Healthcare Waste Management - UST General Santos PDF

PRAYER BEFORE CLASS Holy Spirit, Divine Creator, true source of light and fountain of wisdom! Pour forth your brilliance upon my dense intellect, dissipate the darkness which covers me, that of sin and of ignorance. Grant me a penetrating mind to understand, a retentive memory, method and ease of le...

PRAYER BEFORE CLASS Holy Spirit, Divine Creator, true source of light and fountain of wisdom! Pour forth your brilliance upon my dense intellect, dissipate the darkness which covers me, that of sin and of ignorance. Grant me a penetrating mind to understand, a retentive memory, method and ease of learning, the lucidity to comprehend, and abundant grace in expressing myself. Guide the beginning of my work, direct its progress and bring it to successful completion. This I ask through Jesus Christ, true God, and true man, living and reigning with You and the Father, forever and ever. Amen.  UST General Santos Medical Technology Department UNIT 6: Healthcare Waste Management PRINCIPLES OF MEDICAL TECHNOLOGY PRACTICE 1 Outline Part I Healthcare Wastes ○ Definition ○ Categories Impact of Healthcare Wastes Part II Healthcare Waste Management System ○ Reuse, Recovery, and Recycling Legal Issues and Local Regulatory Agencies Learning Outcome At the end of the unit, the student must be able to: Classify biomedical and hazardous wastes and explain the process of proper health care waste management.  UST General Santos HEALTHCARE WASTE MANAGEMENT SYSTEM HEALTHCARE WASTE MANAGEMENT Healthcare Waste Management System Waste Minimization ○ Most important step ○ Using green procurement policy approach - Waste prevention - Avail services that are least harmful - Purchase less polluting products - Waste reduction - Proper waste segregation Healthcare Waste Management System Resource Development ○ Reusing - New application for a used material - Using the same product for the same application repeatedly Ex: laboratory glassware can be used repeatedly after decontamination  Healthcare Waste Management System Resource Development ○ Recycling - Processing of used materials into new products Ex: computer printouts can be recycled into new paper products Healthcare Waste Management System Resource Development ○ Recovery - Energy recovery — waste is converted to fuel - Broader term — encompassing recycling, composting, and energy recovery Healthcare Waste Management System End Pipe Approach ○ For wastes that cannot be safely reused, recycled, recovered ○ Involves two aspects - Treatment - Changing the biological and chemical characteristics of waste - Disposal - Discharging, depositing, placing, or releasing any healthcare waste into aire, land, or water Segregation, Collection, Storage, and Transport of Health Care Wastes Healthcare facilities are tasked to ensure proper and safe disposal of healthcare wastes. Healthcare facilities must: - Segregate, collect, store, and transport healthcare wastes while considering the risk and occupational safety and compliance with regulations - Assign a waste manager officer HOW TO EFFECTIVELY MANAGE HEALTHCARE WASTES? By considering these principles: 1. Waste minimization 2. Waste identification 3. Waste segregation Segregation of Health Care Wastes Segregation - Responsibility of the waste generator - Process of separating different types of waste from the point of generation until their final disposal using garbage bins Segregation of Health Care Wastes To improve efficiency of segregation and minimize the incorrect use of garbage bins, implement: - Strategic placement: place waste bins in convenient locations - Clear labelling: label bins with clear and concise information - Color-coded plastic liners/garbage bags: use color-coded liners to visually differentiate waste types Guidelines for the Proper Labelling, Marking, and Color Coding COLOR OF CONTAINER/BAG TYPE OF WASTE BLACK Non-infectious dry waste GREEN Non-infectious wet waste YELLOW Infectious and pathological waste YELLOW WITH BLACK BAND Chemical waste including those with heavy metals ORANGE Radioactive waste RED Sharps and pressurized containers SYMBOLS USED FOR YELLOW PLASTIC LINERS Guidelines for the Proper Labelling, Marking, and Color Coding GENERAL WASTE BIN LINER - Recycle symbol - Black or colorless plastic for non- (optional) for biodegradable recyclable non- - Green for biodegradable hazardous wastes - 0.009 mm thick - With tag indicating source, weight of waste, date of collection Guidelines for the Proper Labelling, Marking, and Color Coding INFECTIOUS WASTE BIN LINER - Strong - Yellow plastic - Leak-proof with cover - Can withstand autoclaving - Labelled “INFECTIOUS” - 0.009 mm thick with biohazard symbol - Labelled “INFECTIOUS WASTE” - With tag indicating source, weight, and date collection - Biohazard symbol (optional) Guidelines for the Proper Labelling, Marking, and Color Coding PATHOLOGICAL AND ANATOMICAL WASTES BIN LINER - Strong - Yellow plastic - Leak-proof with cover - Can withstand autoclaving - Labelled - 0.009 mm thick “PATHOLOGICAL/ANAT - Labelled OMICAL WASTE” with “PATHOLOGICAL/ANATOMICAL biohazard symbol WASTE” - With tag indicating source, weight, and date collection - Biohazard symbol (optional) Guidelines for the Proper Labelling, Marking, and Color Coding BIN LINER CHEMICAL WASTE - Labelled “CHEMICAL - Yellow with black band plastic WASTE” - 0.009 mm thick - Liquid chemicals: - Labelled “CHEMICAL WASTE” inside the bin is - With tag indicating source, disposal bottle made weight, and date of collection of amber colored glass with at least 4 liters capacity; strong; chemical resistant; leak proof Guidelines for the Proper Labelling, Marking, and Color Coding PHARMACEUTICAL WASTE BIN LINER - Strong - Yellow with black band plastic - Leak proof with cover - 0.009 thick - Labelled - Labelled “PHARMACEUTICAL WASTE” “PHARMACEUTICAL - Tag indicating source, weight, date of WASTE” for expired drugs collection and drug containers - Labelled “CYTOTOXIC WASTE” for cytotoxic, genotoxic, and antineoplastic waste Guidelines for the Proper Labelling, Marking, and Color Coding RADIOACTIVE WASTE BIN LINER - Radiation proof - Orange plastic repositories - 0.009 thick - Leak proof - Labelled “RADIOACTIVE” - Lead-lined container - Tag indicating name of radionuclide - Labelled with name of and date of deposition radionuclide and date of deposition with radioactive symbol Guidelines for the Proper Labelling, Marking, and Color Coding SHARP WASTE BIN LINER - Puncture proof - Not applicable - With wide mouth and cover - Labelled “SHARPS” - With biohazard symbol In the implementation of a color-coding system for healthcare wastes, the following practices should be observed: 1. Highly infectious waste must be disinfected at source 2. Anatomical waste including recognizable body parts, placenta waste, and organs should be disposed through safe burial or cremation 3. Pathological waste must be refrigerated if not collected or treated within 24 hours 4. Sharps must be shredded or crushed before they are transported to the landfill In the implementation of a color-coding system for healthcare wastes, the following practices should be observed: 5. Chemical and pharmaceutical wastes shall be segregated and collected separately - Hazardous chemicals 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 pharmaceuticals should be returned to the pharmacy for temporary storage to be returned to the manufacturer/supplier - Pharmaceuticals shall be kept in their original packaging for proper identification and prevention of possible reaction with other chemicals In the implementation of a color-coding system for healthcare wastes, the following practices should be observed: 6. Radioactive waste has to be decayed to background radiation levels - If background radiation levels has been reached, considered as non-infectious waste provided not mixed with infectious or chemical wastes 7. All waste bins must be properly covered to prevent cross contamination 8. Aerosol containers can be collected with general waste Proper Collection and Transport of Healthcare Waste ONSITE COLLECTION AND TRANSPORT OFFSITE TRANSPORT Regular onsite collection Only accredited DENR transporters Use designated trolleys to transport and waste collectors are authorized waste to facility’s treatment or to transport wastes from healthcare storage area facility to a Personnel handling waste must be Treatment/Storage/Disposal facility trained and equipped with proper PPE TREATMENT OF HEALTHCARE WASTES Healthcare wastes can be decontaminated either by STERILIZATION or DISINFECTION STERILIZATION - kills all microorganisms DISINFECTION - reduces the level of microorganisms present in the material TREATMENT OF HEALTHCARE WASTES PYROLYSIS - Thermal decomposition in the absence of oxygen - Waste is converted to gaseous, liquid or solid form - Waste residues: greasy aggregates, slugs, recoverable materials, carbon black TREATMENT OF HEALTHCARE WASTES AUTOCLAVE - Steam sterilization - Using high pressure (15 psi) and heat (121oC) for 15-30 minutes - Efficient wet thermal disinfection process TREATMENT OF HEALTHCARE WASTES MICROWAVE - Shredding of wastes is done before disinfection - Waste is exposed to microwaves that raises temperature to 100oC for at least 30 minutes - Microorganisms are destroyed by moist heat TREATMENT OF HEALTHCARE WASTES CHEMICAL DISINFECTION - Uses chemicals: sodium hypochlorite, hydrogen peroxide, peroxyacetic acid, and heated alkali - Generates chemical wastes  TREATMENT OF HEALTHCARE WASTES BIOLOGICAL PROCESS - Uses enzymes to decontaminate healthcare wastes - Resulting by-product is put through an extruder to remove water for wastewater disposal TREATMENT OF HEALTHCARE WASTES ENCAPSULATION - Uses high density polyethylene or metallic drums - Waste management technique that involves - Filling containers with waste - Sharps, chemicals, pharmaceutical wastes - Adding and immobilizing material - Plastic - foam, bituminous sand, cement mortar Aft ermediumhasdri ed Seali n gt hecon t ainers  TREATMENT OF HEALTHCARE WASTES INERTIZATION - Suitable for pharmaceutical waste - Homogenous mass produced can be transported to suitable storage site or poured into municipal waste Process steps: 1. Packaging removal 2. Grinding 3. Mix with water, lime, cement  DISPOSAL OF HEALTHCARE WASTES After treatment, healthcare wastes are usually disposed in landfills 1. Landfills must secure permit from DENR 2. Properly treated healthcare wastes can be mixed with general wastes provided that it is certified by the DOH that the organisms in the waste are inert and cannot regenerate  DISPOSAL OF HEALTHCARE WASTES Healthcare facilities in far-flung areas - Disposal usually through safe burial - Only applicable for treated infectious wastes, sharps, pathological and anatomical wastes, small quantities of encapsulated/inertisized solid chemical, and pharmaceutical wastes  UST General Santos LEGAL ISSUES AND LOCAL REGULATORY AGENCIES HEALTHCARE WASTE MANAGEMENT INTERNATIONAL AGREEMENTS PERTAINING TO HEALTHCARE WASTE MANAGEMENT International Agreements Pertaining to Healthcare Waste Management 1. The Montreal Protocol on Substances that Deplete the Ozone Layer (1987) Final objective — eliminate ozone depleting substances in the environment International Agreements Pertaining to Healthcare Waste Management 2. The Basel Convention on the Control of the Transboundary Movements of Hazardous Wastes and Their Disposal (1989) 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 International Agreements Pertaining to Healthcare Waste Management 3. The United Nations Framework Convention on Climate Change (1992) By 2000, major industrialized nations would voluntarily reduce their greenhouse gas emissions to 1900 levels International Agreements Pertaining to Healthcare Waste Management 4. The Stockholm Convention on Persistent Organic Pollutants (2001) Global treaty to protect human health and environment from POPs Persistent Organic Pollutants (POPs) - Remain unchanged in the environment for long periods of time - Accumulate in the fatty tissues of living organisms - Toxic to both humans and wildlife International Agreements Pertaining to Healthcare Waste Management 5. The ASEAN Framework Agreement on the Facilitation of Goods in Transit (1998) Provides nine (9) level protocols that set out generic standards for the implementation of an international transit system Protocol 9 on Dangerous Goods - Provisions on the transport of toxic and infectious substances NATIONAL LAWS AND POLICIES ON HEALTHCARE WASTE MANAGEMENT National Laws and Policies on Healthcare Waste Management 1. RA No. 4226 “Hospital Licensure Act” - Requires the registration and licensure of all hospitals in the country - Mandates the DOH to provide guidelines for hospital technical standards as to personnel, equipment, and physical facilities DOH AO No. 70-A Series of 2002 “ Revised Rules and Regulations Governing the Registration, Licensure, and Operation of Hospitals and Other Health Facilities in the Philippines - Application or renewal of license, submissions of plans, and other design requirements under the Code of Sanitation of the Philippines - Manuals on Hospital Waste Management and Health Facilities Maintenance are required for submission for verification by the DOH-BHFS National Laws and Policies on Healthcare Waste Management 1. RA No. 4226 “Hospital Licensure Act” - Requires the registration and licensure of all hospitals in the country - Mandates the DOH to provide guidelines for hospital technical standards as to personnel, equipment, and physical facilities DOH AO No. 2005-0029 “Amendment to AO. No. 70-A series of 2002 Re: Revised Rules and Regulations Governing the Registration, Licensure and Operation of Hospitals and Other Health Facilities in the Philippines” - Requires HCF to submit a healthcare waste management plan to DOH-BHFS as one of the requirements for the issuance of license to operate National Laws and Policies on Healthcare Waste Management 1. RA No. 4226 “Hospital Licensure Act” - Requires the registration and licensure of all hospitals in the country - Mandates the DOH to provide guidelines for hospital technical standards as to personnel, equipment, and physical facilities DOH AO No. 2007-0027 “Revised Rules and Regulations Governing the Licensure and Regulation of Clinical Laboratories in the Philippines” - Requires written procedures for the proper disposal of healthcare waste and other hazardous substances - Requires written policy guidelines on biosafety and biosecurity National Laws and Policies on Healthcare Waste Management 2. RA No. 6969 “An Act to Control Substances and Hazardous and Nuclear Wastes” - Requires the registration of waste generators, waste transporters, and operators of toxic and hazardous waste treatment facilities with the EMB. DENR AO No. 36 Series of 2004 “Revising DENR AO No. 29, Series of 1992, to Further Strengthen the Implementation of Republic Act 6969 and Prescribing the Use of the Procedural Manual” - Procedural Manual requires a comprehensive documentation on the legal and technical requirements of hazardous waste management. National Laws and Policies on Healthcare Waste Management 2. RA No. 6969 “An Act to Control Substances and Hazardous and Nuclear Wastes” - Requires the registration of waste generators, waste transporters, and operators of toxic and hazardous waste treatment facilities with the EMB. DOH-DENR Joint AO No. 02 Series of 2005 “Policies and Guidelines on Effective and Proper Handling, Collection, Transport, Treatment, Storage, and Disposal of HCW” - Provide guidelines to generators, transporters, and operators/owners of TSD Facilities on the proper handling, collection, transport, storage, treatment, and disposal of health care wastes - Clarify the jurisdiction, authority, and responsibility of DENR and DOH with regard to HCWM - Harmonize the efforts of DENR and DOH on HCWM. National Laws and Policies on Healthcare Waste Management 2. RA No. 6969 “An Act to Control Substances and Hazardous and Nuclear Wastes” - Requires the registration of waste generators, waste transporters, and operators of toxic and hazardous waste treatment facilities with the EMB. DOH AO No. 2007-0014 “Guidelines on the Issuance of Certificate of Product Registration for Equipment or Devices Used for Treating Sharps, Pathological and Infectious Waste” - Requires institutions/companies selling or using equipment and devices treating sharps, pathological, and infectious wastes to secure a Certificate of Product Registration from DOH through the Bureau of Health Devices and Technology National Laws and Policies on Healthcare Waste Management 3. RA No. 8749 “The Philippine Clean Air Act of 1999” - Prohibits the incineration of biomedical wastes - Promoting use of environmentally sound, and safe non-burn technologies for handling, treatment, and disposal of biomedical and hazardous wastes. National Laws and Policies on Healthcare Waste Management 4. RA No. 9003 “Ecological Solid Waste Management Act of 2000” - Segregation of solid wastes at the sources including households and institutions by using separate container for each type of waste National Laws and Policies on Healthcare Waste Management 5. Presidential Decree nO. 1586 “Environmental Impact Statement System” - Requires projects, like the construction of new hospital buildings or expansion of existing hospitals, to secure an Environmental Compliance Commitment Certificate prior to the construction and operation of the facility. National Laws and Policies on Healthcare Waste Management 6. AOH AO No. 2008-0021 “Gradual Phaseout of Mercury in all Philippine Health Care Facilities and Institutions” - Requires all HCF to gradually phase out the use of mercury-containing devices and equipment. National Laws and Policies on Healthcare Waste Management 7. DOH “Manual on Health Care Waste Management” - Reference for HCF administrators in the implementation of an effective and efficient waste management program National Laws and Policies on Healthcare Waste Management 8. BFAD Memorandum Circular No. 2, Series of 1994, "Inventory, Proper Disposal, and/or Destruction of Used Vials or Bottles" and BFAD Bureau Circular No. 16, Series of 1999: "Amending BFAD MC No. 2 dated September 8, 1994, Regarding Inventory, Proper Disposal, and/or Destruction of Used Vials or Botles" - To prevent the proliferation of adulterated, misbranded, and counterfeit drugs brought about by the recycling of used pharmaceutical bottles and vials  UST General Santos Medical Technology Department UNIT 6: Healthcare Waste Management PRINCIPLES OF MEDICAL TECHNOLOGY PRACTICE 1 References Benitez, P., Dumaoal, O., Estrella, F., Mortel, F., Nava, M. (2019). Principles of Medical Laboratory Science 1. C and E Publishing, Inc. Department of Health Administrative. Health Care Waste Management Manual Fourth Edition(2020). https://www.washinhcf.org/wp-content/uploads/2021/07/DOH-Health-Care-Waste- Management-Manual_4th-Edition_FINAL.pdf Dominican Blessing May God the Father bless us May God the Son heal us May God the Holy Spirit enlighten us Give us eyes to see with, ears to hear with, hands to do the work of God with, feet to walk with, and mouth to preach the word of salvation with; And may the angel of peace watch over us, and lead us at last by the Lord’s gift of the kingdom. Amen.