Abstract
It is widely accepted that the inappropriate management of antimicrobial waste in the clinical setting can result in environmental antimicrobial contamination. The consequences of environmental antimicrobial contamination include a decline in microorganisms vital for ecosystem services, adverse effects on wildlife, and the development of antimicrobial resistance (AMR). Due to these concerns, antimicrobial stewardship (AMS) has become increasingly important, both on a national and international scale. AMS refers to an organisational or healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness. Registered Nurses (RNs) are well positioned in the health system to advance the aims of antimicrobial stewardship, having fundamental roles in various aspects of antimicrobial therapy. Understanding current actions, attitudes and knowledge regarding antimicrobial waste disposal will contribute to developing meaningful strategies toward minimising harm caused by antimicrobial waste.
Aim: The aim of this study is to understand the actions, attitudes and knowledge of RNs at Christchurch Hospital regarding the disposal of antimicrobial waste. The findings from this study will be presented to the AMS committee and may influence document review and local policy development.
Methodology and methods: This study utilised a quantitative descriptive research methodology. Quantitative descriptive research aims to observe, describe and document a situation as it naturally occurs, without attempting to reveal a deeper meaning. The inclusion criteria for this study were RNs working on select wards at Christchurch public Hospital. Data were collected via an anonymous internet-based survey, comprising of five scenario-based questions centred around the actions, attitudes and knowledge of RNs, with free text entry boxes. A quantitative content analysis approach was selected to analyse data.
Results: The findings indicate that the actions of RNs in regard to the disposal of antimicrobial waste vary greatly, with no waste disposal method being significantly more common than the others. The attitude-based questions revealed that 29 percent of participants had no concerns in regard to the disposal of antimicrobial waste. The remaining concerns were varied, with environmental contamination, and overuse and AMR development being the most common. There were conflicting responses about the most appropriate method of antimicrobial waste disposal. Fifty percent considered the yellow biohazard bag to be most appropriate, while 12.5 percent reported that antimicrobial waste should be disposed of down the sink, and another 12.5 percent specified that antimicrobials should not go down the sink. This study revealed a lack of RN knowledge regarding District Health Board (DHB) recommendations for the disposal of antimicrobial waste, with 57 percent of participants being unaware of any DHB recommendations
Conclusion: This study demonstrated that the RN management of antimicrobial waste from Christchurch public Hospital directly contributes to environmental antimicrobial contamination. Additionally, the findings indicated that close to one-third of participants had no concerns regarding the disposal of antimicrobial waste. This study also revealed a lack of RN knowledge about DHB antimicrobial waste disposal recommendations. This was expected, as there are a lack of recommendations and the few recommendations available are obscure and relatively inaccessible. The overarching conclusion from this research is that there is a concerning absence of antimicrobial waste disposal guidelines, that may result in the hazardous management of antimicrobial waste by RNs. This highlights the necessity for clear, easily accessible guidelines related to the disposal of antimicrobial waste.