CHAPTER 1 Flashcards by Kizha Javillo

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

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According to WHO

75-90% of health care wastes are non- hazardous
• 10-25% is considered hazardous & may be infectious, toxic, radioactive

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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

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are those which may contain pathogens or toxins in sufficient concentration that may cause disease to susceptible host.

Infectious

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Ex: microbial cultures, used specimen containers, blood bags, clinical specimens

Infectious

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refers to tissue sections & body fluids or organs derived from surgical procedures, autopsies

Pathological & anatomical waste

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refer to items that can cause cuts, pricks or puncture wounds

Sharps

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Most dangerous because they cause both injury & infection

Sharps

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refers to discarded chemicals generated during disinfection & sterilization procedures

Chemical waste

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It also includes wastes with high content of heavy metals & their derivatives

Chemical waste

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Chemicals used in laboratories must have

chemical Safety Data Sheet
( CSDS) and identification code as Hazardous Materials Identification (HMIS)

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OSHA hazard rating
blue, red, orange, white

blue
Health hazards
red
Flammability
orange
Physical hazards
white
Personal protect

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OSHA hazard rating
0,1,2,3,4

0
No significant risk
1
Irritation
2
Minor injury
3
Major injury
4
Life-threatening

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Characteristics of hazardous waste

Unstable & reacts violently when exposed to chemical change

Explosivity and reactivity

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Releases toxic fumes when mixed with water

Explosivity and reactivity

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Explode under extreme conditions

Capable of detonation & explosive
decomposition at standard temperature

Explosivity and Reactivity

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Cause fire

Ignibility

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toxicity

Causes health effects

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Corrode steel waste containers & aqueous substances with pH less than 2 or more than 12.5

Corrosivity

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Corrosivity

React with heavy metals to produce toxic contaminates

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Also includes empty vials, medicine bottles, etc

Pharmaceutical waste

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refers to expired , spilt, contaminated pharmaceutical products, drugs & vaccines

Pharmaceutical waste

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Usual hospital radioactive wastes are:

Cobalt 90 (Co90), iodine 131 I (131 I), technetium (99 Tc), iridium (192 Ir)

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refers to wastes that have not been in contact with infectious or communicable agents, hazardous chemicals, or radioactive substances

Non-hazardous or general waste

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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