Part 1 Flashcards
Refers to all solid or liquid wastes generated by any of the ff activities:
• Research pertaining to diagnosis, treatment, and
immunization of humans;
• Research using laboratory animals geared towards improvement of human health;
• Production and testing of biological products;
• Other activities performed by a healthcare facility that generates wastes.
It is a by-product of healthcare that includes hsarps, non-sharps, blood, body parts, chemicals, pharmaceuticals, medical devices and radioactive materials.
Health Care Wastes
These are the ones who generate waste also called
“Health Care Waste Generators”
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• Hospitals and medical centers;
• Infirmaries;
• Birthing homes;
• Clinics and other health-related facilities
• Laboratories and research centers;
• Drug manufacturers;
• Institutions
• Mortuary and autopsy centers
2 Categorization of Healthcare Wastes
Hazardous
Non-Hazardous (General)
It can be further classified into:
• Sharps
• Infectious
• Pathological
• Anatomical
• Pharmaceutical
• Genotoxic
• Chemical
• Readioactive
• Pressurized Containers
Hazardous
Under Hazardous, what are those?
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• Sharps
• Infectious
• Pathological
• Anatomical
• Pharmaceutical
• Genotoxic
• Chemical
• Readioactive
• Pressurized Containers
These are the:
• Recyclable
• Biodegradable
• Residual
Non- Hazardous (General)
it refers to waste that may pose a variety of environmental and health risks
Hazardous Healthcare Wastes
Classification of Hazardous Waste as per DENR Adminitrative Order No. 2013-22:
Waste with Cyanide
what waste number?
A101
Acid Wastes
what waste number?
B201 - B299
Alkali Wastes
what waste number?
C301 - C399
Waste with Inorganic CHemicals
what waste number?
D401 - D499
Reactive Chemical Waste
what waste number?
E501 - E599
Inks, dyes, pigments, paint, resins, latex, adhesive, organic sludge
what waste number?
F601 - F699
Waste Organic Solvents
what waste number?
G703 - G704
Organic Waste
what waste number?
H802
Oil
what waste number?
I101 - I104
Containers
what waste number?
J201
Stabilized Waste
what waste number?
K301 - K303
Organic Chemicals
what waste number?
L401-L404
Miscellaneous Wastes
what waste number?
M501 - M507
Healthcare Waste fall under what sub-classification Miscellaneous Waste (Class M)?
Pathological or Infectious Waste (Waste No. M501)
Pharmaceuticals and Drugs (Waste No. M503)
It is a sub-classification of Class M
It includes health care wastes from hospitals, medical centers, colinics containing PATHOLOGICAL, PHATOGENIC, and INFECTIOUS WASTE, SHARPS and others
Pathological or Infectious Waste (Waste No. M501)
It is a sub-classification of Class M
where expired pharmaceuticals and drugs stocked at producers and retailer’ facilities which contains HAZARDOUS CONSTITUENTS HARMFUL to the environment such as ANTIBIOTICS, VETERINARY and PHYTOPHARMACEUTICALS, and others.
Pharmaceuticals and Drugs (Waste No. M503)
A101
Waste with Cyanide
B201 - B299
Acid Wastes
C301 - C399
Alkali Wastes
D401 - D499
Wastes with Inorganic Chemicals
E501 - E599
Reactive Chemical Wastes
F601 - F699
Inks, Dyes, Pigments, Paint, Resins, Latex, Adhesive, Organic Sludge
G703 - G704
Waste Organic Solvents
H8802
Organic Wastes
I101 - I104
Oil
J201
Containers
K301 - K303
Stabilized Wastes
L401 - L404
Organic Chemicals
M501 to M507
Miscellaneous Wastes
Refers to ALL wastes suspected to contain pathogens or TOXINS
ex.
discarded microbial culture, sputum cups, urine containers etc.
What Waste Category?
Infectious
Refers to tissue sections and body fluids or organs derived from biopsies, autopsies or SX procedures sent to lab afor examination
ex. Amputated limbs, surgical pathology samples
What Waste Category?
Pathological and Anatomical
Refers to waste items that can cause cuts, pricks, or puncture wounds. MOST DANGEROUS HCW.
ex. Syringes in phlebotomy, blood lancetss, broken glasswares
What Waste Category?
Sharps
Refers to discarded chemicals generated during disinfectetion and sterilization procedure
ex. Acid, Bases, Metals etc
What Waste Category?
Chemical Wastes
Refers to expired, split and contaminated pharmaceutical products, drugs, vaccines etc.
ex. Empty drug vials, medicine bottles, syringes, needles and vials
Pharmaceutical Wastes
Waste exposed to radionucleotides incldg. radioactive diagnotic materials
ex. waste contaminated with ionizing radiation such as cobalt, iodine, and iridium
What Waste Category?
Radioactive Waste
Waste with mutagenic and Teratogenic Potential
ex. Antineoplastic (anti-tumor) and cytotoxic (cell-killer) drugs
What Waste Category?
Genotoxic incldg. Cytotoxic Wastes
Highly infectious disease refers to those causative organism under Biosafety Levels III and IV, such as
- SARS
- HIV
- AIDS
- PTB
- antrax
- Ebola
Based on whom?
Based on WHO Laboratory Biosafety Manual, 3rd Edition (2004)
Considered as dangerous communicable disease are:
- Heptitis B & C
- Rabies
- Invasive Group A streptococcal infections
- transmissible spongiform encephalitis
- HIV/AIDS
- meningococcemina
- viral hemorrhagic fevers (african ebola, lassa or marburg)
- yellow fever
- plague
- SARS
Sino nagsabi nyan?
DOH Administrative Order 2010-33
6 Catgeories of harmful cytotoxic drugs
Alkylating Agents
Anti-metabolites
Mitotic Inhibitors
Intercalating Agents
Plant Alkaloids and Terpenoids
Podophyllotoxins
called DNA-damaging agents
cause alkylation of DNA nucelotides
leads to cross-linking and miscoding of genetic stock
(e.g., vesicant drugs — clarubicin, mechlorethamine, cisplatin, mitomycin; irritant drugs — carmustine, cyclophosphamine, dacarbazine, ifosfamide, melphalan, streptozocin, thiotepa)
Alkylating Agents
Under Alkylating Agents:
what are the vesicant drugs?
aclarubicin
mechlorethamine
cisplatin
mitomycin
Under Alkylating Agents:
what are the irritant drugs?
carmustine
cyclophosphamide
dacarbazine
ifosfamide
melphalam
streptozocin
thiotepa
It imitate the roles of purine and pyrimidine as the building blocks of DNA thus inhibiting the biosynthesis of nucleic acids in the cell
(e.g., irritant — methotrexate, fludarabine, cytarabine)
Anti-metabolites
it prevent cell division
Mitotic Inhibitors
it wedge between DNA bases, affecting the structure of DNA and prevents polymerase and other DNA binding proteins from functioning properly
(e.g., Vesicant drug - amsacrine, dactinomycin, daunorubicin, doxorubicin, epirubicin, pirarubicin, zorubicin; Irritant drugs - mitoxantrone)
Interacting Agents
Under Interacting Agents:
what are the vesicant drugs?
amsacrine
dactinomycin
daunorubicin
doxorubicin
epirubicin
pirarubicin
zorubicin
Under Interacting Agents:
what are the Irritant drugs?
mitoxantrone
It inhibit microtuble function thereby halting cell division.
ex. vinca alakloids derived from Catharanthus roseus plant or Tsitsirika (e.g., Vesicant Drugs - vinblastine, vincristine, vindesine, vinorelbine)
Plant Alkaloids and Terpenoids
Under Plant Alkaloids and Terpenoids
What are the Vesicant drugs?
vinblastine
vincristine
vindesine
vinorelbine
It prevent cell division by inhibiting the cell from entering the G1 Phase; also affect DNA synthesis; derived from Podophyllum peltattum or Mayapple
(e.g., irritant drugs - teniposide)
Podophyllotoxins
Under Podophyllotoxins
what is that 1 Irritant Drug?
Tentiposide
5 Chemical Wastes
Toxic
Reactive
Flammable
Corrosive
Oxidizing
type of chemical waste that have the capacity to harm biological tissue
Toxic Chemical Waste
Type of chemical Waste that can react by themselves whene xposed to heat, pressure, shock, friction, catalyst presence or by contact with air or water
Reactive Chemical Waste
Type of Chemical waste that chemicals that ignite/burn easily in normal working temperatures
(e.g., chemicals with flashpoint below 37.8 °C or 100°F
Flammable Chemical Waste
Type of chemical that can cause severe burns to skin and other biological tissue including eyes and lungs
(e.g., acids of pH<2 and bases of pH>12
Corrosive Chemical Waste
Type of Chemical Waste where liquid or solid chemicals readily give off oxygen or other oxidizing substance (such as bromine, chlorine, or flourine
Also include materials that react chemically to oxidize combustible (burnable) materials
This means that oxygen combines chemically with the other material in a way that increases the chance of a fire or explosion
Oxidizing Chemical Waste
Common types of Hazardous chemical used in Health Care
- Formaldehyde
- Fixing and developing solutions
- Wast eorganic chemicals generated in HCFs include disinfecting and cleaning solutions, vacuum-pump and engine oils, insecticides, and rodenticides
- watses from materials with high heavy metal contents represent a subcategory of hazardous chemical waste and are usually HIGHLY TOXIC
It consists of chemical with non of the aforementioned properties.
ex. sugars, amino acids, and certain organic and inorganic salts
Non-hazardous chemical waste
Refers to waste that has not been in contact with infectious agents, hazardous chemicals, or radioactive substance and does not pose any special handling problem or hazard to human health or to the environmeny
More commonly known as “general waste”
Non-hazardous healthcare waste
3 Non hazardous wastes
Recyclable General Waste
Biodegradable General Waste
Residual General Waste
Who are the persons at risk?
doctors, nurses, auxiliaries, and maintenance personnel
Patients, Visitors to the HCF
laundry, workers transporting hazardous HCW
operators of waste management facility (e.g., sanitary landfill and TSD facilities) including informal recyclers or scavengers.
15 Potential infections caused by exposure to HCW
Gastroenteric Infection
Respiratory Infection
Ocular Infection
Genital infection
SKin Infection
Anthrax
Meningitis
Acquired Immunodeficiency Syndrone (AIDS)
Hemorrhagic fever
Septicemia
Bacteremia
Viral Hepatitis A
Viral Hepatitis B and C
Avian Influenza
Causative Agent: Enterobacteria, e.g. Salmonella, Shigella spp.; Vibrio cholera; Giardia lambdia;
Clostridium difficile; helminths
Through: Feces and/or Vomit
Gastroenteric Infection
Causative Agent: Mycobacterium tuberculosis; measles virus; Streptococcus pneumonia, Severe
Acute Respiratory Syndrome
Through: Inhaled secretions; saliva
Respiratory Infection
Causative Agent: Herpes Virus
Through: Eye Secretions
Ocular Infection
Causative Agent: Neisseria gonorrheae; herpes virus
Through: Genital Secretion
Genitial infection
Causative Agent: Streptococcus spp
Through: Pus
Skin Infection
Causative Agent: Bacillus anthracis
Through: Skin secretions
Anthrax
Causative Agent: Neisseria meningitides
Through: Cerebrospinal Fluid
Meingitis
Causative Agent: Human Immunodeficiency Virus (HIV)
Through: Blood, sexual secretions, body fluids
Acquired Immunodeficiency Syndrome (AIDS)
Causative Agent: Junin, Lassa, Ebola, and Marburg Viruses
Through: Feces and all body secretions
Hemorrhagic fever
Causative Agent: Staphylococcus spp.
Through: Blood
Septicemia
Causative Agent: Coagulase-negative Staphylococcus
spp.; (including Methicillin-resistantS.
aureus); Enterobacter, Enterococcus,
Klebsiella, and Streptococcus spp
Through: Nasal secretion, skin contact
Bacteremia
Causative Agent: Candida Albicans
Through: Blood
Candidemia
Causative Agent: Hepatitis A Virus
Through: Feces
Viral Hepatitis A
Causative Agent: Hepatitis B and C Viruses
Through: Blood and Body Fluids
Viral Hepatitis B and C
Causative Agent: H5N1 Viruses
Through: Blood, feces
Avian Influenza
If an indivs are exposed to helath care wastes susch as medical staff, in- and out- patients etc.
Are they potentially at risk of being injured or infected?
Yes duh ofc
Why does Incinerating waste causes problems?
Incenerating means burning
because plastics tend to produce toxic substances, such as DIOXINS, when they are burnt.
Gases from incineration may cause air pollution and contribute to acid rain, while the ash from incinerators may contain heavy metals and other toxins.
8 Local Legislation
first 4
Republic Act No. 4226 “Hospital Licensure Act” (1965)
Republic Act No. 6969 “An Act to Control Substances and Hazardous and Nuclear Wastes” (1990)
Republic Act No. 8749 “The Philippine Clean Air Act of 1999”
Republic Act No. 9003 “Ecological Solid Waste Management Act of 2000”
8 Local Legislation
last 4
Republic Act 9275 “The Philippine Clean Water Act of 2004” Presidential Decree 856 “The Code on Sanitation of the Philippines”
Presidential Decree No. 984 “Providing for the Revision of Republic Act No. 3931, Commonly known as the Pollution Control Law, and for Other Purposes” (1976)
Presidential Decree No. 1586 “Environmental Impact Statement (EIS) System”
Republic Act No. 11223: “Universal Health Care Act” (2018)
It is a document that serve as the most comprehensive set of guidelines on the safe management of waste generated from healthcare activities in the country
DOH Healthcare Waste Management Manual, 4th edition
6 Other Related Local Regulation
first 3
DOH-DENR Joint Administrative Order No. 02 series of 2005 dated August 24, 2005 entitled “Policies and Guidelines on Effective and Proper Handling, Collection, Transport, Treatment, Storage and Disposal of HCW”
Executive Order No. 301 (2004) “Establishing a Green Procurement Program for All Departments, Bureau, Offices and Agencies of the Executive Branch of Government”
DOH Administrative Order No. 2008-0021 dated July 30, 2008 “Gradual Phase out of Mercury in all Philippine Healthcare Facilities and Institutions”
6 Other Related Local Regulation
last 3
DOH Administrative Order No. 2008-0023 dated July 30, 2008 “National Policy on Patient Safety”
Philhealth Benchbook for Quality Assurance in Healthcare (2006)
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”
7 International regulations and agreements
FIrst 4
The Montreal Protocol on Substances that Deplete the Ozone Layer (1987)
The Basel Convention on the Control of the Transboundary Movements of Hazardous Wastes and Their Disposal (1989)
The United Nations Framework Convention on Climate Change (1992)
The ASEAN Framework Agreement on the Facilitation of Goods in Transit (1998)
7 International regulations and agreements
Last 3
The Stockholm Convention on Persistent Organic Pollutants (2001)
The Minamata Convention on Mercury (2013)
World Health Assembly Resolution on Water, Sanitation and Hygiene (WASH) in Health Care Facilities (2019)
