TOPIC PMLS VIII: HEALTHCARE WASTE MANAGEMENT

HEALTHCARE WASTES

• Diagnosis, treatment and immunization of humans;

• Research pertaining to diagnosis, treatment and

immunization of humans;

• Research using laboratory animals geared towards

improvement of human health

• Production and testing of biological products; and

• Other activities performed by a healthcare facility that

generate wastes

Healthcare Waste Generators

- all healthcare facilities, institutions, business

establishments, and other spaces where healthcare

services are offered with activities or work processes

that generate healthcare wastes

• Hospitals & medical centers

• Infirmaries

• Birthing homes

• Clinics & other health- related facilities

• Laboratories & research centers

• Drug manufacturers

• Institutions

• Mortuary & autopsy centers

Healthcare Waste Generators

● Infectious Waste

● Sharps

● Pathological and Anatomical Waste

● Pharmaceutical Waste

● Chemical Waste

● Radioactive Waste

● Non-hazardous or general waste

CATEGORIES OF HEALTHCARE

WASTES

Infectious Waste

- refers to all wastes suspected to contain pathogens

or toxins in sufficient concentration that may cause

disease to a susceptible host.

- refers to all wastes suspected to contain pathogens

or toxins in sufficient concentration that may cause

disease to a susceptible host.

- refers to tissue sections and body fluids or organs

derived from biopsies, autopsies or surgical

procedures sent to the laboratory for examination

Anatomical waste:

a subgroup of pathological waste

that refers to recognizable body parts usually from

amputation procedures

Sharps

• cuts, pricks or puncture wounds

• most dangerous healthcare waste

Chemical Waste

refers to discarded chemicals

• Toxic

• Corrosive

• Flammable

• Reactive

Considered hazardous

Pharmaceutical Waste

- refers to expired, spilt, and contaminated

pharmaceutical products, drugs, and vaccines

including discarded items used in handling

pharmaceuticals

Radioactive Waste

- refers to wastes exposed to radionuclides including

radioactive diagnostic materials or radiotherapeutic

materials

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

plastic products including polyethylene

terephthalate (PET) plastic water bottles, aluminum

containers, scrap wood, etc.

Biodegradable

leftover food from non- infectious patients,

garden wastes, etc.

Non- recyclable/ Non- biodegradable

Cannot be classified into either of the first two categories

IMPACT OF HEALTHCARE

WASTES

Adverse health outcomes associated with healthcare

wastes

• Sharp- inflicted injuries

• Toxic exposure to antibiotics and cytotoxic drugs

• Chemical burns from disinfection or sterilization, etc.

IMPACT OF HEALTHCARE

WASTES

Guidelines in the Treatment &

Disposal of Healthcare Wastes

• untreated healthcare wastes in landfills can lead to the contamination

• treatment of healthcare wastes with chemical disinfectants can result in the release of

  chemical substances into the environment

• Incinerated materials containing or treated with chlorine can generate dioxins

  and furans,

850°C to 1100°C

disposal of healthcare waste by incineration is NOT allowed in the

Philippines.

autoclaving, microwaving, and steam treatment

A. International agreements pertaining to health care waste management

B. Philippine laws and policies on health care waste management

Legislation, Policies, and Guidelines

Governing Healthcare Wastes

B. Philippine laws and policies on health care waste management

4. RA 9003 “Ecological Solid Waste Management Act of 2000“

B. Philippine laws and policies on health care waste management

13. DOH Health Care Waste Management Manual Fourth Edition 2020

Health care waste

generated by health care facilities follow a well defined flow from the point of generation down to the treatment and disposal

Waste management hierarchy

IT IS HIGHLY PREFERABLE TO PREVENT THE GENERATION OF WASTE AND TO REDUCE THE QUANTITY ofgenerated waste by using different methods

1. Reusing

2. Recycling

3. Recovering Wastes

3 types of waste management hierarchy

More Preferable Prevent Green Procurement

Reduce

Reuse Ressource Development

Recycle

Recover

Treat End of Pipe

Least Preferable Dispose

HEALTHCARE WASTE

MANAGEMENT SYSTEM

WASTE MINIMIZATION

the most important step in the proper managemmet of health care waste

Waste prevention/avoidance

Waste reduction

waste minimization involves two aspects

Waste prevention/avoidance

Waste reduction

it is the highest priority and its goal is to maximize efficiency and avoid unnecessary consumptions.

01 Selecting items with the least packaging or that require the fewest resources to produce

02 Avoiding disposable goods or single-use materials

03 Buying products that are re-usable, repairable, refillable, recycled or recyclable

WASTE HIERARCHY GREEN PROCUREMENT BEHAVIORS TO MAXIMIZE EFFICIENCY & UNNECESSARY CONSUMPTION

• The second priority

• maximizes options for REUSING, RECYCLING & RECOVERING WASTES

WASTE HIERARCHY RESOURCE DEVELOPMENT • RESOURCE DEVELOPMENT

1 REUSING

2 RECYCLING

3 RECOVERY

WASTE HIERARCHY RESOURCE DEVELOPMENT

1 REUSING

-Refers to either finding a new application for a used material or using the same product for the same application repeatedly -Example: Laboratory glassware like glass culture tubes can be used repeatedly after decontamination

2 RECYCLING

-Refers to the processing of used materials into new products -Example: Computer printouts from the hospital can be sold and recycled into new paper products.

3 RECOVERY

-It is defined in two ways:

(1) Energy recovery - waste is converted to fuel for generating electricity or for direct heating of premises

(2) as a term used to encompass three subsets of waste recovery

Energy recovery

- waste is converted to fuel for generating electricity or for direct heating of premises

Waste Hierarchy

is implemented for wastes that can't be safely reused, recycled or recovered

• WASTE TREATMENT

• WASTE DISPOSAL

• It has two aspects:
Waste Hierarchy

• WASTE TREATMENT

process of changing the biological and chemical chatacteristics 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.

REDUCTION AT SOURCE

REUSE

RECYCLING

SEGRAGATION OF WASTE

COMPOSTING

PRINCIPLES OF WASTE MINIMIZATION

REDUCTION AT SOURCE

-involves measures that either completely eliminate use of a material or generate less waste.

REUSE

- entails the selection of reusable rather than disposable products whenever possible - reuse also entail setting reliable standards for disinfection and sterilization of equipment and materials use

03 RECYCLING

-is collecting waste and processing it into something new.

SEGRAGATION OF WASTE

-an important step in waste management

COMPOSTING

-an important strategy to minimize waste such as food discards, kitchen waste, cardboard and yard waste -techniques range from simple un-aerated static piles to aerated windrows to more advanced methods such as vermi-composting. -the resulting rich compost can be sold or donated to local farmers and gardeners or used for plants around the health care facility grounds.

• Highly infectious waste must be disinfected at source

• Anatomical waste including recognizable body parts, placenta, waste and organs should be disposed through sage burial or cremation

• Pathological waste must be refrigerated if not

• Sharps must be shredded or crushed before they

• Chemicals and pharmaceutical wastes shall be segregated and collected separately.

• Radioactive waste has to be decayed to background radiation levels.

• All waste bins must be properly covered to prevent cross contamination • Aerosol containers can be collected with the general waste.

Practices for the Implementation of Color-Coding Scheme for Healthcare Waste

INFECTIOUS WASTE

PATHOLOGICAL & ANATOMICAL WASTE

SHARPS

CHEMICAL WASTE

PHARMACEUTICAL WASTE

RADIOACTIVE WASTE

GENERAL WASTE

COLOR CODING SCHEME FOR HEALTHCARE WASTES

INFECTIOUS WASTE

• Strong leak-proof bin with cover labelled "INFECTIOUS" with Biohazard symbol INFECTIOUS • Liner is yellow plastic

GENERAL WASTE

• Strong leak-proof bin with cover labelled "PATHOLOGICAL/ANATOMICAL" with Biohazard symbol • Liner is yellow plastic

SHARPS

• Puncture-proof container with wide mouth and cover labelled "SHARPS" with biohazard symbol • Liner is not applicable

CHEMICAL WASTE

• Labelled "CHEMICAL WASTE"; For liquid chemical waste, inside the bin is a disposable bottle made of amber-colored glass with at least 4 liters capacity that is string, chemical-resistant and leak-proof

• Liner is Yellow with black band plastic

PHARMACEUTICAL WASTE

• 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 is yellow with black band plastic

RADIOACTIVE WASTE

• Radiation proof repositories, leak-proof and lead- lined container labelled with name of radionuclide and date of deposition with radiation symbol • Liner is orange plastic

GENERAL WASTE

• Optional recycle symbol for recyclable non-hazardous wastes, varying sizes depending on the volume of waste • Liner is black or colorless plastic for non-biodegradable & green for biodegradable

STORAGE

• Waste should be collected and stored in waste storage area until transported to a designated off-site treatment facility. This area shall be marked with warning sign: "CAUTION: "BIOHAZARDOUS WASTE STORAGE AREA- UNAUTHORIZED PERSONS KEEP OUT."

TREATMENT & DISPOSAL OF WASTE

• Proper waste treatment is necessary to ensure that wastes do not pose harm to people and the environment

1. PYROLYSIS

2. AUTOCLAVE

3. MICROWAVE

4. CHEMICAL DISINFECTION

5. BIOLOGICAL PROCESS

6. ENCAPSULATION

7. INERTIZATION BIOHAZARD

The following are the acceptable technologies & methods used in the treatment of Health care wastes.

PYROLYSIS

AUTOCLAVE

MICROWAVE

CHEMICAL DISINFECTION

BIOLOGICAL PROCESS

ENCAPUSALTION

INERTIZATION

WASTE TREATMENT TECHNOLOGIES & METHODS

PYROLYSIS

-is the thermal decomposition of wastes in the absence of supplied molecular oxygen in the destruction chamber where the waste is converted into gaseous, liquid and solid form -waste residues may be in the form of greasy aggregates or slugs or carbon black and are disposed to landfills.

AUTOCLAVE

-is the use of steam sterilization to render waste harmless and is an efficient wet thermal disinfection process. - this method of using pressure and heat is widely used and the usual setting is at 121°C with a pressure of 15 psi for 15-30 minutes.

MICROWAVE

- incorporates some type of size reduction device -Shredding of wastes is being done either before disinfection or after disinfection. In this process, waste is exposed to microwave that raises the temperature to 100° (237.6°F) for at least 30 minutes. -Microorganisms are destroyed by moist heat which irreversibly coagulates and denatures

CHEMICAL DISINFECTION

-chemicals like NaCIO, H2O2, Peroxyacetic acid and heated alkali are added to wastes to kill or inactivate present pathogens. -it is recommended to use 5% NaCIO for chemical disinfectant

BIOLOGICAL PROCESS

-uses an enzyme mixture to decontaminate wastes. -the resulting by-product is put through an extruder to remove water for wastewater disposal. -this is suited for large applications and is also being developed for possible use in the agricultural sector.

ENCAPUSALTION

- Filling of containers with waste, adding and immobilizing material and sealing containers -the process uses either cubic boxes made of high-density polyethylene or metallic drums.

INERTIZATION

- a process that involves mixing of the waste with cement and other substances before disposal. - Thiroue ize the is of toxic substances contained in the waste migrating into surface water

LANDFILL

• After treatment, this is where wastes are usually disposed

• it is an engineered site designed to keep waste isolated from environment

• it should have a proper permit from DENR before accepting wastes

• For healthcare facilities with no access to landfills, disposal is usually through SAFE BURIAL.