
head nurses. (Figure 2)
Figure 2. Generation of hospital waste in
departments
38
Total number of responders
10
Laboratory waste
22
Infectious waste
38
Sharp objects
35
Biological waste
0
5
10
15
20
25
Number of responders
10
30
35
40
PERSON RESPONSIBLE



11
Person responsible for waste management
existed in 24 and was lacking in 13 departments.
The existence of the person responsible for
waste management in the department was
important according to 37 head nurses.
2 head nurses considered unnecessary the
employment of the person responsible for the waste
management. As a commentary was added: In the
department everybody must be responsible.
Assignments to perform by the person
responsible for waste management

12
The main tasks for the person responsible
for the waste management according to
head nurses were supervision of waste
collection and sorting, instructing the workers
at the department, supervision of waste
packaging, supervision of waste labelling and
training of new employees. (Figure 3)
Figure 3. Assignments to perform by the person
responsible for waste management
38
Total number of responders
27
Informing the hospital management
35
Training of the new employee
37
Instruction of own department workers
Supervision of waste storage
22
Supervision of waste transportation
25
Supervision of waste labelling
36
Supervision of waste packaging
36
Supervision of waste collection and sorting
38
0
13
5
10
15
20
25
30
Number of responders
35
40
The waste management at the WTCH Ltd



14
All head nurses were of opinion that all workers at
the department has the obligation to comply with
the rules of waste management.
The waste management at the WTCH Ltd is
organized perfectly, without shortcomings and
environment friendly in opinion of 6 head nurses.
Waste management has some shortcomings and
needs a little polishing according to 32 head nurses.
Harmful to the environment was waste management
according to 4 and hazardous to the workers
according to 1 head nurse.
Reporting of shortcomings in organization
of waste management

15
When noticing a deficiency in the
organization of waste management the
head nurses report primarily to the
clinic’s/center’s chief nurse, nurse
infectionists’ and to the waste management
service department. (Figure 4)
Figure 4. Reporting of shortcomings in
organization of waste management
Total number of responders
39
4
Management
2
17
Head nurse infectionist
17
17
3
Head of the clinic/center
12
Colleague
6
0
16
10
20
30
40
Number of responders
50
Reporting about deficiencies of the
waste managenent


17
About the deficiencies of the waste
management has reported 15 and has not
reported 24 head nurses. One head nurse
added that there are no shortcomings.
Situation changed after the reporting of
deficiencies in 10 and did not change in 6
cases
III WORK ENVIRONMENT
AND SAFETY

18
According to all head nurses the work
environment is safer primarily due to the
quality tools and protective equipment.
(Figure 5)
Figure 5. Providing the safe working
environment within the department
Total number of responders
39
Possibility of consulting
27
Working instructions
33
Personal instruction
28
Protective equipment
39
Quality tools
39
Training and refresher course
33
0
19
10
20
30
Number of responders
40
50
Assessment of their department working
environment by head nurses

20
29 head nurses consider the working
environment at their department safe
(Figure 6).
Figure 6. Assessment of their department
working environment by head nurses
Total number of responders
38
Dangerous
1
There are shortcomings
14
29
Safe
Very safe 0
0
21
5
10
15
20
25
Number of responders
30
35
40
Main hazard at working environment

22
As a main hazard at their working environment (department),
head nurses considered to be primarily deficit of explanations. (Figure
7). Category “other” was chosen by 11 (36.7%) senior nurses. This
category consists of following aspects:
– Deliberate disregard of corresponding rules by the workers, due to
carelessness and negligence
– Neglecting the protective equipment
– Always exists a certain risk as a biological hazard factor (risk of
infection)
– We exercise control but teach a little
– Unrepaired rooms, no security signalization
– Draught
– Risk exist when there is no possibility to obtain safety devices and
equipment
– There is no danger
– Everything is alright in our department
Figure 7. Hazard factors of the working
environment (department)
Total number of responders
30
Other
11
No possibility of consulting
2
Not enough explanations
9
Insufficient training
5
Insufficient instructions
1
Non-quality tools
2
0
5
10
15
20
Number of responders
23
25
30
35
Emergencies and work accidents




24
Instructions for the case of emergencies or work accidents
existed in every department.
Occurrence of emergencies or work accidents at the
department mentioned 11 head nurses. No work accidents or
emergencies were observed at 26 departments.
About the occurrence of work accidents 16 head nurses
report to the head of the department; 6 to the working
environment representative and to the doctor on duty; 4 to the
working environment specialist and administration; 3 head
nurses report to their direct superior.
The working accident will be immediately reported by 14
head nurses and within 24 hours by 13 head nurses. (Figure 8)
Figure 8. Time of reporting the working
accident
Total number of responders
37
At first opportunity
1
Fast
1
In an hour
3
Within 0.5 hours
3
Within 24 hours
13
Within 6 hours
2
Immediately
14
0
25
10
20
30
Number of responders
40
Factors that contribute to the safety of the
working environment

26
The personnel of the department can
contribute to the safety of the working
environment by following the safety rules
according to all head nurses. (Figure 9)
Figure 9. Factors that contribute to the
safety of the working environment
Total number of responders
37
Compliance with safety regulations
37
Training
30
34
Prevention of risk situations
Correct use of protective equipment
36
0
10
20
30
Number of responders
27
40
IV QUALITY


28
Environment and safety are connected
with quality in opinion of 37 and are not
connected according to 1 head nurse.
There is no problem with environment,
safety and quality training of new
employees in opinion of 22 head nurses.
(Figure 10)
Figure 10. Environment, safety and
quality training of new employees
Total number of responders
36
Training is excellent 0
Training is adequate
22
Training is insufficient
12
No training
2
0
10
20
30
Number of responders
29
40
Environment, safety and quality training of
existing employees


30
There is no problem with environment, safety and
quality training of existing employees according
to 21 head nurses. (Figure 11)
In the words of head nurses the environment,
safety and quality training of the personnel is
mainly carried out by work environment specialist
on (24), then by the head of the department (13) and
by the head nurse (13).
Figure 11. Environment, safety and quality
training of existing employees
Total number of responders
37
Training is excellent 0
Training is adequate
21
Training is insufficient
14
No training
2
0
5
10
15
20
25
Number of responders
31
30
35
40
Infections controll committee



32
In opinion of head nurses the main objective of
the infection controll committee is avoidance of
hospital infections within the hospital.
The infections control committee at the WTCH
fulfils its objective according to 27 head nurses.
The objectives of the infection prevention named
by the head nurses are fulfilled in opinion of 21
head nurses.
Additional information and training was
required in following areas:





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33
Prevention of the infections (2).
Environment protection (2).
One-day seminar for all employees “Work environment and
safety” (2).
Legal basis of work quality at the health care institution (2).
Teaching nurses and cleaners about the prevention of
infections and waste management at the hospital (1).
Additional information about the prevention of the infections (1).
One senior nurse stated: Everything is clear.
18 senior nurses did not answer the question.
Study conclusions:
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34
The study results indicate that nursing staff at WTCH
is aware about the environmental, occupational
safety and quality legislation, principles and
problems.
Most departments have persons responsible for
following the established rules, but every employee
is also personally responsible.
Also proved was the assumption of the necessity to
create a certain strategy for development and
implementation of common waste management
training plan and updating and revision of already
existent knowledges.
S
U
P
O
R
T
I
N
G
GOOD PACKING
AND WASTE
MANAGEMENT
H
U
M
A
N
R
E
S
O
U
R
C
E
Guidelines &
legislation
35
ECONOMY AND
ENVIROMENTAL
FRIENDLY HABIT
GOOD INSTRUMENTS &
PROTECTION DEVICES
SAFETY WORK
ENVIROMENT&
vaccination
ETC.
EMPLOYEES WITH KNOWLEDGES,
ATTITUDES, HABITS, CULTURE
W. ENVIRONMENTAL
SPECIALIST
WASTE MANAGER
MANAGEMENT BOARD
ENVIRONMENT &
SAFETY &
QUALITY
Instruction of occupational safety for all
empolyees; Internal work procedure rules;
safety instructions, IC guidelines; X
guidelines etc.
LEGISLATION
ICC
TRAINING SHOULD INCLUDED




Basic information about HCW and the risks of bad
manageent of HCW
Basic information on the facility’s waste management
plan
Each employee’s responsibility and role in HCW
management
Technical instructions and guidelines
/WHO, 1988  The Theacher’s
Guide: Management of Wastes of Healthcare Activities
36
WHAT NEXT?

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

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37


Support by the management of the hospitals is necessary  to
make clear why we need this  present the result of this project
and make a review…
To have qualified person  Waste Manager or Ecology
Coordinator in hospital (why not in near future Department of
Enviromental Health and Safety?)
To make internal waste management plan
Addittional training is needed among all the group (nurses,
doctors, helpers etc.)
Systematic and continous review needed (every year audit each
department?)
More information needed in every stage and to siirtää
responsibility to each one  to talk importness of environment
issues and
To improve collecting - waste segeration and minimization
Also waste management process describing needed