PRINCIPLES OF MEDICAL LABORATORY SCIENCE-1
LESSON 11- HEALTHCARE WASTE MANAGEMENT
HEALTHCARE WASTES
Refer to all solid or liquid wastes generated by :
o diagnosis, treatment and immunization
o research pertaining to DTI, research using lab animals
o production of testing biological products and others
Between 75-90% are non hazardous
o In the Philippines, 30.37% of waste from health care
facilities are hazardous while the remaining 69.63% are
general waste
o 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 WASTE GENERATORS
health care faciities, institutions, business and establishments
that generate health care wastes
1. hospitals and medical centers, infirmaries, birthing homes
2. clinics and other health-related facilities
o medical, ambulatory, dialysis
o health care centers and dispensaries
o surgical, alternative medicine, dental, veterinary
3. laboratories and research centers
o medical and biomedical laboratories
o medical research centers
o blood banks and blood collection services
o dental prosthetic laboratories
o nuclear medicine lab, biotechnology lab
o animal research and testing, drug testing lab
o HIV testing lab
4. drug manufacturers
5. institutions
o drug rehab centers, training centers for embalmers
o medtech internship training centers, schools of RadTech
o med schools nursing homes, dental schools
6. mortuary and autopsy centers
LABORATORY WASTE MANAGEMENT
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
CATEGORIES OF HEALTH CARE WASTE
INFECTIOUS 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.
PATHOLOGICAL AND ANATOMICAL WASTE
tissue sections and body fluids or organs derived from biopsies,
autopsies, or surgical procedures sent to the lab for examination.
internal organs and tissues
Anatomical waste is a subgroup of pathological waste that refers
to recognizable body parts usually from amputation procedures.
SHARPS
waste items that can cause cuts, pricks, or puncture wounds.
considered the most dangerous health care waste because of
their potential to cause both injury and infection.
syringes in phlebotomy, blood lancets, surgical knives, and
broken glasswares.
CHEMICAL WASTE
discarded chemicals (solid, liquid, or gaseous) 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.
Chemicals are considered hazardous when they are:
o toxic (with health and environment hazards)
o corrosive (acid of pH<2.0 and bases of pH>12.0)
o flammable (with a flash point below 60 °C)
o reactive (explosive with water)
PHARMACEUTICAL WASTE
refers to expired, spilt, and contaminated pharmaceutical
products, drugs, and vaccines including discarded items used in
handling pharmaceuticals.
1
PRINCIPLES OF MEDICAL LABORATORY SCIENCE-1
LESSON 11- HEALTHCARE WASTE MANAGEMENT
antineoplastic, cytotoxic, and genotoxic wastes such as drugs
used in oncology or radiotherapy, and biological fluids from
patients treated with the said drugs.
empty drug vials, medicine bottles, and containers of cytotoxic
drugs including materials used for their preparation and
administration such as syringes, needles, and vials.
RADIOACTIVE WASTE
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, liquids, gases, and solids contaminated with radionuclides
whose ionizing radiations have genotoxic effects.
products and contaminated waste, patient's excretion, and all
materials used by patient exposed to radionuclides within 48 hrs
NON-HAZARDOUS OR GENERAL WASTE
wastes that have not been in contact with communicable or
infectious agents, hazardous chemicals, or radioactive
substances, and do not pose a hazard.
plastic bottles, used paper products, office wastes, scrap wood,
and food waste of non-infectious patients.
Recyclable wastes in health care facilities such as
o paper products such as used office paper, computer printouts,
and corrugated cardboard boxes
o aluminum from beverage cans and other aluminum containers
o pressurized gas containers such as oxygen tanks
o plastic products including polyethylene terephthalate (PET)
plastic water, bottles, plastic milk containers, and polypropylene
plastic bottles for saline solutions and irrigation fluids
o glass such as used vials for sterile solutions
o wood such as scrap wood and used wood shipping pallets
o durable goods such as used furniture and furnishings
o electronic devices such as used computer equipment and print
cartridges
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
IMPACT OF HEALTHCARE WASTES
Sharps-inflicted injuries
Toxic exposure
Chemical burns
Air pollution
Thermal injuries
Radiation burns
GUIDELINES IN THE TREATMENT AND DISPOSAL
OF HEALTH CARE WASTE
Disposal of untreated health care waste to landfill can lead to the
contamination of drinking, surface and ground waters if those
landfills are not properly constructed.
The treatment of health care waste with 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.
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 8500C to 11000C and
fitted with special gas-cleaning equipment are able to comply
with the international emission standards for dioxin and furans.
(INCINERATION is not allowed in the Philippines)
Alternative to incineration such as autoclaving, microwaving and
steam treatment integrated with internal mixing, which
maximize the formation and release of chemicals or hazardous
emissions should be given consideration in setting where there
are sufficient resources to operate and maintain such systems
and disposal of treated waste.
BENEFITS ACHIEVED THROUGH PROPER AND
STRICT COMPLIANCE
Protection of patients, health workers and general population
contribution to collaborative efforts around the world
Increased compliance to the laws, regulations and health care
waste
Prevention of long term liabilities and loss of reputation
LEGISLATIONS, POLICIES AND GUIDELINES
GOVERNING HEALTH CARE WASTE
INTERNATIONAL AGREEMENT PERTAINING TO
HEALTH CARE WASTE MANAGEMENT
Montreal Protocol On Substances That Deplete
The Ozone Layer (1987)
adopted in Montreal, Canada on SEPT. 16, 1987 and came into
force on Jan. 1, 1989
sets the final objective of the Protocol to eliminate ozone
depleting substances in the environment.
Basel Convention On The Control Of
Transboundary Movements Of Hazardous Waste
And Their Disposal ( 1989 )
concerned with transboundary movements of hazardous waste.
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.
2
PRINCIPLES OF MEDICAL LABORATORY SCIENCE-1
LESSON 11- HEALTHCARE WASTE MANAGEMENT
UN Framework Convention on Climate Change
(1992)
includes a legally non-binding pledge that by the year 2000,
major industrialized nations would reduce their greenhouse gas
emissions to 1990 levels
Stockholm Convention On Persistent Organic
Pollutants (2001)
global treaty to protect human health and the environment from
persistent organic pollutants (POPs).
POPs are chemicals that:
o remain unchanged in environment for long periods of time
o accumulate in the fatty tissues of living organisms
o toxic to both humans and wildlife.
ASEAN Framework Agreement on the Facilitation
of Goods in Transit ( 1998 )
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.
includes Protocol 9 on Dangerous Goods which provides
provisions on the transport of toxic and infectious substances.
NATIONAL LAWS AND POLICIES ON HEALTH
CARE WASTE MANAGEMENT
Republic Act No. 4226
Hospital Licensure Act (1965)
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)
registration of waste generators, waste transporters, and
operators of toxic and hazardous waste treatment facilities
waste generators are required to ensure that their hazardous
wastes are properly collected transported, treated, and disposed
in a sanitary landfill.
Republic Act No. 8749
The Philippine Clean Air Act of 1999
prohibits the incineration of bio-medical wastes
effective July 17, 2003.
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.
Republic Act No. 9003
Ecological Solid Waste Management Act of 2000
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 9275
The Philippine Clean Water Act of 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
PD 813 (1975) and EO 927 (1983)
Strengthening the Functions of Laguna Lake
Development Authority (LLDA)
further strengthens the powers and functions of the LLDA to
include environmental protection and jurisdiction over surface
waters of the Laguna Lake basin. Through
E.O. 927, the LLDA is empowered to issue permits for the use of
surface waters within Laguna de Bay
Presidential Decree 856
The Code on Sanitation of the Philippines -
Chapter XVII on Sewage Collection and Excreta
Disposal" (1998)
requires the approval of DOH in terms of the following:
o constructions of any approved type of toilet in every house and
community which may be allowed for a group of small houses of
light material or temporary in nature
o plans of individual sewage or sewage system and the sub-surface
absorption system or other treatment device
o location of any toilet or sewage disposal system in relation to a
source of water supply
o the discharge of untreated effluent from septic tanks and/or
sewage treatment plants to bodies of water
o manufacture of septic tanks
o method of disposal of sludge from septic tanks or other
treatment plants.
Presidential Decree No. 984
Providing for the Revision of Republic Act No.
3931, Commonly known as the Pollution Control
Law, and for Other Purposes (1976)
discharge of potentially polluting substances to air and water.
provides the basis for the DENR regulations on water pollution
through its IRR, DENR Administrative Order Nos. 34 and 35.
Presidential Decree No. 1586
Environmental Impact Statement (EIS) System (1978)
requires projects, like the construction of new hospital buildings
or expansion of existing hospitals, to secure an Environmental
Compliance Commitment (formerly
Environmental Compliance) Certificate (ECC) is required for the
installation and operation of HCW treatment systems like
pyrolysis, autoclave, microwave, and other treatment technology
including landfills.
3
PRINCIPLES OF MEDICAL LABORATORY SCIENCE-1
LESSON 11- HEALTHCARE WASTE MANAGEMENT

Executive Order No. 301 HEALTH CARE WASTE MANAGEMENT SYSTEM

Establishing a Green Procurement Program for All
Departments, Bureaus, Offices, and Agencies of
the Executive Branch of Government" (2004)
promote the culture of making environmentally informed
decisions in the government, especially in the purchase and use
of different products
include environmental criteria in public tenders, whenever
possible and practicable
establish the specifications and requirements for products or
services to be considered environmentally advantageous
develop incentive programs for suppliers of environmentally
advantageous products or services.
Green Procurement Policy- waste minimization
DOH Administrative Order No. 2008-0021
- most important step in the proper management of HCW
Gradual Phaseout of Mercury in all Philippine
Health Care Facilities and Institutions - involves two aspects: waste prevention and waste
dated July 30, 2008 "Gradual Phaseout reduction.
requires all health care facilities (HCF) to gradually phaseout the Reusing- either finding a new application for a used material or using
use of mercury-containing devices and equipment. the same product for the same application repeatedly.
DOH Administrative Order No. 2008-0023 Recycling- processing of used materials into new products.
National Policy on Patient Safety recovery of waste- defined in two ways: (1) energy recovery, whereby
dated July 30, 2008 waste is converted to fuel to generating electricity or for
requires the establishment and maintenance of a culture of direct heating of premises and (2) as a term used to
patient safety in the HCF as the responsibility of its leaders. encompass three subsets of waste recovery: recycling,
proper patient identification, assurance of blood safety, safe composting, and energy recovery.
clinical and surgical procedures, provision and maintenance of Waste treatment- process of changing the biological and chemical
safe quality drugs and technology, strengthening infection characteristics of waste to min. its potential to cause harm.
control standards, maintenance of the environment of care Waste disposal- discharging, depositing, placing, or releasing any
standards, and energy and waste management standards. health care waste into air, land, or water.
DOH "Manual on Health Care Waste Management"
in 2011 Some materials need to be treated first before disposal.
Revising the 2007 Health Care Waste Management Manual
reference for HCF administrators in the implementation of an
SEGREGATION, COLLECTION, STORAGE, AND
effective and efficient waste management program. TRANSPORT OF HEALTH CARE WASTES
standards of performance, defining the mandatory health care wastes must be segregated, collected, stored, and
requirements, providing new concepts, and citing examples and transported while considering risk and occupational safety and
tools compliance with existing laws, policies, and guidelines.
Philhealth Benchbook for Quality Assurance in Hazardous wastes must never be mixed with general wastes and
health care (2006)
there must be a waste management officer responsible for the
health care waste management as one of its parameters in the
management of the health care wastes of a facility
quality assurance of healthcare.
minimization, identification, and segregation. Segregation at
BFAD Memorandum Circular No. 22, Series of 1994,
the source of waste generation should be the responsibility of the
"Inventory, Proper Disposal, and/or Destruction of
Used Vials or Bottles" and BFAD Bureau Circular waste generator.
No. 16, Series of 1999 Segregation- separating different types of waste at the point of
Amending BAD MC No. 22 dated September 8, 1994, Regarding generation until their final disposal.
Inventory, Proper Disposal, and/or Destruction of Used Vials or purpose of color coding- make it easier for personnel in a health care
Bottles" facility to put waste into correct bins and maintain
released to prevent the proliferation of adulterated, misbranded, segregation during collection, storage, transport,
and counterfeit drugs brought about by the recycling of used treatment, and disposal.
pharmaceutical bottles and vials.

4
PRINCIPLES OF MEDICAL LABORATORY SCIENCE-1
LESSON 11- HEALTHCARE WASTE MANAGEMENT
IN THE IMPLEMENTATION OF A COLOR-CODING
SYSTEM FOR HEALTH CARE WASTE, THE
FOLLOWING PRACTICES SHOULD BE OBSERVED:
Highly infectious waste must be disinfected at source.
Anatomical waste should be disposed through safe burial or
cremation.
Pathological waste must be refrigerated if not collected or treated
within 24 hours.
Sharps must be shredded or crushed before they are transported
to the landfill.
Chemical and pharmaceutical waste must be segregated and
collected separately. Waste with high content of heavy metals,
except mercury, should be collected separately and sent to the
waste treatment facility. Waste containing mercury must be
collected separately. Hazardous chemical waste shall never be
mixed or disposed down the drain but shall be stored in strong
chemical resistant leak-proof containers or amber disposal
bottles. Expired and discolored pharmaceutical waste should be
returned to pharmacy for temporary storage to be returned to the
manufacturer
Radioactive waste has to be decayed to background radiation
levels. If it has reached the background radiation level and is not
mixed with infectious or chemical waste, the radioactive waste is
considered as regular non-infectious waste.
All waste bins must be properly covered to prevent cross
contamination.
Aerosol containers can be collected with the general waste.
DIFFERENT SYMBOLS USED BY DENR
ENVIRONMENT MANAGEMENT BUREAU
TREATMENT AND DISPOSAL OF HEALTH CARE
WASTE
PYROLYSIS
thermal decomposition of health care wastes in the absence of
supplied molecular oxygen in the destruction chamber where
the said waste is converted into gaseous, liquid, or solid form.
Waste residues may be in the form of greasy aggregates or slugs,
recoverable metals, or carbon black and are disposed in a landfill.
AUTOCLAVE
use of (stead sterilization to render waste harmless and is an
efficient wet thermal disinfection process.
Indicators such as color-changing tapes or biological test
ampules containing bacterial spores can be used to check the
validity of the sterilization.
5
PRINCIPLES OF MEDICAL LABORATORY SCIENCE-1
LESSON 11- HEALTHCARE WASTE MANAGEMENT
MICROWAVE
technology that typically incorporates some type of size
reduction device.
Shredding of wastes is done before disinfection.
Microorganisms are destroyed by moist heat which irreversibly
coagulates and denatures enzymes and structural proteins.
CHEMICAL DISINFECTION
chemicals are added to health care wastes to kill or inactivate
present
generates chemical wastes from the used chemical
BIOLOGICAL PROCESS
uses an enzyme mixture to decontaminate health care wastes.
suited for large applications and is also being developed for
possible use in the agricultural sector.
ENCAPSULATION
filling of containers with waste, adding and immobilizing
material, and sealing the containers.
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.
INERTIZATION
suitable for pharmaceutical waste that involves the mixing of
waste with (cement) and other substances before disposal.
homogeneous mixture can be transported in liquid state to a
landfill and poured into municipal waste.
relatively inexpensive and can be performed using relatively
unsophisticated equipment.
After treatment, health care wastes are usually disposed in landfills.
landfill- engineered site designed to keep waste isolated from the
environment.
safe burial- only applicable to treated infectious wastes, sharps,
pathological and anatomical wastes, small guantities of
encapsulated, inertisized solid chemical and
pharmaceutical wastes and only allowed in health care
facilities located in remote areas.
Used sharps and syringes-disposed using septic or concrete vaults if
the health care facility has no access to a TSD facility.
COMMON ERRORS IN WASTE HANDLING
Improper Labeling of Waste
o a. Failing to label a waste bottle
o b. Storing waste in a bottle lacking the words "Hazardous
Waste"
Improper Storage of Waste
o a. Storage of waste in a fume hood where reactions are being
carried out
o b. Using metal cans for waste
o c. Storing flammable waste containers on a bench or floor
o d. Storing waste bottles in or near a sink or floor drain
Failure to cap waste bottles
o a. Leaving the cap off an organic waste bottle
o b. Leaving a funnel in the waste bottle
Accumulation of excessive waste
Improper Segregation of Waste
o a. Storing acids and bases in the same cabinet
o b. Storing acids and organic waste in the same cabinet
o c. Mixing incompatibles in a waste container
How to segregate waste in the Laboratory
WASTE CHARACTERISTICS AND CURRENT WASTE
MANAGEMENT PRACTICES
Less than 50 percent of respondents practices waste
minimization and recycling as their main measure to achieve
waste minimization.
Out of the 12 hospitals surveyed, 50% were noted of practicing
color- coding scheme.
A large percentage of the respondents do not practice waste
sterilization prior to the disposal of blood and body fluids and
feces
As to transportation of hospital waste, it was found out that the
local government garbage truck collects the waste as confirmed
by the orderlies/ waste handlers (90.9%). It was observed that
although wastes were properly sorted in the hospital, the local
government garbage collectors do not follow the proper
segregation, transport and disposal.
6
PRINCIPLES OF MEDICAL LABORATORY SCIENCE-1
LESSON 11- HEALTHCARE WASTE MANAGEMENT
WASTE CHARACTERISTICS AND CURRENT WASTE
MANAGEMENT PRACTICES 7S
a basic, fundamental, systematic approach for productivity,
quality and safety improvement in all types of business
SORT
first step in making things clean & organized
To sort through everything in each work area.
Keep only what is necessary.
Materials, tools, equipment and supplies that are not frequently
used should be moved to a separate, common storage area.
Items that are not used should be discarded.
Don't keep things around just because they might be used
someday.
Sorting is the first step in making a work area tidy. It makes it
easier to find the things you need and frees up additional space.
As a result of the sorting process you will eliminate (or repair)
broken equipment and tools. Obsolete fixtures, molds, jigs,
scrap material, waste and other unused items and materials are
disposed of. Only keep those things in your work area that are is
necessary for getting the job done.
SET IN ORDER/ SYSTEMIC ORGANIZATION
organize,identify & arrange everything in work area
organize, arrange and identify everything in a work area for the
most efficient and effective retrieval and return to its proper place
Commonly used tools should be readily available
Storage areas, cabinets and shelves should be properly labeled.
Paint floors to make it easier to spot dirt, waste materials and
dropped parts and tools.
Outline areas on the floor to identify work areas, storage areas,
finished product areas, etc.
Put shadows on tool boards, making it easy to quickly see where
each tool belongs.
In an office, provide bookshelves for frequently used manuals,
books and catalogs. Labels the shelves and books so that they are
easy to identify and return to their proper place.
OBJECTIVE: to have a place for everything and have everything in it's
place, with everything properly identified and labeled.
SHINE
regular cleaning and maintenance
Regular, usually daily, cleaning is needed or everything will
return to the way it was.
Regular cleaning and inspection makes it easy to spot lubricant
leaks, equipment misalignment, breakage, missing tools and
low levels of supplies. Problems can be identified and fixed when
they are small.
When done on a regular, frequent basis, cleaning and inspecting
generally will not take a lot of time, and in the long run will most
likely save time.
STANDARDIZE
make it easy to maintain - simplify and standardize
Develop a work structure that will support the new practices and
make them into habits. As you learn more, update and modify
the standards to make the process simpler and easier.
Use standards to help people work into new habits that are a part
of your Five S program.
Any easy way to make people aware of, and remind them about
the standards is to use labels, signs, posters and banners.
SUSTAIN
maintaining what has been accomplished
To continue training and maintaining the standards
Have a formal system for monitoring the results of your 5S
program
Continue to educate people about maintaining standards. When
changes occur, provide employees with training that covers the
changes.
Think of this step as sustaining the benefits you are getting from
your Five S program.
Use equipment such as labelers, sign makers and poster printers
to help inform and educate people about your Five S program,
new procedures and standards.
SAFETY
Create a safe work environment
SECURITY
Has two main categories: physical and intellectual
o Physical security includes things like access to buildings,
areas of buildings and specific rooms.
o Intellectual security deals with intellectual property and
information.