Health Care Waste Management

All solid or liquid waste generated by Diagnosis, Treatment and Immunizations of humans

health care waste

All solid or liquid waste generated by research pertaining to diagnosis, treatment and immunization of humans

health care waste

All solid or liquid waste generated by research using laboratory animals geared towards improvement of human health

health care waste

All solid or liquid waste generated by production and testing of biological products

health care waste

All solid or liquid waste generated by other activities performed by a health care facility that generates waste

health care waste

categories of health care waste

1. Infectious waste

2. Pathological and Anatomical waste

3. Sharps

4. Chemical Waste

5. Pharmaceutical Waste

6. Radioactive Waste

7. Non-Hazardous or General Waste

All waste suspected to contain pathogens or toxins that may cause disease to susceptible host and also includes discarded materials or equipment used for diagnosis, treatment and management of patient with infectious diseases

infectious waste

Discarded microbial cultures

Solid waste with infections (dressings, sputum cups, urine containers and blood bags)

Liquid wastes with infection ( blood, urine, vomitus and other body secretions

Food wastes (liquid or solid) coming from patients with highly infectious

diseases

examples of infectious waste

 Refers to tissue sections and body fluids or organs derived from biopsies, autopsies or surgical procedures sent to the laboratory for examination

pathological and anatomical waste

subgroup of pathological waste that refers to recognizable body parts usually from amputation procedures

anatomical waste

Internal organs and tissues used for histopathological examination

example of pathological and anatomical waste

Refers to waste items that can cause cuts, pricks or puncture wounds

sharps

Considered most dangerous health care waste as it can cause both injury

and infection

sharps

• Syringes in phlebotomy

• Blood lancets

• Surgical knives

• Broken glasswares

examples of sharps

Refers to discarded chemical(solid, liquid or gaseous) generated

during disinfection and sterilization procedures and also

includes waste with high content of heavy metals and their derivatives

chemical waste

• Laboratory Reagents

• X-ray film developing solutions

• Disinfectants and Soaking Solutions

• Used batteries

• Conc. Ammonia solutions

• Conc. Hydrogen Peroxide

• Chlorine

• Mercury from broken thermometers and sphygmomanometer

examples of chemical waste

Chemicals are considered hazardous when they are:

toxic

corrosive

flammable

reactive

common chemical waste in health care facilities

acids

alcohols

aldehydes

bases

halogenated disinfectants

halogenated solvents

metals

non-halogenated solvents

other disinfectants

oxidizers

reducers

miscellaneous

examples of acids

Acetic, Chromic, hydrochloric, nitric, sulfuric

examples of alcohols

Ethanol, isopropanol, phenols

examples of aldehydes

Formaldehyde, glutaraldehyde, ortho-pthalaldehyde

examples of bases

Ammonium hydroxide, potassium hydroxide

examples of halogenated disinfectants

Calcium hypochlorite, chlorine dioxide, iodine solutions,

iodophores, sodium dichloroisocyanurate, sodium hypochlorite

(bleach)

examples of halogenated solvents

Chloroform, methylene chloride, percholoethylene, refrigerants,

trichloroethylene

examples of metals

Arsenic, cadmium, chromium, lead, mercury, silver

examples of non-halogenated solvents

Acetone, acetonitrite, ethanol, ethyl acetate, formaldehyde,

isopropanol, methanol, toluene, xylenes

examples of other disinfectants

Hydrogen peroxide, peroxyacetic acid, quaternary amines

examples of oxidizers

Hydrogen peroxide, potassium dichromate, potassium permanganate

examples of reducers

Sodium bisulfite, sodium sulfite

examples of miscellaneous

 Anesthetic gases, asbestos, ethylene oxide, herbicides, waste oils

Refers to expired, spilt, and contaminated pharmaceutical products, drugs, vaccines including discarded items used in handling pharmaceuticals.

pharmaceutical waste

Includes antineoplastic, cytotoxic and genotoxic waste ( drugs used in oncology or radiotherapy and biological fluids from patients treated with the said drugs

pharmaceutical waste

• Empty drug vials

• Medicine bottles containers of cytotoxic drugs (including

materials used in preparation and administration)

examples of pharmaceutical waste

Refers to waste exposed to radionuclides including radioactive diagnostic materials or radiotherapeutic materials

radioactive waste

• Cobalt (Co 90)

• Technetium (99 Tc)

• Iodine ( 131 I)

• Iridium ( 192 Ir)

• Irradiated blood products

• All materials used by patients exposed to radionuclides within 48 hrss

examples of radioactive waste

 Refers to waste that have not been in contact with communicable or

infectious agents, hazardous chemicals or radioactive substances and do

not pose a hazard

non-hazardous or general waste

Further classified: Recyclable Waste, Biodegradable waste and Non-recyclable/ non-biodegradable waste

non-hazardous or general waste

• Plastic bottles

• Used paper products

• Office waste

• Scrap wood

• Food waste from non-infectious patients

examples of non-hazardous or general waste

Adopted in Montreal, Canada on September 16, 1987 and came into force as agreed upon January 1, 1989

The Montreal Protocol on Substances that Deplete the Ozone Layer (1987)

Sets the final objective of the protocol to eliminate ozone depleting substances in the environment

The Montreal Protocol on Substances that Deplete the Ozone Layer (1987)

Concerned with the transboundary movements of hazardous waste

The Basel Convention on the Control of the transboundary movements of Hazardous waste and their disposal (1989)

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 waste

to other countries that have both facilities and expertise

The Basel Convention on the Control of the transboundary movements of Hazardous waste and their disposal (1989)

Legally non-binding pledge that by the year 2000, major industrialized nations would voluntarily reduce their greenhouse gas emissions to 1990 levels

The United Nations Framework Convention on Climate Change (1992)

Global treaty to protect human health and the environment from persistent organic pollutants (POPs)

The Stockholm convention on persistent organic pollutants (2001)

POPs are chemicals that:

• Remain unchanged in the environment for long periods of time

• Accumulate in the fatty tissues of living organisms

• Toxic to both human and wildlife

A core instrument that provides nine high level protocols that set out generic standards to be put into a place for the implementation of an international transit system

The ASEAN Framework Agreement on the Facilitation of Goods in Transit (1998)

Specifically, the framework agreement includes Protocol 9 on Dangerous Goods which provides provisions on the transport of toxic and infectious substances

The ASEAN Framework Agreement on the Facilitation of Goods in Transit (1998)

what are the 9 dangerous goods

Class 1 - Explosives

Class 2 - Gases

Class 3 - Flammable Liquids

Class 4 - Flammable Solids

Class 5 - Oxidizing Substances and Organic Peroxides

Class 6 - Toxic and Infectious Substances

Class 7 - Radioactive Material

Class 8 - Corrosives

Class 9 - Miscellaneous Dangerous Goods

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

Republic Act No. 4226 “Hospital Licensure Act” (1965)

Includes application or renewal of license, submission of plans and other design requirements under the: Code of Sanitation of the Philippines, National Plumbing Code of the Philippines, Revised Fire Code of the Philippines and National Building Code of the Philippines

DOH Administrative Order No. 70- Series of 2002 “ Revised Rules and Regulations Governing the Registration, Licensure and Operation of Hospitals and Other Health Facilities in the Philippines

The Manuals on Hospital Waste Management and Health Facilities Maintenance are also required for submission for verification by the DOH- Bureau of Health Facilities and Services (BHFS)

DOH Administrative Order No. 70- Series of 2002 “ Revised Rules and Regulations Governing the Registration, Licensure and Operation of Hospitals and Other Health Facilities in the Philippines

Requires HCF to submit a health care waste management Plan to

BHFS as one of its requirements for the issuance of license to

operate

DOH Administrative Order No. 2005-0029 dated December 12,2005 “Amendment to A.O. No. 70 series of 2002 re: Revised Rules and Regulations Governing the Registration, Licensure and Operation of Hospitals and other Health Facilities in the Philippines

Requires written procedures for the proper disposal of health care waste and

other hazardous substances and required written policy guidelines on

biosafety and biosecurity

DOH Administrative Order No. 2007-0026 dated August 22, 2007 “Revised Rules and Regulations Governing the Licensure and Regulation of Clinical Laboratories in the Philippines”

Requires the registration of waste generators, waste transporters and operators of toxic and hazardous waste facilities with the EMB

Republic Act No. 6969 “An Act to Control Substances and Hazardous and Nuclear Waste” (1990)

The waste generators are required to ensure that their hazardous wastes are properly collected, transported, treated and disposed in a sanitary landfill

Republic Act No. 6969 “An Act to Control Substances and Hazardous and Nuclear Waste” (1990)

Procedural Manual requires a comprehensive documentation on the legal and technical requirements of hazardous waste management

DENR Administrative Order No. 36- Series of 2004 “Revising DENR Administrative Order 29-Series of 2002, to Further Strengthen the Implementation of R.A 6969 and Prescribing the Use of the Procedural Manual”

1. Classification of hazardous wastes

2. Waste generators

3. Waste Transporters

4. Storage and labelling

5. Treatment, Storage and Disposal (TSD) Facilities

6. Manifest system

7. Monitoring

8. Prohibited Acts

9. Schedule of fees

10. Import of recyclable materials containing hazardous substances and export of hazardous waste

DENR Administrative Order No. 36- Series of 2004 “Revising DENR Administrative Order 29-Series of 2002, to Further Strengthen the Implementation of R.A 6969 and Prescribing the Use of the Procedural Manual”

Harmonize the efforts of DENR and DOH on HCWM

DOH- DENR Joint Administrative Order No. 02 series of 2005 dated August 24, 2005 “ Policies and Guidelines on Effective and Proper Handling, Collection, Transport, Treatment, Storage and Disposal of HCW”

Provide guidelines to generators, transporters, and operators/owners of TSD Facilities on the proper handling, collection, transport, storage, treatment and disposal of Health Care Wastes (HCW)

DOH- DENR Joint Administrative Order No. 02 series of 2005 dated August 24, 2005 “ Policies and Guidelines on Effective and Proper Handling, Collection, Transport, Treatment, Storage and Disposal of HCW”

Clarify jurisdiction, authority and responsibility of DENR and DOH regard to health care waste management (HCWM)

DOH- DENR Joint Administrative Order No. 02 series of 2005 dated August 24, 2005 “ Policies and Guidelines on Effective and Proper Handling, Collection, Transport, Treatment, Storage and Disposal of HCW”

Requires the manufacturers, importers, and distributors including generators of HCW that sell and/or use equipment and devices treating sharps, pathological and infectious waste to secure a Certificate of Product Registration (CPR) from DOH through the Bureau of Health Devices and Technology

DOH Administrative Order 2007-0014 “ Guidelines on the Issuance of Certificate of Product Registration for Equipment or Devices Used for Treating Sharps, Pathological and Infectious Waste”

Prohibits the incineration of bio-medical waste effective July 17, 2003

Republic Act No. 8749 (The Philippine Clean Air Act of 1999)

Promotes the use of state-of-the-art, environmentally-sound and safe non-burn technologies for handling, thermal destruction, utilization and disposal of sorted, unrecycled, biomedical and hazardous wastes

Republic Act No. 8749 (The Philippine Clean Air Act of 1999)

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

Republic Act No. 9003 “Ecological Solid Waste Management Act of 2000”

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

 Republic Act No. 9275 “ The Philippine Clean Water Act of 2004”

Further strengthens the power and functions of LLDA to include environmental protection and jurisdiction over surface waters of the Laguna Lake basin

Presidential Decree 813 (1975) and Executive Order 927 (1983) “ Strengthening the Functions of Laguna Lake Development Authority (LLDA)”

Through E.O 927, LLDA is empowered to issue permits for the use of the surface waters within Laguna de Bay

Presidential Decree 813 (1975) and Executive Order 927 (1983) “ Strengthening the Functions of Laguna Lake Development Authority (LLDA)”

Constructions of any 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

Presidential Decree 856 “ The Code on Sanitation of the Philippines- Chapter XVII on Sewage Collection and Excreta Disposal” (1998)

Plans of individual sewage or sewage system and the sub-surface absorption system or other treatment

Presidential Decree 856 “ The Code on Sanitation of the Philippines- Chapter XVII on Sewage Collection and Excreta Disposal” (1998)

Location of any toilet or sewage disposal system in relation to a source of water supply

Presidential Decree 856 “ The Code on Sanitation of the Philippines- Chapter XVII on Sewage Collection and Excreta Disposal” (1998)

Discharge of untreated effluent from septic tanks and/or sewage treatment plants to bodies of water

Presidential Decree 856 “ The Code on Sanitation of the Philippines- Chapter XVII on Sewage Collection and Excreta Disposal” (1998)

Manufacture of Septic Tanks

Presidential Decree 856 “ The Code on Sanitation of the Philippines- Chapter XVII on Sewage Collection and Excreta Disposal” (1998)

Method of disposal of sludge from septic tanks or other treatment plants

Presidential Decree 856 “ The Code on Sanitation of the Philippines- Chapter XVII on Sewage Collection and Excreta Disposal” (1998)

Require individuals, firms, public and private operators, owners and administrators engaged in desludging, collection , handling and transport, treatment and disposal of domestic sewage treatment plants/ facilities and septage from house septic tanks to secure environmental sanitation clearances from DOH

Rules and Regulations Governing the Collection, Handling, Treatment and Disposal of Domestic Sludge and Septage (2004), a “Supplement to IRR of the Chapter XVII on Sewage Collection and Disposal and Excreta Disposal and Drainage of 1998”

Require cities and municipalities to provide an adequate and efficient system of collecting, transporting and disposing refuse in their areas of jurisdiction

Chapter XVIII of P.D 856 “ The Code of Sanitation of the Philippines” on Refuse Disposal (1998)

Also require occupants of buildings, institution such as hospitals and residences to provide sufficient number of receptacles for refuse

Chapter XVIII of P.D 856 “ The Code of Sanitation of the Philippines” on Refuse Disposal (1998)

Designed to guide private and public service providers as well as government regulators towards effective sludge and septage management program in the country

Operation Manual on the Rules and Regulations Governing Domestic Sludge and Septage (June 2008)

Provides detailed procedures and forms which need to comply with the IRR governing the collection, handling, transport, treatment, and disposal of domestic sludge and septage

Operation Manual on the Rules and Regulations Governing Domestic Sludge and Septage (June 2008)

Implemented a new restriction on open viewing of remains when the individual’s death was caused by certain communicable disease

A.O 2010-0033 “Revised Implementing Rules and Regulations of P.D 856 Code on Sanitation of the Philippines, Chapter XXI on Disposal of Dead Persons”(December 2010)

Explicitly States, “The remains shall be placed in a plastic cadaver bag or other durable airtight container at the point of death and a biohazard tag attached, provided that, this container shall not be opened for viewing or any other purpose prior to burial or cremation

A.O 2010-0033 “Revised Implementing Rules and Regulations of P.D 856 Code on Sanitation of the Philippines, Chapter XXI on Disposal of Dead Persons”(December 2010)

Governs the discharge of potentially polluting substances to air and water

Presidential Decree 984 “ Providing for the Revision of R.A 3931, Commonly known as the Pollution Control Law and for Other Purposes” (1976)

Provides basis for the DENR regulations on water pollution through its IRR, DENR A.O Nos 34 and 35

Presidential Decree 984 “ Providing for the Revision of R.A 3931, Commonly known as the Pollution Control Law and for Other Purposes” (1976)

The IRR for air emission was initially set by DENR A.O No 14 but was later replaced by Clean Air Act of 1999 (R.A 8749)

Presidential Decree 984 “ Providing for the Revision of R.A 3931, Commonly known as the Pollution Control Law and for Other Purposes” (1976)

Classified bodied of water according to their designated uses and did not preclude use of the bodies of water for other purposes that are lower than the classification provided that such use does not prejudice quality required for such waters

DENR Administrative Order No. 34 series of 1990 “Revised Water Usage and Classification/ Water Quality Criteria Amending Sections No. 68 and 69, Chapter III of the 1978 National Pollution Control Commission (NPC now EMB) Rules and Regulations”

Lists their effluent regulations for the different levels of pollutants according to their water category/class

DENR Administrative Order No. 35 series of 1990 “Effluent Regulations”

Requires the appointment/ designation of a Pollution Control Officer (PCO) and lists the qualifications, reporting requirements and duties and responsibilities of accredited PCOs.

DENR Administrative Order No. 26 series of 1992 “Amending Memorandum Circular No. 2 series of 1981: Appointment/ Designation of Pollution Control Officers”

Requires projects like construction of new hospital building or expansion of existing hospitals to secure an Environmental Compliance Commitment (formerly Environmental Compliance) Certificate (ECC) prior to the construction and operation of the facility

Presidential Decree No. 1586 “Environmental Impact Statement (EIS) System” (1978)

An ECC is required for the installation and operation of HCW treatment like pyrolysis, autoclave, microwave and other treatment technology including landfills

Presidential Decree No. 1586 “Environmental Impact Statement (EIS) System” (1978)

Aims to provide:

a) Promote the culture of making environmentally informed decisions in

the government especially in the purchase and use of different products

b) Include environmental criteria in public tenders whenever possible and

practicable

c) Establish the specifications and requirements for products or services to

be considered environmentally advantageous

d) Develop incentive programs for suppliers of environmentally

advantageous products or services

Executive Order No. 301 “Establishing a Green Procurement Program for All Departments, Bureaus, Offices and Agencies of the Executive Branch of Government” (2004)

Requires all HCF to gradually phaseout the use of mercury-containing

devices and equipment

DOH Administrative Order No. 2008-0021 dated July 30, 2008 “Gradual Phaseout of Mercury in all Philippine Health Care Facilities and Institutions”

Initial targets of the phaseout are mercury thermometers and sphygmomanometers in HCF

DOH Administrative Order No. 2008-0021 dated July 30, 2008 “Gradual Phaseout of Mercury in all Philippine Health Care Facilities and Institutions”

Provides the detailed guidelines on the temporary storage of mercury-containing devices and the management of mercury spills to enhance patient safety measures in HCF, to protect health care workers from potential hazards from mercury exposures and to minimize the accumulation of mercury in the environment

Department Memorandum No. 2011-0145 “ Guidelines for Temporary Storage of Mercury Waste in HCF in Accordance with AO No. 0021 s.2008 on the Gradual Phaseout of Mercury in All Philippine Health Care Facilities and Institutions”

Requires the establishment and maintenance of a culture of patient safety in HCF as the responsibility of its leader

DOH Administrative Order No. 2008-0023 dated July 30, 2008 “National Policy on Patient Safety”

HCF shall ensure that an enabling mechanism/ strategy is in place to ensure patient safety

DOH Administrative Order No. 2008-0023 dated July 30, 2008 “National Policy on Patient Safety”

The key priority areas in patient safety include ( but not limited

to):

• Proper patient identification

• Assurance of blood safety

• Safe clinical and surgical procedures

• Provision and maintenance of safe quality drugs and technology

• Strengthening infection control standards

• Maintenance of the environment of care standards

• Energy and waste management standards

DOH Administrative Order No. 2008-0023 dated July 30, 2008 “National Policy on Patient Safety”

Serves as a reference for HCF administrators in the implementation of an effective and efficient waste management program

DOH “ Manual on Health Care Waste Management” in 2011 (Revising the 2007 Health Care Waste Management Manual)

The requirement for doing such are provided in the manual by listing the standards of performance, defining the mandatory requirements, providing new concepts and citing examples and tools

DOH “ Manual on Health Care Waste Management” in 2011 (Revising the 2007 Health Care Waste Management Manual)

The manual is designed to be used by all workers within the HCF

DOH “ Manual on Health Care Waste Management” in 2011 (Revising the 2007 Health Care Waste Management Manual)

Includes health care waste management as one of its parameters in quality assurance of healthcare

PhilHealth Benchbook for Quality Assurance in Health Care (2006)

Contain guidelines on the proper inventory and destruction of bottles and vials

BFAD Memorandum Circular No. s1994 “ Inventory, Proper Disposal and/or Destruction of Vials or Bottles” and BFAD Bureau Circular No 16, s1999 “Ammending BFAD MC No.22 dated September 8, 1994, Regarding Inventory, Proper Disposal and/or Destruction of Vials or Bottles