Legislation, Policies, and Guidelines Governing Health Care Waste

The Basel Convention on the Control of the transboundary movements of Hazardous waste and their disposal (1989)

- concerned with the transboundary movements of hazardous waste - countries that signed the Convention accepted the principle that only legitimate transboundary shipments of hazardous waste are exported from countries that lack the facilities or expertise to safely dispose certain waste to other countries that have both facilities and expertise

Republic Act No. 4226 "Hospital Licensure Act" (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

The United Nations Framework Convention on Climate Change (1992)

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

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

sets the final objective of the protocol to eliminate ozone depleting substances in the environment

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

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

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

• aims to provide: 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 d) develop incentive programs for suppliers of environmentally advantageous products or services

Presidential Decree 813 (1975) and Executive Order 927 (1983) " Strengthening the Functions of Laguna Lake Development Authority (LLDA)"

• further strengthens the power and functions of LLDA to include environmental protection and jurisdiction over surface waters of the Laguna Lake basin • through E.O 927, LLDA is empowered to issue permits for the use of the surface waters within Laguna de Bay

The Stockholm convention on persistent organic pollutants (2001)

• global treaty to protect human health and the environment from persistent organic pollutants (POPs) • POPs are chemicals that: - remain unchanged in the environment for long periods of time - accumulate in the fatty tissues of living organisms - toxic to both human and wildlife

Presidential Decree 984 " Providing for the Revision of R.A 3931, Commonly known as the Pollution Control Law and for Other Purposes" (1976)

• governs the discharge of potentially polluting substances to air and water • provides basis for the DENR regulations on water pollution through its IRR, DENR A.O Nos 34 and 35 • the IRR for air emission was initially set by DENR A.O No 14 but was later replaced by Clean Air Act of 1999 (R.A 8749)

PhilHealth Benchbook for Quality Assurance in Health Care (2006)

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

Republic Act No. 9003 "Ecological Solid Waste Management Act of 2000"

• 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

Republic Act No. 8749 " The Philippine Clean Air Act of 1999)

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

Republic Act No. 9275 " The Philippine Clean Water Act of 2004"

• 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

BFAD Memorandum Circular No. s1994 " Inventory, Proper Disposal and/or Destruction of Vials or Bottles" and BFAD Bureau Circular No 16, s1999 "Ammending BFAD MC No. 22 dated September 8, 1994, Regarding Inventory, Proper Disposal and/or Destruction of Vials or Bottles

• released to prevent the proliferation of adulterated, misbranded, and counterfeit drugs brought about by recycling of used pharmaceutical bottles and vials • contain guidelines on the proper inventory and destruction of bottles and vials

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

• requires all HCF to gradually phaseout the use of mercury-containing devices and equipment • initial targets of the phaseout are mercury thermometers and sphygmomanometers in HCF

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

• requires projects like construction of new hospital building 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 like pyrolysis, autoclave, microwave and other treatment technology including landfills

Presidential Decree 856 " The Code on Sanitation of the Philippines- Chapter XVII on Sewage Collection and Excreta Disposal" (1998)

• requires the approval of DOH in term of the following: a) constructions of any type of toilet in every house and community which may be allowed for a group of small houses of light material or temporary in nature b) plans of individual sewage or sewage system and the sub-surface absorption system or other treatment c) location of any toilet or sewage disposal system in relation to a source of water supply d) discharge of untreated effluent from septic tanks and/or sewage treatment plants to bodies of water e) manufacture of Septic Tanks f) method of disposal of sludge from septic tanks or other treatment plants

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

• requires the establishment and maintenance of a culture of patient safety in HCF as the responsibility of its leader • HCF shall ensure that an enabling mechanism/ strategy is in place to ensure patient safety • the key priority areas in patient safety include ( but 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 • energy and waste management standards

Republic Act No. 6969 "An Act to Control Substances and Hazardous and Nuclear Waste" (1990)

• requires the registration of waste generators, waste transporters and operators of toxic and hazardous waste 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

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

• serves as a reference for HCF administrators in the implementation of an effective and efficient waste management program • the requirement 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