Lesson 12: Health Care Waste Management

• In 2015, a joint WHO/UNICEF assessment


  found that just over half (58%) of sampled facilities from 24 countries had adequate systems in place for the safe disposal of 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, andimmunization of humans;(3) research using laboratory animals geared towardsimprovement of human health;(4) production and testing of biological products; and(5) other activities performed by a health care facility thatgenerates wastes.
• average are non- hazardous.


  According to WHO, between 75% to 90% of wastes generated by health care activities on average are ___
• 10% to 25%


  The remaining ___ is considered hazardous and may be infectious, toxic, or radioactive.
• 0.5 kg


  High-income countries typically generating larger volumes of health care wastes produce ___ kg of hazardous waste per hospital bed per day
• 0.2 kg


  while low- income countries generate ___kg on average.
• 30.37%


  In the Philippines, ___% of wastes from health care facilities are hazardous while the remaining 69.63% are general wastes.
• 0.34 kg of infectious sharps, 0.39 kg of general wastes


  Philippine hospitals generate an average of___ kg of infectious sharps and pathological wastes and__ kg of general wastes per bed per day.
• health care waste generators.


  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 _____
• 1.infectious wastes, 2.pathological and anatomical wastes, 3.sharps, 4.chemical waste, 5.pharmaceutical waste, 6.radioactive waste, and 7.non-hazardous or general waste.

  Health care wastes generated by health care facilities are categorized into seven -
• 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 Wastes


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


  is a subgroup of pathological wastethat refers to recognizable body parts usually from amputation procedures.
• 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.
• Toxic


  Chemicals are considered hazardous when they are: o (with health and environment hazards)
• Corrosive


  Chemicals are considered hazardous when they are:(Acid of pH <2.0 and bases of pH>12.0)
• Flammable

  Chemicals are considered hazardous when they are:(with a flash point below 60°C)
• Flammable

  Chemicals are considered hazardous when they are: (with a flash point below 60°C)
• Reactive

  Chemicals are considered hazardous when they are:(explosive with water)
• 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.
• a.Recyclable wastesb. Biodegradable health care wastesc.Non-recyclable/non-biodegradable health care wastes

  Non-hazardous or General Waste can be further classified asa.b.c.
• Recyclable wastes

  Paper products such as used office paper, computer printouts, and corrugated cardboard boxes
• Biodegradable health care wastes


  such as left- over 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)
• chlorine


  Incinerated materials containing or treated with ___ can generate dioxins and furans, which are human carcinogens and have been associated with a range of adverse health effects.
• heavy metals


  Incineration of____ or materials with high metal content (in particular lead, mercury, and cadmium) can lead to the spread of toxic metals in the environment.
• modern incinerators


  Only _____ 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.
• autoclaving, microwaving, and steam treatment


  Alternatives to incineration such as_____, _____, and______ 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.
• Montreal Protocol on Substances that Deplete the Ozone Layer (1987)


  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
• Basel Convention on the Control of the Transboundary Movements of Hazardous Wastes and Their Disposal (1989)


  is 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.
• The 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 longperiods 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 (1998)


  is 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- 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.
• Republic Act No. 6969 "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.• The waste generators are required to ensure that their hazardous wastes are properly collected transported, treated, and disposed in a sanitary landfill.