HEALTHCARE WASTE MANAGEMENT
Defining Healthcare Wastes
 All the waste generated by health-care
establishments, research facilities, and
laboratories
 Includes the waste originating from “minor” or
“scattered” sources—such as that produced in the
course of health care undertaken in the home
(dialysis, insulin injections, etc.)
 75-90% = Non-risk or “general” waste (comparable
to domestic waste). From administrative,
maintenance, and housekeeping functions
 10-25% = Hazardous and creates a variety of
healthcare risk (Also known as Health-care risk
waste)
Categories of Healthcare Wastes
1. Infectious Waste - Waste suspected to contain
pathogens e.g. laboratory cultures; waste from
isolation wards; tissues (swabs), materials, or
equipment that have been in contact with infected
patients; excreta
2. Pathological Waste - Human tissues or fluids e.g.
body parts; blood and other body fluids; fetuses
3. Sharps - Sharp waste e.g. needles; infusion sets;
scalpels; knives; blades; broken glass
4. Pharmaceutical Waste - Waste containing
pharmaceuticals e.g. pharmaceuticals that are
expired or no longer needed; items contaminated
by or containing pharmaceuticals (bottles, boxes)
5. Genotoxic Waste - Waste containing substances
with genotoxic properties e.g. waste containing
cytostatic drugs (often used in cancer therapy);
genotoxic chemicals
6. Chemical Waste - Waste containing chemical
substances e.g. laboratory reagents; film
developer; disinfectants that are expired or no
longer needed; solvents
7. Wastes with high content of heavy metal -
Batteries; broken thermometers; blood-pressure
gauges; etc.
8. Pressurized containers - Gas cylinders; gas
cartridges; aerosol cans
9. Radioactive waste - Waste containing radioactive
substances e.g. unused liquids from radiotherapy
or laboratory research; contaminated glassware,
packages, or absorbent paper; urine and excreta
from patients treated or tested with unsealed
radionuclides; sealed sources
Impact of Healthcare Wastes
1. Impact of infectious waste and sharps
 Health-care workers, other hospital workers,
waste-management operators outside health-
care establishments, and individuals who
scavenge on waste disposal sites are at
significant risk of blood-borne infections
(through sharps)
 General public and hospital patients are at
significant risk of agents spread through other
media like sewage (cholera etc.)
 In any health-care establishment, nurses and
housekeeping personnel are the main groups
at risk of injuries; annual injury rates are 10–20
per 1000 workers. Highest rates of
occupational injury among all workers who
may be exposed to health-care waste are
reported by cleaning personnel and waste
handlers
2. Impact of chemical and pharmaceutical –waste
 examples may be found of extensive
intoxication caused by industrial chemical
waste
 many cases result from the improper handling
of chemicals or pharmaceuticals in health-care
establishments
 To minimize this type of occupational risk, less
hazardous chemicals should be substituted
whenever possible and protective equipment
should be provided to all personnel likely to be
exposed. Premises where hazardous
chemicals are used should be properly
ventilated, and personnel at risk should be
trained in preventive measures and in
emergency care in case of accident
3. Impacts of genotoxic waste
 No scientific publication has yet reported
adverse effects on health resulting from
mismanagement of genotoxic waste
4. Impacts of radioactive waste
 In Brazil, one case of carcinogenic impact on
the general population linked to exposure to
 radioactive hospital waste has been analysed
and fully documented. While moving, a
radiotherapy institute left a sealed radiotherapy
source in its old premises. An individual who
gained access to these premises removed the
source and took it home. As a consequence,
249 people were exposed, of whom several
either died or suffered severe health problems
(IAEA, 1988)
 The only recorded accidents involving
exposure to ionizing radiations in health-care
settings have resulted from unsafe operation of
X-ray apparatus, improper handling of
radiotherapy solutions, or inadequate control of
radiotherapy
Legislation, Policies, and Guidelines
governing Healthcare Wastes
INTERNATIONAL
1. The Montreal Protocol on Substances that
Deplete the Ozone Layer (1987)
2. The Basel convention on the Control of the
Transboundary Movements of Hazardous Wastes
and Their Disposal (1989)
3. The United Nations Framework Convention on
Climate Change (1992)
4. The Stockholm Convention on Persistent
Organic Pollutants (2001)
5. The ASEAN Framework Agreement on the
Facilitation of Goods in Transit (1998)
NATIONAL
1. Republic Act no. 4226 “Hospital Licensure Act”
(1965) – Act that requires the registration and
licensure of all hospitals in the country
2. Republic Act no. 6969 Än Act to Control
Substances and Hazardous and Nuclear Wastes”
(1990) – Requires the registration of waste
generators, waste transporters, and operators of toxic
and hazardous waste treatment facilities with the EMB
3. R.A No. 8749 “The Philippine Clean Air Act of
1999” – prohibits incineration of bio-medical wastes.
4. R.A No. 9003 “Ecological Solid Waste
Management Act of 2000” – mandates the
segregation of solid wastes at the sources including
households and institutions like hospitals by using a
separate container for each type of waste.
5. R.A No. 9275 “The Philippine Clean Water Act of
2004” – Protection, preservation and revival of the
quality of the country’s fresh, brackish, and marine
waters
6. Presidental Decree 813 (1975) and Executive
Order 927 (1983) “Strengthening the Functions of
Laguna Lake Development Authority (LLDA)” –
environmental protection and jurisdiction over surface
waters of the Laguna Lake basin.
7. Presidential Decree 856 “The Code on
Sanitation of the Philippines – Chapter XVII on
Sewage Collection and Excreta Disposal” (1998) –
Approval of DOH regarding toilets, sewage systems,
and septic tanks
8. Presidential Decree No. 984 “Providing for the
Revision of R.A 3931, Pollution Control Law, and
for other purposes” (1976) – Governs discharge of
potentially polluting substances to air and water.
9. Presidential decree No. 1586 “Environmental
Impact Statement (EIS) System” (1978) – requires
projects to secure Environmental Compliance
Commitment Certificate (ECC)
10. DOH Administrative Order No. 2008-0021 dated
July 30, 2008 “Gradual Phaseout of Mercury in all
Philippine Health Care Facilities and Institution”
11. DOH “Manual on Health Care Waste
Management” in 2011
Healthcare Waste Management System
Health Care Waste Management Hierarchy in
order of More Preferable to Least Preferable
Green Procurement
1. PREVENT - Wastes are minimized even before
their generation
2. REDUCE – Implemented by encouraging proper
waste segregation to determine the nature and
 volume of generated wastes to allow efficient
waste management at the least cost
Resource Development
3. REUSE – Either finding a new application for a
used material or using the same product for the
same application repeatedly.
4. RECYCLE – Processing of used materials into
new products
5. RECOVER – (1) energy recovery, whereby waste
is converted to fuel for generating electricity or for
direct heating of premises and (2) as a term used
to encompass three subsets of waste recovery:
recycling, composting, and energy recovery.
End of Pipe
6. TREAT – Process of changing the biological and
chemical characteristics of waste to minimize its
potential to cause harm.
7. DISPOSE – Discharging, depositing, placing, or
releasing any health care waste into air, land, or
water.
Segregation, Collection, Storage, and
Transport of Healthcare Wastes
 Hazardous wastes should never be mixed with
general wastes. A waste management officer is
needed to be responsible for the management of
these wastes.
 Segregation at the source of waste generation
should be the responsibility of the waste generator.
 Segregation is the process of separating different
types of waste at the point of generation until their
final disposal.
SEGREGATION (BINS)
Infectious waste – Yellow plastic that can withstand
autoclaving with 0.009mm thickness. Labeled
“infectious waste”.
Pathological and Anatomical wastes – Yellow
plastic that can withstand autoclaving with 0.009mm
thickness. Labeled “Pathological/Anatomical waste”
Sharps – Puncture-proof container with wide mouth,
biohazard symbol, and cover labelled “Sharps”
Chemical Waste – Labelled “chemical waste”. Inside
the bin is a disposal bottle made of amber-colored
glass with at least 4L capacity that is strong, chemical-
resistant, and leak-proof. Plastic has 0.009mm
thickness.
Pharmaceutical Waste – Strong leak-proof bin. Liner
is yellow with black band plastic with 0.009mm
thickness and labelled “Pharmaceutical waste”
Radioactive waste – Radiation proof repositories,
leak-proof, and lead-lined container labelled with
name of radionuclide. Orange plastic with 0.009mm
thickness and labelled “Radioactive”
General Waste – Black or colorless plastic for non-
biodegradable and green for biodegradable with a
thickness of 0.009mm.
Other important things:
 Highly infectious waste must be disinfected at
source
 Anatomical waste should be disposed through safe
burial or cremation
 Pathological waste must be refrigerated if not
collected or treated within 24 hours
 Waste containing Mercury must be collected
separately.
 Hazardous chemical waste shall never be mixed or
disposed down the drain.
 Pharmaceuticals shall be kept in their original
packaging for proper identification.
 Radioactive waste has to be decayed to
background radiation levels. If it has reached
background radiation level and is not mixed with
infectious or chemical waste, the radioactive waste
is considered as regular non-infectious waste.
Treatment and Disposal of Healthcare
Wastes
TYPES OF TREATMENT
1. Pyrolysis – Uses heat but in the absence of
oxygen in a destruction chamber where the waste is
converted to gas, liquid, or solid form. Residues may
be in the form of greasy aggregates or slugs,
recoverable metals, or carbon black. These are then If no access to landfills, disposal is usually done
disposed in a landfill through safe burial. This is only applicable to treated
infectious wastes, sharps, pathological and anatomical
2. Autoclave – Steam sterilization (wet thermal
wastes and only allowed in health care facilities
disinfection). Usual setting is 121oC with a pressure of
located in remote areas.
15 psi for 15 to 30 mins. Indicators are used such as
color-changing tapes or biological test ampules
containing bacterial spores to check validity.
3. Microwave – Temperature of 100oC for at least 30
minutes. Microorganisms are destroyed by moist heat
which irreversibly coagulates and denatures enzymes
and structural proteins.
4. Chemical Disinfection – Chemicals like sodium
hypochlorite, hydrogen peroxide, peroxyacetic acid,
and heated alkali are added. Recommendation is
bleach (sodium hypochlorite) with 5% concentration
be used. Disadvantage of this method is that it
generates chemical wastes.
5. Biological Process – Enzyme mixture to
decontaminate wastes. Resulting by-product is put
through an extruder to remove water.
6. Encapsulation – Filling of containers with waste
and sealing the containers. Uses either cubic boxes
made of high-density polyethylene or metallic drums,
that are three-quarters filled with sharps, or chemicals,
or pharmaceutical residues. Then filled up with a
medium such as plastic foam, bituminous sand, and
cement mortar to immobilize. It is then disposed in a
landfill.
7. Intertization – Suitable for pharmaceutical waste
that involves the mixing of waste with cement and
other substances before disposal. The
pharmaceuticals are grounded up, and a mixture of
water, lime, and cement will be added. The
homogenous mass can be transported to a storage
site or poured in a landfill. Relatively inexpensive
procedure.

DISPOSAL
LANDFILL – An engineered site designed to keep
waste isolated from the environment. Site must secure
proper permits from DENR before it can accept
wastes.