1. 1 TO EVALUATE EXISTING PROBLEMS AND TRAINING NEEDS IN WEST- TALLINN CENTRAL HOSPITAL Questionnaire for head nurses Qestrain task no 1 K.Linsmann June 2003

2. 2 INTRODUCTION AimsAims: 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 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.

3. 3 STUDY RESULTS I LEGISLATION 1 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.

4. 4 LEGISLATION 2 Legal basis that regulate the work safety at the health care institution – 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.

5. 5 LEGISLATION 3 Legal basis that regulate the quality of the work at the health care institution – 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.

6. 6 Head nurses need addition information in following areas 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)

7. 7 II ENVIRONMENTAL PROTECTION 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).

8. 8 Figure 1. Most hazardous waste for the environment according to head nurses

9. 9 Hospital waste generated at the departments 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)

10. 10 Figure 2. Generation of hospital waste in departments

11. 11 PERSON RESPONSIBLE 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.

12. 12 Assignments to perform by the person responsible for waste management 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)

13. 13 Figure 3. Assignments to perform by the person responsible for waste management

14. 14 The waste management at the WTCH Ltd 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.

15. 15 Reporting of shortcomings in organization of waste management 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)

16. 16 Figure 4. Reporting of shortcomings in organization of waste management

17. 17 Reporting about deficiencies of the waste managenent 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

18. 18 III WORK ENVIRONMENT AND SAFETY According to all head nurses the work environment is safer primarily due to the quality tools and protective equipment. (Figure 5)

19. 19 Figure 5. Providing the safe working environment within the department

20. 20 Assessment of their department working environment by head nurses 29 head nurses consider the working environment at their department safe (Figure 6).

21. 21 Figure 6. Assessment of their department working environment by head nurses

22. 22 Main hazard at working environment 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

23. 23 Figure 7. Hazard factors of the working environment (department)

24. 24 Emergencies and work accidents 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)

25. 25 Figure 8. Time of reporting the working accident

26. 26 Factors that contribute to the safety of the working environment 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)

27. 27 Figure 9. Factors that contribute to the safety of the working environment

28. 28 IV QUALITY 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)

29. 29 Figure 10. Environment, safety and quality training of new employees

30. 30 Environment, safety and quality training of existing employees 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).

31. 31 Figure 11. Environment, safety and quality training of existing employees

32. 32 Infections controll committee 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.

33. 33 Additional information and training was required in following areas: 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.

34. 34 Study conclusions: 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.

35. 35 EMPLOYEES WITH KNOWLEDGES, ATTITUDES, HABITS, CULTURE ENVIRONMENT & SAFETY & QUALITY LEGISLATION Instruction of occupational safety for all empolyees; Internal work procedure rules; safety instructions, IC guidelines; X guidelines etc. W. ENVIRONMENTAL SPECIALIST WASTE MANAGER ICC MANAGEMENT BOARD Guide- lines & legisla- tion GOOD PACKING AND WASTE MANAGEMENT ECONOMY AND ENVIROMENTAL FRIENDLY HABIT GOOD INSTRUMENTS & PROTECTION DEVICES SAFETY WORK ENVIROMENT& vaccination ETC. HUMANRESOURCEHUMANRESOURCEHUMANRESOURCEHUMANRESOURCE SUPORTINGSUPORTING

36. 36 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

37. 37 WHAT NEXT? 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