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IntroductionHospital waste
Focus lies mainly on biological hazards caused by pathogenic waste
Has considerable repercussions human health Environment
In the Philippines DOH and DENR
Have set guidelines regarding Handling Collection Storage of pathogenic waste
But the degree to which hospitals follow these set of rules is not known
The University of Sato Tomas Hospital is a premier health care center should be committed in the service of public
healthwhether it be through patient care or ensuring
a clean healthy environment for their employees and the community
Definition of Hospital Waste Health care waste (WHO)
› all waste generated by healthcare establishments, research facilities, and health laboratories
› classified as 1. non-risk/general healthcare waste/domestic
waste2. hazardous waste
Prüss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva
Research Question
Does the University of Santo Tomas Hospital comply with the guidelines on handling, collection and storage of Pathogenic waste as written in the Health Care Waste Management Manual of the Department of Health and the Procedural Manual Title III of Dao 92-29 “Hazardous Waste Management” of the Department of Environment and Natural Resources?
General ObjectiveTo assess the compliance of University of Santo
Tomas Hospital regarding the handling, collection and storage of Pathogenic waste in accordance to Health Care Waste Management Manual of Department of Health and the Procedural Manual Title III of Dao 92-29 “Hazardous Waste Management” of Department of Environment and Natural Resources
Specific ObjectivesTo describe the handling of Pathogenic WasteTo describe the collection of Pathogenic WasteTo describe the Storage of Pathogenic WasteTo determine the compliance of UST hospital
regarding the handling, collection and storage of Pathogenic waste in accordance to Health Care Waste Management Manual of Department of Health
To determine the compliance of UST hospital regarding the handling, collection and storage of Pathogenic waste in accordance to the Procedural Manual Title III of Dao 92-29 “Hazardous Waste Management” of Department of Environment and Natural Resources
Definition of Terms
Pathogenic waste:A subset of health care waste which includes both
Pathological and Infectious waste as defined by the Hazardous Waste manual of the DENR
Infectious waste contains pathogens in sufficient quantity to
cause disease in susceptible hostsPathological waste
consists of tissues, organs, body parts, human fetus, animal carcasses, blood and other body fluids
Definition of Terms
Handling Collection and Storage:Component of waste management in which
health care waste is gathered and segregated resulting in the passage of a waste material from the source of production to the point of storage until transported to an off-site treatment facility
Definition of Terms
Health Care Waste Management Manual: Written by the DOH designed to ensure no
adverse health and environmental consequences involved in the generation, handling, storage and disposal of health care waste
Definition of Terms
Procedural Manual Title III of Dao 92-29 Hazardous Waste Management: Written by DENR designed to serve as a
primary reference for those involved in the generation, handling, storage and disposal of health care waste
To provide technical standards and requirements for hazardous waste generators, transporters, and premises/facilities involved in the treatment, storage, recycle, reprocess, and disposal of hazardous wastes in the country
Significance
Pathogenic Healthcare waste Identified as a major problem that negatively
impacts both human health and the environment
Little information available regarding the handling, collection storage and transport of
pathogenic waste in USTHThere are guidelines in place
appraisal of the current situation regarding pathogenic waste management in the USTH is essential
Review of Related LiteratureTwo studies conducted by the Department
of Health indicated the need to introduce modifications to the existing health care waste management practicesWaste Management Practices of DOH-Retained
Hospitals in 1995 Waste Management Practices of Private and
Government Hospitals in Metro-Manila in 1997
Most common problems encountered:Inadequate waste management practicesLack of awareness about the health hazardsInsufficient financial and human resourcesPoor control of waste disposal
Environmental and Occupational Health Office (EOHO) initiated the revision of the existing Hospital Waste Management Manual (EHS-DOH, 1997)
The revision was meant to:assist facility administrators in evaluating their
operations in order to improve the health care waste management practices
promote the use of appropriate technologies and to communicate with heath care personnel as well as to the public the risks associated with health care waste
Hospitals and other health care establishments have the responsibility of ensuring that there are no adverse health and environmental consequences on their handling, storage, treatment and disposal of health care waste
Through this manual, health care establishments will be able to install a more appropriate waste management system
Definition of Hospital Waste Healthcare waste (WHO)
› all waste generated by healthcare establishments, research facilities, and health laboratories
› classified as 1. non-risk/general healthcare waste/domestic
waste2. hazardous waste
Prüss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva
Definition of Hospital WasteClassification of Hazardous Waste (DENR)
based on these four characteristics accordance with the Toxicity Characteristic Learning Procedure (TCLP): IgnitableCorrosiveReactiveToxic
Department of Environment and Natural Resources. 2004. HazardousWaste Management. Procedural Manual Title III of DAO 92-29
Effects on HealthAll individuals exposed to hazardous health-
care waste are potentially at risk
Certain infections, caused by more resilient agents, pose a significant risk to the general public and to hospital patients
Mühlich, M. et. al. 2003. Comparison of infectious waste management in European hospitals. Institute for Environmental Medicine and Hospital
Epidemiology, Freiburg University Hospital, Freiburg, Germany
Prüss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva
People at riskhealth-care workers, particularly nurses, are at
greatest risk of infectionother hospital workers and waste-management
operators outside health-care establishmentsindividuals who scavenge on waste disposal sites lower risk for patients and the public
Mühlich, M. et. al. 2003. Comparison of infectious waste management in European hospitals. Institute for Environmental Medicine and Hospital
Epidemiology, Freiburg University Hospital, Freiburg, Germany
Regulation of Hospital Waste in the Philippines
Metropolitan Manila Authority (MMA) Ordinance No. 16
Hospital Licensure Law (Republic Act No. 4226)
Toxic Substances and Hazardous and Nuclear Waste Control Act of 1990 (Republic Act No. 6969
Soncuya, Matias, Lapid. 1997. Hospital Waste Management in the Philippines, two Case Studies in Manila. WASTE. Urban Waste Expertise Programme
Metropolitan Manila Authority (MMA) Ordinance No. 16
use four types of trash bags for easy identification of waste:1) black trash bag for non-infectious dry waste2) green trash bags for non-infectious wet waste3) yellow trash bags for dry and wet chemical and
other potentially infectious waste, pathological waste, chemical waste and sharps contained in puncture-proof containers covered with solution of lime
4) orange trash bags with trefoil sign for radioactive waste that will be stored in the hospital until rendered as inactive and/or disposed in accordance with the prescribed rules and regulations of the Philippine Nuclear Research Institute
Hospital Licensure Lawhospitals are categorized as government
or private hospitalsspecifies the needed physical facilities of a
hospital for solid waste management such as the physical plant, hospital equipment and maintenance of these physical facilities
Toxic and Hazardous and Nuclear Wastes Control Act of 1990
covers the importation, manufacture, processing, handling, storage, transportation, sale, distribution, use and disposal of all unregulated chemical substances and mixtures in the Philippines
defines the prohibited acts and provides for administrative and criminal penalties
Waste Management in the Philippineswastes, segregated or not, are collected by workers
employed by the health care establishment(usually cleaners or janitors of the premises) aware of local opportunities for recycling of components of the
waste unaware of, or insensitive to, the hazards associated with
handling health care waste generally take no precautions in handling, transporting and
separating the waste not supplied with protective clothing or special equipment
Pescod, S. 1998. Hospital Waste Management in Four Major Cities. WASTE. Urban Waste Expertise Programme
Waste Management in the Philippinesplastic bags, covered bins/trash cans, and glass
jars with covers
due to inadequate segregation of infectious from non-infectious much of the generated hospital waste is being disposed directly to municipal landfills
Department of Environment and Natural Resources. 1993. Pasig River Rehabilitation Program: Feasibility Report on Hospital Hazardous Waste Management in Metro Manila. Volume I
Waste Management in the Philippinescollected by the municipal waste
collection service transported for disposal with municipal
wasteall types of wastes are mixed and
transported, often along with municipal solid waste, to municipal landfills
Pescod, S. 1998. Hospital Waste Management in Four Major Cities. WASTE. Urban Waste Expertise Programme
Waste Management in the Philippinesexisting treatment capacity is insufficient for
the proper disposal of the major part of medical wastes generated in Metro Manila area
the existing capacity for incinerating these wastes totals to less than 3 tons/day
total daily quantity of dangerous medical wastes generated was estimated to at least 12.4 tons
Department of Environment and Natural Resources. 1993. Pasig River Rehabilitation Program: Feasibility Report on Hospital Hazardous
Waste Management in Metro Manila. Volume I
Problems in Medical Waste ManagementIn developing countries, medical waste has not
received much attention and it is disposed of together with domestic waste
Lack of a system of medical waste management, a lack of necessary supplies and facilities, a lack of knowledge among health workers and a lack of coordination among different ministries.
A national program for medical waste management is essential in Palestine
Massrouje, HTN., 2001. Medical waste and health workers in Gaza governorates. Eastern Mediterranean Health Journal
Problems in Medical Waste ManagementIn Lagos Metropolis, Nigeria, there is absence of
full compliance with the protocol stipulated in the guidelines and standards of environmental pollution control
There were problems in collection, segregation, storage, treatment, and disposal among the hospitals that were observed
Longe, E.O., Williams, A., 2006. A Preliminary Study of Medical Waste Management in Lagos Metropolis, Nigeria. Iran Journal of Environ.
Health Sci. Eng., 3:2:133-139
Problems in Medical Waste ManagementIn Dhaka, Bangladesh there is no proper,
systematic management of medical waste except in a few private Health Care Establishments that segregate their infectious wastes
Some cleaners were found to salvage used sharps, saline bags, blood bags and test tubes for resale or reuse
Hassan, M., Ahmed, S., Rahman, K., Biswas, T. 2008. Pattern of medical waste management: existing scenario in Dhaka City, Bangladesh.
BMC Public Health. 8:36
Review of Related LiteratureEvidence showed that there are many
flaws in the compliance, implementation and even in the construction of guidelines concerning hospital management in the Philippines and around the world
Several studies have recommended several steps that may be undertaken to address these flaws
Review of Related LiteratureRecommendations:
establishment of directorates responsible for medical waste management
coordination of different ministriesprovision of adequate supplies and health
education including encouragement of studies on different aspects of medical waste (creation of database information in different sectors, risk analysis and disposal methods)
Massrouje, HTN., 2001. Medical waste and health workers in Gaza governorates. Eastern Mediterranean Health Journal
Review of Related LiteratureCase studies in the Philippines have only
focused on two distinct hospitals in Metro Manila
Should include the University of Santo Tomas Hospital
MethodologyDescriptive StudyInclusion Criteria:
Super Clean ServicesExclusion Criteria:
Waste TransporterWaste TreatersTSD facility
MethodologyData Collection
Semi Structured Interview of authorities and Personnel of Super Clean Services
Visual inspection and Field investigation of collection, handling and storage of pathogenic waste
Data ProcessingFlow Chart and narrative of collection,
handling and storage of pathogenic waste
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Selection and planning of research topicCoordinating with UST Hospital’s maintenance officerWorkplace inspectionLiterature researchResearch methodology planningData gatheringData evaluationConstruction of research conclusion and recommendation Final research paper formation