HEALTH CARE WASTE

MANAGEMENT
DEFINING HEALTH CARE
WASTES
The disposal of wastes generated by health care facilities has
become a growing concern in the country and around the world.
It has given special attention that the wastes generated by the
health care industry may be hazardous to nature and are
detrimental to a person’s health and to the environment.
As such, ALL HEALTH CARE FACILITIES ARE TASKED TO
ENSURE THAT THERE ARE NO ADVERSE HEALTH EFFECTS
AND ENVIRONMENTAL CONSEQUENCES RESULTING FROM
THEIR GENERATION, SEGREGATION, COLLECTION,
STORAGE, TRANSPORT, TREATMENT, AND DISPOSAL OF
HEALTH CARE WASTES.
DEFINING HEALTH CARE
WASTES
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
5. Other activities performed by a health care facility
that generates wastes
DEFINING HEALTH CARE
WASTES
All health care facilities, institutions,
business establishments, and other spaces
where health care services are offered with
activities or work processes that generate
health care wastes are called health care
waste generators. These include:
1. Hospital and medical centers
2. Infirmaries
3. Birthing homes
DEFINING HEALTH CARE
WASTES
Continuation:
4. Clinics and other health-related facilities
a. Medical centers
b. Ambulatory centers
c. Dialysis centers
d. Surgical
e. Alternative medicine
f. Dental
g. Veterinary
h. Health care centers and dispensaries
DEFINING HEALTH CARE
WASTES
Continuation:
5. Laboratories and research centers
a. Medical and biomedical laboratories
b. Medical research centers
c. Blood banks and blood collection services
d. Dental prosthetic laboratories
e. Drug testing laboratories
f. HIV testing laboratories
DEFINING HEALTH CARE
WASTES
Continuation:
6. Drug manufacturers
7. Institutions
a. Drug rehab centers
b. Medical technology internship training centers
c. Medical schools
d. Nursing homes
e. Dental schools
8. Mortuary and autopsy centers
CATEGORIES OF HEALTH
CARE WASTES
I. INFECTOUS WASTES
 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 infections diseases.
 Examples include:
o Discarded microbial cultures
o Sputum cups
o Urine containers
o Blood bags; and any secretions coming from patients with
infectious diseases.
CATEGORIES OF HEALTH
CARE WASTES
II. PATHOLOGICAL AND ANATOMICAL
WASTES
 Refers to tissue sections and body fluids or organs
derived from biopsies, autopsies, or surgical
procedures sent to the laboratory for examination.
 Examples include internal organs and tissues used
for histopath examinations.
 Anatomical waste is a subgroup of pathological
waste that refers to recognizable body parts
usually from amputation procedures.
CATEGORIES OF HEALTH
CARE WASTES
III.SHARPS
 Refer to waste items that can cause cuts,
pricks, or puncture wounds.
 They are considered the most dangerous
health care wastes because of their potential
to cause injury and infection.
 Examples include syringes in phlebotomy,
blood lancets, surgical knives, and broken
glassware.
CATEGORIES OF HEALTH
CARE WASTES
IV. CHEMICAL WASTES
 Chemicals are considered hazardous when
they are:
1. Toxic
2. Corrosive (acid of pH 2.0 and below, bases of pH 12
and above)
3. Flammable (with a flash point below 60 degrees
celcius)
4. Reactive (explosive with water)
CATEGORIES OF HEALTH
CARE WASTES
IV.CHEMICAL WASTES
Chemical Examples
Waste
Acids Acetic, chromic, hydrochloric, nitric, sulfuric
Alcohols Ethanol, isopropanol, phenols
Aldehydes Formaldehyde, glutaraldehyde, ortho-phthalaldehyde
Bases Ammonium hydroxide, potassium hydroxide, sodium
hydroxide, sodium bicarbonate
Halogenated Calcium hypochlorite, calcium dioxide, iodine solutions,
disinfectants iodophors, sodium hypochlorite (bleach)
Halogenated Chloroform, methylene chloride, perchloroethylene,
solvents refrigerants, trichloroethylene
CATEGORIES OF HEALTH
CARE WASTES
IV.CHEMICAL WASTES
Chemical Examples
Waste
Metals Arsenic, cadmium, chromium, lead, mercury, silver
Non- Acetone, acetonitrile, ethanol, ethyl acetate,
halogenated formaldehyde, isopropanol, methanol, toluene, xylenes
solvents
Other Hydrogen peroxide, peroxyacetic acid, quaternary
disinfectants amines
Oxidizers Hydrogen peroxide, potassium dichromate, potassium
permanganate
Reducers Sodium bisulfite, sodium sulfite
Miscellaneous Anesthetic gases, asbestos, ethylene oxide, herbicides,
CATEGORIES OF HEALTH
CARE WASTES
V. PHARMACEUTICAL WASTES
 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.
 Examples include empty drug vials, medicine bottles,
and containers of cytotoxic drugs including the
materials used in preparing them.
CATEGORIES OF HEALTH
CARE WASTES
VI.NON-HAZARDOUS OR GENERAL WASTES
 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.
 Examples include plastic bottles, used paper products,
office wastes, scrap wood, and food waste of non-
infectious patients.
 This type of waste can be further classified as:
1. Recyclable wastes
2. Biodegradable health care wastes
3. Non-recyclable/non-biodegradable health care wastes
IMPACT OF HEALTH CARE
WASTES
Individuals exposed to health care wastes such as the
medical staff, in- and out-patients, visitors,
caregivers, support staff, waste haulers, garbage
pickers, and the general public are potentially at risk
of being injured or infected.
Other potential hazards may include drug-resistant
microorganisms that can spread from health facilities into the
environment.
Exposure of the general population can be mainly through
chronic exposure (for prolonged periods in minute quantities)
or acute exposure (for short periods in large quantities).
IMPACT OF HEALTH CARE
WASTES
Adverse health outcomes associated with health care
wastes and by-products also include:
 Sharp-inflicted injuries
 Toxic exposure to pharmaceutical products, in particular, antibiotics
and cytotoxic dugs released into the surrounding environment
 Chemical burns from disinfection, sterilization, or waste treatment
activities
 Air pollution arising as a result of the release of particulate matter
during medical waste incineration
 Thermal injuries occurring in conjunction with open burning and the
operation of medical waste incinerators
 Radiation burns
IMPACT OF HEALTH CARE
WASTES
Treatment and disposal of health care wastes may pose health
risks indirectly through the release of pathogens and toxic
pollutants into the environment. Following are some
guidelines in the treatment and disposal of health care
wastes:
The disposal of untreated health care wastes in landfills can
lead to the contamination of drinking, surface, and ground
waters if those landfills are not properly constructed.
The treatment of health care wastes with chemical
disinfectants can result in the release of chemical substances
into the environment if those substances are not handled,
stored, and disposed in an environmentally-sound manner.
IMPACT OF HEALTH CARE
WASTES
Treatment and disposal of health care wastes may pose health risks
indirectly through the release of pathogens and toxic pollutants into
the environment. Following are some guidelines in the
treatment and disposal of health care wastes:
Incineration of waste is widely practiced, but inadequate
incineration or the incineration of unsuitable materials results in
the release of pollutants into the air and in the generation of ash
residue.
Only modern incinerators operating at 850°C to 1100°C and fitted
with special gas-cleaning equipment are able to comply with the
international emission standards for dioxins and furans. It should
be noted that disposal of health care wastes by
incineration is not allowed in the Philippines.
IMPACT OF HEALTH CARE
WASTES
Treatment and disposal of health care wastes may pose
health risks indirectly through the release of pathogens and
toxic pollutants into the environment. Following are some
guidelines in the treatment and disposal of health
care wastes:
Alternatives to incineration such as autoclaving,
microwaving, and steam treatment integrated with internal
mixing, which minimize the formation and release of
chemicals or hazardous emissions should be given
consideration in settings where there are sufficient
resources to operate and maintain such systems and
disposal of the treated waste.
IMPACT OF HEALTH CARE
WASTES
The following are the benefits achieved through proper
and strict compliance with standards on the
management of health care wastes:
 Protection of patients, health care workers, and the general population
from the adverse effects of health care wastes to human health.
 Contribution to the collaborative efforts around the world to protect the
environment from pollution and contamination caused by health care
wastes.
 Increased compliance of health care institutions to the laws,
regulations, and guidelines on health care wastes
 Prevention of long-term liabilities and loss of reputation caused by
violations to the laws, guidelines, and regulations on health care wastes
NATIONAL LAWS AND POLICIES
ON HEALTH CARE WASTE
MANAGEMENT
 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.
NATIONAL LAWS AND POLICIES
ON HEALTH CARE WASTE
MANAGEMENT
 Republic Act No. 6969 “An Act to
Control Substances and Hazardous
and Nuclear Wastes” (1990)
This act requires the registration of waste
generators, waste transporters, and operators of
toxic and hazardous waste treatment facilities with
the EMB. The waste generators are required to
ensure that their hazardous wastes are properly
collected, transported, treated, and disposed in a
sanitary landfill.
IMPORTANT NATIONAL LAWS
AND POLICIES ON HEALTH CARE
WASTE MANAGEMENT
 Republic Act No. 8749 “The
Philippine Clean Air Act” (1999)
This act prohibits the incineration of bio-medical
wastes effective July 17, 2003. It promotes the use
of state-of-the-art, environmentally-sound, and safe
non-burn technologies for the handling, treatment,
thermal destruction, utilization, and disposal of
sorted, unrecycled, biomedical, and hazardous
wastes.
IMPORTANT NATIONAL LAWS
AND POLICIES ON HEALTH CARE
WASTE MANAGEMENT
 Republic Act No. 9003 “Ecological
Solid Waste Management Act”
(2000)
This mandates the segregation of solid wastes at
the sources including households and institutions
like hospitals by using a separate container for
each type of wastes.
IMPORTANT NATIONAL LAWS ON
HEALTH CARE WASTE
MANAGEMENT
 Republic Act No. 9275 “The
Philippine Clean Water Act” (2004)
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.
DIFFERENT TYPES OF WASTES
AND THEIR RECOMMENDED BIN
COLORS/SPECIFICATIONS
Types of Waste Color-code of Trash
Bins
Non-infectious dry BLACK
wastes
Non-infectious wet GREEN
wastes
Infectious and YELLOW
pathological wastes
Chemical wastes YELLOW WITH A
BLACK BAND
Radioactive wastes ORANGE
Sharps and RED
TREATMENT AND DISPOSAL
OF HEALTH CARE WASTES
PYROLYSIS
oThermal decomposition of health care wastes in
the absence of supplied molecular oxygen in the
destruction chamber where the said waste is
converted to gaseous, liquid or solid form. Waste
residues may be in the form of greasy aggregates
or slugs, recoverable metals, or carbon black.
These residues are disposed in a landfill
TREATMENT AND DISPOSAL
OF HEALTH CARE WASTES
AUTOCLAVE
oThis 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℃ with a pressure of 15 psi for 15-30 minutes.
Indicators such as color-changing tapes or
biological test ampules containing bacterial spores
can be used to check the validity of the
sterilization.
TREATMENT AND DISPOSAL
OF HEALTH CARE WASTES
MICROWAVE
oIs a technology that typically incorporates some
type of size reduction device. Shredding of wastes
is done before disinfection. In this process, waste is
exposed to microwaves that raise the temperature
to 100℃ for at least 30 minutes. Microorganisms
are destroyed by moist heat which irreversibly
coagulates and denatures enzymes and structural
proteins.
TREATMENT AND DISPOSAL
OF HEALTH CARE WASTES
CHEMICAL DISINFECTION
oChemicals like sodium hypochlorite, hydrogen
peroxide, peracetic acid, and heated alkali are
added to health care wastes to kill or inactivate
present pathogens. It is recommended that sodium
hypochlorite with a concentration of 5 percent is
used for chemical disinfection. This method,
however, generates chemical wastes from the used
chemical disinfectants.
TREATMENT AND DISPOSAL
OF HEALTH CARE WASTES
BIOLOGICAL PROCESS
oUses and enzyme mixture to decontaminate health
care wastes. The resulting by-product is put
through an extruder to remove water for
wastewater disposal. The technology is suited for
large applications and is also being developed for
possible use in the agricultural sector.
TREATMENT AND DISPOSAL
OF HEALTH CARE WASTES
ENCAPSULATION
oInvolves the filling of containers with waste, adding
and immobilizing material, and sealing the containers.
This process uses either cubic boxes made of high-
density polyethylene or metallic drums, that are three-
quarters filled with sharps, or chemicals. The
containers or boxes are then filled up with a medium
such as plastic foam, bituminous sand, and cement
mortar. After the medium has dried, the containers are
sealed and disposed in a landfill.
TREATMENT AND DISPOSAL
OF HEALTH CARE WASTES
INERTIZATION
oIs especially suitable for pharmaceutical waste that
involves the mixing of waste with cement and other
substances before disposal. The homogenous mass
produced can be transported to a suitable storage
site. Alternatively, the homogenous mixture can be
transported in liquid state to a landfill and poured
into municipal waste. The process is relatively
inexpensive and can be performed using relatively
unsophisticated equipment.