Introduction
 Hospital waste
 Focus lies mainly on biological hazards caused by
pathogenic waste
 Has considerable repercussions


human health
Environment


In the Philippines

DOH and DENR

Have set guidelines regarding

Handling

Collection

Storage of pathogenic waste
But the degree to which hospitals follow these set of rules is not
known
 The University of Sato Tomas Hospital is a premier
health care center
 should be committed in the service of public health
 whether it be through patient care or ensuring a clean
healthy environment for their employees and the
community
Definition of Hospital Waste
 Health care waste (WHO)
› all waste generated by healthcare establishments,
research facilities, and health laboratories
› classified as
1.
2.
non-risk/general healthcare waste/domestic waste
hazardous waste
Prüss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes
From Health Care Activities. World Health Organization, Geneva
Research Question
 Does the University of Santo Tomas Hospital comply
with the guidelines on handling, collection and storage
of Pathogenic waste as written in the Health Care
Waste Management Manual of the Department of
Health and the Procedural Manual Title III of Dao 9229 “Hazardous Waste Management” of the Department
of Environment and Natural Resources?
General Objective
To assess the compliance of University of Santo Tomas
Hospital regarding the handling, collection and
storage of Pathogenic waste in accordance to Health
Care Waste Management Manual of Department of
Health and the Procedural Manual Title III of Dao 9229 “Hazardous Waste Management” of Department of
Environment and Natural Resources
Specific Objectives




To describe the handling of Pathogenic Waste
To describe the collection of Pathogenic Waste
To describe the Storage of Pathogenic Waste
To determine the compliance of UST hospital regarding the
handling, collection and storage of Pathogenic waste in
accordance to Health Care Waste Management Manual of
Department of Health
 To determine the compliance of UST hospital regarding the
handling, collection and storage of Pathogenic waste in
accordance to the Procedural Manual Title III of Dao 92-29
“Hazardous Waste Management” of Department of
Environment and Natural Resources
Definition of Terms
 Pathogenic waste:
 A subset of health care waste which includes both
Pathological and Infectious waste as defined by the
Hazardous Waste manual of the DENR
 Infectious waste
 contains pathogens in sufficient quantity to cause
disease in susceptible hosts
 Pathological waste
 consists of tissues, organs, body parts, human fetus,
animal carcasses, blood and other body fluids
Definition of Terms
 Handling Collection and Storage:
 Component of waste management in which health care
waste is gathered and segregated resulting in the
passage of a waste material from the source of
production to the point of storage until transported to
an off-site treatment facility
Definition of Terms
 Health Care Waste Management Manual:
 Written by the DOH designed to ensure no adverse
health and environmental consequences involved in
the generation, handling, storage and disposal of health
care waste
Definition of Terms
 Procedural Manual Title III of Dao 92-29 Hazardous
Waste Management:
 Written by DENR designed to serve as a primary
reference for those involved in the generation,
handling, storage and disposal of health care waste
 To provide technical standards and requirements for
hazardous waste generators, transporters, and
premises/facilities involved in the treatment, storage,
recycle, reprocess, and disposal of hazardous wastes in
the country
Significance
 Pathogenic Healthcare waste
 Identified as a major problem that negatively impacts
both human health and the environment
 Little information available regarding

the handling, collection storage and transport of pathogenic
waste in USTH
 There are guidelines in place

appraisal of the current situation regarding pathogenic waste
management in the USTH is essential
Review of Related Literature
 Two studies conducted by the Department of
Health indicated the need to introduce
modifications to the existing health care waste
management practices
 Waste Management Practices of DOH-Retained
Hospitals in 1995
 Waste Management Practices of Private and
Government Hospitals in Metro-Manila in 1997
 Most common problems encountered:
 Inadequate waste management practices
 Lack of awareness about the health hazards
 Insufficient financial and human resources
 Poor control of waste disposal
 Environmental and Occupational Health Office
(EOHO) initiated the revision of the existing Hospital
Waste Management Manual (EHS-DOH, 1997)
 The revision was meant to:
 assist facility administrators in evaluating their
operations in order to improve the health care waste
management practices
 promote the use of appropriate technologies and to
communicate with heath care personnel as well as to the
public the risks associated with health care waste
 Hospitals and other health care establishments
have the responsibility of ensuring that there are no
adverse health and environmental consequences on
their handling, storage, treatment and disposal of
health care waste
 Through this manual, health care establishments
will be able to install a more appropriate waste
management system
Definition of Hospital Waste
 Healthcare waste (WHO)
› all waste generated by healthcare establishments,
research facilities, and health laboratories
› classified as
1.
2.
non-risk/general healthcare waste/domestic waste
hazardous waste
Prüss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes
From Health Care Activities. World Health Organization, Geneva
Definition of Hospital Waste
 Classification of Hazardous Waste (DENR) based
on these four characteristics accordance with the
Toxicity Characteristic Learning Procedure
(TCLP):
 Ignitable
 Corrosive
 Reactive
 Toxic
Department of Environment and Natural Resources. 2004. Hazardous
Waste Management. Procedural Manual Title III of DAO 92-29
Effects on Health
 All individuals exposed to hazardous health-care waste
are potentially at risk
Prüss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From
Health Care Activities. World Health Organization, Geneva
 Certain infections, caused by more resilient agents,
pose a significant risk to the general public and to
hospital patients
Mühlich, M. et. al. 2003. Comparison of infectious waste management in
European hospitals. Institute for Environmental Medicine and Hospital
Epidemiology, Freiburg University Hospital, Freiburg, Germany
People at risk
 health-care workers, particularly nurses, are at greatest risk
of infection
 other hospital workers and waste-management operators
outside health-care establishments
 individuals who scavenge on waste disposal sites
 lower risk for patients and the public
Mühlich, M. et. al. 2003. Comparison of infectious waste management in
European hospitals. Institute for Environmental Medicine and Hospital
Epidemiology, Freiburg University Hospital, Freiburg, Germany
Regulation of Hospital Waste
in the Philippines
 Metropolitan Manila Authority (MMA) Ordinance No.
16
 Hospital Licensure Law (Republic Act No. 4226)
 Toxic Substances and Hazardous and Nuclear Waste
Control Act of 1990 (Republic Act No. 6969
Soncuya, Matias, Lapid. 1997. Hospital Waste Management in the
Philippines, two Case Studies in Manila. WASTE.
Urban Waste Expertise Programme
Metropolitan Manila Authority (MMA)
Ordinance No. 16
 use four types of trash bags for easy identification of
waste:
1)
2)
3)
4)
black trash bag for non-infectious dry waste
green trash bags for non-infectious wet waste
yellow trash bags for dry and wet chemical and other
potentially infectious waste, pathological waste, chemical
waste and sharps contained in puncture-proof containers
covered with solution of lime
orange trash bags with trefoil sign for radioactive waste
that will be stored in the hospital until rendered as inactive
and/or disposed in accordance with the prescribed rules
and regulations of the Philippine Nuclear Research
Institute
Hospital Licensure Law
 hospitals are categorized as government or private
hospitals
 specifies the needed physical facilities of a hospital
for solid waste management such as the physical
plant, hospital equipment and maintenance of
these physical facilities
Toxic and Hazardous and Nuclear Wastes
Control Act of 1990
 covers the importation, manufacture, processing,
handling, storage, transportation, sale,
distribution, use and disposal of all unregulated
chemical substances and mixtures in the
Philippines
 defines the prohibited acts and provides for
administrative and criminal penalties
Waste Management in the Philippines
 wastes, segregated or not, are collected by workers employed by the
health care establishment(usually cleaners or janitors of the premises)
 aware of local opportunities for recycling of components of the waste
 unaware of, or insensitive to, the hazards associated with handling health
care waste
 generally take no precautions in handling, transporting and separating the
waste
 not supplied with protective clothing or special equipment
Pescod, S. 1998. Hospital Waste Management in Four Major Cities.
WASTE. Urban Waste Expertise Programme
Waste Management in the Philippines
 plastic bags, covered bins/trash cans, and glass jars with
covers
 due to inadequate segregation of infectious from non-
infectious much of the generated hospital waste is being
disposed directly to municipal landfills
Department of Environment and Natural Resources. 1993. Pasig River
Rehabilitation Program: Feasibility Report on Hospital Hazardous
Waste Management in Metro Manila. Volume I
Waste Management in the Philippines
 collected by the municipal waste collection service
 transported for disposal with municipal waste
 all types of wastes are mixed and transported,
often along with municipal solid waste, to
municipal landfills
Pescod, S. 1998. Hospital Waste Management in Four Major Cities.
WASTE. Urban Waste Expertise Programme
Waste Management in the Philippines
 existing treatment capacity is insufficient for the
proper disposal of the major part of medical wastes
generated in Metro Manila area
 the existing capacity for incinerating these wastes
totals to less than 3 tons/day
 total daily quantity of dangerous medical wastes
generated was estimated to at least 12.4 tons
Department of Environment and Natural Resources. 1993. Pasig River
Rehabilitation Program: Feasibility Report on Hospital Hazardous
Waste Management in Metro Manila. Volume I
Problems in Medical Waste Management
 In developing countries, medical waste has not received
much attention and it is disposed of together with
domestic waste
 Lack of a system of medical waste management, a lack of
necessary supplies and facilities, a lack of knowledge
among health workers and a lack of coordination among
different ministries.
 A national program for medical waste management is
essential in Palestine
Massrouje, HTN., 2001. Medical waste and health workers in Gaza
governorates. Eastern Mediterranean Health Journal
Problems in Medical Waste Management
 In Lagos Metropolis, Nigeria, there is absence of full
compliance with the protocol stipulated in the guidelines
and standards of environmental pollution control
 There were problems in collection, segregation, storage,
treatment, and disposal among the hospitals that were
observed
Longe, E.O., Williams, A., 2006. A Preliminary Study of Medical Waste
Management in Lagos Metropolis, Nigeria. Iran Journal of Environ.
Health Sci. Eng., 3:2:133-139
Problems in Medical Waste Management
 In Dhaka, Bangladesh there is no proper,
systematic management of medical waste except in
a few private Health Care Establishments that
segregate their infectious wastes
 Some cleaners were found to salvage used sharps,
saline bags, blood bags and test tubes for resale or
reuse
Hassan, M., Ahmed, S., Rahman, K., Biswas, T. 2008. Pattern of medical
waste management: existing scenario in Dhaka City, Bangladesh.
BMC Public Health. 8:36
Review of Related Literature
 Evidence showed that there are many flaws in the
compliance, implementation and even in the
construction of guidelines concerning hospital
management in the Philippines and around the
world
 Several studies have recommended several steps
that may be undertaken to address these flaws
Review of Related Literature
 Recommendations:
 establishment of directorates responsible for medical
waste management
 coordination of different ministries
 provision of adequate supplies and health education
including encouragement of studies on different aspects
of medical waste (creation of database information in
different sectors, risk analysis and disposal methods)
Massrouje, HTN., 2001. Medical waste and health workers in Gaza
governorates. Eastern Mediterranean Health Journal
Review of Related Literature
 Case studies in the Philippines have only focused on
two distinct hospitals in Metro Manila
 Should include the University of Santo Tomas Hospital
Methodology
 Descriptive Study
 Inclusion Criteria:
 Super Clean Services
 Exclusion Criteria:
 Waste Transporter
 Waste Treaters
 TSD facility
Methodology
 Data Collection
 Semi Structured Interview of authorities and Personnel
of Super Clean Services
 Visual inspection and Field investigation of collection,
handling and storage of pathogenic waste
 Data Processing
 Flow Chart and narrative of collection, handling and
storage of pathogenic waste
Week Week Week Week Week Week Week Week
1
2
3
4
5
6
7
8
Selection and planning
of research topic
Coordinating with UST
Hospital’s
maintenance officer
Workplace inspection
Literature research
Research methodology
planning
Data gathering
Data evaluation
Construction of
research conclusion
and recommendation
Final research paper
formation