Legislation, Policies, and Guidelines Governing Healthcare Wastes

Question 1

When and where was The Montreal Protocol on Substances that Deplete the Ozone Layer (1987) adopted?

Answer 1

Montreal, Canada on September 16, 1987

Question 2

When did The Montreal Protocol on Substances that Deplete the Ozone Layer (1987) came into force?

Answer 2

January 1, 1989

Question 3

It sets the final objective of the Protocol to eliminate ozone-depleting substances in the environment

Answer 3

The Montreal Protocol on Substances that Deplete the Ozone Layer (1987)

Question 4

Concerned with the transboundary movements of hazardous wastes

Answer 4

The Basel Convention on the Control of the Transboundary Movements of Hazardous Wastes and their Disposal (1989)

Question 5

Countries that signed this accepted the principle that only legitimate transboundary shipments of hazardous waste are exporter from countries that lack the facilities or expertise to safely dispose certain wastes to other countries that have both facilities and experties

Answer 5

The Basel Convention on the Control of the Transboundary Movements of Hazardous Wastes and their Disposal (1989)

Question 6

Includes a legally non-binding pledge that by the year 2000, major industrialized nations would voluntarily reduce their greenhouse emissions to 1990 levels

Answer 6

The United Nations Framework Convention on Climate Change (1992)

Question 7

A global treaty to protect human health and the environment from persistent organic pollutants (POPs)

Answer 7

The Stockholm Convention on Persistent Organic Pollutants (2001)

Question 8

Chemicals that:
1. remain unchanged in the environment for long periods of time;
2. accumulate in the fatty tissues of living organisms; and
3. are toxic to both humans and wild life

Answer 8

Persistent Organic Pollutants (POPs)

Question 9

• A core instrument that provides nine high level protocols that set out generic standards to be put into place for the implementation of an international transit system
• specifically, it includes Protocol 9 on Dangerous Goods which provides provisions on the transport of toxic and infectious substances

Answer 9

The ASEAN Framework Agreement on the Facilitation of Goods in Transit (1998)

Question 10

An act that requires the registration and licensure of all hospitals in the country and mandates DOH to provide guidelines for hospital technical standards as to personnel, equipment, and physical facilities

Answer 10

RA No. 4226 “Hospital Licensure Act” (1965)

Question 11

• Revised Rules and Regulations Governing the Registration, Licensure, and Operation of Hospitals and Other Health Facilities in the Philippines
• includes the application or renewal of license, submission of plans, and other design requirements under the Code of Sanitation of the PH, National Plumbing Code of the PH, Revised Fire Code of the PH, and National Building Code of the PH

Answer 11

DOH AO No. 70-A s. 2002

Question 12

• amendment to AO No. 70-A
• requires the HCF to submit a health care waste management plan to BHFS as one of its requirements for the issuance of license to operate

Answer 12

DOH AO No. 2005-2009 (dated Dec 12, 2005)

Question 13

Requires written procedures for the proper disposal of health care waste and other hazardous substances and required written policy guidelines on biosafety and biosecurity

Answer 13

DOH AO No. 2007-0027 dated on August 22, 2007

Question 14

• Requires the registration of waste generators, waste transporters, and operators of toxic and hazardous waste treatment facilities with the EMB
• the waste generators are required to ensure that their hazardous wastes are properly collected, transported, treated, and disposed in a sanitary landfill

Answer 14

RA No. 6969 “An Act to Control Substances and Hazardous and Nuclear Wastes” (1990)

Question 15

• requires a comprehensive documentation on the legal and technical requirements of hazardous waste management
• does not include provisions regarding the management of nuclear wastes

Answer 15

DENR AO No. 36, s. 2004 “Revising DENR AO No. 29, s. 1992, to Further Strengthen the Implementation of RA 6969 and Prescribing the Use of a Manual

Question 16

aims to (a) provide guideline to generators, transporters, and operators/owners of TSD Facilities on the proper handling, collection, transport, storage, treatment, and disposal of health care wastes (b) clarify the jurisdiction, authority, and responsibility of DENR and DOH with regard to health care waste management, and (c) harmonize the efforts of DENR and DOH an HCWM

Answer 16

DOH-DENR Joint Administrative Order No. 02 s. 2005 dated August 24, 2005 “Policies and Guidelines on Effective and Proper Handling, Collection, Transport, Treatment, Storage, and Disposal of HCW”

Question 17

• requires the manufacturers, importers, and distributors, including generators of HCW that sell and/or use equipment and devices in treating sharps, pathological, and infectious waste to secure a Certificate of Product Registration (CPR) from DOH through the Bureau of Health Devices and Technology

Answer 17

DOH AO 2007-0014 “Guidelines on the Issuance of Certificate of Product Registration for Equipment or Devices Used for Treating Sharps, Pathological, and Infectious Waste”

Question 18

• Prohibits the incineration of bio-medical wastes effective July 17, 2003.
• promotes the use of state-of-the-art, environmentally-sound, and safe non-burn technologies for the handling, treatment, thermal destruction, utilization, and disposal of sorted, unrecycled, biomedical, and hazardous wastes

Answer 18

RA No. 8749 “The Philippine Clean Air Act of 1999”

Question 19

mandates the segregation of solid wastes at the sources including households and institutions like hospitals by using a separate container for each type of waste

Answer 19

RA No. 9003 “Ecological Solid Waste Management Act of 2000”

Question 20

pursues a policy of economic growth in a manner consistent with the protection, preservation, and revival of the quality of the country’s fresh, brackish, and marine waters

Answer 20

RA 9275 “The Philippine Clean Water Act of 2004”

Question 21

further strengthens the powers and functions of the LLDA to include environmental protection and jurisdiction over surface waters of the Laguna Lake basin.

Answer 21

Presidential Decree 813 (1975) and EO 927 (1983) “Strengthening the Functions of Laguna Lake Development Authority (LLDA)”

Question 22

Requires the approval of DOH in terms of
1. constructions of any approved type of toilet in every house and community which may be allowed for a group of small houses of light material or temporary nature
2. plans of individual sewage or sewage system and the sub-surface absorption system or other treatment device
3. location of any toilet or sewage disposal system in relation to a source of water supply
etc.

Answer 22

PD 856 “The Code on Sanitation of the Philippines - Chapter XVII on sewage collection and excreta disposal”

Question 23

require individuals, firms, public and private operators, owners, and administrators engaged in desludging, collection, handling and transport, treatment, and disposal of domestic sewage treatment plants/facilities and septage from house septic tanks to secure environmental sanitation clearances from DOH

Answer 23

Rules and Regulations Governing the Collection, Handling, Transport, Treatment, and Disposal of Domestic Sludge and Septage, (2004), a “Supplement to the IRR of Chapter XVII on Sewage Collection and Disposal and Excreta Disposal and Drainage of 1998

Question 24

requires cities and municipalities to provide an adequate and efficient system of collecting, transporting, and disposing refuse in their areas of jurisdiction. They also also require occupants of buildings, institutions such as hospitals and residences to provide a sufficient number of receptacle for refuse

Answer 24

Chapter XVIII of PD 856 “The Code on Sanitation of the Philippines” on Refuse Disposal (1998)

Question 25

provides detailed procedures and forms which need to comply with the IRR governing the collecting, handling, transport, treatment, and disposal of domestic sludge and septage. It is designed to guide private and public service providers, ass well as govt. regulators, towards effective sludge and septage management program in the country

Answer 25

Operation Manual on the Rules and Regulations Governing Domestic Sludge and Septage (June 2008)

Question 26

• implemented a new restriction on open viewing of remains when the individual’s death was caused by certain communicable diseases.
• explicitly states “the remains shall be placed in a plastic cadaver bag or other durable airtight container at the point of death and a biohazard tag attached, provided that, the container shall not be opened for viewing or any other purpose prior to burial or cremation

Answer 26

AO 2010-003 “Revised Implementing Rules and Regulations of PD 856 Code on Sanitation of the Philippines, Chapter XXI on Disposal of Dead Persons

Question 27

• governs the discharge of potentially polluting substances to air and water
• provides the basis for the DENR regulations on water pollution through its IRR, DENR AO Nos. 34 and 235

Answer 27

PD No. 984 “Providing for the Revision of the RA 3931, commonly known as the Pollution Control Law, and for Other Purposes” (1976)

Question 28

classified bodies of water according to their designated uses and did not preclude use of the bodies of water for other purposes that are lower than the classification, provided that, such use does not prejudice quality required for such waters.

Answer 28

DENR Administrative Order No. 34, Series of 1990 “Revised Water Usage and Classification/Water Quality Criteria Amending Section Nos. 68 and 69, Chapter III of the 1978 National Pollution Control Commission (NPCC now EMB) Rules and Regulations”

Question 29

lists the effluent regulations for the different levels of pollutants according to their water category/class.

Answer 29

DENR Administrative Order No. 35, Series of 1990, “Effluent Regulations”

Question 30

requires the appointment/designation of a Pollution Control Officer (PCO) and lists the qualifications, reporting requirements, and duties and responsibilities of accredited PCOS.

Answer 30

DENR Administrative Order No. 26, Series of 1992, “Amending Memorandum Circular No. 02, Series of 1981: Appointment/Designation of Pollution Control Officers”

Question 31

requires projects, like the construction of new hospital buildings or expansion of existing hospitals, to secure an Environmental Compliance Commitment (formerly Environmental Compliance) Certificate (ECC) prior to the construction and operation of the facility. An ECC is required for the installation and operation of HCW treatment systems like pyrolysis, autoclave, microwave, and other treatment technology including landfills.

Answer 31

Presidential Decree No. 1586 “Environmental Impact Statement (EIS) System” (1978)

Question 32

aims to (a) promote the culture of making environmentally informed decisions in the government, especially in the purchase and use of different products; (b) include environmental criteria in public tenders, whenever possible and practicable; (c) establish the specifications and requirements for products or services to be considered environmentally advantageous; and (d) develop incentive programs for suppliers of environmentally advantageous products or services.

Answer 32

Executive Order No. 301 “Establishing a Green Procurement Program for All Departments, Bureaus, Offices, and Agencies of the Executive Branch of Government” (2004)

Question 33

requires all health care facilities (HCF) to gradually phaseout the use of mercury-containing devices and equipment. The initial targets of the phaseout are mercury thermometers and sphygmomanometers in the health care facility.

Answer 33

DOH Administrative Order No. 2008-0021 dated July 30, 2008 “Gradual Phaseout of Mercury in all Philippine Health Care Facilities and Institutions”

Question 34

provides the detailed guidelines on the temporary storage of mercury-containing devices and the management of mercury spills to enhance patient safety measures in HCF, to protect health care workers from potential hazards from mercury exposures, and to minimize the accumulation of mercury in the environment.

Answer 34

Department Memorandum No. 2011-0145, “Guidelines for the Temporary Storage of Mercury Wastes in HCF in Accordance with AO No. 0021, s. 2008 on the Gradual Phaseout of Mercury in All Philippine health care Facilities and Institutions”

Question 35

requires the establishment and maintenance of a **culture of patient safety in the HCF ** as the responsibility of its leaders. As such, HCF shall ensure that an enabling mechanism/strategy is in place to ensure patient safety. The key priority areas in patient safety include, but are not limited to, proper patient identification, assurance of blood safety, safe clinical and surgical procedures, provision and maintenance of safe quality drugs and technology, strengthening infection control standards, maintenance of the environment of care standards, and energy and waste management standards.

Answer 35

DOH Administrative Order No. 2008-0023 dated July 30, 2008 “National Policy on Patient Safety”

Question 36

serves as a reference for HCF administrators in the implementation of an effective and efficient waste management program. The requirements for doing such are provided in the manual by listing the standards of performance, defining the mandatory requirements, providing new concepts, and citing examples and tools. The Manual is designed to be used by all workers within the HCF.

Answer 36

DOH “Manual on Health Care Waste Management” in 2011 (Revising the 2007 Health Care Waste Management Manual)

Question 37

includes health care waste management as one of its parameters in the quality assurance of healthcare.

Answer 37

Philhealth Benchbook for Quality Assurance in health care (2006)

Question 38

these circulars are released to prevent the proliferation of adulterated, misbranded, and counterfeit drugs brought about by the recycling of used pharmaceutical bottles and vials. It contains the guidelines on the proper inventory and destruction of bottles and vials.

Answer 38

• BFAD Memorandum Circular No. 22, 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. 22 dated September 8, 1994, Regarding Inventory, Proper Disposal, and/or Destruction of Used Vials or Bottles”