11 - Healthcare Waste Management

• Healthcare Wastes - refers to all solid or liquid wastes generated by diagnosis, treatment and immunization, research pertaining to DTI, research using laboratory animals, production of testing biological products, and others.
• Between 75 - 90% of medical waste are non-hazardous.
• In the Philippines, 30.37% of waste from health care facilities are hazardous while the remaining 69.63% are general waste.
• Philippine hospitals generate an average of 0.34 kg of infectious sharps and pathological wastes and 0.39 kg of general waste per bed per day.
• Most hospital waste is simply "trash".
• Health care facilities, institutions, business and establishments that generate health care wastes pertain to the handling, storage, and disposal of solid (hazardous), radioactive, and biological (medical) wastes to maintain and promote a safe, healthy and productive workplace environment.
• Biological waste refers to all wastes suspected to contain pathogens or toxins that may cause disease to a susceptible host.
• Discarded microbial cultures, solid wastes with infections such as dressings, sputum cups, urine containers, and blood bags, liquid wastes with infections such as blood, urine, vomitus, and other body secretions, and food wastes (liquid or solid) coming from patients with highly infectious diseases are considered biological waste.
• Anatomical waste is a subgroup of pathological waste that refers to recognizable body parts usually from amputation procedures.
• Pathological waste includes tissue sections and body fluids or organs derived from biopsies, autopsies, or surgical procedures sent to the lab for examination.
• Residues from shipment of radioactive materials and unwanted solutions of radionuclides intended for diagnostic or therapeutic use, liquids, gases, and solids contaminated with radionuclides whose ionizing radiations have genotoxic effects are considered hazardous waste.
• Discarded chemicals include solid, liquid, or gaseous chemicals generated during disinfection and sterilization procedures, wastes with high content of heavy metals and their derivatives, laboratory reagents, X-ray film developing solutions, disinfectants and soaking solutions, used batteries, concentrated ammonia solutions, concentrated hydrogen peroxide, chlorine, and mercury from broken thermometers and sphygmomanometers.
• Wastes that have not been in contact with communicable or infectious agents, hazardous chemicals, or radioactive substances, and do not pose a hazard are considered non-hazardous waste.
• Non-hazardous waste includes plastic bottles, used paper products, office wastes, scrap wood, and food waste of non-infectious patients.
• Chemicals are considered hazardous when they are expired, spilt, and contaminated pharmaceutical products, drugs, and vaccines including discarded items used in handling pharmaceuticals.
• Antineoplastic, cytotoxic, and genotoxic wastes include drugs used in oncology or radiotherapy, and biological fluids from patients treated with the said drugs.
• Wastes exposed to radionuclides include radioactive diagnostic materials or radiotherapeutic materials.
• Chemicals are considered hazardous when they are toxic, corrosive, flammable, or reactive.
• Empty drug vials, medicine bottles, and containers of cytotoxic drugs including materials used for their preparation and administration such as syringes, needles, and vials are considered hazardous waste.
• Sharps are waste items that can cause cuts, pricks, or puncture wounds and are considered the most dangerous health care waste because of their potential to cause both injury and infection.
• Examples of sharps include syringes in phlebotomy, blood lancets, surgical knives, and broken glasswares.
• Recycling is the processing of used materials into new products.
• Hazardous wastes must never be mixed with general wastes and there must be a waste management officer responsible for the management of the health care wastes of a facility.
• Reusing involves finding a new application for a used material or using the same product for the same application repeatedly.
• Waste containing mercury must be collected separately.
• Waste disposal is the discharging, depositing, placing, or releasing any health care waste into air, land, or water.
• Recovery of waste can be achieved through energy recovery, where waste is converted to fuel to generate electricity or for direct heating of premises, or as a term used to encompass three subsets of waste recovery: recycling, composting, and energy recovery.
• Waste with high content of heavy metals, except mercury, should be collected separately and sent to the waste treatment facility.
• Principles of Medical Laboratory Science include minimization, identification, and segregation.
• Green Procurement Policy involves waste minimization, which involves two aspects: waste prevention and waste reduction.
• Chemical and pharmaceutical waste must be segregated and collected separately.
• Segregation involves separating different types of waste at the point of generation until their final disposal.
• Some materials need to be treated first before disposal.
• Waste treatment is the process of changing the biological and chemical characteristics of waste to minimize its potential to cause harm.
• Highly infectious waste must be disinfected at source.
• The 1994 FDA guidance "Inventory, Proper Disposal, and/or Destruction of Used Vials or Bottles" was released to prevent the proliferation of adulterated, misbranded, and counterfeit drugs brought about by the recycling of used pharmaceutical bottles and vials.
• Segregation at the source of waste generation should be the responsibility of the waste generator.
• Pathological waste must be refrigerated if not collected or treated within 24 hours.
• Anatomical waste should be disposed through safe burial or cremation.
• Health care wastes must be segregated, collected, stored, and transported while considering risk and occupational safety and compliance with existing laws, policies, and guidelines.