MTY1201: PMLS 1

TOPIC 11: HEALTHCARE WASTE

MANAGEMENT

GENERAL GUIDLINES

LEGEND FOR HEADERS DEFINING HEALTHCARE WASTES

MAIN TOPIC • All the waste generated by health-care

establishments, research facilities, and
SUBTOPIC
laboratories
SUB-SUBTOPIC
• Includes the waste originating from ―minor‖
or ―scattered‖ sources — such as that
CHAIN OF INFECTION 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)

CLASSIFICATION OF WASTES
Hazardous
o All waste materials that are contaminated
by infectious microorganisms or chemicals
o Used cotton, specimen container, gauze
pad, syringe needles, and culture plates.
o Has a potential threat in our health

Explosivity and Reactivity

o Unstable and reacts violently to chemical
PERSONAL PROTECTIVE
changes
EQUIPMENT
o Can cause explosion or releases toxic
 fumes when mixed with water
• Things to wear for us, medical
technologist, to be protected from the Corrosivity
infectious agents from patient sample
o Waste that needs to be separated from
o Gloves other wastes, due to corrosiveness to steel
o Hair cap and Hair net o Reagents are too acidic (pH < 2) or too
o Laboratory gown alkaline (pH >12.5)
o Goggles Toxicity
o Mask

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o Can cause acute health effect such as
rashes, skin irritation, headache, nausea or
burns
o Can cause chronic health effects such
as liver failure, stunted growth and
development
o Some substance contains carcinogens
o Carcinogens – a substance capable of
causing cancer in living tissue.
Ignitability
o Waste that can cause fire during waste
disposal and storage conditions
o Flash point – lowest temperature, at
which a chemical produces vapor to cause
ignition
LABORATORY WASTES
• Infectious
• Pathological
• Radioactive
• Chemical
• Biomedical
DIFFERENT HAZARD SYMBOLS
CATEGORIES OF HEALTHCARE
WASTES
Infectious
o Waste suspected to contain pathogens
o Examples: laboratory cultures; waste
from isolation wards; tissues (swabs),
materials, or equipment that have been in
contact with infected patients; excreta
Pathological Waste
o Human tissues or fluids
o Examples: body parts, blood and other
body fluids, fetuses
Sharps
o Sharp waste
o Examples: needles, infusion sets,
scalpels, knives, blades, and broken glass
Pharmaceutical Waste
o Waste containing pharmaceuticals
o Examples: pharmaceuticals that are
expired or no longer needed; items
contaminated by or containing
pharmaceuticals (bottles, boxes)
Genotoxic Waste
o Waste containing substances with
genotoxic properties
o Examples: waste containing cytostatic
drugs (often used in cancer therapy)
Chemical Waste
o Waste containing chemical substances
o Examples: laboratory reagents; film
developer, disinfectants that are expired or
no longer needed, solvents
Wastes with high content of heavy metal
o Examples: batteries, broken
thermometers, blood-pressure gauges
Pressured Containers
o Examples: gas cylinders, gas cartridges,
aerosol cans
Radioactive Waste
o Waste containing radioactive substances
o Examples: unused liquids from
radiotherapy or laboratory research,
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contaminated glassware, packages, or
absorbent paper, urine and excreta from
patients treated or tested with unsealed
radionuclides, sealed sources
IMPACT OF HEALTHCARE WASTES
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
healthcare waste are reported by
cleaning personnel and waste
handlers
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
Impact of genotoxic waste
 No scientific publication has yet
reported adverse effects on health
resulting from mismanagement of
genotoxic waste
Impact of radioactive waste
 In Brazil, one case of carcinogenic
impact on the general population
linked to exposure to
 radioactive hospital waste has been
analyzed 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)
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• 5. The ASEAN Framework
Agreement on the Facilitation of Goods in
Transit (1998)
Local
1. Republic Act No. 4226 “Hospital
Licensure Act” (1965)
o Act that requires the registration and
licensure of all hospitals in the
country
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 incineration of bio-medical
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 Protection, preservation and revival
of the quality of the country’s fresh,
brackish, and marine waters
6. Presidential Decree 813 (1975)
and Executive Order 927 (1983)
“Strengthening the Functions of
Laguna Lake Development
Authority (LLDA)”
o 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)
o 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)
o Governs discharge of
potentially polluting
substances to air and water.
9. Presidential Decree No. 1586
“Environmental Impact
Statement (EIS) System”(1978)
o 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
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 product for the same application
repeatedly.
4. Recycle
Processing of used materials into
new products
5. Recover
Energy recovery, whereby waste is
converted to fuel for generating
electricity or for direct heating of
premises and;
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 waste
 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
 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.
 Labeled “Chemical waste”
Pharmaceutical waste
 Strong leak-proof bin.
 Liner is yellow with black band
plastic with 0.009mm thickness and;
 Labeled “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;
 Labeled “Radioactive”
General waste
 Black or colorless plastic for non-
biodegradable and;
 Green for biodegradable with a
thickness of 0.009mm.
OTHER IMPORTANT THINGS TO
REMEMBER
• Highly infectious waste must be
disinfected at source
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• 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 OF HEALTHCARE WASTES
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 disposed in a
landfill
2. Autoclave
 Steam sterilization (wet thermal
disinfection).
 Usual setting is 121°C with a
pressure of 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 100°C 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. Inertization
 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.
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 DISPOSAL OF HEALTHCARE WASTES
1. Landfill
 An engineered site designed to
keep waste isolated from the
environment.
 Site must secure proper permits
from DENR before it can accept
wastes
 If no access to landfills, disposal
is usually done through safe
burial.
 This is only applicable to treated
infectious wastes, sharps,
pathological and anatomical
wastes and only allowed in
health care facilities located in
remote areas.

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