DOÑA REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION, INC.
COLLEGE OF MEDICAL TECHNOLOGY
Principles of Medical Laboratory Science 1
Lesson 10: HEALTH CARE WASTE MANAGEMENT
At the end of the lesson, the students should be able to:
 discuss the importance of proper waste management in health care facilities
 examine the laws and regulations governing health care waste management;
 describe the proper identification, segregation, collection, storage, transport,
treatment, and disposal of health care wastes
Health Care Wastes
 Health care wastes refer to all solid or liquid wastes generated by any of the
following activities:
1. diagnosis, treatment, and immunization of humans;
2. research pertaining to diagnosis, treatment, and immunization of
humans;
3. research using laboratory animals geared towards improvement of
human health;
4. production and testing of biological products; and
5. other activities performed by a health care facility that generates
wastes
 According to WHO, between 75-90% of wastes generated by health care
activities on average are non-hazardous. The remaining 10-25% is
considered hazardous and may be infectious, toxic, or radioactive.
Categories of Health Care Wastes
1. Infectious Waste
o all wastes suspected to contain pathogens or toxins in sufficient
concentration that may cause disease to a susceptible host
o examples: discarded microbial cultures, solid wastes with infections such as
dressings, sputum cups, urine containers, and blood bags, liquid wastes with
infections such as blood, urine, vomitus, and other body secretions, and food
wastes coming from patients with highly infectious diseases
2. Pathological and Anatomical Waste
o refers to tissue sections and body fluids or organs derived from
biopsies, autopsies, or surgical procedures sent to the laboratory
for examination
o examples: internal organs and tissues used for histopathological
examinations
o anatomical waste is a subgroup of pathological waste that refers to
recognizable body parts usually from amputation procedures
3. Sharps
o refer to waste items that can cause cuts, pricks, or puncture wounds
o considered the most dangerous health care waste because of their
potential to cause both injury and infection
o examples: syringes in phlebotomy, blood lancets, surgical knives, and
broken glasswares
4. Chemical Waste
o refers to discarded chemicals generated during disinfection and
sterilization procedures
o examples: laboratory reagents, x-ray film developing solutions,
disinfectants and soaking solutions, used batteries, concentrated
ammonia solutions, concentrated hydrogen peroxide, chlorine,
mercury from broken thermometers and sphygmomanometers
o 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 60⁰C)
 reactive (explosive with water)
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CHEMICAL WASTE EXAMPLES

Acids acetic, chromic, hydrochloric, nitric, sulfuric
Alcohols ethanol, isopropanol, phenols o in hospital, usual examples of radioactive wastes include: cobalt (Co 90),
Aldehydes formaldehyde, glutaraldehyde, ortho-phthaldehyde technetium (99 Tc), iodine (131 I) and iridium (192 Ir), irradiated blood
Bases ammonium hydroxide, potassium hydroxide, sodium products and contaminated waste, patient’s excretion, and all materials
hydroxide, sodium bicarbonate used by patients exposed to radionuclides within 48 hours
Halogenated calcium hypochlorite, chlorine dioxide, iodine solutions,
Disinfectants iodophors, sodium dichloroisocyanurate, sodium hypochlorite
Halogenated chloroform, methylene chloride, perchloroethylene, 7. Non-hazardous or General Waste
Solvents refrigerants, trichloroethylene o refers to wastes that have not been in contact with communicable or
Metals arsenic, cadmium, chromium, lead, mercury, silver infectious agents, hazardous chemicals, or radioactive substances, and
Non-Halogenated acetone, acetonitrile, ethanol, ethyl acetate, formaldehyde, do not pose a hazard
Solvents isopropanol, methanol, toluene, xylenes
o examples: plastic bottles, used paper products, office wastes, scrap
Other Disinfectants hydrogen peroxide, peroxyacetic acid, quaternary amines
wood, and food waste of non-infectious patients
Oxidizers hydrogen peroxide, potassium dichromate, potassium
permanganate o this type of waste can be further classified as:
Reducers sodium bisulfite, sodium sulfite
Miscellaneous anesthetic gases, asbestos, ethylene oxide, herbicides, paints, a) Recyclable wastes in health care facilities
pesticides, waste oils  paper products such as used office paper, computer
printouts, and corrugated cardboard boxes
 aluminum from beverage cans and other aluminum
5. Pharmaceutical Waste containers
o refers to expired, spilt, and contaminated pharmaceutical products,  pressurized gas containers such as oxygen tanks
drugs, and vaccines including discarded items used in handling  plastic products including polyethylene terephthalate (PET)
pharmaceuticals plastic water bottles, plastic milk containers, and
o includes antineoplastic, cytotoxic, and genotoxic wastes such as drugs polypropylene plastic bottles for saline solutions and
in oncology or radiotherapy, and biological fluids from patients treated irrigation fluids
with the said drugs  glass such as used vials for sterile solutions
 wood such as scrap wood and used for shipping pallets
o examples: empty drug vials, medicine bottles, and containers of  durable goods such as used furniture and furnishings
cytotoxic drugs including materials used for their preparation and  electronic devices such as used computer equipment and
administration such as syringes, needles, and vials print cartridges

6. Radioactive Waste b) Biodegradable health care wastes such as left-over food from non-
o refers to wastes exposed to radionuclides including radioactive infectious patients and garden wastes such as grass trimmings, and
diagnostic materials or radiotherapeutic materials tree cuttings

o examples: residues from shipment of radioactive materials and c) Non-recyclable/non-biodegradable health care wastes that cannot
unwanted solutions of radionuclides intended for diagnostic or be classified into either of the first two categories
therapeutic use, as well as liquids, gases, and solids contaminated
with radionuclides whose ionizing radiations have genotoxic effects
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Impact of Health Care Wastes
 Individuals exposed to health care wastes are potentially at risk of being
injured or infected.
 Exposure of the general population can be through chronic (for prolonged
periods in minute quantities) or acute exposure (for short periods in large
quantities).
 Adverse health outcomes associated with health care wastes and by-products
also include:
 sharps-inflicted injuries
 toxic exposure to pharmaceutical products, in particular, antibiotics
and cytotoxic drugs released into the surrounding environment,
and to substances such as mercury or dioxins, during handling or
incineration of health care wastes
 chemical burns from disinfection, sterilization, or waste treatment
activities
 air pollution arising as a result of the release or particulate matter
during medical waste incineration
 thermal injuries occurring in conjunction with open burning and the
operation of medical waste incinerators
 radiation burns
 The following are some guidelines in the treatment and disposal of health
care wastes:
 The disposal of untreated health care wastes in landfills can lead to
the contamination of drinking, surface, and ground waters if those
landfills are not properly constructed.
 The treatment of healthcare wastes with chemical disinfectants can
result in the release of chemical substances into the environment if
those substances are not handled, stored, and disposed in an
environmentally-sound manner.
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 Incineration of waste is widely practiced, but inadequate incineration
or the incineration of unsuitable materials results in the release of
pollutants into the air and in the generation of ash residue.
 Incinerated materials containing or treated with chlorine can
generate dioxins and furans, which are human carcinogens and have
been associated with a range of adverse health effects. Incineration
of heavy metals or materials with high metal content (lead, mercury,
cadmium) can lead to the spread of toxic metals in the environment.
 Only modern incinerators operating at 850⁰C to 1100⁰C and fitted
with special gas-cleaning equipment are able to comply with the
international emission standards for dioxins and furans. It should be
noted that disposal of health care wastes by incineration is not
allowed in the Philippines.
 Alternatives to incineration such as autoclaving, microwaving, and
steam treatment integrated with internal mixing, which minimize the
formation and release of chemicals or hazardous emissions should
be given consideration in settings where there are sufficient
resources to operate and maintain such systems and disposal of
treated waste.
 The following are the benefits achieved through proper and strict compliance
with standards on the management of health care wastes:
 protection of patients, health workers, and the general population
from the adverse effects of health care wastes to human health;
 contribution to the collaborative efforts around the world to protect
the environment from pollution and contamination caused by health
care wastes;
 increased compliance of health care institutions to the laws,
regulations, and guidelines on health care wastes; and
 prevention of long-term liabilities and loss of reputation caused by
violations to the laws, regulations, and guidelines on health care
wastes

Legislation, Policies, and Guidelines
Governing Health Care Wastes
INTERNATIONAL AGREEMENTS PERTAINING TO HEALTH CARE WASTE MANAGEMENT
1. The Montreal Protocol on Substances that Deplete the Ozone Layer (1987)
o it sets the final objective of the Protocol to eliminate ozone depleting
substances in the environment
2. The Basel Convention on the Control of the Transboundary Movements of
Hazardous Wastes and Their Disposal (1989)
o the countries that signed the Convention accepted the principle that only
legitimate transboundary shipments of hazardous waste are exported from
countries that lack the facilities or expertise to safely dispose certain wastes
to other countries that have both facilities and expertise
3. The United Nations Framework Convention on Climate Change (1992)
o includes a legally non-binding pledge that by the year 2000, major
industrialized nations would voluntarily reduce their greenhouse gas
emissions to 1990 levels
4. The Stockholm Convention on Persistent Organic Pollutants (2001)
o a global treaty to protect human health and the environment from
persistent organic pollutants (POPs)
o POPs are chemicals that (1.) remain unchanged in the environment for long
periods of time; and (2.) accumulate in the fatty tissues of living organisms;
and (3.) are toxic to both humans and wildlife
5. The ASEAN Framework Agreement on the Facilitation of Goods in
Transit (1998)
o a core instrument that provides nine high level protocols that set out generic
standards to be put into place for the implementation of an international
transit system
o specifically, the framework agreement includes Protocol 9 on Dangerous
Goods which provides provisions on the transport of toxic and infectious
substances
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NATIONAL LAWS AND POLICIES ON HEALTH CARE WASTE MANAGEMENT
1. Republic Act No. 4226 “Hospital Licensure Act” (1965)
o an act that requires the registration and licensure of all hospitals in the
country and mandates the DOH to provide guidelines for hospital technical
standards as to personnel, equipment, and physical facilities
2. Republic Act No. 6969 “An Act to Control Substances and Hazardous and
Nuclear Wastes” (1990)
o requires the registration of waste generators, waste transporters, and
operators of toxic and hazardous waste treatment facilities with the EMB
3. Republic Act No. 8749 “The Philippine Clean Air Act of 1999”
o prohibits the incineration of biomedical wastes effect July 17, 2003
o it promotes the use of state-of-the-art, environmentally-sound, and safe
non-burn technologies for the handling, treatment, thermal destruction,
utilization, and disposal of sorted, unrecycled, biomedical and hazardous
wastes
4. Republic Act No. 9003 “Ecological Solid Waste Management Act of 2000”
o 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. Republic Act No. 9275 “The Philippine Clean Water Act of 2004”
o pursues a policy of economic growth in a manner consistent with the
protection, preservation, and revival of the quality of the country’s fresh,
brackish, and marine waters
6. P.D. No. 813 (1975) and Executive Order 927 (1983) “Strengthening the
Functions of Laguna Lake Development Authority (LLDA)”
o strengthen the powers and functions of the LLDA to include environmental
protection and jurisdiction over surface waters of the Laguna Lake basin
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NATIONAL LAWS AND POLICIES ON HEALTH CARE WASTE MANAGEMENT (cont.,)

7. P.D. No. 856 “The Code on Sanitation of the Philippines – Chapter XVII (c.) establish the specifications and requirements for products or services to
on Sewage Collection and Excreta Disposal” (1998) be considered environmentally advantageous; and
o requires the approval of DOH in terms of the following:
(d.) develop incentive programs for suppliers of said products or services
(a.) construction of any approved type of toilet in every house and community
which may be allowed for a group of small houses of light material or
temporary in nature 11. DOH Administrative Order No 2008-0021 “Gradual Phase-out of
Mercury in all Philippine Health Care Facilities and Institutions”
(b.) plans of individual sewage or sewage system and the sub-surface
o requires all health care facilities to gradually phase-out the use of
absorption system or other treatment device
mercury-containing devices and equipment
(c.) location of any toilet or sewage disposal system in relation to a source of
water supply
12. DOH Administrative Order No. 2008-0023 “National Policy on Patient
(d.) the discharge of untreated effluent from septic tanks and/or sewage Safety”
treatment plants to bodies of water o requires the establishment and maintenance of a culture of patient
safety in the health care facility as the responsibility of its leaders
(e.) manufacture of septic tanks
o the health care facility shall ensure that an enabling
(f.) method of disposal of sludge from septic tanks or other treatment plants
mechanism/strategy is in place to ensure patient safety

8. P.D. No. 984 “Providing for the Revision of Republic Act No. 3931,
13. DOH “Manual on Health Care Waste Management” (2001)
commonly known as the Pollution Control Law, and for Other Purposes
o serves as the reference for health care facilities administrators in the
o governs the discharge of potentially polluting substances to air and water
implementation of an effective and efficient waste management
program
9. P.D. No. 1586 “Environmental Impact Statement (EIS) System” (1978)
o requires projects, like the construction of new hospital buildings or expansion
14. PhilHealth Benchbook for Quality Assurance in Health Care (2006)
of existing hospitals, to secure an Environmental Compliance Commitment
o includes health care waste management as one of its parameters in the
Certificate (ECC) prior to the construction and operation of the facility
quality assurance of healthcare

10. E.O. No. 301 “Establishing a Green Procurement Program for All
15. BFAD Memorandum Circular No. 22, Series of 1994 “Inventory,
Departments, Bureaus, Offices, and Agencies of the Executive Branch of
Proper Disposal, and/or Destruction of Used Vials or Bottles” and
Government” (2004)
BFAD Bureau Circular No. 16, Series of 1999 “Amending BFAD MC
o aims to:
No. 22”
(a.) promote the culture of making environmentally informed decisions in
o these circulars are released to prevent the proliferation of adulterated,
the government, especially in the purchase and use of different products;
misbranded, and counterfeit drugs brought about by the recycling of
(b.) include environmental criteria in public tenders, whenever possible and used pharmaceuticals bottles and vials
practicable;
o it also contains guidelines on the proper inventory and destruction of
bottles and vials

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Health Care Waste Management System

PREVENT
 The most important step in the proper management of health care wastes is Green
Most Procurement
waste minimization using an approach known as the Green Procurement Preferable REDUCE
Policy.
REUSE
 This policy involves two aspects: waste prevention and waste
reduction. Resource
RECYCLE Development
 Waste reduction is implemented by encouraging proper waste RECOVER
segregation to determine the nature and volume of generated
wastes to allow efficient waste management at the least cost. TREAT
End of Pipe
 Resource development: safely reusing, recycling, and recovering wastes DISPOSE
Least
 Reusing refers to either finding a new application for a used Preferable
material or using the same product for the same application
repeatedly.
 Recycling refers to the processing of used materials into new
products. Segregation, Collection, Storage, and Transport

 Recovery is defined in two ways: (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 the encompass
three subsets of waste recovery: recycling, composting, and
energy recovery.
 Hazardous wastes must never be mixed with general wastes and there must
be a waste management officer responsible for the management of the
health care wastes of a facility.
 Segregation is the process of separating different types of waste at the point
of generation until their final disposal.

 For wastes that cannot be safely reused, recycled, or recovered, the end of
pipe approach is implemented which involves two aspects: treatment and
disposal.
 Waste treatment is the process of changing the biological and
chemical characteristics of waste to minimize its potential to
cause harm.
 Waste disposal refers to discharging, depositing, placing, or
releasing any health care waste into air, land, or water.
 To improve the efficiency of the segregation and minimize the incorrect use
of bins: proper placement, labelling of waste bins, and use of color-coded
plastic liners must be strictly implemented.
 The purpose of color coding is to make it easier for personnel in a health
care facility to put waste into correct bins and maintain segregation during
collection, storage, transport, treatment, and disposal.
 In the implementation of a color-coding system for health care wastes, the
following practices should be observed:
1. Highly infectious waste must be disinfected at source
2. Anatomical waste including recognizable body parts, placenta waste,
and organs should be disposed through safe burial or cremation

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3. Pathological waste must be refrigerated if not collected or treated

within 24 hours.

4. Sharps must be shredded or crushed before they are transported to the

landfill.

5. Chemical and pharmaceutical wastes shall be segregated and collected New

Explosive Cytotoxic Infectious
separately. Wastes with high content of heavy metals, except mercury, Radiation
Symbol Symbol Symbol
should be sent to the waste treatment facility, Waste containing mercury Symbol
must be collected separately.

6. Hazardous chemical waste shall never be mixed or disposed down the

drain but shall be stored in strong chemical resistant leak-proof
containers or amber disposal bottles. Expired and discolored
pharmaceuticals should be returned to the pharmacy for temporary
storage to be returned to the manufacturer/supplier. Pharmaceuticals Reactive Flammable Flammable Poison / Toxic
shall be kept in their original packaging for proper identification and Symbol Solid Symbol Liquid Symbol Symbol
prevention of possible reaction with other chemicals.

7. Radioactive waste has to be decayed to background radiation levels. If it

has reached the background radiation level and is not mixed with  Health care facilities should have storage areas for general wastes, recyclable
infectious or chemical waste, the radioactive waste is considered as materials, hazardous wastes, and phase-out mercury devices.
regular on-infectious waste.  Cytotoxic wastes must be stored separately from other wastes in a
designated secured location.
8. All waste bins must be properly covered to prevent cross contamination.  Radioactive wastes must be stored in containers that can prevent
9. Aerosol containers can be collected with general waste. dispersion of radiation during the period that their radionuclide
contents are being allowed to decay.
 Aside from the information placed on the tag, yellow plastic liners should also
be labelled with symbols appropriate for the types of waste they contain. The  There must be a regular on-site collection of wastes and these must be
following are the symbols used by the DENR Environmental Management transported using designated trolleys to the facility’s waste treatment area or
Bureau: waste storage facility.
 During on-site collection and transport, the personnel hauling the
wastes must be properly trained and should wear appropriate
personal protective equipment to minimize the risk of infection and
injury.
 For off-site transport of health care wastes, only accredited DENR
Old
Radiation
transporters and official waste collectors are allowed to transport
Symbol waste from the health care facility to a Treatment /Storage/Disposal
Recycle Biohazard (TSD) facility or to the final disposal site.
Corrosive
Symbol Symbol

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Guidelines For Waste Segregation In Health Care Facilities:

TYPE OF WASTE SPECIFICATIONS TYPE OF WASTE SPECIFICATIONS

BIN: Strong leak-proof bin with cover labelled “infectious”

with biohazard symbol
LINER: Yellow plastic that can withstand autoclaving with 0.009
mm 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 bin with cover labelled “Pathological/
Anatomical Waste” with biohazard symbol
BIN: Strong leak-proof bin 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 0.009 mm thickness
and labelled “Pharmaceutical Waste” with a tag
indicating source and weight of waste and date of
collection

LINER: Yellow plastic that can withstand autoclaving with 0.009

BIN: Radiation proof repositories, leak-proof, and lead-lined
mm thickness and labelled “Pathological/Anatomical
container labelled with name of radionuclide and date of
Waste” with a tag indicating source and weight of waste
deposition with radioactive symbol
and date of collection. Biohazard symbol is optional.
LINER: Orange plastic with 0.009 mm thickness and labelled
“Radioactive” with a tag indicating name of radionuclide
and date of deposition
BIN: Puncture-proof container with wide mouth and cover
labelled “Sharps” with biohazard symbol

LINER: Not applicable

BIN: Optional recycle symbol for recyclable and non-hazardous
wastes; varying sizes depending on the volume of wastes

LINER: Black or colorless plastic for non-biodegradable and

green for biodegradable with a thickness of 0.009 mm
BIN: Labelled “Chemical Waste”; For liquid chemical waste,
with a tag indicating source, weight of waste, and date
inside the bin is a disposal bottle made of amber-colored
of collection
glass with at least 4 liters capacity that is strong, chemical-
resistant, and leak-roof

LINER: Yellow with black band plastic with 0.009 mm thickness

and labelled “Chemical Waste” with a tag indicating
source and weight of waste and date of collection

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Treatment and Disposal of Health Care Wastes

 Proper waste treatment is necessary to ensure that health care wastes
do not pose harm to the people and the environment.
 Health care wastes can be decontaminated either by sterilization or
disinfection: sterilization kills all the microorganisms while disinfection
reduces the level of microorganisms present in the material
 The following are the acceptable technologies and methods used in
the treatment of health care wastes:
 Pyrolysis
 Autoclave
 Microwave
 Chemical disinfection
 Biological process
 Encapsulation
 Inertization
1. Pyrolysis
o the thermal decomposition of health care wastes in the absence of
supplied molecular oxygen in the destruction chamber where the
said waste is converted into gaseous, liquid, or solid form
o waste residues may be in the form of greasy aggregates or slugs,
recoverable metals, or carbon black, which are disposed in a landfill
2. Autoclave
o the use of steam sterilization to render waste harmless and is an
efficient wet thermal disinfection process
o the usual setting is at 121⁰C with a pressure of 15 psi for 15-30
minutes
o indicators such as color-changing tapes or biological test ampules
containing bacterial spores can be used to check the validity of the
sterilization
o in this process, waste is exposed to microwaves that raise the
temperature to 100⁰C (237.6⁰F) for at least 30 minutes
o microorganisms are destroyed by moist heat which irreversibly
coagulates and denatures enzymes and structural proteins
4. Chemical disinfection
o chemicals like sodium hypochlorite, hydrogen peroxide,
peroxyacetic acid, and heated alkali are added to health care
wastes to kill or inactivate present pathogens
o it is recommended that sodium hypochlorite (bleach) with a
concentration of 5% be used for chemical disinfection
5. Biological process
o uses an enzyme mixture to decontaminate health care wastes
o the resulting by-product is put through an extruder to remove
water for wastewater disposal
6. Encapsulation
o involves the filling of containers with waste, adding and
immobilizing material, and sealing the containers
o the process uses either cubic boxes made of high-density
polyethylene or metallic drums, that are three-quarters filled with
sharps, or chemicals or pharmaceutical residues
o the containers or boxes are then filled up with a medium such as
plastic foam, bituminous sand, and cement mortar
o after the medium has dried, the containers are sealed and disposed
in a landfill

7. Inertization
3. Microwave
o especially suitable for pharmaceutical waste that involves the
o typically incorporates some type of size reduction device and
mixing of waste with cement and other substances before disposal
shredding of wastes is done before disinfection

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o for the inertization of pharmaceutical waste, the packaging shall be

removed, the pharmaceuticals ground and a mixture of water, lime,
and cement will be added

o the homogenous mass produced can be transported to a suitable

storage site or in a liquid state to a landfill and poured into
municipal waste

 After treatment, health care wastes are usually disposed in landfills.

 A landfill is an engineered site designed to keep waste from the
environment. This site must secure proper permits from DENR
before it can accept wastes.

 Health care wastes that are properly treated can be mixed with general
wastes provided that it is certified by the DOH that the organisms in the
waste products are inert and cannot regenerate.

 For health care facilities in far-flung areas with no access to landfills, disposal
is usually through safe burial.
 Safe burial is only applicable to treated infectious wastes, sharps,
pathological and anatomical wastes, small quantities of encapsulated/
inertisized solid chemical and pharmaceutical wastes and only allowed
in health care facilities located in remote areas.

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