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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 28-32

A meta-analysis of quality assessment reports using prevalidated tool to evaluate the quality of health-care services in three-core domains biomedical waste management, Hospital Infection Control Practices, and Patient Safety Practices in government health-care organizations of U.P.


Department of Hospital Administration, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission29-Nov-2021
Date of Acceptance13-Jan-2022
Date of Web Publication12-Feb-2022

Correspondence Address:
Ankita Srivastava
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jigims.jigims_49_21

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  Abstract 


Background: Improper biomedical waste management (BMWM) poses a serious threat not only to health-care providers and patients but also to the community and environment at large; hence, with an aim to promote cleanliness, hygiene, and infection control practices in government health-care facilities, GoI launched “Kayakalp-Swacchta Guidelines for public health facilities.” A meta-analysis of quality assessment reports of five government hospitals of U.P. was done with an aim to evaluate the quality of health-care services in three-core domains (BMWM, Hospital Infection Control Practices [HICPs], and Patient Safety Practices [PSPs]).
Materials and Methods: Meta-analysis of quality assessment reports pertaining to three domains (BMWM, HICP, and PSP) drawing preidentified parameters from therein was done using purposive sampling technique. Data acquisition was based on record review, patient interview (PI), staff interview, and observation and vendor interview. Parameters were scored for compliance with 2, 1, and 0 score for complete, partial, and noncompliance, respectively.
Results: The average compliance of five health-care organizations with respect to the conformance with quality parameters was 77.85%. Wherein, domain-specific scores were 81.42% for BMWM, 78.15% for HICP, and 64% for PSP. The individual highest score in the domains observed was 91.2%, 93.6%, and 100%, respectively. The individual lowest score observed was 58.7%, 49.09%, and 14%, respectively.
Conclusion: It can be safely concluded from the overall average compliance score that quality of health-care services pertaining to the three preidentified domains in the health-care organizations is satisfactory; however, the wide gap in the individual highest and lowest score suggests an eminent need for pragmatic strategy toward improvement.

Keywords: Biomedical waste management, Kayakalp, meta-analysis


How to cite this article:
Harsvardhan R, Srivastava A, Mehrotra A, Singh S, Gupta G, Kumari S, Alvi S. A meta-analysis of quality assessment reports using prevalidated tool to evaluate the quality of health-care services in three-core domains biomedical waste management, Hospital Infection Control Practices, and Patient Safety Practices in government health-care organizations of U.P. J Indira Gandhi Inst Med Sci 2022;8:28-32

How to cite this URL:
Harsvardhan R, Srivastava A, Mehrotra A, Singh S, Gupta G, Kumari S, Alvi S. A meta-analysis of quality assessment reports using prevalidated tool to evaluate the quality of health-care services in three-core domains biomedical waste management, Hospital Infection Control Practices, and Patient Safety Practices in government health-care organizations of U.P. J Indira Gandhi Inst Med Sci [serial online] 2022 [cited 2022 Aug 10];8:28-32. Available from: http://www.jigims.co.in/text.asp?2022/8/1/28/338367




  Introduction Top


Improper biomedical waste management (BMWM) poses a serious threat not only to health-care providers and patients but also to the community and environment at large. To promote cleanliness, hygiene, and infection control practices in government health-care facilities, GoI launched “Kayakalp-Swacchta Guidelines for public health facilities.” Government sector covers the major part of health-care delivery in India, especially at primary and secondary levels of health care: BMWM, infection control, and patient safety are important domains of health care. Hence, there was an urgent need to study how hospitals are performing with respect to these domains. Therefore, “A meta-analysis of quality assessment reports using prevalidated tool to evaluate the quality of health-care services in three-core domains: Bio-Medical Waste Management (BMWM), Hospital Infection Control Practices (HICP), and Patient Safety Practices (PSP) in government health-care organizations of U.P.” with the objectives: (1) to identify parameters pertaining to three domains BMWM, infection control, and patient safety from the overall band parameters of quality assessment reports (Kayakalp-checklist) and (2) to do a meta-analysis of the compliance of five health-care organizations with respect to the conformance with quality parameters in the preidentified domains, was undertaken.


  Materials and Methods Top


  • Meta-analysis of quality assessment reports pertaining to three domains (BMWM, HICP, and PSP) drawing preidentified parameters from therein
  • Study sample: Five health-care organizations of government of U.P.
  • Study parameters: Thirty-seven parameters were used in the study; these were drawn from the existing 250 parameters of Kayakalp Checklist of district hospitals and CHCs
  • Sampling technique: Purposive sampling
  • Data acquisition was based on record review (RR), PI, staff interview, and observation and vendor interview
  • Scoring criteria: for compliance, scores awarded were with 2, 1, and 0 score for complete, partial, and noncompliance, respectively.


[Table 1], [Table 2], [Table 3] how the study parameters from preidentified three domains of BMWM, HICP, and PSP deduced from the parent Kayakalp Checklist.
Table 1: Study parameters: Biomedical waste management

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Table 2: Study parameters: Hospital Infection Control Practices

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Table 3: Study parameters: Patient Safety Practices

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A, B, C, D, E, F and G were the Themes of the Kayakalp 2019 Checklist for District Hospital in Uttar Pradesh.

The nos. like C1 correspond to the specific parameter in the thematic area.

Explanation for C1: C denotes 'Theme' – 'Waste Management' and C1 Denotes the parameter 'Implementation of Biomedical Waste Rules'


  Results Top


The overall average compliance of five health-care organizations with respect to the conformance with quality parameters was 77.85%. Domain-specific average score was:

  • BMWM: 81.42%
  • Hospital Infection Control Practices: 78.15%
  • Patient Safety Practices: 76%.


Here, it is pertinent to mention that in-built Benchmark score in Kayakalp assessment is 70%.

The highest score of individual hospitals in the domains observed:

  • BMWM: 91.2%
  • HIC Practices: 93.6%
  • Patient Safety Practices: 100%.


The lowest score of individual hospitals in the domains observed:

  • BMWM: 58.7%
  • HIC Practices: 49.09%
  • Patient Safety Practices: 14%.


The percentage range observed here is 14%–100%.

[Figure 1] shows the domain-specific score of each one of the five government hospitals in BMWM being compared with the overall domain-specific average score of 77.85% and the Kayakalp Benchmark score of 70%.
Figure 1: Biomedical waste management (BMWM)

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[Figure 2] shows the domain-specific score of each one of the five government hospitals in Hospital Infection Control Practices being compared with the overall domain-specific average score of 77.85% and the Kayakalp Benchmark score of 70%.
Figure 2: Hospital infection control practices (HICP)

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[Figure 3] shows the domain-specific score of each one of the five government hospitals in Patient Safety Practices being compared with the overall domain-specific average score of 77.85% and the Kayakalp Benchmark score of 70%.
Figure 3: Patient safety practices (PSP)

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[Figure 4] tabulates the highest score of the specific domain, the average score of three domains, and the lowest score of each domain of the five government hospitals.
Figure 4: Domain specific highest and lowest scores at hospital level

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  Discussion Top


The high score of hospitals was mainly attributed to good performance of all hospitals in the following parameters:

Parameters with highest compliance rate in the domain of biomedical waste management

  • Storage of biomedical waste: All health-care facilities had a dedicated storage space for biomedical waste with appropriate biomedical waste signage, storage facility in all hospitals was located away from the patient area and had connectivity of a motorable road. The storage facility was secured against pilferage and reach of animal and rodents. The waste was disposed/handed over to Common Treatment Facility within 48 h of generation, availability of soap, and running water in vicinity of storage facility
  • Management of hazardous waste: Majority of the health-care providers were aware of the management of mercury spill; the mercury spill kit was also available, the staff knew about the adequate disposal method of disposal of radiographic developer and fixer, disposal of disinfectant solution like glutaraldehyde, and disposal of laboratory reagents
  • Equipment and supplies of biomedical waste management: Needle/Hub cutter/Puncture-proof boxes, bins, and liners were available in all health-care facilities for segregated collection of waste at the point of use. Adequate supply of personal protective equipment was noted, trolleys for waste collection and transportation were also available.


A study done in Khordha district of Odisha, India, Mayadhar Panda, and Sikata Nanda with an aim to “assess the clean hospital initiative and quality of health services using Kayakalp tool in a first referral unit, of Khordha district of Odisha, India, Mayadhar Panda, Sikata Nanda”[1] during 2016–2018 also attributes demonstrates good performance of the government hospitals in similar parameters.

Another study “Kayakalp: Impact of Swachh Bharat Abhiyan on cleanliness, infection control, and hygiene promotion practices in district hospitals of Chhattisgarh, India, Dr Apurva Tiwari1, Ankita Tiwari21 (National Health Mission Raipur Chhatisgarh, Kasturba Medical College/Manipal University, India) 2 (National Health MissionKawardha Chhattisgarh, School of Management/Manipal University, India)”[2] also showed a great improvement in the overall BMWM due to the effect of kayakalp program.

Parameters with highest compliance rate in the domain Hospital Infection Control Practices

  • Personal protective practices: Staff was found aware of the standard precautions and use of PPE, staff at most of the hospitals was aware of the correct method of donning and doughing of gloves
  • Decontamination and cleaning of instruments: Staff knew how to make chlorine water and the adequate contact time for disinfection.
  • Infection control program: Infection control committee was constituted and functional in all hospitals, immunization record of health-care providers was maintained
  • Isolation and barrier nursing: The hospitals had provision of isolation ward, visitors' restriction was maintained in isolation areas, and external footwear was well restricted in critical care areas.


“A study on needs assessment of infection control practices at a district hospital in southern India, using Kayakalp Tool Parvathy T Somaiah1 and Shivaraj B Mallappa2”[3] showed similar results for personal protective practices (70%) and isolation and barrier nursing (90%).

Parameters with highest compliance rate in the domain patient safety practices

  • Maintenance of trolleys, wheelchairs, etc.: The trolleys, wheelchair, etc., were in good condition
  • Bed-to-bed distance: was found to be satisfactory in health-care facilities.


A study done in Khordha district of Odisha, India, Mayadhar Panda, and Sikata Nanda with an aim to “assess the clean hospital initiative and quality of health services using Kayakalp tool in a first referral unit, of Khordha district of Odisha, India, Mayadhar Panda, and Sikata Nanda”[1] during 2016–2018 shows a high score of 80% in maintenance of trolleys, wheelchair, etc., and of 100% in adequate bed-to-bed distance both of which are in support of this study.

The low score of hospitals was mainly attributed to low performance of hospitals in the following parameters:

Parameters with lowest compliance rate in the domain of biomedical waste management

  • Solid general waste management: low scores were due to poor compliance in innovations in the recycling of general waste, mixing of general and biomedical waste, and poor segregation of recyclable and biodegradable waste.


A study on BMWM using Kayakalp tool at district hospital in southern India Parvathy T Somaiah1, Shivaraj B M2[4] done in July 2016 also demonstrates a low score of 30% in solid general waste management.

Parameters with lowest compliance rate in the domain of hospital infection control practices

  • Surveillance of hospital-acquired infections: All hospitals were defaulter in compliance to surveillance of various HCAI rates
  • Environment control: Common deficit was observed in maintenance of positive pressure in OT, required air changes per hour, and carbolization of OT and labor Room for want of A.H.U.


Parameters with lowest compliance rate in the domain of Patient Safety Practices

  • Surgical site infection rate: Surgical site infection was being measured by only one hospital out of five.


A study on BMWM using Kayakalp tool at district hospital in southern India Parvathy T Somaiah1, Shivaraj B M2 done in July 2016[2] demonstrates 0% score of the hospital in surveillance of hospital-acquired infections and measure of surgical site infections and a score of 60% in environment control.


  Conclusion Top


  • It can be safely concluded from the overall average compliance score that quality of health-care services pertaining to the three preidentified domains in the health-care organizations is satisfactory; however, the wide gap in the individual highest and lowest score suggests an eminent need for pragmatic strategy toward improvement.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Panda M, Nanda S. A study to assess the clean hospital initiative and quality of health services using kayakalp tool in a first referral unit, of Khordha district of Odisha, India. Int J Community Med Public Health 2018;5:5397-403.  Back to cited text no. 1
    
2.
Tiwari A, Tiwari A. Kayakalp: Impact of Swachh Bharat Abhiyan on cleanliness, infection control & hygiene promotion practices in District Hospitals of Chhattisgarh, India. IOSR J Environ Sci Toxicol Food Technol (IOSR-JESTFT) 2016;10:55-8.  Back to cited text no. 2
    
3.
Somaiah PT, Shivaraj BM. A study on bio-medical waste management using kayakalp tool at District Hospital in Southern India. Int J Community Med 2016;7:614-7.  Back to cited text no. 3
    
4.
Mallappa SB, Somaiah PT. Assessment of swacchta guidelines implementation at government district teaching hospital, Madikeri, Kodagu District, Karnataka State using KAYAKALP assessment tool. Community Med 2016;7:887-9.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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