Healthcare Waste Management (Book)

Hazardous

Hazardous

Classification of waste

• All waste materials that are contaminated by infectious microorganisms or chemicals

• Used cotton, specimen container, gauze pad, syringe needles, and culture plates.

• Has a potential threat in our health

Explosivity and Reactivity

Classification of waste

• Unstable and reacts violently to chemical changes

• Can cause explosion or releases toxic fumes when mixed with water

Corrosivity

Classification of waste

• Waste that needs to be separated from other wastes, due to corrosiveness to steel

• Reagents are too acidic (pH < 2) or too alkaline (pH >12.5)

Toxicity

Classification of waste

• Can cause acute health effect such as rashes, skin irritation, headache, nausea or burns

• Can cause chronic health effects such as liver failure, stunted growth and development

• Some substance contains carcinogens

• Carcinogens – a substance capable of causing cancer in living tissue.

Ignitability

Classification of wastes

• Waste that can cause fire during waste disposal and storage conditions

• Flash point – lowest temperature, at which a chemical produces vapor to cause ignition

Laboratory Wastes

• Infectious

• Pathological

• Radioactive

• Chemical

• Biomedical

Infectious

Categories of Healthcare wastes

• Waste suspected to contain pathogens

• Examples: laboratory cultures; waste from isolation wards; tissues (swabs), materials, or equipment that have been in contact with infected patients; excreta

Pathological Waste

Categories of Healthcare wastes

• Human tissues or fluids

• Examples: body parts, blood and other body fluids, fetuses

Sharps

Categories of Healthcare wastes

• Sharp waste

• Examples: needles, infusion sets, scalpels, knives, blades, and broken glass

Pharmaceutical Waste

Categories of Healthcare wastes

• Waste containing pharmaceuticals

• Examples: pharmaceuticals that are expired or no longer needed; items contaminated by or containing pharmaceuticals (bottles, boxes)

Genotoxic Waste

Categories of Healthcare wastes

• Waste containing substances with genotoxic properties

• Examples: waste containing cytostatic drugs (often used in cancer therapy)

Chemical Waste

Categories of Healthcare wastes

• Waste containing chemical substances

• Examples: laboratory reagents; film developer, disinfectants that are expired or no longer needed, solvents

Wastes with high content of heavy metal

Categories of Healthcare wastes

• Examples: batteries, broken thermometers, blood-pressure gauges

Pressured Containers

Categories of Healthcare wastes

• Examples: gas cylinders, gas cartridges, aerosol cans

Radioactive Waste

Categories of Healthcare wastes

• Waste containing radioactive substances

• Examples: unused liquids from radiotherapy or laboratory research, contaminated glassware, packages, or absorbent paper, urine and excreta from patients treated or tested with unsealed radionuclides, sealed sources.

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

Republic Act No. 4226

• Also known as “Hospital Licensure Act” (1965)

• Act that requires the registration and licensure of all hospitals in the country

Republic Act No. 6969

• Also known as “An Act to Control Substances and Hazardous and Nuclear Wastes” (1990)

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

Republic Act No. 8749

• Also known as “The Philippine Clean Air Act of 1999”

• Prohibits incineration of bio-medical wastes.

Republic Act No. 9003

• “Ecological Solid Waste 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 No. 9275

• Also known as “The Philippine Clean Water Act of 2004”

• Protection, preservation and revival of the quality of the country’s fresh, brackish, and marine waters

Presidential Decree 813 (1975) and Executive Order 927 (1983)

• Also known as “Strengthening the Functions of Laguna Lake Development Authority (LLDA)”

• Environmental protection and jurisdiction over surface waters of the Laguna Lake basin.

Presidential Decree 856

• Also known as “The Code on Sanitation of the Philippines – Chapter XVII on Sewage Collection and Excreta Disposal”(1998)

• Approval of DOH regarding toilets, sewage systems, and septic tanks

Presidential Decree No. 984

• Also known as “Providing for the Revision of R.A 3931, Pollution Control Law, and for other purposes”(1976)

• Governs discharge of potentially polluting substances to air and water.

Presidential Decree No. 1586

• Also known as “Environmental Impact Statement (EIS) System”(1978)

• Requires projects to secure Environmental Compliance Commitment Certificate (ECC)

DOH Administrative Order No. 2008-0021

Dated July 30, 2008 “Gradual Phaseout of Mercury in all Philippine Health Care Facilities and Institution”

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 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.

Infectious waste/Pathological and Anatomical waste

Segregation (Bins)

• Yellow plastic that can withstand autoclaving with 0.009mm thickness

Sharps

Segregation (Bins)

• Puncture-proof container with wide mouth, biohazard symbol

Chemical waste

Segregation (Bins)

• 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.

Pharmaceutical waste

Segregation (Bins)

• Strong leak-proof bin.

• Liner is yellow with black band plastic with 0.009mm thickness

Radioactive waste

Segregation (Bins)

• Radiation proof repositories, leakproof, and lead-lined container labelled with name of radionuclide.

• Orange plastic with 0.009mm thickness

General waste

Segregation (Bins)

• Black or colorless plastic for nonbiodegradable and;

• Green for biodegradable with a thickness of 0.009mm.

Pyrolysis

Treatment of Healthcare Wastes

• 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

Autoclave

Treatment of Healthcare Wastes

• 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.

Microwave

Treatment of Healthcare Wastes

• Temperature of 100°C for at least 30 minutes.

• Microorganisms are destroyed by moist heat which irreversibly coagulates and denatures enzymes and structural proteins.

Chemical Disinfection

Treatment of Healthcare Wastes

• 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.

Biological Process

Treatment of Healthcare Wastes

• Enzyme mixture to decontaminate wastes.

• Resulting by-product is put through an extruder to remove water.

Encapsulation

Treatment of Healthcare Wastes

• Filling of containers with waste and sealing the containers.

• Uses either cubic boxes made of high-density polyethylene or metallic drums, that are threequarters 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.

Inertization

Treatment of Healthcare Wastes

• 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

Landfill

Disposal of Healthcare Wastes

• 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.