Week 11-12 BRM and Health Care Waste Management

What is the hierarchy of controls?

-Elimination -Substitution -Engineering Controls -Administrative controls -PPE

- Puncture-resistant containers for disposal and transport of needles and sharps- Safety needles that automatically retract after removal - Biohazard bags - Splash guards - Volatile liquid carriers - Centrifuge safety buckets - Biological safety cabinets and fume hoods - Mechanical pipetting devices - Computer wrist/arm pads - Sensor-controlled sinks or foot/knee/elbow-controlled faucets

-Engineering Control

what is the performance evaluation procedure?

-Identify the key issues of concern -Define OUTCOME indicators and metrics -Define ACTIVITIES indicators and metrics -Collect Data and Report indicator Results -Provide findings from Performance indicators -Evaluate and Refine Performance indicators

what are the 5Ps?

-Pathogen -Procedures -Personnel -PPE -Place

- Nonlatex gloves - Isolation gowns - Masks, including particulate respirators (have HEPA filter) - Face shields - Protective eyewear (goggles, safety glasses)

-Personal Protective Equipment (PPE)

- Hand washing after each patient contact - Cleaning surfaces with disinfectants - Avoiding unnecessary use of needles and sharps and not recapping - Red bag waste disposal - Immunization for hepatitis jab rotation to minimize repetitive tasks - Orientation, training, and continuing education - No eating, drinking, or smoking in a laboratory- Warning signage

-Work Practice Control

What are the Laboratory Hazard Prevention Strategies

-Work Practice Control -Engineering Control -Personal Protective Equipment (PPE) -Emergency Equipment

how many kilograms of infectious sharps and pathological waste is generated in the Philippines per day?

0.34 kg

how much general waste is produced in the Philippines per day?

0.39 kg of general wastes

Steps in Performing Risk Assessment

1. Define the situation 2. Define the risks 3. Characterize the risks 4. Determine if the risk is acceptable or not

steps of risk analysis

1. identify the hazard or threat 2. determine the consequences of the identified threat/hazard 3. identify all the existing controls that need to be applied

how many percent is considered hazardous and may be infectious, toxic, or radioactive?

10-25 %

how many percent of wastes is generated by HCA on average are non-hazardous?

75-90%

Full implementation of the standard process- audit the full implementation in order to monitor along the way

ACT

- function as a balance role between the three primary components (the components are equally important)

AMP Model

illustrates the balanced role among the components of BRM.

AMP model

Core instrument that provides 9 high level protocols that set out generic standards to be put into place for the implementation of an international transit system.

ASEAN framework agreement on the facilitation of good transit (1998)

• refers to the policies, standards, and guidelines used to control risks - work practice controls - practices and procedures Proficiency and competency training for laboratory staff is considered administrative control.

Administrative controls

is a subgroup of pathological waste that refers to recognizable body parts usually from amputation procedures.

Anatomical waste

Three Primary Key Components of BRM

Assessment (A) Mitigation (M) Performance (P)

These circulars are released to prevent the proliferation of adulterated, misbranded, and counterfeit drugs brought about by the recycling of used pharmaceutical bottles and vials.

BFAD memorandum Circular No. 22, Series of 1994

• encompasses the identification, understanding, and management aspects of a system in interrelated processes.

BRM

- left-over food not from the patient

Biodegradable waste

• the risk associated to biological toxins or infectious agents

Biorisk

is an integral part in the implementation of the concept of biosafety and biosecurity in a laboratory. It involves the process of assessment, mitigation, and performance evaluation.

Biorisk Management (BRM)

a system or process to control safety and security risks associated with the handling or storage and disposal of biological agents and toxins in laboratories and facilities

Biorisk Management/ Laboratory Biorisk Management

the integration of biosafety and biosecurity to manage risks when working with biological toxins and infectious agents

Biorisk management

• containment principles, technologies, and practices which are implemented to prevent unintended exposure to pathogens and toxins, or their unintentional release - people are protected against pathogens

Biosafety

• institutional and personal security measures designed to prevent the loss, theft, misuse, diversion or intentional release of pathogens and toxins

Biosecurity

Test and optimize new concepts by basic means of one working space

DO

Requires all Health care facilities to gradually phaseout the use of mercury containing devices and equipment. To phaseout mercury thermometers and sphygmomanometer in the health care facility.

DOH AO No. 2008-0021 dated July 30, 2006 "Gradual Phaseout of Mercury in all Philippine Health Care Facilities and Institutions"

Requires the establishment and maintenance of a culture of a patient safety in health care facility as the responsibility of its leaders.

DOH administrative order No. 2008-0023 dated July 30, 2008 "National Policy and Patient Safety "

Serve as a reference for HCF administrators in the implementation of an effective and efficient waste management program.

DOH"ManualonHealthCareWasteManagement"in 2011

defining the risks must include a review of how individuals inside and outside the laboratory may be exposed to the hazards. It could either be through droplets, inhalation, ingestion, or inoculation in case a biological agent has been identified as the hazard. - 1H

Define the risks

The risk assessment team must IDENTIFY the hazards and risks of the biological agents to be handled. Next, at-risk hosts, who could be humans or animals inside and outside the laboratory, must be identified. The work activities and laboratory environment including location, procedures, and equipment should also be defined. - 4W's

Define the situation

this process of evaluating the biorisk arising from a biohazard takes into account the adequacy of any existing controls and deciding whether or not the biorisk is acceptable.

Determine if risks are acceptable or not

Promotes the culture of making environmentally informed decisions in the government, especially in the purchase and use of different products

EO no. 301 "Establishing a Green procurement Program for the all departments, bureau, offices and agencies and the executive branch of government" (2004)

- removes the risk the most difficult and most effective control measure involves the total decision not to work with a specific biological agent or even not doing the intended work. provides the highest degree of risk reduction

Elimination

- Chemical-resistant gloves; subzero (freezer) gloves; thermal gloves - Hearing protection (earplugs or earmuffs) - Eyewash station - Safety shower - Fire extinguisher - Laboratory spill kit - First aid kit

Emergency Equipment

• includes physical changes in work stations, equipment, production facilities, or any other relevant aspect of the work environment that can reduce or prevent exposure to hazards

Engineering controls

flashpoint below 60 degrees Celsius

Flammable

waste minimization involves waste prevention and reduction. - preferable to prevent than produce

Green procurement Policy

the best way to break the chain of infection

Handwashing

anything in the environment that has the potential to cause harm

Hazard

any healthcare facilities, institutions, business establishments, and other spaces where healthcare services are offered with activities or work processes that generate healthcare wastes.

Health care wastes generators

are tasked to ensure that there are no adverse health effects and environmental consequences resulting from their generation, aggregation, collection, storage, transport, treatment, and disposal of healthcare wastes.

Healthcare facilities

Refers to all wastes suspected to contain pathogens or toxins in sufficient concentration that may cause disease to a susceptible host.

Infectious waste

Are actions and control measures that are put into place to reduce or eliminate the risks associated with biological agents and toxins.

Mitigation Procedures

refers to wastes that have not been in contact with communicable or infectious agents, hazardous chemicals or radioactive substances and do not pose a hazard.

Non-Hazardous or General waste

includes environmental protection and jurisdiction over surface waters of the laguna lake basin.

PD 813 (1975) and EO 927 (1983) "Strengthening the functions of Laguna lake Development Authority"

- poso negro, Pasig River

PD 856 "The code on sanitation of the Philippines - Chapter XVII and sewage collection and excreta disposal" (1998)

requires projects like the construction of new hospital buildings, and expansion of existing hospitals to secure an environmental compliance commitment.

PD No. 1586 "Environmental Impact Statement System"

Governs the discharge of potentially polluting substances to air and water

PD No. 984 "Providing for the Revision of RA No. 3931, commonly known as the Pollution Control law, and for other purposes"

Identify potential improvement - analyze the current situation- develop new concepts

PLAN

of the personnel

PPE

cause biological hazard

Pathogens

Refers to tissue sections and body fluids or organs derived from biopsies, autopsies, or surgical procedures sent to the laboratory for examination.

Pathological and Anatomical waste

• systematic process intended to achieve organizational objectives and goals

Performance Evaluation

not a linear process, rather, it is a continuous process to monitor the implementation of existing biosafety procedures and practices. It provides direction for decision-makers to be able to come up with reasonable and justifiable biosafety guidelines.

Performance evaluation

• a reevaluation of the overall mitigation strategy

Performance management

devices are worn by workers to protect them against chemicals, toxins, and pathogenic hazards in the laboratory. Least effective measure because it only protects the person who is wearing it, and only when it is used correctly.

Personal Protective Equipment (PPE)

handling/doing the procedures

Personnel

Refers to expired, split, and contaminated pharmaceutical products, drugs, and vaccines, including discarded items used in handling pharmaceuticals.

Pharmaceutical waste

includes health care waste management as one of its parameters in the QA of healthcare.

Philhealth Benchbook for Quality Assurance in Health Care (2006)

needed to carry out total safety of laboratory workers and patients

Proper management

for easier recognition and maintain segregation during collection, storage, transport, treatment and disposal.

Purpose of color coding

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. - due to oil spills

RA 9275 "The Philippine Clean Water Act of 2004"

Requires the registration of waste generators, waste transporters and operators of toxic and hazardous waste treatment facilities with EMB. The waste generators are required to ensure that their hazardous wastes are properly collected, transported, treated and disposed in a sanitary landfill.

RA No. 6969 "An act to control substances and hazardous and nuclear wastes" (1990)

Prohibits incineration of biomedical wastes effective of July 17, 2003. Promotes the use of state of the art, environmentally-sound, and safe non burn technologies for handling, treatment, thermal destruction, utilization, and disposal of sorted, unrecycled, biomedical, and hazardous wastes.

RA No. 8749 "Philippine Clean Air act of 1999"

Mandates the segregation of solid wastes at the source including households and institutions like hospitals by using a separatecontainerforeachtypeofwaste.

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

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

RA no. 4226 "Hospital Licensure Act" managements

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

Radioactive waste

explosive with water

Reactive

energy recovery; waste is converted to fuel for generating electricity

Recovery

ex: office papers, cardboard, pet bottles, state of the art products

Recyclable waste

refers to the processing of used materials into new products.

Recycling

refers to either finding a new application for used material or using the same product for the same application repeatedly. (ex. Lab glass ware, glass culture tubes)

Reusing

the possibility that something bad or unpleasant (such as an injury or loss) will happen. the likelihood that an adverse event involving a specific hazard or threat will occur followed by the consequences of that occurrence

Risk

the initial step in implementing a risk management process relies on a risk assessment which includes the identification of hazards and characterization of risks that are possibly present in the laboratory.

Risk Assessment

to conduct a judicious evaluation of risks selecting which mitigation measures will be employed

Role of Managers -

process of separating different types of waste at the point of generation until their final disposal.

Segregation

what is the adverse effect of HCW?

Sharp in inflicted injuries - needle prick injury Toxic exposure - prolonged exposure can induce disease Chemical burns - mishandling Air pollution Thermal Injuries Radiation burns

Refers to waste items that can cause cuts, pricks, or puncture wounds. They are considered the most dangerous healthcare waste because of their potential to cause both injury and infection. - prone to needle prick injury

Sharps

Global treaty to protect human health and the environment from persistent organic pollutants.

Stockholm Convention on persistent organic pollutants (2001)

• the replacement of the procedures or biological agent with a similar entity in order to reduce the risks

Substitution

The principle is that only legitimate transboundary shipments of hazardous waste is exported from countries that lack facilities or expertise to safely dispose of certain wastes to other countries that have both facilities and expertise.

The Basel convention on the control of the transboundary movements of hazardous wastes and their disposal (1989)

It sets the objective of the protocol to eliminate ozone- depleting substances in the environment.

The montreal protocol on substances that deplete the OZONE layer (1987)

an individual/animal/organization that has the intent or ability to cause harm

Threat

detrimental to everything that is around us

Toxic

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

United Nations framework convention on climate change (1992)

is the heart of BRM. It ensures the safety and security of the people working in the laboratory as well as all the stakeholders in an organization. The different mitigation procedures to be employed depend on the result of a robust risk assessment. It is recommended not to overdo or underdo the measures.

robust risk assessment

what is the goal of the PDCA approach?

to ensure continuous improvement in BRM

check the appropriateness of the facility and the equipment for us to be able to do proper handling of the said biohazard

• Place

what is the PDCA approach ?

• Plan • Do • Check • Act

in lab wherein, we are exposed to the pathogen•

• Procedures

Carefully check the process and results - determine if the concept or the implementation is successful for us to approve the standard process

CHECK

Components of A Biorisk Management Program is under the

CWA 15793: 2011

to characterize the overall biosafety risks, the risk assessment team needs to compare the likelihood and the consequences of infection—either qualitatively or quantitatively.

Characterize the risks

Refers to discarded chemicals (solid, liquid, gaseous) generated during disinfection and sterilization procedures.

Chemical waste

- if the pH is less than 5 = acidic - greater than 12 = basic

Corrosive