CHAPTER 1 Flashcards
Sources of health care wastes
• Diagnosis, treatment, & immunization
• Research pertaining the first item
• Research using laboratory animals geared towards improvement of human health
• Production & testing of biological products
• Other activities performed by a health care facility
According to WHO
75-90% of health care wastes are non- hazardous
• 10-25% is considered hazardous & may be infectious, toxic, radioactive
In the Phil, health care waste
30.37% are hazardous; 69.63 are general waste
• Ave of 0.34kg of infectious sharps & pathological wastes & 0.39 kg of general waste are derived per bed per day
are those which may contain pathogens or toxins in sufficient concentration that may cause disease to susceptible host.
Infectious
Ex: microbial cultures, used specimen containers, blood bags, clinical specimens
Infectious
refers to tissue sections & body fluids or organs derived from surgical procedures, autopsies
Pathological & anatomical waste
refer to items that can cause cuts, pricks or puncture wounds
Sharps
Most dangerous because they cause both injury & infection
Sharps
refers to discarded chemicals generated during disinfection & sterilization procedures
Chemical waste
It also includes wastes with high content of heavy metals & their derivatives
Chemical waste
Chemicals used in laboratories must have
chemical Safety Data Sheet
( CSDS) and identification code as Hazardous Materials Identification (HMIS)
OSHA hazard rating
blue, red, orange, white
blue
Health hazards
red
Flammability
orange
Physical hazards
white
Personal protect
OSHA hazard rating
0,1,2,3,4
0
No significant risk
1
Irritation
2
Minor injury
3
Major injury
4
Life-threatening
Characteristics of hazardous waste
Unstable & reacts violently when exposed to chemical change
Explosivity and reactivity
Releases toxic fumes when mixed with water
Explosivity and reactivity
Explode under extreme conditions
Capable of detonation & explosive
decomposition at standard temperature
Explosivity and Reactivity
Cause fire
Ignibility
toxicity
Causes health effects
Corrode steel waste containers & aqueous substances with pH less than 2 or more than 12.5
Corrosivity
Corrosivity
React with heavy metals to produce toxic contaminates
Also includes empty vials, medicine bottles, etc
Pharmaceutical waste
refers to expired , spilt, contaminated pharmaceutical products, drugs & vaccines
Pharmaceutical waste
Usual hospital radioactive wastes are:
Cobalt 90 (Co90), iodine 131 I (131 I), technetium (99 Tc), iridium (192 Ir)
refers to wastes that have not been in contact with infectious or communicable agents, hazardous chemicals, or radioactive substances
Non-hazardous or general waste
The disposal of untreated health care wastes in landfills can lead
to the contamination of drinking, surface, & ground waters if those landfills are not properly constructed
can result in the release of chemical substances into the environment if those substances are not handled, stored, & disposed in an environmentally-sound manner
The treatment of health care wastes with chemical disinfectants
Is widely practiced, but inadequate incineration or the incineration of unsuitable materials results in the release of pollutants into the air & in the generation of ash residue
Incineration of waste
Incinerated materials with chlorine can generate
dioxins & furans ( carcinogens)
Incineration of heavy metals
spread of toxic metals in the environment
are able to comply with the international emission standards for dioxins & furans
Only modern Incinerators operating at 850C to 1100C & fitted with gas cleaning equipment
Incineration is NOT allowed in the
Phil
Alternative to incineration
autoclaving, microwaving & steam treatment can be given consideration
should never be mixed with reducing agents or organic materials
Oxidizers
should not be mixed with any acids
Acid-reactive compounds
should be segregated from inorganic acids
Organic compounds
should not be mixed with cyanide salts or solutions
Acids
Oxidizing acids cannot be stored with
combustible materials
must be kept separate from water
Alkali metals
Segregation of biomedical wastes
Red
Blue (puncture proof)
Yellow
Black
Red
Syringe
Blue (puncture- proof)
Broken glassware, sharp objects, needles, scalpels
yellow
Anatomical wastes, items with blood & body fluids, microbiological wastes
black
Chemical wastes
Benefits achieved through strict compliance with standards on health care management
Protection of patients, health workers, general population from the adverse effects of health care wastes to human health
Contribution to the collaborative efforts around the world to protect the environment from pollution & contamination caused by health care wastes
Benefits achieved through strict compliance with standards on health care management
Increased compliance of health care institutions to the laws, regulations & guidelines on health care wastes
Prevention of long-term liabilities & loss of reputation caused by violations to the laws, regulations & guidelines on health care wastes
Proper handling of waste
• Correct Segregation
• Proper Storage
• Capping waste bottles
LEGISLATIONS, POLICIES, GUIDELINES GOVERNING HEALTH CARE WASTES
International agreements
• Montreal Protocol on Substances that deplete the ozone layer (1987)
•Basel Convention on the Control of the Transboundary Movements of Hazardous Wastes & their Disposal (1989)
• United Nations Framework Convention on Climate Change (1992)
• Stockholm Convention on Persistent Organic Pollutants(2001)
are chemicals that (1) remain unchanged in the environment for long periods; (2) accumulate in fatty tissues of living organisms; (3) are toxic to both humans & wildlife
Persistent Organic Pollutants(2001)
A core instrument that provides 9 high level protocols that set out generic standards to be put into place for the implementation of an international transit system
ASEAN Framework Agreement on the facilitation of Goods in Transit (1998)
National laws
• RA 4226 “Hospital Licensure Act” (1965)
a) DOH AO 70-A s2002 “Revised Rules & Regulations Governing the Registration, Licensure & Operation of Hospitals & Other Health Facilities in the Philippines”
b) DOHAO2005-0029s2005“Amendmentto AO 70-A”
c) DOH AO 2007-0027 s2007 “Revised Rules & Regulations Governing the Licensure & Regulation of Clin Labs in the Phil”
National laws
• RA 6969 “An Act to Control Substances & Hazardous & Nuclear Wastes” (1990)
a) DENR AO 36 s2004 “Revising DENR AO 29 s 1992, to further Strengthen the Implementation of RA 6969 & Prescribing the Use of Procedural Manual”
b) DOH-DENR joint AO 02 s2005 “Policies & Guidelines on Effective & Proper Handling, Collection, Transport, Treatment, Storage & Disposal of HCW”
c) DOH AO 2007-0014 “Guidelines on the Issuance of Certificate of Product Registration for Equipment or Devices Used for Treating Sharps, Pathological & Infectious Wastes”
“ The Phil Clean Air Act of 1999”
RA 8749
RA 9003
“Ecological Solid Waste
Management Act of 2000”
“The Phil Clean Water Act of 2004”
RA 9275
“ Strengthening the Functions of Laguna Lake Development Authority (LLDA)”
PD 813 (1975) & EO 927 (1983)
“The Code on sanitation of the Phil-Chapter XVII on Sewage Collection & Excreta Disposal (1998)
PD 856
PD 984
“Providing for the Revision of RA 3931, Commonly known as the Pollution Control Law, & for other Purposes” 1976
“Environmental Impact Statement (EIS) System (1978)
PD 1586
EO 301
“Establishing a Green Procurement Program for all Depts, Bureau offices, & Agencies of the Executive Branch of Government” 2004
“Gradual Phase out of Mercury in all Phil Health Care Facilities & Institutions (2008)
DOH AO 2008-0021
DOH AO 2008-0023
“National Policy on Patient Safety”
( Revising the 2007 Health Care Waste Management Manual)
• PhilHealth Benchbook for Quality Assurance in Health care (2006)
DOH “Manual on Health Care Waste Management” in 2011
BFAD Memo Circular 22s1994,
Inventory, proper disposal , &/or destruction of used vials or bottles”
“Amending BFAD MC #22 (1994), Regarding inventory, proper disposal & or destruction of used vials or bottles”
BFAD Bureau Circular #16 s1999:
refers to either finding a new application for a used material or using the same product for the same application repeatedly
Reusing
refers to the processing of used materials into new products
Recycling
• For waste which can not be removed, recycled, or recovered, they treated before disposed
Recovery
as a term used to encompass 3 subsets of waste recovery: recycling, composting, & energy recovery
Recovery
refers to (1) energy recovery, whereby waste is converted to fuel for generating electricity or for direct heating of premises
Recovery
3 subsets of waste recovery:
recycling, composting, & energy recovery
Residues could be greasy aggregates or slugs, recoverable metals, carbon black which can be disposed in land fills
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
Pyrolysis
Indicators to check the validity of sterilization:
color-changing tapes or biological test ampules containing bacterial spores
121C, pressure of 15 psi
For 15-30 min
Is the use of stem sterilization to render waste harmless & is an efficient wet thermal disinfection process
Autoclave
Shredding of wastes is done before disinfection
Microwave
• A technology that typically incorporates some type of size reduction device.
Microwave
CHEMICAL DISINFECTION is recommended
• 5-10% sodium hypochlorite
• Uses an enzyme mixture to decontaminate health care wastes
• Suited for large applications & is also being developed for possible use in agriculture
Biological processes
Involves the filling of containers with waste, adding & immobilizing material, & sealing the containers
Encapsulation
• For pharmaceutical waste that involves the mixing of waste with cement
Interization
After treatment, health care wastes are usually
Disposed in landfills
before it can accept waste. It keeps waste are isolated from the environment
• A landfill must have permits from DENR
Health care wastes that are properly treated can be mixed with general wastes provided that it is certified by DOH that organisms
are inert and cannot regenerate
