11: HEALTHCARE WASTE MANAGEMENT Flashcards
- Includes all the solid and liquid wastes generated as a result of any of the following:
a. Diagnosis, treatment or immunization of human beings;
b. Research pertaining to the above activities;
c. Research using laboratory animals for the improvement of human health;
d. Production or testing of biologicals; and
e. Other activities performed by HCF (Health Care Facility)
HEALTHCARE WASTE (HCW)
- are public, private and non-governmental institutions/facilities that contribute to the improvement of the health status of an individual.
HEALTH CARE FACILITY (HCF)
- All waste suspected to contain pathogens (or their toxins) in sufficient concentration to cause diseases to a potential host.
INFECTIOUS WASTE
______________ is from patients with infectious disease (e.g., dressings, swabs, blood bags, urine bag, sputum cups)
Solid wastes
___________ from patients with infectious disease (e.g., feces, urine, blood or other body secretions).
Liquid wastes
_____________ (liquid or solid) of patients with highly infectious disease.
Food wastes
Items that can cause cuts or puncture wounds.
SHARPS WASTE
____________ are considered as the most hazardous waste generated in HCF and must be managed with utmost care this is because of the double danger it poses.
* It can cause injuries through accidental pricks, cuts or punctures one can also be infected with a pathogen through these injuries.
Sharps
Refers to tissue sections and body material derived from biopsies or surgical procedures that are then examined in the laboratory.
PATHOLOGICAL AND ANATOMICAL WASTE
is a subgroup of pathological waste. This type of waste refers to recognizable human body parts such as amputated limbs, etc.
Anatomical waste
consists of tissues, organs, body parts, blood, body fluids, other waste from surgery and autopsies, including human fetuses and animal carcasses. Recognizable human or animal body parts are also called anatomical waste.
Pathological waste
- Refers to expired, spilt and contaminated pharmaceutical products, drugs and vaccines.
- Also refers to discarded items used in handling pharmaceuticals.
PHARMACEUTICAL WASTE (INCLUDING GENOTOXIC/CYTOTOXIC/ANTINEOPLASTIC WASTE)
- Pharmaceutical wastes include ______________, __________, and ____________ waste.
antineoplastic, cytotoxic, genotoxic
is a word in genetics defined as a destructive effect on a cell’s genetic material (DNA, RNA) affecting its integrity.
Genotoxicity
_____________ are mutagens; they can cause mutations. _________ include both radiation and chemical genotoxins.
Genotoxins
_________ can be carcinogens, or cancer-causing agents, mutagens, or mutation-causing agents, or teratogens, birth defect-causing agents.
Genotoxins
- Are discarded chemicals (solid, liquid, or gaseous) generated during disinfecting and sterilizing procedure.
- ____________ also include wastes with high content of heavy metals and their derivatives.
Chemical wastes
- Chemical wastes can be further classified into _________________________
corrosive, reactive, toxic and flammable
Most ___________ are either acids or bases.
corrosives
_____________ are materials that can attack and chemically destroy exposed body tissues. ___________ can also damage or even destroy metal.
Corrosives
____________ is a term given to a chemical class that displays a broad range of reactions.
Reactive Chemicals
The toxicity of a chemical refers to its ability to damage an organ system (kidneys, liver), disrupt a biochemical process (e.g., the blood-forming process) or disturb an enzyme system at some site remote from the site of contact.
Toxic Chemicals
______________ of a chemical refers to its ability to inflict systemic damage as a result (in most cases) of a one-time exposure to relative large amounts of the chemical.
Acute toxicity
________________ refers to a chemical’s ability to inflict systemic damage as a result of repeated exposures, over a prolonged time period, to relatively low levels of the chemical.
Chronic toxicity
_____________ are those gases, liquids and solids that will ignite and continue to burn in air if exposed to a source of ignition.
Flammable Chemicals
Many flammable and combustible liquids and solids are ___________ in nature; that is, they evaporate quickly and are continually giving off vapours.
volatile
______________ represents a subcategory of hazardous chemical waste and refers to metallic elements that have high densities and relatively toxic at low levels
Waste with high heavy metal content
- Wastes exposed to radionuclide. Residues from shipment of radioactive materials and unwanted solution of radionuclides intended for diagnostic or therapeutic use.
- Liquids, gas and solids contaminated with radionuclides whose ionizing radiations have genotoxic effects.
RADIOACTIVE WASTE
- Waste that has not been in contact with communicable or infectious agents, hazardous chemicals or radioactive substances, and does not pose a hazard.
- Papers, cardboards, empty bottles, tetra packs, scrap materials, pressurized containers, office wastes, food waste and other materials of patients with non-communicable disease, x-ray plates.
NON-HAZARDOUS OR GENERAL WASTE
According to the Asian Development Bank (ADB), only __________ of the wastes coming from HCF are hazardous.
30.37%
___________ is a circle of links, each representing a component in the cycle. Each link must be present and in sequential order for an infection to occur.
Chain of Infection
_____________ an immunodeficient person who cannot resist a pathogen invading the body, multiplying and resulting in infection.
Susceptible Host
___________________ an opening allowing the microorganism to enter the host.
Portal of Entry
method of transfer by which the organism moves or is carried from one place to another.
Mode of Transmission
_____________ is an opening providing a way for a microorganism to leave the reservoir.
Portal of Exit
a location within which microorganisms can thrive and reproduce.
Reservoir
microbial organism with the ability to cause disease.
Infectious Agent
Modes of transmission may involve:
contact, vehicle-borne, air-borne, vectorborne
- A ______________ first and key step in creating a sustainable healthcare waste management system for any country
national policy
- It was designed to stop the production and use of ozone depleting substances and reduce their concentration in the atmosphere to help protect the earth’s ozone layer.
- Under the Vienna Convention for the Protection of the Ozone Layer
- is widely considered as the most successful environment protection agreement. It sets out a mandatory timetable for the phase out of ozone depleting substances.
- The Montreal Protocol sets binding progressive phase out obligations for developed and developing countries for all the major ozone depleting substances, including chlorofluorocarbons (CFCs), halons and less damaging transitional chemicals such as hydrochlorofluorocarbons (HCFCs).
The Montreal Protocol (1987)
- is an international treaty that was designed to reduce the movements of hazardous waste between nations, and specifically to prevent transfer of hazardous waste from developed to less developed countries (LDCs).
- The overarching objective of the Basel Convention is to protect human health and the environment against the adverse effects of hazardous wastes.
- restriction of transboundary movements of hazardous wastes except where it is perceived to be in accordance with the principles of environmentally sound management; and
- a regulatory system applying to cases where transboundary movements are permissible.
The Basel Convention (1989)
- is an international environmental treaty produced at the United Nations Conference on Environment and Development (UNCED), informally known as the Earth Summit, held in Rio de Janeiro from June 3 to 14, 1992.
- The objective of the treaty is to stabilize greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate system.
- The treaty itself set no mandatory limits on greenhouse gas emissions for individual countries and contains no enforcement mechanisms. In that sense, the treaty is considered legally non-binding. Instead, the treaty provides for updates (called “protocols”) that would set mandatory emission limits. The principal update is the Kyoto Protocol, which has become much better known than the UNFCCC itself.
The United Nations Framework Convention on Climate Change (1992)
- The Kyoto Protocol is an international treaty which extends the 1992 United Nations Framework Convention on Climate Change (UNFCCC) that commits state parties to reduce greenhouse gas emissions, based on the scientific consensus that (part one) global warming is occurring and (part two) it is extremely likely that human-made CO2 emissions have predominantly caused it.
- The Protocol is based on the principle of common but differentiated responsibilities: it acknowledges that individual countries have different capabilities in combating climate change, owing to economic development, and ergo puts the obligation to reduce current emissions on developed countries on the basis that they are historically responsible for the current levels of greenhouse gases in the atmosphere.
The Kyoto Protocol to the United Nations Framework Convention on Climate Change (1997)
- is a global treaty to protect human health and the environment from chemicals that remain intact in the environment for long periods, become widely distributed geographically, accumulate in the fatty tissue of humans and wildlife, and have harmful impacts on human health or on the environment.
- Exposure to Persistent Organic Pollutants (POPs) can lead to serious health effects including certain cancers, birth defects, dysfunctional immune and reproductive systems, greater susceptibility to disease and damages to the central and peripheral nervous systems.
The Stockholm Convention on Persistent Organic Pollutants (2001)
“Hospital Licensure Act” (1965)
Republic Act No. 4226
“An Act to Control Substances and Hazardous and Nuclear Wastes” (1990)
Republic Act No. 6969
“The Philippine Clean Air Act of 1999”
Republic Act No. 8749
“Ecological Solid Waste Management Act of 2000”
Republic Act No. 9003
“The Philippine Clean Water Act of 2004”
Republic Act 9275
“The Code on Sanitation of the Philippines – Chapter XVII on Sewage Collection and Excreta Disposal” (1998)
Presidential Decree 856
______________ dated July 30, 2008 “Gradual Phase out of Mercury in all Philippine Healthcare Facilities and Institutions”
DOH Administrative Order No. 2008-0021
________________ dated July 30, 2008 “National Policy on Patient Safety”
DOH Administrative Order No. 2008-0023
_________________ in 2004 (Revising the 1997 Hospital Waste Management Manual)
DOH “Healthcare Waste Management Manual”
“Inventory, Proper Disposal and/or Destruction of Used Vials or Bottles” and BFAD Bureau Circular No. 16 Series of 1999: “Amending BFAD MC No. 22 dated September 8, 1994, Regarding Inventory, Proper Disposal and/or Destruction of Used Vials or Bottles”
BFAD Memorandum Circular No. 22 Series of 1994
The Presidential Decree No. 856, or most well known to be the Code on Sanitation, was promulgated by the late President _____________ on _______________.
Ferdinand Marcos, December 23, 1975
The ultimate objective of this was to improve the way of the Filipinos by directing public health services towards the protection and promotion of the health of our people.
Presidential Decree 856
Illustrates that it is most preferable to prevent the generation of waste at source and reduce the quantity of waste generated by adopting different methods of safe re-use, recycling and recovery.
Healthcare Waste Management Hierarchy
o principle of purchasing products and services that are least damaging in terms of environmental impact;
o items/goods to be purchased will have minimum packaging and will ,
o will utilize proper inventory of stocks and conduct Life Cycle Analysis for equipment.
- Green Procurement
a) Waste Prevention and Reduction at Source
Ways to do waste minimization:
By purchasing environmentally friendly product and process of segregation.
(through the supplier registration form with emphasis on environmental performance of supplier)
Supplier Focus
(including environmental specifications)
Product and Service Focus
(internal analyses, or utilizing LCA completed by external groups)
Life Cycle Analysis
______________ minimizes the amount of waste that needs to be managed as hazardous waste
o Facilitates waste minimization by generating a solid waste stream which can be easily, safely and cost-effectively managed through recycling or composting;
o Reduces the amount of hazardous substances released to the environment through disposal of general waste
o Makes it easier to conduct assessment of the quantity and composition of different waste streams
b) Waste Prevention at Source thru Segregation:
o Segregation
Promoting safe re-use entails the selection of reusable rather than disposable products whenever possible. Re-use will also entail setting reliable standards for disinfection and sterilization of equipment and materials for use.
RE-USE
involves processing of used materials (waste) into new products to prevent loss of potentially useful materials, reduce the consumption of fresh raw materials, reduce energy usage, reduce air pollution and water pollution (from land filling) by reducing the need for “conventional” waste disposal and lower greenhouse gas emissions as compared to virgin production.
Recycling
recovery of waste
RECOVERY
whereby waste is converted to fuel for generating electricity or for direct heating of premises.
energy recovery
is a term used to encompass three sub-sets of waste recovery: recycling, composting and energy recovery
waste recovery
________________ refers to the process of changing the biological and chemical character of the waste to minimize its potential to cause harm
Waste treatment
_______________ refers to discharge, deposit, placing or release of any health care waste into or on any air land or water.
Waste disposal
______________ is the process of separating different types of waste at the point of generation until its final disposal.
Segregation
This refers to the collection of waste using transport trolleys from the waste bins to the central storage area of the HCF by the general service personnel.
On-Site Collection of HCW
This refers to the transport of waste from the point of generation to the treatment facility in the HCF or to the central storage area
On-Site Transport of HCW
This refers to the collection of waste from the central storage area by an accredited DENR transporter, Municipal Collector or Supplier into their respective vehicles.
Off-Site Collection of HCW
This refers to the transport of waste from the central storage of the HCF to a TSD or to the final disposal site
Off-Site Transport of HCW
______________ is an engineered method designed to keep the waste isolated from the environment.
Landfill
A disposal method is applicable only to treated infectious waste, sharps waste, pathological and anatomical waste, small quantities of encapsulated/ inertisized solid chemical and pharmaceutical wastes.
Safe Burial at HCF Located in Remote Areas
