Chapter 2

REVIEW OF RELATED LITERATURES AND STUDIES

This chapter presents the relevant literature and studies local or foreign taken from some

books, journals, published thesis and dissertation, and from the internet.

Related Literatures

A. Local Literatures

Biohazardous waste is any waste in the form of solid or liquid, including its containers

and any product, which are generated during the treatment, diagnosis and immunization of

human beings and animals in research. Basically biohazardous wastes refer to all wastes

produced which are discarded and not intended for any further use in hospitals.

These wastes represent a relatively small portion of the total solid waste stream, and are

simple to identify, to separate, and to treat properly. Hospital wastes include sharps like

hypodermic syringes, glass slide, and scalpels, and human or animal tissue or excretion, medical

products like including swabs and dressings, etc.

According to the Republic Act 6969: An Act to Control Toxic Substance and Hazardous

and Nuclear Wastes─ This law sets policies and guidelines on the importation, manufacture,

processing, handling, storage, transportation, sale, distribution, use, and disposal of toxic

substances, and hazardous and nuclear wastes. Many of the requirements of the Revised Health

Care Waste Management Manual (RHCWMM) are drawn from the revision of this law.
 The effective management of Health Care Waste considers the basic elements of waste

minimization, segregation and proper identification of the waste. Appropriate handling,

treatment and disposal of waste by type reduce costs and do much to protect public health.

Segregation at source shall always be the responsibility of the waste generator.

Segregation shall take place as close as possible to where the waste is generated and shall

be maintained in storage areas and during transport.

Segregation is the process of separating different types of waste at the point of generation

until its final disposal. Appropriate resource recovery and recycling technique can be applied to

each separate waste stream. Moreover, the amount of hazardous waste that needs to be treated

will be minimized or reduced subsequently prolonging the operational life of the disposal facility

and may gain benefit in terms of conservation of resources.

Segregation is the separation of the entire waste generated from the Health Care Facility

according to the specific treatment and disposal requirements. Depending on the type of facility,

10% - 25% of waste generated by Health Care Facility is considered hazardous. On the other

hand, the hazardous waste produced by Health Care Facilities in the Philippines is around 30%

(ADB, 2003).

Hazardous wastes generated require special treatment methods for the safety of Health

Care Facility workers, patients, visitors and the general public. Segregating the hazardous waste

will significantly reduce the waste management costs.

Segregation of waste must be strictly implemented at source. It must be applied from the

point of generation, during collection, transport, storage and at the treatment site prior to final

disposal.
 Hazardous waste shall be placed in clearly marked waste bins with plastic liners that meet

the standard thickness of 0.009mm and are appropriately labelled for the type and weight of the

waste. Sharps shall be placed in puncture-proof containers. Hazardous chemical liquid waste can

be placed in amber disposal bottles or its equivalent.

To improve segregation efficiency and minimize incorrect use of bins, proper placement,

labelling of waste bins and use of color-coded plastic liner must be strictly implemented. Waste

bins with yellow liners for infectious wastes shall be placed in, but not limited to, the following

areas: Emergency Room, Out Patient Department, Laboratory, Radiology, Dental and Isolation

Rooms, Infectious Wards, Dialysis and Nurses Stations.

Proper collection and transport is an important component in Healthcare Waste

Management. Its implementation requires commitment and cooperation of the Healthcare

facilities maintenance, housekeeping and motor pool services personnel and all the Healthcare

facilities workers.

HCW collection practices shall be designed to achieve an efficient movement of waste

from point of generation to storage or treatment while minimizing the risk to personnel.

Suggested collection frequency on room to room basis is once every shift or as often as

necessary depending on the volume of waste generated. Collection of waste shall be completed

by the end of every shift.

B. Foreign Literatures

Hospitals, nursing homes and the private clinics are places to serve patients but they also

generate a huge corpus of dangerous or hazardous wastes. Since the beginning, hospitals have

been made for the treatment of sick people, though during that time we neither knew about the
adverse effects of garbage produced by the health care units nor did we have a clue that it poses

serious health problems and that filth is also generated on human body and their environment.

Biomedical waste is a small fraction of municipal waste. There should be a greater concern

on how much of the waste produced is actually contagious or unsafe. Infectious hospital waste

represents only a small fraction of total medical waste. Mostly hazardous and infectious waste is

coming from hospitals and clinical activities. Only small amount is coming from industrial and

domestic sources.

According to World Health Organization (BAN & HCWH, 1999) and (WHO, 2002)

approximately 85% hospital wastes are non-hazardous in nature, 10% consist of infectious waste,

and around 5% waste are non-infectious but come in hazardous category .

Infectious waste is the waste which consists of pathogens in sufficient concentrations could

cause diseases in the human beings. Some examples of the infectious wastes which are produced

after the handling of different hospital workers are: Discarded syringes and needles used to draw

blood or give vaccination to the patients; Production of culture dishes, petriplates, glassware, test

tubes and other glass instruments used in laboratory work; Removed body organs like placenta,

limbs, appendices, uterus and other body parts etc.; Swabs used to inoculate cultures and stocks;

Discarded surgical gloves and surgical instruments; Contaminated blood-soaked bandages and

cotton plugs; Specimens and laboratory cultures etc.; Blood contaminated materials, sharps and

other instruments etc.

Chemical wastes is a type of waste category includes discarded liquid, solid and gaseous

chemicals which are used in disinfecting the products, in cleaning and in housekeeping.
 Pathological wastes: It includes body organs, human fetus, placenta, blood and body fluids

etc.

Sharps includes those waste materials which could be infectious to people taking care of it.

Sharps can also cut or puncture the skin. They can include blades, needles, nails, saws, scalpels

and broken glasses etc.

Radioactive waste consists of radionuclide in the form of solid, liquid and gaseous waste

form used in in-vitro analysis of body tissues and body fluid and in-vivo body organ imaging and

tumour location and therapeutic procedures.

Pharmaceutical wastes comprises outdated drugs and chemicals which have been discarded

from different wards. These outdated chemicals and drugs contaminate the environment.

General wastes are mainly composed from household wastes such as wrappers, Packaging

material, kitchen waste, paper and plastics etc. It is to human beings.

Many synonyms to medical waste exist and they are currently used interchangeably in

different parts of the world and in different scientific journals. According to Moritz (1995) some

of the easily come across synonyms are clinical waste, hospital waste and bio-medical waste.

The WHO uses the term “healthcare waste” in reports and other official publications.

Al-Mutair et al., (2004) defined medical waste as any solid or liquid waste capable of

causing infectious diseases generated as a result of patient diagnosis, treatment or in related

research through the immunization of humans and animals.

According to Pruss et al. (1999) Health care waste is defined as the total waste generated in

health care facilities and in addition to hospitals and clinics includes waste generated by blood
banks, research facilities and laboratories irrespective of the volumes, characteristics and

composition.

Abor and Bouwer (2008) focus their definition to include all types of wastes produced by

health facilities such as general hospitals, medical centers and dispensaries.

Medical wastes constitute a larger part of hazardous wastes (ChulJang et al., 2006). The

generation of these wastes is an ongoing phenomenon as long as human civilization persists.

Hospital waste is sub-divided into health care general waste and health care risk waste (HCRW).

The health system is under pressure to dispose of health care waste in such a way as to avoid

unnecessarily high levels of environmental degradation.

The aim of health care facilities worldwide is beginning to subscribe to the social goals of a

cleaner and safer environment. To manage health care waste optimally, health care providers

should consider all stages or whole life cycle of the medical product by looking at the medical

product’s upstream and down-stream activities (Kaiser et al. 2001).

In general, for waste to be infectious, it has to contain enough virulence capable of causing

an infectious disease including a portal of entry in a susceptible host. Biomedical wastes are

considered a special area where hazards and risks not just confined to the health of generators

and operators of hospitals but also the health of general people. In general hospital waste is

broadly grouped into infectious waste and non-infectious waste.

In selecting clinical waste management technologies, the terms ‘treatment’ and ‘disposal’ are

often wrongly used interchangeably. (Luttrell et al., 2003) clarify treatment as an alteration of a

waste stream or contaminated site in order to reduce, eliminate or immobilize hazardous

storage or release.

Pruss-Ustun et al. (2005) suggested that strategies such as education of health care workers

on the risks and precautions, reduction of invasive procedures, use of safer devices, and

procedure and management of exposures are available to prevent infections due to sharps

injuries.

Infectious waste contains different types of microbes which are pathogenic in nature. The

pathogenic microbes which are present in infectious waste may enter into the human body

accidently through mucous membrane, cuts in the skin, a puncture or by inhalation and ingestion

causing different kinds of fatal diseases. There is strong evidence that the main concern about the

infectious hospitals waste is the transmission of HIV-AIDS viruses and more often of hepatitis B

virus (HBV) through the injuries caused by syringes and needles contaminated by HBV in

human blood, (WHO, 1999).

Sharps may not only cause cuts and punctures but also infect the wounds if they are

contaminated with pathogenic microbes. So sharps are considered as a very harmful because this

hazardous waste poses double risk of causing infections and injuries both. There is a risk of

injuries related to medical waste handling and carrying by waste operators, workers and cleaners.

Some of those examples are cut, injury, punctured wound, strain and sprain of the joint of limbs

and backache due to handling of overloaded waste.

Related Studies

A. Local Studies
 According to Arnel Christian Dy of Ateneo De Manila University, to improve

segregation efficiency, hospital staff underwent health care waste management training. Waste is

collected at least thrice a day by housekeeping personnel. Segregation efficiency is also achieved

by strategically placing proper labeled green, yellow, and black containers in locations with

increased traffic and waste generation. Apart from segregation, staff are never permitted to

correct errors in waste segregation after disposal. If general and hazardous wastes are mixed,

then the mixed waste is now considered infectious. Storage area is easily accessible to staff

handling the wastes. Lastly, daily cleaning of floors as well as collection of infectious wastes are

practiced.

B. Foreign Studies

Hospital waste must be separated from municipal waste, but in many parts of Africa it

tends to be collected along with the rest of the waste stream (Kgathi and Bolanee, 2001; Taru and

Kuvarega, 2005).

Most hazardous and toxic wastes are placed on landfills with few safeguards to protect

nearby inhabitants and water sources from contamination. This is usually the case in developing

nations (Hardoy, 1992).

The WHO estimates that each year there are 8-16 million cases of hepatitis B Virus, 2.3-

4.7 million cases of hepatitis C Virus and 80,000-160,000 cases of HIV due to unsafe injections

and mostly due to very poor hospital waste management system (WHO,UNICEF,UNFPA,

1999).

Unregulated clinical waste treatment and disposal has been linked to several public health

threats. Solberg, (2009) reported that 240 people in Indian State of Gujarat contacted hepatitis B
after receiving medical care with previously used syringes acquired through the illegal trade of

clinical waste. The improper disposal of medical waste constitutes a problem in most of the

developing countries.

Talaat et al (2003) reported that of the 1485 Health care workers interviewed, 529

(35.6%) were exposed to at least one needle stick injury during the past 3 months with an

estimated annual number of 4-9 needle sticks per worker.

As BAN & HCWH (1999), sharps, which include needles and syringes, have the highest

disease diffusion potential amongst all categories of hospital waste. Almost 80-85% of injuries

related to sharps are caused between their usage and subsequent disposal. More than 20% of

those who handle them encounter the stick injuries. The study also mentioned that injuries from

needle-stick and sharps occur frequently in developing countries.

If the used syringes, needles and other sharps are not destroyed properly and are being

recirculated in the market it will adversely affect the human and animal life. In the same way

improper practices such as dumping of BMW in municipal dust bins and on open spaces leads to

spread of diseases (Sreelatha, 1999).

When wastes are burn it may lead to air pollution, when it dump, the water and soil

quality affected resulting the risk of life of living organisms. In addition, if waste is not managed

properly, members of the poor family specially rag pickers may have an opportunity to collect

disposable medical equipment for selling in the market (recycle) which are hazardous for human

beings.

Improper waste management can cause environmental pollution and multiplication of

vectors like worms, insects and rodents which may lead to the transmission of diseases like
cholera, typhoid, hepatitis and AIDS etc. consideration must be given to the impact on

environment, especially to the risks of all type of pollution like air, water and soil etc.