PRINCIPLES IN MLS PRACTICE 1
Title of the lesson: Health Care Waste Management
Date| Lecturer/Professor: December 2019 | Ma’am Maria Katrina B. Pilit, RMT
Transcriber: Julia Pauline P. Husmillo
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OUTLINE
Defining Health Care Wastes
Categories of Health Care Wastes
Legislation, Policies, and Guidelines Governing Health
Care Wastes
Health Care Waste Management System
DEFINING HEALTH CARE WASTES
Health care wastes refer to all solid or liquid wastes
generated by any of the following activities:
 Diagnosis, treatment, and immunization of
humans
 Research pertaining to diagnosis, treatment, and
immunization of humans
 Research using laboratory animals geared
towards improvement of human health
 Production and testing of biological products
 Other activities performed by a health care facility
that generates waste
● All heath care facilities are tasked to ensure that there are
no adverse health effects and environment consequences
from: generation, segregation, collection, storage, transport,
and treatment, disposal of health care wastes
● Health care waste generators - health care facilities and
other spaces where health care services are offered with
activities that generate wastes:
 Hospitals and medical centers
 Infirmaries
 Birthing homes
 Clinics and other health-related facilities
 Laboratories and research centers
 Drug manufacturers
 Institutions
 Mortuary and autopsy centers
2.
Infectious & Pathological Wastes
 Infectious – contains pathogens,
 Pathological – tissues, organs, body parts, human fetus, and
animal carcasses, blood and body fluids
3.
Sharps
items that can cause a cut or puncture wounds (needles,
syringes, scalpels, saws, blades)
considered the most dangerous waste because of its
potential to cause both injury and infection
4.
Pharmaceutical Wastes
expired, unused, split, and contaminated pharmaceutical
products, drugs, vaccines, and sera
includes antineoplastic, cytotoxic, and genotoxic wastes
such as drugs used in oncology or radiotherapy, and
biological fluids from patients treated with the said drugs
5.
Genotoxic Wastes
cytostatic drugs, vomit, urine, feces from patients treated
with cytostatic drugs
highly hazardous and may have mutagenic (mutation),
teratogenic (birth defects), or carcinogenic (cancers)
properties (violet waste bin)
6.
Chemical Wastes
discarded chemicals (solid, liquid, or gaseous) generated
during disinfection and sterilization procedures
chemicals are considered hazardous when they are:
 toxic (with health and environment hazards)
 corrosive (acid of pH < 2.0 and bases of pH > 12.0)
 flammable (with a flash point below 60˚C)
 reactive (explosive with water)
7.
Radioactive Wastes
wastes exposed to radionuclides including radioactive
diagnostic materials or radiotherapeutic materials
disused sealed radiation sources, liquid, and gaseous
materials contaminated with radioactivity
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HEALTH CARE WASTE STATISTICS
Estimated 16 billion injections are administered worldwide,
but not all of the needles and syringes are properly disposed
of afterwards
According to a joint assessment of the World Health
Organization (WHO) and United Nations Children’s Fund
(UNICEF) – over half (58%) of the 24 countries had
adequate systems for healthcare waste disposal
According to WHO – 75-90% wastes are non-hazardous; 1025% of wastes are hazardous and may be infectious, toxic,
or radioactive
High-income countries – 0.5kg of hazardous waste/hospital
bed/day
Low-income countries – 0.2kg of hazardous waste/hospital
bed/day
CATEGORIES OF HEALTH CARE WASTES
Non-hazardous/General Waste
wastes that have not been in contact with communicable or
infectious agents, hazardous, chemicals, or radioactive
materials
comes mostly from the administrative and housekeeping
functions of health care establishments
IMPACT OF HEALTH CARE WASTES
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Individuals exposed to health care wastes are more likely at
risk of getting injured or infected
Exposure of the general population can be mainly through
chronic exposure (for prolonged periods in minute
quantities) or acute exposure (for short periods in large
quantities)
Hazards may include drug resistant microorganisms,
chronic and acute exposure to pathogens
Other causes; sharp inflicted injuries, toxic exposure,
chemical burns, air pollution, thermal injuries, radiation
burns
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LEGISLATION, POLICIES, AND GUIDELINES GOVERNING
HEALTH CARE WASTES
INTERNATIONAL AGREEMENTS PERTAINING TO HEALTH
CARE WASTE MANAGEMENT
1.
2.
3.
4.
The Montreal Protocol on Substances that Deplete the Ozone
Layer (1987)
Montreal, Canada on September 16, 1987
January 1, 1989 – came into force
designated to stop the production and import of ozone
depleting substances and reduce their concentration in
the atmosphere to help protect the earth’s ozone layer
The United Nations Framework Convention on Climate
Change (1992)
by the year 2000, major industrialized nations would
voluntarily reduce their greenhouse gas emissions to
1990 levels
OBJECTIVE: to stabilize greenhouse gas concentrations in
the atmosphere at a level that would prevent dangerous
anthropogenic interference with the climate system
The Stockholm Convention on Persistent Organic
Pollutants (2001)
international treaty to protect human health and the
environment from the harmful effects of persistent
organic pollutants (POPs)
persistent organic pollutants are chemicals that:
 remain unchanged in the envirnment for long
periods of time
 accumulate in the fatty tissues of living
organisms
 are toxic to both humans and wildlife
Republic Act No. 3931 – “Pollution Control Law”
1.a. DENR Administrative Order No. 34, Series of 1990
– “Revised Water Usage and Classification/Water
Quality Criteria”
appointment of Pollution Control Officers
(PCO)
2.
Presidential Decree No. 1586 – “Environmental Impact
Statement (EIS) System” (1978)
secure an Environmental Compliance Commitment
Certificate (ECC) prior to the construction and
operation of the facility
3.
DOH Administrative Order No. 2008-0021 dated July 30,
2008 – “Gradual Phaseout of Mercury in all Philippine
Healthcare Facilities and Institutions”
requires all health care facilities (HCF) to gradually
phaseout the use of mercury-containing devices and
equipment
The Basel Convention on the Control of the transBoundary
Movements of Hazardous Wastes and Their Disposal (1989)
Basel, Switzerland
an international treaty that was designed to regulate
transboundary movements (TBM) of hazardous wastes
and other wastes and is specifically created to prevent
transfer of hazardous waste from developed to less
developed countries
NATIONAL LAWS AND POLICIES ON HEALTH CARE WASTE
MANAGEMENT
1.
o
3.a. Department Memorandum No. 2011-0145 –
“Guidelines for the Temporary Storage of Mercury
Wastes in Healthcare Facility”
o detailed guidelines on the temporary storage
of mercury-containing devices and the
management of mercury spills
4.
DOH Administrative Order No. 2008-0023 dated July 30, 2008
– “National Policy on Patient Safety
5.
BFAD Memorandum Circular No. 22, Series of 1994 –
“Inventory, Proper Disposal, and/or Destruction of Used
Vials or Bottles”
contains guidelines on the proper inventory and
destruction of bottles and vials
6.
Republic Act No. 6969 – “An Act to Control Substances and
Hazardous Nuclear Wastes of 1990”
policies and guidelines on effective and proper
handling, collection, transport, storage, and disposal of
healthcare wastes
7.
Republic Act No. 8749 – “The Philippine Clean Air Act of
1999”
prohibits the incineration of bio-medical wastes
effective July 17, 2003
8.
Republic Act No. 9275 – “The Philippine Clean Water Act of
2004”
9.
Presidential Decree No. 856 – “The Code on Sanitation of the
Philippines – Chapter XVII on Sewage Collection and Excreta
Disposal” (1998)
1.b. DENR Administrative Order No. 35, Series of 1990
– “Effluent Regulations”
o lists the effluent regulations for the different
levels of pollutants according to their water
category/class
1.c. DENR Administrative Order No. 26, Series of 1992
– “Amending Memorandum Circular No. 02, Series of
1981”
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HEALTH CARE WASTE MANAGEMENT SYSTEM
Pathological and Anatomical
(Yellow bin)
Figure 4.1. Health Care Waste Management Hierarchy
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Green Procurement – Prevent and Reduce
 Health care facilities are encouraged to avail of
services that are least harmful to the environment and
to purchase less polluting products
Resource Procurement
 Reusing – either finding a new application for a used
material or using the same product for the same
application repeatedly
 Recycling – processing of used materials into new
products
 Recovery – defined in two ways:
o whereby waste is converted to fuel for
generating electricity or for direct heating of
premises
o a term used to encompass three subsets of
waste recovery: recycle, composting, and
energy recovery
End of Pipe – implemented when wastes are not safe for
reuse, recycle, or recovery
 Treatment – process of changing the biological
and chemical characteristics of waste to minimize
its potential to cause harm
 Disposal – refers to discharging, depositing,
placing, or releasing any healthcare waste into air,
land, or water
Sharps
(Red bin)
Chemical
(Orange bin)
Pharmaceutical
(Blue bin)
Radioactive
(Yellow bin w/ radioactive sign)
SEGREGATION, COLLECTION, STORAGE, AND TRANSPORT
OF HEALTH CARE WASTES
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Healthcare facilities are tasked to ensure that generated
wastes are properly and safely managed; wastes must be
segregated, collected, stored, and transported
The effective management of health care wastes considers
the basic elements of waste minimization, identification, and
segregation
Proper placement, labelling, and use of color-coded plastic
liners must be implemented
Type of Waste
Specifications
Infectious
(Yellow bin)
Bin: Strong leak-proof with cover
labelled “Infectious” with biohazard
symbol
General
(Green or black bin)
Dental
(White bin)
0.009mm thickness and labelled
“Infectious Waste” with a tag
indicating source and weight of
waste and date of collection; may
or may not have biohazard symbol
Bin: Strong leak-proof with cover
labelled “Pathological/Anatomical”
with biohazard symbol
Liner: Yellow plastic that can
withstand
autoclaving
with
0.009mm thickness and labelled
“Pathological/Anatomical Waste”
with a tag indicating source and
weight of waste and date of
collection; biohazard symbol is
optional
Bin: Puncture-proof with wide
mouth and cover labelled “Sharps”
with biohazard symbol
Liner: Not applicable
Bin: Labelled “Chemical Waste”;
For liquid chemical waste, inside
the bin is a disposal bottle made of
amber-colored glass with at least 4
liter-capacity that is strong,
chemical resistant, and leak-proof
Liner: Yellow with black band
plastic with 0.009mm thickness and
labelled “Chemical Waste” with a
tag indicating source and weight of
waste and date of collection
Bin: Strong leak-proof with cover
labelled “Pharmaceutical Waste”
for expired drugs and drug
containers, and “Cytotoxic Waste”
for cytotoxic, genotoxic, and
antineoplastic waste
Liner: Yellow with black band
plastic with 0.009mm thickness and
labelled “Pharmaceutical Waste”
with a tag indicating source and
weight of waste and date of
collection
Bin: Radiation-proof repositories,
leak-proof, and lead-lined container
labelled with name of radionuclide
and date of deposition with
radioactive symbol
Liner: Orange plastic with
0.009mm thickness and labelled
“Radioactive” with a tag indicating
name of radionuclide and date of
deposition
Bin: Optional recycle symbol for
recyclable non-hazardous wastes;
varying sizes depending on the
volume of waste
Liner: Black or colorless plastic for
non-biodegradable and green for
biodegradable with a thickness of
0.009mm with a tag indicating
source, weight of waste, and date
of collection
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Table 4.2. Guidelines for the proper labelling, marking, and color coding for waste
segregation in healthcare facilities
Liner: Yellow plastic that can
withstand
autoclaving
with
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TREATMENT AND DISPOSAL OF HEALTH CARE WASTES
 Health care wastes can be decontaminated either by:
 Sterilization – kills all microorganisms
 Disinfection – reduces the level or
microorganisms present in the material
Acceptable technologies and methods used in the treatment
of health care wastes:
1.
Pyrolysis
thermal decomposition in absence of supplied
molecular oxygen in the destruction chamber
waste is converted to gaseous, liquid, or solid form
2.
Autoclave
steam sterilization, an efficient wet thermal disinfection
process
usual setting is at 121 ˚C with a pressure of 15 psi for
15-30 minutes
3.
Microwave
size reduction device
shredding of wastes is done before disinfection
temperature of 100 ˚C for at least 30 minutes
4.
Chemical Disinfection
kill or inactivate present pathogens
chemicals used: 10% sodium hypochlorite
(recommended), hydrogen peroxide, peroxyacetic acid
and heated alkali
5.
Encapsulation
filling of container with waste, adding and immobilizing
material and sealing
to reduce the risk of scavengers gaining access to the
hazardous healthcare wastes
6.
Inertization
mixing of waste with cement, lime, and water
to minimize the risk of toxic substances contained in
waste migrating into surface water or groundwater
7.
Landfill
engineered site (w/ secured proper permits from
DENR) designed to keep waste isolated from the
environment
located in San Mateo, Rizal & Navotas
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