Introduction

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Page 1: Introduction
Page 2: Introduction

IntroductionHospital waste

Focus lies mainly on biological hazards caused by pathogenic waste

Has considerable repercussions human health Environment

Page 3: Introduction

In the Philippines DOH and DENR

Have set guidelines regarding Handling Collection Storage of pathogenic waste

But the degree to which hospitals follow these set of rules is not known

Page 4: Introduction

The University of Sato Tomas Hospital is a premier health care center should be committed in the service of public

healthwhether it be through patient care or ensuring

a clean healthy environment for their employees and the community

Page 5: Introduction

Definition of Hospital Waste Health care waste (WHO)

› all waste generated by healthcare establishments, research facilities, and health laboratories

› classified as 1. non-risk/general healthcare waste/domestic

waste2. hazardous waste

Prüss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva

Page 6: Introduction

Research Question

Does the University of Santo Tomas Hospital comply with the guidelines on handling, collection and storage of Pathogenic waste as written in the Health Care Waste Management Manual of the Department of Health and the Procedural Manual Title III of Dao 92-29 “Hazardous Waste Management” of the Department of Environment and Natural Resources?

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General ObjectiveTo assess the compliance of University of Santo

Tomas Hospital regarding the handling, collection and storage of Pathogenic waste in accordance to Health Care Waste Management Manual of Department of Health and the Procedural Manual Title III of Dao 92-29 “Hazardous Waste Management” of Department of Environment and Natural Resources

Page 8: Introduction

Specific ObjectivesTo describe the handling of Pathogenic WasteTo describe the collection of Pathogenic WasteTo describe the Storage of Pathogenic WasteTo determine the compliance of UST hospital

regarding the handling, collection and storage of Pathogenic waste in accordance to Health Care Waste Management Manual of Department of Health

To determine the compliance of UST hospital regarding the handling, collection and storage of Pathogenic waste in accordance to the Procedural Manual Title III of Dao 92-29 “Hazardous Waste Management” of Department of Environment and Natural Resources

Page 9: Introduction

Definition of Terms

Pathogenic waste:A subset of health care waste which includes both

Pathological and Infectious waste as defined by the Hazardous Waste manual of the DENR

Infectious waste contains pathogens in sufficient quantity to

cause disease in susceptible hostsPathological waste

consists of tissues, organs, body parts, human fetus, animal carcasses, blood and other body fluids

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Definition of Terms

Handling Collection and Storage:Component of waste management in which

health care waste is gathered and segregated resulting in the passage of a waste material from the source of production to the point of storage until transported to an off-site treatment facility

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Definition of Terms

Health Care Waste Management Manual: Written by the DOH designed to ensure no

adverse health and environmental consequences involved in the generation, handling, storage and disposal of health care waste

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Definition of Terms

Procedural Manual Title III of Dao 92-29 Hazardous Waste Management: Written by DENR designed to serve as a

primary reference for those involved in the generation, handling, storage and disposal of health care waste

To provide technical standards and requirements for hazardous waste generators, transporters, and premises/facilities involved in the treatment, storage, recycle, reprocess, and disposal of hazardous wastes in the country

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Significance

Pathogenic Healthcare waste Identified as a major problem that negatively

impacts both human health and the environment

Little information available regarding the handling, collection storage and transport of

pathogenic waste in USTHThere are guidelines in place

appraisal of the current situation regarding pathogenic waste management in the USTH is essential

Page 14: Introduction

Review of Related LiteratureTwo studies conducted by the Department

of Health indicated the need to introduce modifications to the existing health care waste management practicesWaste Management Practices of DOH-Retained

Hospitals in 1995 Waste Management Practices of Private and

Government Hospitals in Metro-Manila in 1997

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Most common problems encountered:Inadequate waste management practicesLack of awareness about the health hazardsInsufficient financial and human resourcesPoor control of waste disposal

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Environmental and Occupational Health Office (EOHO) initiated the revision of the existing Hospital Waste Management Manual (EHS-DOH, 1997)

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The revision was meant to:assist facility administrators in evaluating their

operations in order to improve the health care waste management practices

promote the use of appropriate technologies and to communicate with heath care personnel as well as to the public the risks associated with health care waste

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Hospitals and other health care establishments have the responsibility of ensuring that there are no adverse health and environmental consequences on their handling, storage, treatment and disposal of health care waste

Through this manual, health care establishments will be able to install a more appropriate waste management system

Page 19: Introduction

Definition of Hospital Waste Healthcare waste (WHO)

› all waste generated by healthcare establishments, research facilities, and health laboratories

› classified as 1. non-risk/general healthcare waste/domestic

waste2. hazardous waste

Prüss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva

Page 20: Introduction

Definition of Hospital WasteClassification of Hazardous Waste (DENR)

based on these four characteristics accordance with the Toxicity Characteristic Learning Procedure (TCLP): IgnitableCorrosiveReactiveToxic

Department of Environment and Natural Resources. 2004. HazardousWaste Management. Procedural Manual Title III of DAO 92-29

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Effects on HealthAll individuals exposed to hazardous health-

care waste are potentially at risk

Certain infections, caused by more resilient agents, pose a significant risk to the general public and to hospital patients

Mühlich, M. et. al. 2003. Comparison of infectious waste management in European hospitals. Institute for Environmental Medicine and Hospital

Epidemiology, Freiburg University Hospital, Freiburg, Germany

Prüss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva

Page 22: Introduction

People at riskhealth-care workers, particularly nurses, are at

greatest risk of infectionother hospital workers and waste-management

operators outside health-care establishmentsindividuals who scavenge on waste disposal sites lower risk for patients and the public

Mühlich, M. et. al. 2003. Comparison of infectious waste management in European hospitals. Institute for Environmental Medicine and Hospital

Epidemiology, Freiburg University Hospital, Freiburg, Germany

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Regulation of Hospital Waste in the Philippines

Metropolitan Manila Authority (MMA) Ordinance No. 16

Hospital Licensure Law (Republic Act No. 4226)

Toxic Substances and Hazardous and Nuclear Waste Control Act of 1990 (Republic Act No. 6969

Soncuya, Matias, Lapid. 1997. Hospital Waste Management in the Philippines, two Case Studies in Manila. WASTE. Urban Waste Expertise Programme

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Metropolitan Manila Authority (MMA) Ordinance No. 16

use four types of trash bags for easy identification of waste:1) black trash bag for non-infectious dry waste2) green trash bags for non-infectious wet waste3) yellow trash bags for dry and wet chemical and

other potentially infectious waste, pathological waste, chemical waste and sharps contained in puncture-proof containers covered with solution of lime

4) orange trash bags with trefoil sign for radioactive waste that will be stored in the hospital until rendered as inactive and/or disposed in accordance with the prescribed rules and regulations of the Philippine Nuclear Research Institute

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Hospital Licensure Lawhospitals are categorized as government

or private hospitalsspecifies the needed physical facilities of a

hospital for solid waste management such as the physical plant, hospital equipment and maintenance of these physical facilities

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Toxic and Hazardous and Nuclear Wastes Control Act of 1990

covers the importation, manufacture, processing, handling, storage, transportation, sale, distribution, use and disposal of all unregulated chemical substances and mixtures in the Philippines

defines the prohibited acts and provides for administrative and criminal penalties

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Waste Management in the Philippineswastes, segregated or not, are collected by workers

employed by the health care establishment(usually cleaners or janitors of the premises) aware of local opportunities for recycling of components of the

waste unaware of, or insensitive to, the hazards associated with

handling health care waste generally take no precautions in handling, transporting and

separating the waste not supplied with protective clothing or special equipment

Pescod, S. 1998. Hospital Waste Management in Four Major Cities. WASTE. Urban Waste Expertise Programme

Page 28: Introduction

Waste Management in the Philippinesplastic bags, covered bins/trash cans, and glass

jars with covers

due to inadequate segregation of infectious from non-infectious much of the generated hospital waste is being disposed directly to municipal landfills

Department of Environment and Natural Resources. 1993. Pasig River Rehabilitation Program: Feasibility Report on Hospital Hazardous Waste Management in Metro Manila. Volume I

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Waste Management in the Philippinescollected by the municipal waste

collection service transported for disposal with municipal

wasteall types of wastes are mixed and

transported, often along with municipal solid waste, to municipal landfills

Pescod, S. 1998. Hospital Waste Management in Four Major Cities. WASTE. Urban Waste Expertise Programme

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Waste Management in the Philippinesexisting treatment capacity is insufficient for

the proper disposal of the major part of medical wastes generated in Metro Manila area

the existing capacity for incinerating these wastes totals to less than 3 tons/day

total daily quantity of dangerous medical wastes generated was estimated to at least 12.4 tons

Department of Environment and Natural Resources. 1993. Pasig River Rehabilitation Program: Feasibility Report on Hospital Hazardous

Waste Management in Metro Manila. Volume I

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Problems in Medical Waste ManagementIn developing countries, medical waste has not

received much attention and it is disposed of together with domestic waste

Lack of a system of medical waste management, a lack of necessary supplies and facilities, a lack of knowledge among health workers and a lack of coordination among different ministries.

A national program for medical waste management is essential in Palestine

Massrouje, HTN., 2001. Medical waste and health workers in Gaza governorates. Eastern Mediterranean Health Journal

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Problems in Medical Waste ManagementIn Lagos Metropolis, Nigeria, there is absence of

full compliance with the protocol stipulated in the guidelines and standards of environmental pollution control

There were problems in collection, segregation, storage, treatment, and disposal among the hospitals that were observed

Longe, E.O., Williams, A., 2006. A Preliminary Study of Medical Waste Management in Lagos Metropolis, Nigeria. Iran Journal of Environ.

Health Sci. Eng., 3:2:133-139

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Problems in Medical Waste ManagementIn Dhaka, Bangladesh there is no proper,

systematic management of medical waste except in a few private Health Care Establishments that segregate their infectious wastes

Some cleaners were found to salvage used sharps, saline bags, blood bags and test tubes for resale or reuse

Hassan, M., Ahmed, S., Rahman, K., Biswas, T. 2008. Pattern of medical waste management: existing scenario in Dhaka City, Bangladesh.

BMC Public Health. 8:36

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Review of Related LiteratureEvidence showed that there are many

flaws in the compliance, implementation and even in the construction of guidelines concerning hospital management in the Philippines and around the world

Several studies have recommended several steps that may be undertaken to address these flaws

Page 35: Introduction

Review of Related LiteratureRecommendations:

establishment of directorates responsible for medical waste management

coordination of different ministriesprovision of adequate supplies and health

education including encouragement of studies on different aspects of medical waste (creation of database information in different sectors, risk analysis and disposal methods)

Massrouje, HTN., 2001. Medical waste and health workers in Gaza governorates. Eastern Mediterranean Health Journal

Page 36: Introduction

Review of Related LiteratureCase studies in the Philippines have only

focused on two distinct hospitals in Metro Manila

Should include the University of Santo Tomas Hospital

Page 37: Introduction

MethodologyDescriptive StudyInclusion Criteria:

Super Clean ServicesExclusion Criteria:

Waste TransporterWaste TreatersTSD facility

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MethodologyData Collection

Semi Structured Interview of authorities and Personnel of Super Clean Services

Visual inspection and Field investigation of collection, handling and storage of pathogenic waste

Data ProcessingFlow Chart and narrative of collection,

handling and storage of pathogenic waste

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Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Selection and planning of research topicCoordinating with UST Hospital’s maintenance officerWorkplace inspectionLiterature researchResearch methodology planningData gatheringData evaluationConstruction of research conclusion and recommendation Final research paper formation

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