PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1

HEALTHCARE WASTE MANAGEMENT

Final Date of Lecture: December 5, 2022
Lecture | 1st Semester
OUTLINE concentration or quantity to cause disease in
I. Introduction susceptible hosts.
A. Waste  Pathological and Anatomical Waste -
B. Healthcare Waste Waste consists of tissues, organs, body
C. Healthcare Waste Generators parts, human fetus and animal carcasses,
II. Categories of Healthcare Waste blood and body fluids. Within this category,
III. Impact of Healthcare Waste recognizable human or animal body parts
IV. International Agreements About Health Care are also called anatomical waste. This
Waste Management category should be considered as a
V. National Law and Policies on Health Care subcategory of infectious waste, even
Waste Management though it may also include healthy body
VI. Health Care Waste Management System parts.
VII. Benefits of Proper Waste Disposal  Sharp Waste - Include needles, syringes,
scalpels, saws, blades, broken glass,
INTRODUCTION infusion sets, knives, nails and any other
items that can cause a cut or puncture
 Waste - Any unwanted or unusable wounds. Whether or not they are infected,
materials. Waste is any substance which is such items are usually considered as highly
discarded after primary use, or is worthless, hazardous health care waste.
defective and of no use. A by-product by  Chemical Waste - Waste consists of
contrast is a joint product of relatively minor discarded solid, liquid, and gaseous
economic value. chemicals, for example from diagnostic and
 Healthcare Waste - All waste generated in experimental work and from cleaning,
healthcare facilities, research institutes, and housekeeping, and disinfecting procedures.
other medical procedure-related Chemical waste from health care may be
laboratories. Furthermore, it contains waste hazardous or non-hazardous.
from minors and sporadic sources, such as  Pharmaceutical Waste - Includes expired,
garbage generated during home healthcare. unused, spilt, and contaminated
 Healthcare Waste Generators - A person pharmaceutical products, drugs, vaccines,
who generates or produces hazardous and sera that are no longer required and
wastes, through any commercial, industrial need to be disposed of appropriately. This
or trade activities. Waste transporter means category also includes discarded items used
a person (natural or juridical) who is licensed in handling of pharmaceuticals such as
to transport hazardous wastes. The following bottles or boxes with residues, gloves,
are the main sources of waste in healthcare: masks, connecting tubing and drug vials.
 Hospitals and other health facilities  Genotoxic / Cytotoxic Waste
 Laboratories and research centers  Genotoxic waste may include
 Mortuary and autopsy centers certain cytostatic drugs, vomit, urine,
 Animal research and testing or feces from patients treated with
laboratories cytostatic drugs, chemicals, and
 Blood banks and collection services radioactive materials. This type of
 Nursing homes for the elderly. waste is highly hazardous and may
have mutagenic, teratogenic, or
CATEGORIES OF HEALTHCARE WASTE carcinogenic properties.
 Cytotoxic waste are contaminated
 Infectious Waste - This type of waste is materials from drug preparation and
suspected to contain pathogens (bacteria, administration, such as syringes,
viruses, parasites, or fungi) in sufficient needles, gauges, vials, packaging;
outdated drugs, excess (left over)
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PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1
HEALTHCARE WASTE MANAGEMENT
Final Date of Lecture: December 5, 2022
Lecture | 1st Semester
solutions, and drugs returned from INTERNATIONAL AGREEMENTS ABOUT
the wards. HEALTHCARE WASTE MANAGEMENT
 Radioactive Waste - Includes disused The following international principles are widely
sealed radiation sources, liquid and gaseous recognized as underlying the effective management
materials contaminated with radioactivity, of wastes:
excreta of patients who underwent  Polluter pays Principle - all waste
radionuclide diagnostic and therapeutic procedures are legally and financially
applications, paper cups, straws, needles responsible for:
and syringes, test tubes, and tap water  Safe handling of waste
washings of such paraphernalia.  Environmentally sound disposal of
 Non – Hazardous or General Waste - waste
Comparable to domestic waste, this type of  Creating an incentive to produce less
waste does not pose special handling waste
problem or hazard to human health or to the  Precautionary Principle - in order to protect
environment. It comes mostly from the the environment, the precautionary principle
administrative and housekeeping functions approach shall be widely applied by States
of health care establishments and may also according to their capabilities.
include waste generated during maintenance  Duty of care Principle - stipulates that any
of health care premises. General waste person handling or managing hazardous
should be dealt with by the municipal waste substances or related equipment is ethically
disposal system. responsible for applying the utmost care.
 Proximity Principle - recommends that
IMPACT OF HEALTHCARE WASTE treatment and disposal of hazardous waste
take place as near as possible to the point of
 Hospital personnel are at greater risk of production as is technically and
infection through injuries from contaminated environmentally possible to minimize risks
sharps, other hospital workers and waste involved in transport.
management operators outside of the health  Prior informed consent Principle -
care establishment are also at risk. Certain requires that affected communities and other
infection, however, spread through media or stakeholders be apprised of the hazards and
caused by more resilient agents, may pose a risks involved in the transport of wastes and
significant risk to the public. the siting and operation of waste treatment
 Chemicals used in healthcare and disposal facilities.
establishments are a potential source of
water pollution via the sewer system. Any
NATIONAL LAW AND POLICIES ON
hazardous chemical waste generated should
HEALTHCARE WASTE MANAGEMENT
be dealt with by a proper chemical waste
R.A. 4226 “Hospital Licensure Act”
management system.
 In addition, the public is very sensitive about  The Hospital Licensure Act requires the
the visual impact of anatomical waste, that is, licensure of all hospitals in the country and
recognizable body parts, including fetuses. mandates the DOH to provide guidelines for
The present culture in the country do not hospital technical standards as to personnel,
accept the disposal of anatomical waste equipment, and physical facilities.
inappropriately, such as on a landfill.
P.D. 856 “The Code on Sanitation of the
Philippines”

 The Code of Sanitation of the Philippines

mandates the DOH to promote and preserve

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PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1
HEALTHCARE WASTE MANAGEMENT
Final Date of Lecture: December 5, 2022
Lecture | 1st Semester
public health and upgrade the standard of P.D. 984 “Pollution Control Law”
medical practice. In line with the DOH
mandate, a Manual on Hospital Management  The Pollution Control Law is the primary
was published in 1997 and the Implementing legislation that governs discharges of
Rules and Regulations of Chapter XVIII, potentially polluting substances to air and
Refuse Disposal of PD 856 was water. It provides the basis for the DENR
promulgated. regulations on water pollution through its
IRR, DENR Administrative Order Nos. 34
P.D. 1586 “Environmental Impact Statement and 35. The IRR for air emissions was
(EIS) System” initially set by DENR AO 14, but was later
replaced by the Clean Air Act of 1999 (RA
 The Environmental Impact Statement (EIS)
8749).
System of the Philippines or PD 1586
requires projects like construction of new R.A. 6969 “An Act to Control Toxic Substances
hospital buildings or expansion of existing and Hazardous and Nuclear Wastes”
hospitals to secure an Environmental
Compliance Certificate (ECC) prior to  RA 6969 requires the registration of waste
construction and operation of the facility. An generators, waste transporters, and
ECC is required for the installation and operators of toxic and hazardous waste
operation of health care waste treatment treatment facilities with the EMB. The waste
systems like pyrolysis, autoclave, generators (i.e., hospitals) are required to
microwave, landfills, and other similar ensure that its hazardous or biomedical
treatment technology. waste is properly collected, transported,
treated, and disposed. Quarterly monitoring
R.A. 8749 Clean Air Act (CAA) of 1999 reports should be submitted to the EMB.
 The Clean Air Act of 1999 prohibits the
incineration of biomedical wastes effective HEALTHCARE WASTE MANAGEMENT SYSTEM
July 17, 2003. It promotes the use of state- Segregation of Healthcare Waste
of-the-art, environmentally sound, and safe Color of Type of waste
nonburn technologies for the handling, container/bag
treatment, thermal destruction, utilization, Black Non-infectious dry waste
and disposal of sorted, unrecycled Green Non-infectious wet waste
biomedical and hazardous wastes. (kitchen, dietary etc.)
Yellow Infectious and Pathological
R.A. 9003 Ecological Solid Waste Management waste
(ESWM) Act of 2000 Yellow with Chemical waste including
Band those w/ heavy metals
 The Ecological Solid Waste Management
Orange Radioactive waste
Act of 2000 mandates the segregation of
Red Sharps and pressurized
solid wastes at the source including containers
households and institutions like hospitals by
using a separate container for each type of
waste from all sources (Section 21, Article 2,
RA 9003). However, the term “solid waste”
specifically excludes infectious waste from
hospitals such as equipment, utensils,
laboratory wastes, pathological specimens,
disposable fomites, and similar disposal
materials (Section 3(2), Article 2, RA 9003;
Section 1, Rule III, DENR AO 2001-34).

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PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1
HEALTHCARE WASTE MANAGEMENT
Final Date of Lecture: December 5, 2022
Lecture | 1st Semester

Storage of Healthcare Waste

 All health care waste should be collected and

stored in waste storage area until
transported to a designated off-site treatment
facility. This area shall be marked with
warning sign: "CAUTION: BIOHAZARDOUS
WASTE STORAGE AREA -
UNAUTHORIZED PERSONS KEEP OUT."
 Storage areas for health care waste should
be located within the establishment or
research facility. However, these areas
should be located away from patient rooms,
laboratories, hospital function/operation
rooms or any public access areas. The waste
in bags or containers should be stored in a
separate area, room or building of a size
appropriate to the quantities of waste
produced and the frequency of collection. In
cases where the health care facility lacks the
space, daily collection and disposal should
be enforced.
 Cytotoxic waste should be stored separately
from other waste in a designated secured
location.
 Radioactive waste should be stored
separately in containers that prevent
dispersion, and if necessary behind lead
shielding.
 Waste that is to be stored during radioactive
decay should be labeled with the type of
radionuclide, the date, and details of required
storage conditions.
 Storage facility for radioactive waste must
bear the sign “Radioactive Waste” placed
conspicuously. Methods of treatment and
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PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1
HEALTHCARE WASTE MANAGEMENT
Final Date of Lecture: December 5, 2022
Lecture | 1st Semester
disposal of radioactive waste shall conform odors. If the waste must be stored longer
to the requirements and guidelines of the than 2 days, application of treatment like
PNRI. chemical disinfection or refrigeration at 4℃or
 During “storage for decay”, radioactive waste lower is recommended.
should be separated according to the length
Transport of Healthcare Waste
of time needed for storage, for example,
short-term storage (half-lives less than 30  On-site Transport - Transportation of waste
days) and long-term storage (half-lives from within the establishment could utilize
30 to 65 days). Low level radioactive waste wheeled trolleys, containers, or carts that are
should be stored for a minimum of ten times dedicated solely for the purpose. On-site
the half-life of the longest-lived radionuclides transportation vehicle should meet the
in the container and until radioactivity decays following specifications:
to background levels as confirmed by a  Easy to load and unload
radiation survey.  No sharp edges that could damage
Requirements for Storage Facilities waste bags or containers during
loading and unloading
 The storage area should have an  Easy to clean
impermeable, hard-standing floor with good  Off-site Transport - The health care waste
drainage; it should be easy to clean and generator is responsible for the safe
disinfect. packaging and adequate labeling of waste to
 There should be water supply for cleaning be transported off-site for treatment and
purposes. disposal. Packaging and labeling should
 The storage area should allow easy access comply with the national regulation
for staff in charge of handling the waste. governing the transport of hazardous wastes
 It should be possible to lock the storage area (RA 6969) and maintaining that it presents
to prevent access by unauthorized persons. no danger to the public during transport.
 Easy access for waste collection vehicle is Likewise, the waste generators are ultimately
essential. responsible for ensuring that their wastes are
 There should be protection from sun, rain, properly treated and disposed of in an
strong winds, floods, etc. approved disposal facility.
 The storage area should be inaccessible to Healthcare Waste Treatment
animals, insects and birds. Most common technologies and processes used in
 There should be good lighting and adequate health care waste treatment are:
ventilation.
 The storage area should not be situated in  Thermal Process - Thermal processes rely
the proximity of fresh food stores or food on high heat to destroy pathogens (disease-
preparation areas. causing microorganisms).
 A supply of cleaning equipment, protective  Chemical disinfection - now being applied
clothing, and waste bags or containers for treatment of health care waste.
should be located conveniently close to the Chemicals like aldehydes, chlorine
storage area. compounds, phenolic compounds, etc. are
 Floors, walls, and ceilings of the storage area added to waste to kill or inactivate pathogens
must be kept clean in accordance to present in health care waste.
established procedures, which at a minimum  Irradiation - The disposal of biologically
should include daily cleaning of floors. contaminated waste from hospitals, clinics
 Biodegradable general and hazardous waste and laboratories is of particular concern.
should not be stored longer than 2 days to Waste containing potentially infectious
minimize microbial growth, putrefaction, and microorganisms (sewage sludge, biomedical
wastes, wastewater) are treated using
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PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1
HEALTHCARE WASTE MANAGEMENT
Final Date of Lecture: December 5, 2022
Lecture | 1st Semester
irradiation systems which are currently being  Access to the disposal site should be
used in waste treatment operations. restricted to authorized personnel
 Biological Processes - The process uses only.
an enzyme mixture to decontaminate health  The burial site should be lined with a
care waste and the resulting by-product is material of low permeability, such as
put through an extruder to remove water for clay, if available, to prevent pollution
sewage disposal. of any shallow groundwater that may
 Encapsulation - Encapsulation involves the subsequently reach nearby wells.
filling up of containers with waste, adding  Only hazardous health care waste
and immobilizing material, and sealing the should be buried. If general health
containers. The process uses either cubic care waste were also buried on the
boxes made of high-density polyethylene or premises, available space would be
metallic drums, that are three quarters filled quickly filled-up.
with sharps or chemical or pharmaceutical  Large quantities (>1kg) of
residues. The containers or boxes are then chemical/pharmaceutical wastes
filled up with a medium such as plastic foam, should not be buried.
bituminous sand and cement mortar. After  The burial site should be managed as
the medium has dried, the containers are a landfill, with each layer of waste
sealed and disposed of in landfill sites. The covered with a layer of earth to
process is particularly appropriate for the prevent odor, as well as to prevent
disposal of sharps and chemical or proliferation of rodents and insects.
pharmaceutical residues. The main  Burial site should not be located in
advantage of the process is that it is very flood prone areas.
effective in reducing the risk of scavengers  Hospital ground should be secured.
gaining access to the health care waste. (e.g. fenced with warning signs).
 Inertization - Especially suitable for  The location of waste burial pit should
pharmaceutical waste is the process of be downhill or down-gradient from
inertization that involves the mixing of the any nearby wells and about 50
waste with cement and other substances meters away from any water body
before disposal. This is to minimize the risks such as rivers or lakes to prevent
of toxic substances contained in the waste contaminating sources of water.
migrating into surface water or groundwater.  Health care facilities should keep a
permanent record of the size and
Healthcare Waste Disposal location of all their on-site burial pits
 Sanitary Landfill - Sanitary landfill is an to prevent construction workers,
engineered method designed to keep the builders, and others from digging in
waste isolated from the environment. those areas in the future.
Appropriate engineering preparations should  The safe burial of waste depends
be completed before the site is allowed to critically on rational operational
accept waste. There should be trained staff practices. The bottom of the pit
present on site to control operations, should be at least 1.50 meters higher
organize deposits and daily coverage of than the ground water level. It should
waste. be noted that safe on-site burial is
practicable only for relatively limited
 Safe Burial on Hospital Premises - The
period, say 1 to 2 years, and for
safe burial of waste on the health care
relatively small quantities of waste,
premises may be the only viable option
say up to 5 to 10 tons in total. Where
available at the time. However, certain rules
these conditions are exceeded, a
need to be established for the proper health
longer-term solution will be needed.
care waste management. These include:
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PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1
HEALTHCARE WASTE MANAGEMENT
Final Date of Lecture: December 5, 2022
Lecture | 1st Semester
 Septic/Concrete Vault - This method is
especially suitable for the disposal of used
sharps and syringes. The following
procedures for the safe burial of sharps and
syringes through septic/concrete vault are
recommended:
 Dig a pit (minimum size of 1 m x 1 m
x 1.8 m depth), enough to
accommodate sharps and syringes
for an estimated period of time
without reaching the groundwater
level. The site must be isolated and
at least 500 feet away from the
groundwater supply sources and
dwelling units.
 Construct concrete walls and slabs of
the pit. Provide slab with opening or
manhole for easy deposition of
collected sharps and syringes. The
manhole should be extended a few
centimeters above the soil surface to
overcome infiltration of surface water.
 Deposit the collected safety boxes
filled with used sharps and needles
inside the septic/concrete vault.
 Install a security fence around the
site.
BENEFITS OF PROPER WASTE DISPOSAL

 Proper waste removal helps improve air and

water quality as well as reduces greenhouse
gas emissions.
 It helps in minimizing the extraction of
resources along with reducing pollution and
energy consumption which is associated with
manufacturing new materials.
 One of the most significant benefits of waste
management is the protection of the
environment and the health of the
population.
 You also help conserve natural resources
including minerals, water and wood, so this
is the effect of reducing, reusing and
recycling.

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