Health Care Waste

Management
Lesson 11
LEARNING OBJECTIVES
• Discuss the importance of proper waste management in health
care facilities
• Examine the laws and regulations governing health care waste
management; and
• Describe the proper identification, segregation, collection,
storage, transport, treatment, and disposal of health care
wastes.
 Defining Health Care Waste
Health care waste refers 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 waste
 Defining Health Care Waste
Health care waste generators - health care facilities and other spaces
where health care services are offered with activities that generate wastes:
1. Hospitals and medical centers
2. Infirmaries
3. Birthing homes
4. Clinics and other health-related facilities
5. Laboratories and research centers
6. Drug manufacturers
7. Institutions
8. Mortuary and autopsy centers
 Health Care Waste Statistics
• Estimated 16 billion injections are administered worldwide, but not all of the
needles and syringes are properly disposed of afterwards
• According to a joint assessment of the World Health Organization (WHO) and
United Nations Children’s Fund (UNICEF) – over half (58%) of the 24 countries
had adequate systems for healthcare waste disposal
• According to WHO – 75-90% wastes are non-hazardous; 10- 25% of wastes
are hazardous and may be infectious, toxic, or radioactive
High-income countries – 0.5kg of hazardous waste/hospital bed/day
Low-income countries – 0.2kg of hazardous waste/hospital bed/day
Categories of Health Care Waste
1. Non-hazardous or General Waste
2. Infectious, Pathological and Anatomical Waste
3. Sharps
4. Chemical Waste
5. Pharmaceutical Waste
6. Radioactive Waste
7. Genotoxic Wastes
Categories of Health Care Waste
1. Non-hazardous- wastes that have not been in contact with
communicable or infectious agents, hazardous, chemicals, or
radioactive materials and comes mostly from the administrative and
housekeeping functions of health care establishments.
2. Infectious, Pathological and Anatomical Wastes
▪ Infectious – contains pathogens,
▪ Pathological – tissues, organs, body parts, human fetus, and animal
carcasses, blood and body fluids
▪ Anatomical waste – subgroup of pathological waste refers to recpgnizable
body pars usually from amputation procedures
3. Sharps - items that can cause a cut or puncture wounds (needles,
syringes, scalpels, saws, blades). It is considered the most dangerous
waste because of its potential to cause both injury and infection.
Categories of Health Care Waste
4. Chemical Wastes - discarded chemicals (solid, liquid, or gaseous)
generated during disinfection and sterilization procedures
▪ chemicals are considered hazardous when they are:
✓ Toxic (with health and environment hazards)
✓ Corrosive (acid of pH < 2.0 and bases of pH > 12.0)
✓ Flammable (with a flash point below 60˚C)
✓ Reactive (explosive with water)
5. Pharmaceutical Wastes - expired, unused, split, and contaminated
pharmaceutical products, drugs, vaccines, and sera. It also includes
antineoplastic, cytotoxic, and genotoxic wastes such as drugs used in
oncology or radiotherapy, and biological fluids from patients treated with
the said drugs.
Categories of Health Care Waste
6. Radioactive Wastes - wastes exposed to radionuclides including
radioactive diagnostic materials or radiotherapeutic materials
▪ disused sealed radiation sources, liquid, and gaseous materials
contaminated with radioactivity

7. Genotoxic Wastes - cytostatic drugs, vomit, urine, feces from patients

treated with cytostatic drugs.
▪ These are highly hazardous and may have mutagenic (mutation), teratogenic
(birth defects), or carcinogenic (cancers) properties (violet waste bin).
 Impact of Health Care Waste
• 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)
• Hazards may include drug resistant microorganisms, chronic and acute
exposure to pathogens
• Other causes; sharp inflicted injuries, toxic exposure to pharmaceutical
products, chemical burns, air pollution, thermal injuries, radiation burns
Legislation, Policies, and Guidelines Governing Health Care Waste
International Agreements Pertaining to
Health Care Waste Management
• The Montreal Protocol on Substances
that Deplete the Ozone Layer (1987)
• The Basel Convention on the Control of
the trans Boundary Movements of
Hazardous Wastes and Their Disposal
(1989)
• The United Nations Framework
Convention on Climate Change (1992)
• The Stockholm Convention on Persistent
Organic Pollutants (2001)
National Laws and Policies on
Health Care Waste Management
• Republic Act No. 3931
• Presidential Decree No. 1586 DOH
Administrative Order No. 2008-0021
• DOH Administrative Order No. 2008-
0023
• BFAD Memorandum Circular No. 22,
Series of 1994
• Republic Act No. 6969
• Republic Act No. 8749
• Republic Act No. 9275
• Presidential Decree No. 856
 Legislation, Policies, and Guidelines Governing Health Care Waste
International Agreements Pertaining to Health Care Waste Management
1. The Montreal Protocol on Substances that Deplete the Ozone Layer (1987)
➢ Montreal, Canada on September 16, 1987
➢ January 1, 1989 – came into force
➢ designated to stop the production and import of ozone depleting substances and reduce their
concentration in the atmosphere to help protect the earth’s ozone layer
2. The Basel Convention on the Control of the trans Boundary Movements of Hazardous
Wastes and Their Disposal (1989)
➢ Basel, Switzerland
➢ an international treaty that was designed to regulate transboundary movements (TBM) of
hazardous wastes and other wastes and is specifically created to prevent transfer of hazardous
waste from developed to less developed countries
3. The United Nations Framework Convention on Climate Change (1992)
➢ by the year 2000, major industrialized nations would voluntarily reduce their greenhouse gas emissions
to 1990 levels
➢ OBJECTIVE: to stabilize greenhouse gas concentrations in the atmosphere at a level that would prevent
dangerous anthropogenic interference with the climate system
 Legislation, Policies, and Guidelines Governing Health Care Waste
International Agreements Pertaining to Health Care Waste Management
4. The Stockholm Convention on Persistent Organic Pollutants (2001)
➢ international treaty to protect human health and the environment from the harmful effects of persistent
organic pollutants (POPs)
➢ persistent organic pollutants are chemicals that:
- remain unchanged in the environment for long periods of time
- accumulate in the fatty tissues of living organisms
- are toxic to both humans and wildlife
Legislation, Policies, and Guidelines Governing Health Care Waste
National Laws and Policies on Health Care Waste Management
1. Republic Act No. 3931 – “Pollution Control Law”
1.a. DENR Administrative Order No. 34, Series of 1990 – “Revised Water Usage and
Classification/Water Quality Criteria
1.b. DENR Administrative Order No. 35, Series of 1990 – “Effluent Regulations”
- lists the effluent regulations for the different levels of pollutants according to their water
category/class
1.c. DENR Administrative Order No. 26, Series of 1992 – “Amending Memorandum Circular
No. 02, Series of 1981”
- appointment of Pollution Control Officers (PCO)

2. Presidential Decree No. 1586 – “Environmental Impact Statement (EIS) System” (1978)
- secure an Environmental Compliance Commitment Certificate (ECC) prior to the construction
and operation of the facility

3. DOH Administrative Order No. 2008-0021 dated July 30, 2008 – “Gradual Phaseout of Mercury in all Philippine
Healthcare Facilities and Institutions” -requires all health care facilities (HCF) to gradually phaseout the use of
mercury-containing devices and equipment
3.a. Department Memorandum No. 2011-0145 – “Guidelines for the Temporary Storage of Mercury
Wastes in Healthcare Facility” o detailed guidelines on the temporary storage of mercury containing
devices and the management of mercury spills.
Legislation, Policies, and Guidelines Governing Health Care Waste
National Laws and Policies on Health Care Waste Management
4. DOH Administrative Order No. 2008-0023 dated July 30, 2008 – “National Policy on Patient Safety

5. BFAD Memorandum Circular No. 22, Series of 1994 – “Inventory, Proper Disposal, and/or Destruction of Used
Vials or Bottles -contains guidelines on the proper inventory and destruction of bottles and vials

6. Republic Act No. 6969 – “An Act to Control Substances and Hazardous Nuclear Wastes of 1990” -policies and
guidelines on effective and proper handling, collection, transport, storage, and disposal of healthcare wastes

7. Republic Act No. 8749 – “The Philippine Clean Air Act of 1999” -prohibits the incineration of bio-medical wastes
effective July 17, 2003

8. Republic Act No. 9275 – “The Philippine Clean Water Act of 2004”

9. Presidential Decree No. 856 – “The Code on Sanitation of the Philippines – Chapter XVII on Sewage Collection
and Excreta Disposal” (1998)
Health Care Waste Management System

The Green Procurement Policy

▪ This involves two aspects: Waste Prevention and Waste Reduction
▪ Health care facilities are encouraged to avail of services that are least harmful
to the environment and to purchase less polluting products.
 REUSING, RECYCLING, AND
RECOVERING
• Reusing – Refers to either finding a new application for a used material or
using the same product for the same application repeatedly.
• Recycling – Refers to the processing of used materials into new products.
• Recovery of waste – defined in two ways;
(1) energy recovery, whereby waste is converted to fuel for generating
electricity or for direct heating of premises and
(2) as a term used to encompass three subsets of waste recovery:
recycling, composting, and energy recovery
• End of Pipe - implemented when wastes are not safe for reuse, recycle, or
recovery
• Involves two aspect :
(1) Treatment – Process of changing the biological and chemical
characteristics of waste to minimize its potential to cause harm
(2) Disposal – Refers to the discharging, placing or releasing any health
care waste into air, land, or water.
SEGREGATION, COLLECTION, STORAGE, AND
TRANSPORT OF HEALTH CARE WASTES
• Healthcare facilities are tasked to ensure that generated wastes are
properly and safely managed; wastes must be segregated, collected,
stored, and transported.
• The effective management of health care wastes considers the basic
elements of waste minimization, identification, and segregation.
• Proper placement, labelling, and use of color-coded plastic liners must
be implemented
SEGREGATION, COLLECTION, STORAGE, AND
TRANSPORT OF HEALTH CARE WASTES
SEGREGATION, COLLECTION, STORAGE, AND
TRANSPORT OF HEALTH CARE WASTES
Type of Waste Specifications

Infectious (Yellow bin) Bin: Strong leak-proof with cover labelled

“Infectious” with biohazard symbol

Liner: Yellow plastic that can withstand

autoclaving with 0.009mm thickness and
labelled “Infectious Waste” with a tag
indicating source and weight of waste and
date of collection; may or may not have
biohazard symbol
 Type of Waste
Pathological and Anatomical (Yellow bin)
Sharps (Red bin)
Specifications
Bin: Strong leak-proof with cover labelled
“Pathological/Anatomical” with biohazard
symbol
Liner: Yellow plastic that can withstand
autoclaving with 0.009mm thickness and
labelled “Pathological/Anatomical Waste”
with a tag indicating source and weight of
waste and date of collection; biohazard
symbol is optional
Bin: Puncture-proof with wide mouth and
cover labelled “Sharps” with biohazard
symbol
Liner: Not applicable
 Type of Waste Specifications
Chemical (Orange bin) Bin: Labelled “Chemical Waste”; For liquid
chemical waste, inside the bin is a disposal bottle
made of amber-colored glass with at least 4 liter-
capacity that is strong, chemical resistant, and
leak-proof

Liner: Yellow with black band plastic with

0.009mm thickness and labelled “Chemical Waste”
with a tag indicating source and weight of waste
and date of collection
Pharmaceutical (Blue bin) Bin: Strong leak-proof with cover labelled
“Pharmaceutical Waste” for expired drugs and
drug containers, and “Cytotoxic Waste” for
cytotoxic, genotoxic, and antineoplastic waste

Liner: Yellow with black band plastic with

0.009mm thickness and labelled “Pharmaceutical
Waste” with a tag indicating source and weight of
waste and date of collection
 Type of Waste
Radioactive (Yellow bin w/ radioactive sign)
General (Green or black bin)
Dental (White bin)
Specifications
Bin: Radiation-proof repositories, leak-proof, and
lead-lined container labelled with name of
radionuclide and date of deposition with
radioactive symbol
Liner: Orange plastic with 0.009mm thickness and
labelled “Radioactive” with a tag indicating name
of radionuclide and date of deposition
Bin: Optional recycle symbol for recyclable non-
hazardous wastes; varying sizes depending on the
volume of waste
Liner: Black or colorless plastic for non-
biodegradable and green for biodegradable with a
thickness of 0.009mm with a tag indicating source,
weight of waste, and date of collection
-
Symbols used by DENR Environmental Management Bureau together
with other universally accepted hazard symbol
 STERILIZATION, DISINFECTION,
DECONTAMINATION
• Sterilization is the process that kills all forms of microbial life,
including bacterial endospores
• Disinfection is the process that destroys pathogenic organisms,
but not necessarily all microorganisms, endospores or prions.
• Decontamination is the removal of pathogenic microorganisms
so items are safe to handle or dispose of
Sterilization
• Is a process whereby all forms of microbial life including bacterial
spores, are killed
• Sterilization may be accomplished by physical or chemical means

Physical methods Chemical methods

Incineration Ethylene glycol (ETO)

Autoclave ( Moist heat) Formaldehyde vapor and Vapor
Oven (Dry heat) phase Hydrogen Peroxide
Filtration Hydrogen peroxide gas plasma
Ionizing (gamma) radiation
 Sterilization
Physical methods
Incineratio Used to sterilized inoculating loops and biochemical waste
n Hazardous material is literally burned to ashes to temperature of 870˚C to 980˚C
Safest method to ensure that no infective materials remain in samples or containers when
disposed
Autoclave Most effective method for sterilization
(Moist At 121˚C at 15 pounds pressure per square inch (psi) for 15 minutes -> under steam pressure
Heat) Kills viruses and bacteria
Oven Used to sterilized glasswares, oil, petrolatum, or powders
(Dry Heat) 160˚C to 180 ˚C for 1.5 to 3 hours
Filtration Method of choice for heat-sensitive substances such as antibiotic solutions, toxic chemicals,
radioisotopes, vaccines, and carbohydrates.
Ionizing For sterilizing disposable such as plastic syringes, catheters, or gloves before use
(gamma) Used in microwaves and radiograph machines
radiation Composed of short wavelength and high energy gamma rays
 Sterilization
Chemical methods
Ethylene glycol Most common chemical sterilant
Cold Sterilization
Used for gaseous form of sterilizing heat-sensitive objects (materials that cannot be
autoclaved)

Formaldehyde vapor Oxidizing agent used to sterilize HEPA filters in BSC, metals and nonmetal devices
and Vapor phase such as medical instruments
Hydrogen Peroxide
Hydrogen peroxide -
gas plasma
Disinfection
• Is a process whereby pathogenic organisms, but not necessarily all
microorganisms or spores, are destroyed
• Disinfection may be accomplished by physical or chemical means

Physical methods Chemical methods

Boiling Alcohol
Pausteurization Formalin
Nonionizing radiation Glutaraldehyde
Halogens
Hydrogen peroxide
Phenolics
Quaternary ammonium compounds
 Disinfection
• Is a process whereby pathogenic organisms, but not necessarily all
microorganisms or spores, are destroyed
• Disinfection may be accomplished by physical or chemical means
Physical methods
Boiling 100 for 15 mins, which kills vegetative bacteria, spores
may not be killed
Pasteurization Kills foods pathogen without damaging the nutritional
value or flavor
Batch Method: __ for __ mins
Flash Method : __ for __ mins

Non-ionizing radiation UV Rays are Long wavelength and low energy

UV light ( used in BSC)
 Disinfection
Chemical methods
Alcohol ( Ethanol, Ethyl or Isopropyl alcohol (70%-80%) is non- sporicidal
Isopropanol, Benzyl
Alcohol)
Aldehydes ( in solution) Disinfectant; kills endospore
Toxic to humans ex. Formaldehyde (8%) kills endospore
Glutaraldehyde (2%) – cold sterilant
Halogens Iodine tincture (2% in 70% alcohol) – inactivates protein; used as antiseptic
Iodophor (povidone-iodine) – combination of iodine and a neutral polymer
(detergent); releases iodine slowly and are less irritating and non-
staining; used as antiseptic
Chorine – 10% sodium hypochlorite (NaOCl) or house hold bleach one of
the most effective agent against HIV and HBV
Hydrogen Peroxide 3% solution used as antiseptic

Phenolics Denature proteins and disrupts cell membranes

Disinfectants at high concentration; used in soaps at low concentration
Quaternary Ammonium Used to disinfect bench tops or other surfaces in the laboratory
Compounds Rapidly inactivated by organic matter.
 Biological Indicators
Autoclave B. stearothermophilus spores
Ionizing radiation B. pumilis
Dry heat oven B. subtilis var. niger
Ethylene glycol B. subtilis var. globitii
 Disposal of Hazardous Waste
• All materials contaminated with potentially infectious agents must be
decontaminated before disposal.

Infectious Waste “Double-bagging” – placed into two leak proof plastic bags for
sturdiness
Decontaminated by AUTOCLAVE, INCINERATOR or other methods
Pipet, Swab, other glass Placed into rigid cardboard containers before disposal

Broken Glass Placed in thick boxes lined with plastic biohazard bags; when full,
the box is autoclaved or incinerated
Sharp objects Placed in sharps containers which are autoclaved or incinerated
when full.
TREATMENT AND DISPOSAL OF
HEALTH CARE WASTES
Health care wastes can be decontaminated either by:
▪ Sterilization - kills all microorganisms
▪ Disinfection - reduces the level or microorganisms present in the material

Acceptable technologies and methods used in the treatment of health care wastes:
1. Pyrolysis
2. Autoclave
3. Microwave
4. Chemical Disinfection
5. Biological Process
6. Encapsulation
7. Inertization
Pyrolysis
➢ Thermal decomposition in absence of supplied molecular oxygen in the destruction chamber
➢ Waste is converted to gaseous, liquid, or solid form
➢ Waste residue may in form of greasy aggregates or slugs, recoverable metals or carbon black,
that are disposed in a land fill
Autoclave
➢ steam sterilization, an efficient wet thermal disinfection process
➢ usual setting is at 121 ˚C with a pressure of 15 psi for 15-30 minutes
➢ Uses Indicators such as color-changing tapes (B. stearothermophilus spores)

Microwave
➢ size reduction device - shredding of wastes is done before disinfection
➢ temperature of 100 ˚C ( 237.6 ˚ F) for at least 30 minutes
➢ Destroy microorganism through moist heat that irreversibly coagulates and
denatures enzymes and structural proteins.
Chemical Disinfection
➢ kill or inactivate present pathogens
➢ chemicals used: 10% sodium hypochlorite (recommended), hydrogen peroxide, peroxyacetic acid
and heated alkali

Biological process
➢ Uses an enzyme mixture to decontaminate health care wastes.
➢ The resulting by-product is put through an extruder to remove water for wastewater disposal
➢ Suited for large applications and is also being developed for possible use in the agricultural
sector

Encapsulation
➢ filling of container with waste, adding and immobilizing material and sealing
➢ to reduce the risk of scavengers gaining access to the hazardous healthcare wastes
Inertization
➢ mixing of waste with cement, lime, and water
➢ to minimize the risk of toxic substances contained in waste migrating into surface water or
groundwater

Landfill
➢ engineered site (w/ secured proper permits from DENR) designed to keep waste isolated from
the environment.
➢ Only Health Care Waste that are properly treated can be mixed with general waste provided
that it is certified with DOH that the organism in the waste products are inert and cannot
regenerate.
➢ Safe Burial as a disposal method is only applicable to treated infectious wastes, sharps,
pathological and anatomical wastes, small quantities of encapsulated/inertisized solid
chemical and pharmaceutical waste and only allowed in health care facilities located in a
remote area.
 END
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