Christine Joyce M.

Javier, RMT, MLS(ASCPi)CM

December 4, 2021
 FOR TODAY, WE WILL HAVE:
▪ definition of healthcare wastes
▪ healthcare waste generators
▪ categories of healthcare wastes
o infectious wastes
o pathological wastes
o sharps
o chemical wastes
o pharmaceutical wastes
o radioactive wastes
o general or non-hazardous wastes
 FOR TODAY, WE WILL HAVE:
▪ impact of healthcare waste exposure and management
o benefits of healthcare waste management
o adverse effects of healthcare waste exposure
▪ healthcare waste management hierarchy
▪ healthcare waste management flow
o segregation
o collection
o transport
o storage
o treatment
o disposal
 HEALTHCARE WASTES
▪ wastes generated by facilities, institutions, business establishments,
and other spaces where healthcare services are offered
▪ solid or liquid wastes generated through the following:
o diagnosis, treatment, and immunization of humans
o research pertaining to diagnosis, treatment, and immunization of
humans
o research using laboratory animals geared towards the
improvement of human health
o production and testing of biological products
o other waste-generating activities performed by a healthcare
facility
1 hospital and medical centers
2 infirmaries
3 birthing homes
4 clinics and other health-related facilities
medical surgical
ambulatory alternative medicine
dialysis dental
healthcare centers and dispensaries veterinary
5 laboratories and research centers
medical and biomedical laboratories nuclear medicine laboratories
medical research centers biotechnology laboratories
blood banks animal research and testing
blood collection services drug testing laboratories
dental prosthetic laboratories HIV testing laboratories
6 drug manufacturers
7 other institutions
drug rehabilitation centers medical schools
training centers for embalmers nursing homes
internship training centers dental schools
8 mortuary and autopsy centers
 INFECTIOUS WASTES
▪ refers to all wastes suspected to contain infectious pathogens
▪ discarded materials or equipment used for diagnosis,
treatment and management of infectious diseases could have
microorganisms that may cause disease to a susceptible host
▪ exposure can only cause infection
INFECTIOUS WASTES
 PATHOLOGICAL WASTES
▪ refers to tissue sections and organs derived from surgical
procedures, biopsies or autopsies that were examined in a
laboratory that functions for anatomic pathology
▪ exposure can only cause infection
o anatomical waste – a subgroup of pathological waste;
refers to recognizable body parts
PATHOLOGICAL WASTES
 SHARPS
▪ refers to all types of wastes that can cause pricks, cuts or
puncture wounds
▪ considered as the most dangerous healthcare waste
▪ exposure can cause both injury and infection
SHARPS
 CHEMICAL WASTES
▪ refers to discarded hazardous chemicals in solid, liquid or
gaseous form; wastes with high content of heavy metals and
their derivatives are also included
▪ most chemical wastes are generated during disinfection and
sterilization procedures
▪ exposure can only cause injury
▪ chemicals are only considered hazardous if they are:
o toxic – possess health hazards and environmental hazards
o corrosive – has an pH of <2.0 or a pH of >12.0
o flammable – has a flash point <60oC
o reactive – explosive if combined with water
CHEMICAL WASTES
 PHARMACEUTICAL WASTES
▪ refers to expired, split and contaminated pharmaceutical
products, drugs, and vaccines and items used in handling
pharmaceuticals
o cytotoxic waste – a subgroup of pharmaceutical waste;
refers to expired, split and contaminated pharmaceutical
products and drugs used in oncology and chemotherapy; all
infectious wastes, pathological wastes and sharps used for
patients who underwent chemotherapy are also included
o exposure can cause tissue and organ damage
PHARMACEUTICAL WASTES
 RADIOACTIVE WASTES
▪ refers to radioactive diagnostic materials, radiotherapeutic
materials, and other items exposed to radionuclides
▪ exposure can cause tissue and organ damage
o all infectious wastes, pathological wastes and sharps used for
patients who are exposed to radionuclides for 48 hours are also
included
▪ the usual radionuclides in healthcare facilities are the following:
o Cobalt-90
o Technetium-99
o Iodine-131
o Iridium-192
 GENERAL or NON-HAZARDOUS WASTES
▪ refers to all types of wastes that do not pose a hazard; they
should not be exposed with infectious microorganisms,
hazardous chemicals, drugs, radioactive substances or were
not considered as sharps
▪ classification of general wastes are the following:
o recyclable – wastes that can be converted to new products
o biodegradable – wastes capable of decaying naturally
o non-recyclable/non-biodegradable – cannot be classified
GENERAL or NON-HAZARDOUS WASTES
 BENEFITS OF HCW MANAGEMENT
▪ human health protection of patients, health workers, and the
general population
▪ protection of the environment from pollution and
contamination
▪ increased compliance of health care institutions to existing
healthcare waste regulations and guidelines
▪ prevention of long-term liabilities and loss of reputation
caused by violations to existing healthcare waste laws
 ADVERSE EFFECTS OF HCW EXPOSURE
▪ sharps-inflicted injuries
▪ toxic exposure to pharmaceutical products and substances
▪ chemical burns Did you know?
▪ air pollution Your chances of catching a disease from
a single needle stick are usually very low.
▪ thermal injuries hepatitis B virus → 30%
▪ radiation burns hepatitis C virus → 1.8%
▪ water pollution HIV → 0.3%
▪ types of healthcare waste exposure
o acute exposure – short periods in large quantities
o chronic exposure – prolonged periods in minute quantities
 green
most preferable
procurement
policy

resource
development

end of pipe
least preferable
 GREEN PROCUREMENT POLICY
▪ the most preferable waste minimization approach
▪ considered as the most important step in proper HCW
management
▪ refers to the well-planned purchasing of goods and services which
would minimize wastes even before they are generated
▪ PREVENT → purchase products and avail services that would not
generate any type of waste
▪ REDUCE → purchase less polluting products and
avail of the least harmful services; proper
segregation from the point of generation would
allow efficient waste management
 RESOURCE DEVELOPMENT
▪ refers to the safe reusing, recycling and recovery of healthcare
wastes
▪ REUSE → utilizing used materials for the same application or
finding a new application without compromising safety and
efficiency
▪ RECYCLE → processing used materials to generate new products
▪ RECOVER → processing used materials to generate alternative
products; the three subsets are the following:
o composting
o energy recovery – processing waste to generate fuel and
become an alternative electricity source
 END OF PIPE
▪ the least preferable waste minimization approach
▪ refers to the technique implemented for healthcare wastes
that were not allowed to undergo resource development
▪ TREATMENT → process of changing the biological and chemical
characteristics of waste to minimize its potential to cause
harm
▪ DISPOSAL → process of discharging, depositing, placing, or
releasing any healthcare waste into air, land or water; some
healthcare wastes require treatment prior disposal, while some
healthcare wastes can be disposed directly
 HEALTHCARE WASTE SEGREGATION
▪ defined as the separation of different types of healthcare waste
at the point of generation until their final disposal
▪ must be maintained until collection, storage, transport,
treatment and disposal
▪ efficiency of segregation can be attained through the following:
o proper placement of bins
o correct labelling of waste bins
o usage of color-coded plastic liners
o utilization of color-coded waste bins
 HEALTHCARE WASTE SEGREGATION
▪ dedicated for infectious wastes
and pathological wastes
▪ BIN → yellow, strong, leak-
proof bin with cover, biohazard
symbol and label
▪ LINER → yellow autoclavable
plastic with label and detail tag
(source, weight of waste, date
of collection); biohazard symbol
is optional
 HEALTHCARE WASTE SEGREGATION
▪ dedicated for sharps
▪ CONTAINER → red, wide-
mouthed, puncture-proof
container with cover, biohazard
symbol and label
▪ LINER → not applicable
 HEALTHCARE WASTE SEGREGATION
▪ dedicated for chemical wastes
and pharmaceutical wastes
that are non-cytotoxic
▪ BIN → strong, chemical-
resistant, leak-proof bin with
cover and label; color not
specific
▪ LINER → yellow with black band
plastic with label and detail tag
(source, weight of waste, date
of collection); amber-colored
bottle for liquid chemicals
 HEALTHCARE WASTE SEGREGATION
▪ dedicated for pharmaceutical
wastes that are cytotoxic
▪ CONTAINER → violet, chemical-
resistant, wide-mouthed,
puncture-proof, leak-proof
container with cover and label
▪ LINER → not applicable
 HEALTHCARE WASTE SEGREGATION
▪ dedicated for radioactive
wastes
▪ BIN → leak-proof, lead-lined
bin/barrel with cover,
radioactive symbol and details
(name of radionuclide,
radionuclide deposition); color
not specific but mostly yellow
▪ LINER → orange plastic with
label and tag (name of
radionuclide, radionuclide
deposition)
 HEALTHCARE WASTE SEGREGATION
▪ dedicated for general wastes
that are non-biodegradable
▪ BIN → black bin with cover and
label; recycle symbol is optional
▪ LINER → black plastic with
label and tag (waste source,
weight of waste, date of
collection)
 HEALTHCARE WASTE SEGREGATION
▪ dedicated for general wastes
that are biodegradable
▪ BIN → green bin with cover and
label
▪ LINER → green plastic with
label and tag (waste source,
weight of waste, date of
collection)
 HEALTHCARE WASTE COLLECTION
▪ defined as the obtainment of healthcare wastes from different
points of generation and grouping them according to their
waste type
▪ must be done regularly with a fixed schedule
▪ must be done separately for each type of waste
▪ most type of wastes require daily collection, while infectious
wastes require several collections within the day
 HEALTHCARE WASTE TRANSPORT
▪ defined as the hauling of collected healthcare wastes within and
outside the healthcare facility up
▪ must be done by official waste collectors who were properly trained
▪ must be done using the designated trolleys while wearing the
appropriate PPE
▪ follows a two-step process; types of transport are the following:
o on-site transport – internal transport of wastes from the
buildings of a healthcare facility to the institution’s own
treatment and storage site
o off-site transport – external transport of wastes from healthcare
facility to a DENR-assigned treatment/storage/disposal site
 HEALTHCARE WASTE STORAGE
▪ defined as the temporary holding of healthcare wastes prior
treatment or disposal
▪ the separation of wastes in storage must be consistent with the
initial segregation of wastes from the point of generation
▪ the larger container or location containing similar wastes should
be labelled with the following:
o corresponding hazard symbol
o type of waste
o date of collection
o point of generation or source
 HEALTHCARE WASTE TREATMENT
▪ defined as the inactivation of waste to ensure that they will not
be able to pose harm to the people and to the environment
▪ infectious wastes must be decontaminated; process of
decontamination are the following:
o sterilization – kills all microorganisms
o disinfection – reduces the level of microorganisms
 HEALTHCARE WASTE TREATMENT
▪ PYROLYSIS → decomposition of
healthcare wastes by subjecting
them to high temperatures
inside a chamber in the absence
of oxygen
▪ residues can be disposed in a
landfill
▪ waste aggregates may be in the
form of the following:
o greasy aggregates or slugs
o recoverable materials
o carbon black
 HEALTHCARE WASTE TREATMENT
▪ INCINERATION → decomposition
of healthcare wastes by
subjecting them to high
temperatures inside a chamber
in the presence of oxygen
▪ Philippines is the first country in
the world (and the only country
until 2019) to ban incineration of
healthcare wastes plus municipal
and household waste through RA
8749 or The Philippine Clean
Air Act of 1999
 HEALTHCARE WASTE TREATMENT
▪ AUTOCLAVE → sterilization of
healthcare wastes through moist
heat by subjecting them to
121oC in 15 psi for 15 to 30
minutes
▪ bacterial spores or color-
changing tapes can be used as
indicators of validity
 HEALTHCARE WASTE TREATMENT
▪ MICROWAVE → radiation of
healthcare wastes by exposing
them to microwaves resulting to
100oC for at least 30 minutes
▪ requires the shredding of wastes
before the actual procedure
 HEALTHCARE WASTE TREATMENT
▪ CHEMICAL DISINFECTION →
addition of disinfectants to
healthcare wastes to kill or
inactivate pathogens
▪ common disinfectants are the
following:
o 5% sodium hypochlorite –
the most recommended
o hydrogen peroxide
o peroxyacetic acid
o heated alkali
 HEALTHCARE WASTE TREATMENT
▪ BIOLOGICAL PROCESS →
addition of enzymes to
healthcare wastes for
decontamination
▪ recommended for large volume
of healthcare wastes
▪ developed for future use in the
agricultural sector
 HEALTHCARE WASTE TREATMENT
▪ ENCAPSULATION → sealing of
healthcare wastes inside high-
density plastic drums or
metallic drums and covering it
with plastic foam, bituminous
sand or cement mortar
▪ the drums can be disposed in a
landfill
▪ recommended for sharps,
chemical wastes and
pharmaceutical wastes
 HEALTHCARE WASTE TREATMENT
▪ INERTIZATION → mixing of
healthcare wastes with water,
lime and cement prior disposal
▪ the solidified mixture can be
disposed in landfill; the liquid
mixture can be poured and
mixed with municipal wastes
▪ recommended for
pharmaceutical wastes
 HEALTHCARE WASTE DISPOSAL
▪ defined as the deposition of the healthcare waste materials into
any body of land or water
▪ must be placed in a DENR-permitted area; types of allowed areas
are the following:
o landfill – the usual site for healthcare waste disposal; an
engineered site designed to keep waste isolated from the
environment
o safe burial – only allowed for far-flung healthcare facilities;
applicable if wastes are treated already
▪ healthcare wastes can be mixed with general wastes provided
that DOH certified that the organisms in the HCW are already inert