PERFORMANCE OF HOSPITAL WASTE AND HEALTH LITERACY OF HANDLING INFECTIOUS WASTE AMONG HEALTH WORKERS IN BENGKULU, SUMATRA INDONESIA By : AFRIYANTO

Research Question What are the situations managing of infectious waste in hospital of Bengkulu Province? Is there any association between health literacy, social determinants and practice of handling infectious waste among health workers in Bengkulu?

Research Objective To identify the situation of source, volume, quantity and managing of infectious waste in hospital in Bengkulu To determine the association between health literacy, social determinants and practice of infectious handling waste among health workers in Bengkulu.

PROBLEMS Waste from hospital waste may be harmful because it can be toxic, infectious and radioactive  very important as to develop sustainable Health Care Waste Management Unsafe Handling Practices and Management of Clinical Solid Waste in hospital very dangerous to the cause of nosocomial infection Hospital should be renew the documents Environment impact assessment for 3 years included about the management incinerators  Total hospital in Bengkulu: 22 hospitals, only 10 incinerators operate today. Based on the health service report it was found that there were cases of nurses impaled needle and not using personal protective equipment.

Rationale and background Citizens surrounding of hospital protest against “TIARASELLA” hospital which is a private hospital because its wells are polluted There are hospital waste in general waste like syringe and needle The increasing number of patients due to the existence of BPJS (universal insurance coverage) Situation unsafe condition in hospital for health workers resulting from poor waste management Significant problems:

Health Care Waste Regulations National rules/policies about medical waste which must be obeyed by the hospital in Indonesia are: Government Regulation number 101, 2014, on Hazardous Waste Management; Government Regulation number 74, 2001, on Management of Hazardous Substances; Health Minister Decree number 1204, 2004, on Hospital Environmental Health Requirement; Minister of Environment and Forestry Regulation number P.56 year 2015 on Technical Guideline and Requirement of Hazardous Health- care Waste Management. Prevention of nosocomial infection followed the regulations and standards from the following Health Minister Decree number 27, 2017, Guidelines for Prevention and Infection Control in The Health Service Facility.

GAB KNOWLEDGE Indonesia don’t have data amount of quality and quantity medical waste in Bengkulu New regulation about Prevention of nosocomial infection followed the regulations and standards from the following Health Minister Decree number 27, June 2017 Many studies have examined source person related nosocomial infections and not examined source of environmental conditions affecting infections such Environmental control in health care facilities, Waste Management and Clothing Management.

The spread of nosocomial infection (WHO, Safe management of wastes from health-care activities, 2014)

Research question What are the situations of the health care waste hospitals in Bengkulu Province? Do the implementation of integrated health care waste hospital in Bengkulu Province according to regulation ? Do socioeconomics situation, source of person and environment of hospital workers about health care waste have influence on prevention of infection control?

Research Objective To evaluate the integrated health care waste system in Hospital of Bengkulu Province and other elements related to health care waste management. To identify the source, volume and quantity of health care waste in Bengkulu Province. To identify source of persons, environment and compliance of hospital workers about health care waste and prevention of nosocomial infection.

RESEARCH METHODOLOGY descriptive method in order to get significant volume and quality of Health Care Waste by guideline of Indonesia Policy to know about influence of size hospital, type hospital, coverage of insurance so BOR and AVLOS. Quality and quantity of Health care waste from medical service unit

to know about influence of social economics factors, person source and hospital of hospital workers. The methods included checklist by government policy used to indicate whether or not a hospital management is appropriate or inappropriate. ( LOGISTIC REGRESSION) to know about influence of social economics factors, person source and hospital of hospital workers. The methods included checklist by government policy used to indicate whether or not a hospital management is appropriate or inappropriate. ( LOGISTIC REGRESSION) Socioeconomic factors  Sex  Age  Education level  Marital status  Average personal income/per month  Work experience  Job position  Duration time of work every month  Training about nosocomial infection Persons Source:  Hand decontamination  Personal protect equipment  Periodic check of health officers  Management placement of Patient  Personal hygiene Environment Source:  Environmental control in health care facilities  Waste Management  Clothing Management Knowledge data will be taken using checklist and observation based guideline infection control in hospital (Standard and not standard ) Used laboratory

CharacteristicsNumberPercent (%) SOCIO ECONOMIC FACTORS 1. Sex (years) Female xxxx.x Male xxxx.x 2. Age of hospital workers (years) Lower than 30 xxxx.x 30.0 – 33.9 xxxx.x 40.0 or more xxxx.x Mean (±SD) xx.x(±x.xx) Median (min : max) xx(xx:xx) 3. Education Under Graduate xxxx.x Bachelor Degree xxxx.x Higher than Bachelor Degree xxxx.x Mean (±SD) xx.x(±x.xx) Median (min : max) xx(xx:xx) 4. Marital Status Single xxxx.x Married xxxx.x Others xxxx.x 5. Income (per month) < IDR ,- xxxx.x > IDR ,- xxxx.x Mean (±SD) xx.x(±x.xx) Median (min : max) xx(xx:xx) 6. Works Experience (years) < 5 years xxxx.x > 5 years xxxx.x Mean (±SD) xx.x(±x.xx) Median (min : max) xx(xx:xx) 7. Job positions No xxxx.x Yes xxxx.x 8. Duration time work (per week) > 40 hours xxxx.x < 40 hours xxxx.x 9. Training about nosocomial infection No Yes MOCK RESULT table 1.

CharacteristicsNumbe r Percent (%) PERSONS FACTORS 1. Wash Hand No xxxx.x Yes xxxx.x 2. Personal Protective Equipment No complete xxxx.x Complete xxxx.x Mean (±SD) xx.x(±x.xx) Median (min : max) xx(xx:xx) 3. Periodic Ceck of Health No xxxx.x Yes xxxx.x Mean (±SD) xx.x(±x.xx) Median (min : max) xx(xx:xx) 4. Management placement of patient No xxxx.x Yes xxxx.x 5. Personal Hygiene No xxxx.x Yes xxxx.x CharacteristicsNum ber Perce nt (%) ENVIRONMENT FACTORS 1.Health care facilities (standard regulation) a. Air Quality No Standard xxxx.x Standard xxxx.x b. Water Quality No Standard xxxx.x Standard xxxx.x c. Cleaning of the hospital environment No Standard xxxx.x Standard xxxx.x d. Design Building No Standard xxxx.x Standard xxxx.x 2. Waste management No Standard xxxx.x Standard xxxx.x 3. Clothing Management No Standard xxxx.x Standard xxxx.x

CharacteristicsNumber % Prevent. Of Nosocomi al Infection Crude Odds Ratio 95%CIP-value PERSONS FACTORS 1. Wash Hand xx No xx Yes xx (xx.x– xx.x) 2. Personal Protective Equipment xx No complete xx Complete xx (xx.x– xx.x) Mean (±SD) Median (min : max) 3. Periodic Ceck of Health xx No xx Yes xx (xx.x– xx.x) Mean (±SD) Median (min : max) 4. Management placement of patient xx No xx Yes xx (xx.x– xx.x) 5. Personal Hygiene xx No xx Yes xx (xx.x– xx.x) Table 2. Characteristics Num ber % Prevent. Of Nosocomi al Infection Crude Odds Ratio 95%CIP-value ENVIRONMENT FACTORS 1.Health care facilities (standard regulation) a. Air Quality xx No Standard xx Standard xx (xx.x– xx.x) b. Water Quality xx No Standard xx Standard xx (xx.x– xx.x) c. Cleaning of the hospital environment xx No Standard xx Standard xx (xx.x– xx.x) d. Design Building xx No Standard xx Standard xx (xx.x– xx.x) 2. Waste management xx No Standard xx Standard xx (xx.x– xx.x) 3. Clothing Management xx No Standard xx Standard xx (xx.x– xx.x)

RESEARCH SCHEDULE Activities 2018 NovDesJanFebMarAprMayJunJul Aug Research proposal approval Preliminary consultation with Advisor Ethical approval Onsite visit, engage stakeholders Development of tools Collecting data for Phase I Processing, analyzing data for P II Writing thesis Communication with supervisors Proposal defense/ Publicize