PMLS CHAPTER 12

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.

INFECTIOUS WASTE

refers to all wastes suspected to
contain pathogens or toxins in sufficient concentration
that may cause disease to a susceptible host.
• It includes discarded materials or equipment used for
diagnosis, treatment, and management of patients with
infectious diseases.

PATHOLOGICAL AND ANATOMICAL WASTE

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

SHARPS

refer to waste items that can cause cuts, pricks,
or puncture wounds.
• They are considered the most dangerous health care
waste because of their potential to cause both injury and
infection.

CHEMICAL WASTE

refers to discarded chemicals (solid,
liquid, or gaseous) generated during disinfection and
sterilization procedures.
• It also includes wastes with high content of heavy metals
and their derivatives.
• Common examples of this type of waste are laboratory
reagents, X-ray film developing solutions, disinfectants
and soaking solutions, used batteries, concentrated
ammonia solutions, concentrated hydrogen peroxide,
chlorine, and mercury from broken thermometers and
sphygmomanometers.

Acids

Acetic, chromic, hydrochloric, nitric,
sulfuric

Alcohols

Ethanol, isopropanol, phenols

Aldehydes

Formaldehyde, glutaraldehyde, orthophthaladehyde

Bases

Ammonium hydroxide, potassium
hydroxide, sodium hydroxide, sodium
bicarbonate

Halogenated
disinfectants

Calcium hypochlorite, chlorine dioxide,
iodine solutions, iodophors, sodium
dichloroisocyanurate, sodium hypochlorite
(bleach)

Halogenated
solvents

Chloroform, methylene chloride,
perchloroethylene, refrigerants,
trichloroethylene

Metals

arsenic, cadmium, chromium, lead,
mercury, silver

Nonhalogenated
solvents

acetone, acetonitrile, ethanol, ethyl
acetate, formaldehyde, isopropanol,
methanol, toluene, xyelenes

Other
disinfectants

hydrogen peroxide, peroxyacetic acid,
quaternary amines

Oxidizers

hydrogen peroxide, potassium dichromate,
potassium permanganate

Reducers

sodium bisulfite, sodium sulfite

Miscellaneous

anesthetic gases, asbestos, ethylene
oxide, herbicides, paints, pesticides, waste
oils

PHARMACEUTICAL WASTE

refers to expired, split, and
contaminated pharmaceutical products, drugs, and
vaccines including discarded items used in handling
pharmaceuticals.
• It includes antineoplastic, cytotoxic and genotoxic wastes
such as drugs used in oncology or radiotherapy, and
biological fluids from patients treated with the said drugs.

) RADIOACTIVE WASTE

refers to wastes exposed to
radionuclides including radioactive diagnostic materials
or radiotherapeutic materials.
• Residues from shipment of radioactive materials and
unwanted solutions of radionuclides intended for
diagnostic or therapeutic use are examples of radioactive
wastes as well as liquids, gases, and solids contaminated
with radionuclides whose ionizing radiations have
genotoxic effects.

NON-HAZARDOUS OR GENERAL WASTE

refers to wastes that
have not been in contact with communicable or infectious
agents, hazardous chemicals, or radioactive substances,
and do not pose a hazard.

Recyclable wastes

in health care facilities such as:
§ Paper products such as used office paper,
computer printouts, and corrugated cardboard
boxes
§ Aluminum from beverage cans and other
aluminum containers
§ Pressurized gas containers such as oxygen
tanks
§ Plastic products including polyethylene
terephthalate (PET) plastic water bottles, plastic
milk containers, and polypropylene plastic
bottles for saline solutions and irrigation fluids
§ Glass such as used vials for sterile solutions
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§ Wood such as scrap wood and used wood
shipping pallets
§ Durable goods such as furniture and furnishings
§ Electronic devices such as used computer
equipment and print cartridges

Biodegradable health care wastes

such as leftover food from non-infectious patients and garden
wastes such as grass trimmings and tree cuttings

Non-recyclable/non-biodegradable health care
wastes

that cannot be classified into either of the first
two categories.

chronic exposure

(for prolonged periods in minute
quantities)

acute exposure

(for short periods in large
quantities)

THE MONTREAL PROTOCOL ON SUBSTANCES
THAT DEPLETE THE OZONE LAYER (1987)

was adopted in Montreal,
Canada on September 16, 1987 and came into force, as
agreed upon, on January 1, 1989.
• It sets the final objective of the Protocol to eliminate
ozone depleting substances in the environment.
• CFCs & Hydrochlorofluorocarbons (HFCs) – destroy the
earth’s ozone layers w/c shields the earth from UV rays
generated by the sun; they heat the lower atmosphere of
earth, changing the global climate

THE BASEL CONVENTION ON THE CONTROL
OF THE TRASBOUNDARY MOVEMENTS OF
HAZARDOUS WASTES AND THEIR DISPOSAL

s concerned with the
transboundary movements of hazardous waste.
• 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.

UNITED NATIONS FRAMEWORK CONVENTION
ON CLIMATE CHANGE (1992)

) includes a legally non-binding
pledge that by the year 2000, major industrialized nations
would voluntarily reduce their greenhouse gas emissions
to 1990 levels.

STOCKHOLM CONVENTION ON PERSISTENT
ORGANIC POLLUTANTS (2001)

is a global treaty to protect human
health and the environment from persistent organic
pollutants (POPs).
• POPs are chemicals that:
(1) remain unchanged in the environment for long
periods of time;
(2) accumulate in the fatty tissues of living organisms;
and
(3) are toxic to both humans and wildlife.

ASEAN FRAMEWORK AGREEMENT ON THE
FACILITATION OF GOODS IN TRANSIT

s 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.
• Specifically, the framework agreement includes Protocol
9 on Dangerous Goods à which provide provisions on
the transport of toxic and infectious substances.

REPUBLIC ACT NO. 4226 “HOSPITAL
LICENSURE ACT” (1965)

is 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.

DOH Administrative Order No. 70-

-A series of 2002
“Revised Rules and Regulations Governing the
Registration, Licensure, and Operation of Hospital
and Other Health Facilities in the Philippines” –
includes the 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. 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. 2005-0029

9 dated
December 12, 2005 “Amendment to Administrative
Order No. 70-A series of 2002 re: Revised Rules and
Regulations Governing the Registration, Licensure,
and Operation of Hospitals and Other Health
Facilities in the Philippines” – requires the 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. 2007-0027

dated
August 22, 2007 “Revised Rules and regulations
Governing the Licensure and Regulations of Clinical
Laboratories 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.

REPUBLIC ACT NO. 6969 (1990)

requires
the registration of waste generators, waste transporters,
and operators of toxic and hazardous waste treatment
facilities with the EMB.

DENR Administrative Order No. 36, Series of
2004 “

“Revising DENR Administrative Order No. 29,
Series of 1992, to Further Strengthen the
Implementation of Republic Act 6969 and
Prescribing the Use of the Procedural Manual” – the
Procedural Manual requires a comprehensive
documentation on the legal and technical
requirements of hazardous waste management. The
Manual does not include provisions regarding the
management of nuclear wastes. It is composed of
ten sections that discuss the:
(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, and
(10) import of recyclable materials containing
hazardous substances and export of hazardous
waste.

DOH-DENR Joint Administrative Order No. 02
series of 2005

dated August 24, 2005 entitled
“Policies and Guidelines on Effective and Proper
Handling, Collection, Transport, Treatment, Storage,
and Disposal of HCW” – aims to:
(a) provide guidelines to generators, transporters,
and disposal of health care waste (HCW);
(b) clarify the jurisdiction, authority, and responsibility
of DENR and DOH with regard to health care waste
management (HCWM); and
(c) harmonize the efforts of DENR and DOH on
HCWM.

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

REPUBLIC ACT NO. 8749 “THE PHILIPPINE
CLEAN AIR ACT OF 1999”

prohibits the incineration of bio-medical wastes
effective July 17, 2003.
• It promotes the use of state-of-the-art, environmentallysound, and safe non-burn technologies for the handling,
treatment, thermal destruction, utilization, and disposal of
sorted, unrecycled, biomedical, and hazardous wastes

REPUBLIC ACT NO. 9003 “ECOLOGICAL SOLID
WASTES 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.

REPUBLIC ACT 9275 “THE PHILIPPINE CLEAN
WATER ACT OF 2004”

” pursues a policy of economic growth in a manner
consistent with the protection, preservation, and revival of
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the quality of the country’s fresh, brackish, and marine
waters

PRESIDENTIAL DECREE 813 (1975) AND
EXECUTIVE ORDER 927 (1983)

“Strengthening the Functions of Laguna
Lake Development Authority (LLDA)” which further
strengthens the powers and function of the LLDA to
include environmental protection and jurisdiction over
surface waters of the Laguna Lake basin.
• Through E.O. 927, the LLDA is empowered to issue
permits for the use of surface waters within Laguna de
Bay.

PRESIDENTIAL DECREE 856

“The Code on Sanitation of
the Philippines – Chapter XVII on Sewage Collection
and Excreta Disposal” (1998) requires the approval of
DOH in terms of the following:
(1) constructions 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;
(2) plans of individual sewage or sewage system and the
sub-surface absorption system or other treatment
device;
(3) location of any toilet or sewage disposal system in
relation to a source of water supply;
(4) the discharge of untreated effluent from septic tanks
and/or sewage treatment plants to bodies of water;
(5) manufacture of septic tanks; and
(6) method of disposal of sludge from septic tanks or
other treatment plants.

PRESIDENTIAL DECREE NO. 984

“Providing for the
Revision of Republic Act No. 3931, Commonly known
as the Pollution Control Law, and for Other
Purposes” (1976) governs the discharge of potentially
polluting substances to air and water.

DENR Administrative Order No. 34, Series of 1990

“Revised Water Usage and
Classification/Water Quality Criteria Amending
Section Nos. 68 and 69, Chapter III of the 1978
National Pollution Control Commission (NPCC now
EMB) Rules and Regulations” – classified bodies of
water for the other purposes that are lower than the
classification, provided that, such sue does not
prejudice quality required for such waters.

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

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

DENR Administrative Order No. 26, Series of
1992

“Amending Memorandum Circular No. 02,
Series of 1981: Appointment/Designation of Pollution
Control Officers” – requires the
appointment/designation of a Pollution Control
Officer (PCO) and lists the qualifications, reporting
requirements, and duties and responsibilities of
accredited PCOs.

PRESIDENTIAL DECREE NO. 1586

“Environmental Impact
Statement (EIS) System” (1978) requires projects, like
the construction of new hospital buildings 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.

EXECUTIVE ORDER NO. 301

“Establishing a Green
Procurement Program for All Departments, Bureaus,
Offices, and Agencies of the Executive Branch of
Government”

DOH ADMINISTRATIVE ORDER NO. 2008-0021

“Gradual Phaseout of Mercury in all
Philippine Health Care Facilities and Institutions”
requires all health care facilities (HCF) to gradually
phaseout the use of mercury-containing devices and
equipment.
• The initial targets of the phaseout are mercury
thermometers and sphygmomanometers in the health
care facility.

Department Memorandum No. 2011-0145

“Guidelines for the Temporary Storage of Mercury
Wastes in HCF in Accordance with AO No. 0021, s.
2008 on the Gradual Phaseout of Mercury inn All
Philippines 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.

DOH ADMINISTRATIVE ORDER NO. 2008-0023

dated July
30, 2008 “National Policy on Patient Safety” requires
the establishment and maintenance of a culture of patient
safety in the HCF as the responsibility of its leaders.
• As such, HCF shall ensure that an enabling
mechanism/strategy is in place to ensure patient safety.
• The key priority areas in patient safety include, but are
not limited to:
o proper patient identification
o assurance of blood safety
o safe clinical and surgical procedures
o provision and maintenance of safe quality drugs and
technology
o strengthening infection control standards
o maintenance of the environment of care standards
o and energy and waste management standards.

DOH “MANUAL ON HEALTH CARE WASTE
MANAGEMENT” IN 2011

“Manual on Health Care Waste Management” in
2011 (Revising the 2007 Health Care Waste
Management Manual) serves as a reference for HCF
administrators in the implementation of an effective and
efficient waste management program.
• The requirements 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.
• The Manual is designed to be used by all workers within
the HCF.

) PHILHEALTH BENCHBOOK FOR QUALITY
ASSURANCE IN HEALTH CARE (2006)

includes health care waste
management as one of its parameters in the quality
assurance of healthcare.

BFAD MEMORANDUM CIRCULAR NO. 22,
SERIES OF 1994

“Inventory, Proper Disposal, and/or Destruction of
Used Vials or Bottles” and BFAD Bureau Circular No.
16, Series of 1999: “Amending BFAD MC No. 22 dated
September 8, 1994, Regarding Inventory, Proper
Disposal, and/or Destruction of Used Vials or
Bottles” – these circulars are released to prevent the
proliferation of adulterated, misbranded, and counterfeit
drugs brought about by the recycling of used
pharmaceutical bottles and vials.
• It contains the guidelines on the proper inventory and
destruction of bottles and vials.

Reusing

refers to either finding a new application for
a used material or using the same product for the same
application repeatedly.
o Safety and efficiency, however, should be
considered when reusing medical items and devices.
o For example, laboratory glassware like glass culture
tubes can be used repeatedly after decontamination

• Recycling

refers to the processing of used material
into new products.

• Waste treatment

à is the process of changing the
biological and chemical characteristics of waste to
minimize its potential to cause harm.

Waste disposal

on the other hand, refers to
discharging, depositing, placing, or releasing any health
care waste into air, land, or water.

Segregation

is the process of separating different
types of waste at the point of generation until their final
disposal.

PYROLYSIS

is 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.

AUTCLAVE

is the use of steam sterilization to render
waste harmless and is an efficient wet thermal
disinfection process

MICROWAVE

is a technology that typically incorporates
some type of size reduction device

BIOLOGICAL PROCESS

uses an enzyme mixture to
decontaminate health care wastes

CHEMICAL DISINFECTION

chemicals like sodium
hypochlorite, hydrogen peroxide, peroxyacetic acid, and
heated alkali are added to health care wastes to kill or
inactivate present pathogens.

ENCAPSULATION

involves the filling of containers with
waste, adding and immobilizing material, and sealing the
containers.

Inertization

is especially suitable for pharmaceutical
waste that involves the mixing of waste with cement and
other substances before disposal.