PLMS L9

Categories of Health Care Wastes

1. Infectious Waste 2. Pathological and Anatomical Wastes 3. Sharps 4. Chemical Wastes 5. Pharmaceutical Wastes 6. Radioactive Wastes 7. Non-hazardous or General Waste 6.a. Recyclable wastes b. Biodegradable wastes c. Non-biodegradable wastes

Treatment before Disposal of Health Care Wates

1. Pyrolysis 2. Autoclave 3. Microwave 4. Chemical disinfection 5. Biological Process 6. Encapsulation 7. Inertization

How to properly Tie a Biohazard Bag using a Gooseneck Knot

1. gather twist end 8-10 2. make loop with the twisted end 3. seal tightly with. either duck tape or plastic tie

How to properly Tie a Biohazard Bag Using An Overhand Knot

1. overhand knot. gather. twist end 8-10 2. overhand knot. overhand knot make loop with the twisted end 3. overhand knot loop end

✓Sterilization

6𝑙𝑜𝑔10 (99.9999% reduction) survival probability of the most resistant microorganism of concern in each process

Biohazard Bag

A disposable bag that is impervious to moisture and has a strength to prevent ripping, tearing, or bursting under normal condition of usage and handling of the waste-filled bag. • Highly infectious waste must be contained in a biohazard bags

Bin liner

A disposable bag used to contain solid waste

Republic Act No. 6969

An Act to Control Substances and Hazardous and Nuclear Wastes of 1990 An act that requires the registration of waste generators, waste transporters, and operators of toxic and hazardous waste treatment facilities with Department of Environment and Natural Resources- Environmental Management Bureau

6. Radioactive Wastes

Any wastes exposed to radionuclides including radioactive diagnostic materials or radiotherapeutic materials.

7. Non-hazardous or General Waste

Any wastes that have not been in contact with communicable or infectious agents, hazardous chemicals, or radioactive substances, and do not pose a hazard. a. Recyclable wastes b. Biodegradable c. Non-biodegrable

Infectious Waste

Bin ✓ Strong leak-proof bin with cover labelled "infectious waste" with biohazard symbol • Liner ✓ Yellow plastic that can withstand autoclaving and labelled "infectious waste" ✓ with a tag indicating source, weight of waste and date of collection

Republic Act No. 9003

Ecological Solid Waste Management Act of 2000 An act that 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.

Executive Order No. 301

Establishing a Green Procurement Program for All Departments, Bureaus, offices, and Agencies of the Executive Branch of Government of 2004 -It aims to: (a) to promote the culture of making environmentally- informed decisions in government; especially in the purchases and use of different products. (b) include environmental criteria in public tenders, whenever possible and practicable; (c) establish the specifications and requirements for products of services to be considered environmentally advantageous; (d) develop incentive programs for suppliers of environmentally sound products and services.

5. Pharmaceutical Wastes

Expired, spilt, contaminated pharmaceutical products. • Empty drug vials • Medicine bottles • Syringes • Containers of cytotoxic drugs

Health care Waste Management Hierarchy

Green Procurement -Prevent -Reduce Resource Development -Reuse -Recycle -Recover End of Pipe -Treat -Dispose

Republic Act No. 4426

Hospital Licensure Act of 1965 An act that requires the registration and licensure of all hospitals in the country and mandates the DOH to provide guidelines for hospital technical standards as to personnel, equipment, and physical facilities.

DOH "Manual on Health Care Waste Management" in 201

It serves as a reference for health care facility administrators in the implementation of an effective and efficient health waste management program.

Health care Waste Management Process

Segregation Packaging Handling and Storage Transportation Treatment and Disposal

Republic Act No. 8749

The Philippine Clean Air Act of 1999 An act that prohibits the incineration of bio-medical wastes effective July 17,2003. It 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 wast

Republic Act No. 9275

The Philippine Clean Water Act of 2004 An act 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

Non-Infectious General Wastes

• Black bin • Optional recycle symbol for recyclable non-hazardous wastes • Liner: ✓ Black or colorless for non-biodegradable ✓ Green for biodegradable; ✓ A tag indicating source, weight of waste and date of collection

Dealing with segregation errors

• A person should never attempt to correct errors by removing items from a bag or container after disposal, by placing the waste from one bag inside another bag of a different color. Rule of thumb: If general and hazardous wastes are accidentally mixed, the mixture should be treated as hazardous waste.

3. Microwave

• A technology that typically incorporates some type of size reduction device. • Shredding of wastes is done before disinfection. • Waste is exposed to microwaves that raise the temperature with 100 degrees Celsius or 237 degrees Fahrenheit for at least 30 minutes. • Microorganisms are destroyed by moist heat which irreversibly coagulates and denatures enzymes and structural proteins.

Landfill

• An engineered site designed to keep waste isolated from the environment. • This site must secure proper permits from DENR before it can accept wastes.

• Biological Waste or Biohazardous Waste

• Any material that contains or has been contaminated by a biohazardous agent • Anywastecontaininginfectious materials • Also called infectious waste or biomedical waste

Health care Wastes

• Any material that is generated as a result of any of the following activities: ✓ Diagnosis, treatment, immunization of human beings or animals; ✓ Research ✓ Testing of biologicals ✓ Waste originating from minor or scatter sources

Autoclave Indicators

• Autoclave Indicators such as color- changing tapes or biological test ampules containing bacterial spores can be used to check validity of the sterilization. 1. Chemical indicator 2. Biological indicator ✓Geobacillus stearothermophilus spores for steam sterilization 3. Mechanical indicator

Sharps

• Bin ✓ Punctured-proof container with wide mouth and cover labelled "Sharps" ✓ With biohazard symbol • Liner • Not applicable

Radioactive waste

• Bin ✓ Radiation proof repositories, leak-proof, and lead-lined container ✓ With name of radionuclide and date of disposition ✓ with radioactive symbol • Liner ✓ Orange plastic ✓ Labelled "Radioactive waste" ✓ With a tag indicating name of radionuclide and date of deposition

Pathological & Anatomical Waste

• Bin ✓ Strong leak-proof bin with cover labelled "Pathological/Anatomical waste" with biohazard symbol • Liner ✓ Yellow plastic that can withstand autoclaving and labelled "Pathological/Anatomical " ✓ with a tag indicating source, weight of waste and date of collection ✓ May or may not have biohazard symbol

Pharmaceutical Waste

• Bin ✓ Strong leak-proof bin with cover labelled "Pharmaceutical Waste" for expired drugs and drug containers; and ✓ Strong leak-proof bin with cover labelled "Cytotoxic waste" for genotoxic, and antineoplastic waste • Liner ✓ Yellow with black band plastic with labelled "Pharmaceutical waste" or "Cytotoxic waste" ✓ with a tag indicating source, weight of waste and date of collection

Infectious Waste

• Contain pathogens or toxins • From patients with highly infectious diseases -microbial culture-multiplying microbial organisms -stock culture-culture of microorganism for the purpose of keeping in viable condition

4. Chemical Wastes

• Discarded chemicals generated during disinfection and sterilization procedures • Solid • Liquid • Gas • Wastes with high content of heavy metals and their derivatives • Toxic • Corrosive • acids of pH < 2 • Bases of pH > 12 • Flammable • reactive • Explosive • Water reactive • Shock-sensitive

7. Inertization

• Especially suitable for pharmaceutical waste that involves the mixing of waste with cement and other substances before disposal. • Involves mixing of the waste with a mixture of water, lime, and cement. The homogenous mixture can be transported in liquid state to a landfill and poured into municipal waste. • The process is relatively inexpensive and can be performed using relatively unsophisticated equipment.

Sources of Health care Wastes

• Government hospitals • Private hospitals • Nursing homes • Private clinics • Dentists clinic • Dispensaries • Primary Health Center • Medical Research • training institutions • Blood bank and collection centers • Animal houses • Slaughterhouses • Laboratories • Research organizations • Vaccination centers

6. Encapsulation

• Involves the filling of containers with waste, adding and immobilizing material and sealing the containers. • The process uses either cubic boxes made of high-density polyethylene or metallic drums, that are three-quarters filled with sharps, or chemicals or pharmaceutical residues. • The containers or the boxes are then filled up with a medium such as plastic foam, bituminous sand, and a cement mortar. • After the medium has dried, the containers are sealed and disposed in a landfill.

3. Sharps

• Items that can cause cut, pricks, or puncture wounds • Most dangerous health care waste because of their potential to cause both injury & infection

1. Segregation

• Separation of different classifications of wastes from each other. Beginning at the point of generation, and maintaining the separation during storage and transport, until treatment. • The key to any effective waste management • How to minimize incorrect use of containers: ✓Proper placement of the waste bin ✓Labeling of containers ✓Color coded bin liners

2. Autoclave

• Steam sterilization • A type of moist heat method of sterilization • Slow Exhaust: For liquids & Medical waste • To render waste harmless and is an efficient wet thermal disinfection process • Using pressure and heat is widely used and the usual setting is 121°C (250°F) with a pressure of 15 psi for 15 to 30 minutes

1. Pyrolysis

• The 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. • Waste residues may be in form of greasy aggregates or slugs, recoverable metals, or carbon black. • Residues are disposed in a landfill.

2. Pathological and Anatomical Wastes

• Tissue sections and body fluids • Subcategory of infectious waste • Organs derived from biopsies, autopsies, or surgical procedures

5. Biological process

• Uses an enzyme mixture to decontaminate health care wastes. The resulting by-product is put through an extruder to remove water for wastewater disposal. • The technology is suited for large applications and is also being developed for possible use in the agricultural sector.

Chemical Waste

▪ For liquid chemical waste, a disposable bottle made of amber- colored glass with at least 4 liters capacity that is strong, chemical- resistant, and leak-proof. • Liner ✓ Yellow with black band plastic with labelled "Chemical waste" ✓ with a tag indicating source, weight of waste and date of collection

Biodegradable wastes

✓ Left-over food from non-infectious patients

Disinfection

✓ Low, intermediate or high elimination or reduction of microorganisms, depending on the survival probability of specific microorganism groups.

Recyclable wastes

✓ Paper products ✓ Aluminum ✓ Pressurized gas containers ✓ Plastic products ✓Wood ✓ Glass (i.e. Used vials for sterile solutions)

4. On-site Transport

✓ Placement of all infectious wastes into rigid or semi-rigid containers before transport off-site ✓ Transport of infectious wastes in closed leak- proof trucks or dumpsters ✓ Use of appropriate hazard symbols in accordance with local, state and federal regulations ✓ Properly document transport of biological waste for traceability purposes ✓ Trolley shall be cleansed and disinfected daily using 4-5% concentration of sodium hypochlorite (NaClO)

4. Off-site Transport

✓ Refers to the collection of waste from the central storage area by an accredited DENR transporter, Municipal collector or supplier into their respective vehicles to the final disposal site. ✓ The health care waste generator is responsible for safe packaging and adequate labelling of waste to be transported off-site for treatment and disposal. ✓ The off-site collector of Health care waste shall provide collection bins that meet the following requirements: ✓ Puncture-proof for sharps ✓ Resistant to aggressive chemicals ✓ Made of high-density polyethylene materials ✓ Must be leak-proof and be fitted with a self-sealing lid that is tight enough to withstand turbulence during transport in the vehicle

Decontamination

✓ Use of physical or chemical means to remove, inactivate, or destroy microorganisms on a surface or item, to the point where they are no longer capable of transmitting infectious particles, and the surface or item is rendered safe for handling, use, or disposal

Steam sterilization Principle

✓ saturated steam is used as a sterilizing agent. ✓ It is formed due to boiling of the water at a temperature of 120 degree centigrade. ✓ The steam is in vapor form and is entrapped inside the autoclave without a chance of escape. ✓ When the heat touches the microbe, the proteins and enzymes in the cells get coagulated and denatured instantly. ✓ the steam transfers the heat, it cools down and condenses to water. This creates a vacuum over the point of contact leading to further steam condensation ✓ the rapid heat concentration on the microbes leads to their death without any possibility if escape. ✓ If the temperature increases, the time decreases and vice-verse.

Non-biodegradable wastes

✓Any wastes that cannot be classified into either of the first two categories

3. Handling & Storage

✓Collection of health care waste must be done by trained utility personnel • Storage temperature and duration are important considerations. • Warmer temperatures cause higher rates of microbial growth and putrefaction, resulting in odor problems. • Consider volume of waste generated in the allocation or designation of storage area

Waste bins

✓Containers shall be leak-resistant, have tight-fitting covers, kept clean and in good repair ✓Containers may be of any color and shall be labeled "Biohazardous", or with biohazard symbol on the lid and on the sides so as to be visible on any lateral direction

2. Packaging of Sharps

✓DO NOT OVERFILL! ✓Always have a new, empty sharps container within reach before the container reaches 3⁄4 full

Treatment of Health Care Wates

✓Decontamination ✓Sterilization ✓Disinfection

Mechanical indicator

✓Devices that record time, temperature & pressure with print out or graph documents • NOT an indicator of sterility

2. Packaging

✓Ensure packaging are sealed by closing the top of each bag ✓Label properly

Green Procurement Policy

✓Prevent ✓Reduce ✓through proper procurement planning wastes are minimized even before their generation. ✓Health care facilities are encouraged to avail of services that are the least harmful to the environment and ✓Health care facilities are encouraged to purchase less polluting products. ✓Waste reduction from the source is implemented by encouraging proper waste segregation to determine the nature and volume of generated wastes to allow efficient waste management at the least cost

Resource Development

✓Reusing • Finding a new application for a used material or using the same product for the same application repeatedly. ✓Recycling • Processing of used materials into new products ✓Recovery • Energy recovery: whereby waste is converted to fuel for generating electricity or for direct heating of premises • A term used to encompass 3 subsets of waste recovery: recycling, composting, and energy recovery.

4. Chemical disinfection

✓Sodium hypochlorite ✓Hydrogen peroxide ✓Peroxyacetic acid ✓Heated alkali • 5% sodium hypochlorite is recommended for chemical disinfection. • This method generates chemical wastes from the used chemical disinfectants

Treatment of Health Care Wates

✓To change the biological and chemical character of the waste to minimize its potential to cause harm ✓ Decontamination ✓Sterilization ✓Disinfection ✓It is critical that terms and criteria be established that quantitatively define the level of microbial destruction accomplished by any health care waste treatment process

Why manage health care waste?

✓To protect human and safeguard our environment ✓To minimize generation of hazardous waste

End of Pipe

✓Waste treatment • Changing the biological and chemical characteristics of waste to minimize its potential to cause harm. ✓Waste disposal • Discharging, depositing, placing, or releasing any health care waste into air, land, or water. • Not all types of wastes require treatment before disposal.

Biological indicator

✓have bacterial spores that are used for testing the effectiveness of an autoclave in killing bacteria cells. ✓commonly used in steam and chemical vapor sterilizers. ✓Indicator of sterility ✓Geobacillus stearothermophilus • These spores are commonly used in steam and chemical vapor sterilizers ✓This bacterial spore test is used to determine if the sterilization cycle parameters were sufficient to kill the test microorganisms.

Chemical indicators

✓respond to a certain chemical or physical change that occurs inside the autoclave ✓Chemical tape ✓use of heat sensitive ink which changes color from white to a visible pattern, if the temperature has reached 121 °C ▪ NOT an indicator of sterility