Introduction

Hospital waste Focus lies mainly on biological hazards caused by pathogenic waste Has considerable repercussions

human health Environment

In the Philippines DOH and DENR Have set guidelines regarding Handling Collection Storage of pathogenic waste But the degree to which hospitals follow these set of rules is not known

 The University of Sato Tomas Hospital is a premier

health care center

should be committed in the service of public health whether it be through patient care or ensuring a clean

healthy environment for their employees and the community

Definition of Hospital Waste

Health care waste (WHO) all waste generated by healthcare establishments, research facilities, and health laboratories classified as
1. 2.

non-risk/general healthcare waste/domestic waste hazardous waste

Prss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva

Research Question
Does the University of Santo Tomas Hospital comply

with the guidelines on handling, collection and storage of Pathogenic waste as written in the Health Care Waste Management Manual of the Department of Health and the Procedural Manual Title III of Dao 9229 Hazardous Waste Management of the Department of Environment and Natural Resources?

General Objective
To assess the compliance of University of Santo Tomas Hospital regarding the handling, collection and storage of Pathogenic waste in accordance to Health Care Waste Management Manual of Department of Health and the Procedural Manual Title III of Dao 9229 Hazardous Waste Management of Department of Environment and Natural Resources

Specific Objectives

To describe the handling of Pathogenic Waste To describe the collection of Pathogenic Waste To describe the Storage of Pathogenic Waste To determine the compliance of UST hospital regarding the handling, collection and storage of Pathogenic waste in accordance to Health Care Waste Management Manual of Department of Health To determine the compliance of UST hospital regarding the handling, collection and storage of Pathogenic waste in accordance to the Procedural Manual Title III of Dao 92-29 Hazardous Waste Management of Department of Environment and Natural Resources

Definition of Terms
Pathogenic waste: A subset of health care waste which includes both Pathological and Infectious waste as defined by the Hazardous Waste manual of the DENR
Infectious waste contains pathogens in sufficient quantity to cause disease in susceptible hosts Pathological waste consists of tissues, organs, body parts, human fetus, animal carcasses, blood and other body fluids

Definition of Terms
Handling Collection and Storage: Component of waste management in which health care waste is gathered and segregated resulting in the passage of a waste material from the source of production to the point of storage until transported to an off-site treatment facility

Definition of Terms
Health Care Waste Management Manual: Written by the DOH designed to ensure no adverse health and environmental consequences involved in the generation, handling, storage and disposal of health care waste

Definition of Terms
Procedural Manual Title III of Dao 92-29 Hazardous

Waste Management:
Written by DENR designed to serve as a primary

reference for those involved in the generation, handling, storage and disposal of health care waste To provide technical standards and requirements for hazardous waste generators, transporters, and premises/facilities involved in the treatment, storage, recycle, reprocess, and disposal of hazardous wastes in the country

Significance
Pathogenic Healthcare waste Identified as a major problem that negatively impacts both human health and the environment Little information available regarding

the handling, collection storage and transport of pathogenic waste in USTH

appraisal of the current situation regarding pathogenic waste management in the USTH is essential

There are guidelines in place

Review of Related Literature

Two studies conducted by the Department of Health indicated the need to introduce modifications to the existing health care waste management practices
Waste Management Practices of DOH-Retained

Hospitals in 1995 Waste Management Practices of Private and Government Hospitals in Metro-Manila in 1997

 Most common problems encountered: Inadequate waste management practices Lack of awareness about the health hazards Insufficient financial and human resources Poor control of waste disposal

 Environmental and Occupational Health Office

(EOHO) initiated the revision of the existing Hospital Waste Management Manual (EHS-DOH, 1997)

 The revision was meant to: assist facility administrators in evaluating their operations in order to improve the health care waste management practices promote the use of appropriate technologies and to communicate with heath care personnel as well as to the public the risks associated with health care waste

 Hospitals and other health care establishments have the responsibility of ensuring that there are no adverse health and environmental consequences on their handling, storage, treatment and disposal of health care waste
Through this manual, health care establishments will be able to install a more appropriate waste management system

Definition of Hospital Waste

Healthcare waste (WHO) all waste generated by healthcare establishments, research facilities, and health laboratories classified as
1. 2.

non-risk/general healthcare waste/domestic waste hazardous waste

Prss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva

Definition of Hospital Waste

Classification of Hazardous Waste (DENR) based on these four characteristics accordance with the Toxicity Characteristic Learning Procedure (TCLP):
Ignitable Corrosive Reactive Toxic
Department of Environment and Natural Resources. 2004. Hazardous Waste Management. Procedural Manual Title III of DAO 92-29

Effects on Health
All individuals exposed to hazardous health-care waste

are potentially at risk

Prss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva

Certain infections, caused by more resilient agents,

pose a significant risk to the general public and to hospital patients

Mhlich, M. et. al. 2003. Comparison of infectious waste management in European hospitals. Institute for Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Freiburg, Germany

People at risk
health-care workers, particularly nurses, are at greatest risk

of infection other hospital workers and waste-management operators outside health-care establishments individuals who scavenge on waste disposal sites lower risk for patients and the public

Mhlich, M. et. al. 2003. Comparison of infectious waste management in European hospitals. Institute for Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Freiburg, Germany

Regulation of Hospital Waste in the Philippines

Metropolitan Manila Authority (MMA) Ordinance No.

16 Hospital Licensure Law (Republic Act No. 4226) Toxic Substances and Hazardous and Nuclear Waste Control Act of 1990 (Republic Act No. 6969

Soncuya, Matias, Lapid. 1997. Hospital Waste Management in the Philippines, two Case Studies in Manila. WASTE. Urban Waste Expertise Programme

Metropolitan Manila Authority (MMA) Ordinance No. 16

use four types of trash bags for easy identification of

waste:
1) 2)

3)

4)

black trash bag for non-infectious dry waste green trash bags for non-infectious wet waste yellow trash bags for dry and wet chemical and other potentially infectious waste, pathological waste, chemical waste and sharps contained in puncture-proof containers covered with solution of lime orange trash bags with trefoil sign for radioactive waste that will be stored in the hospital until rendered as inactive and/or disposed in accordance with the prescribed rules and regulations of the Philippine Nuclear Research Institute

Hospital Licensure Law

hospitals are categorized as government or private hospitals
specifies the needed physical facilities of a hospital

for solid waste management such as the physical plant, hospital equipment and maintenance of these physical facilities

Toxic and Hazardous and Nuclear Wastes Control Act of 1990

covers the importation, manufacture, processing, handling, storage, transportation, sale, distribution, use and disposal of all unregulated chemical substances and mixtures in the Philippines
defines the prohibited acts and provides for administrative and criminal penalties

Waste Management in the Philippines

wastes, segregated or not, are collected by workers employed by the

health care establishment(usually cleaners or janitors of the premises)

aware of local opportunities for recycling of components of the waste unaware of, or insensitive to, the hazards associated with handling health

care waste generally take no precautions in handling, transporting and separating the waste not supplied with protective clothing or special equipment

Pescod, S. 1998. Hospital Waste Management in Four Major Cities. WASTE. Urban Waste Expertise Programme

Waste Management in the Philippines

plastic bags, covered bins/trash cans, and glass jars with

covers
due to inadequate segregation of infectious from non-

infectious much of the generated hospital waste is being disposed directly to municipal landfills

Department of Environment and Natural Resources. 1993. Pasig River Rehabilitation Program: Feasibility Report on Hospital Hazardous Waste Management in Metro Manila. Volume I

Waste Management in the Philippines

collected by the municipal waste collection service
transported for disposal with municipal waste all types of wastes are mixed and transported,

often along with municipal solid waste, to municipal landfills

Pescod, S. 1998. Hospital Waste Management in Four Major Cities. WASTE. Urban Waste Expertise Programme

Waste Management in the Philippines

existing treatment capacity is insufficient for the

proper disposal of the major part of medical wastes generated in Metro Manila area the existing capacity for incinerating these wastes totals to less than 3 tons/day total daily quantity of dangerous medical wastes generated was estimated to at least 12.4 tons

Department of Environment and Natural Resources. 1993. Pasig River Rehabilitation Program: Feasibility Report on Hospital Hazardous Waste Management in Metro Manila. Volume I

Problems in Medical Waste Management

In developing countries, medical waste has not received

much attention and it is disposed of together with domestic waste Lack of a system of medical waste management, a lack of necessary supplies and facilities, a lack of knowledge among health workers and a lack of coordination among different ministries. A national program for medical waste management is essential in Palestine
Massrouje, HTN., 2001. Medical waste and health workers in Gaza governorates. Eastern Mediterranean Health Journal

Problems in Medical Waste Management

In Lagos Metropolis, Nigeria, there is absence of full

compliance with the protocol stipulated in the guidelines and standards of environmental pollution control There were problems in collection, segregation, storage, treatment, and disposal among the hospitals that were observed

Longe, E.O., Williams, A., 2006. A Preliminary Study of Medical Waste Management in Lagos Metropolis, Nigeria. Iran Journal of Environ. Health Sci. Eng., 3:2:133-139

Problems in Medical Waste Management

In Dhaka, Bangladesh there is no proper, systematic management of medical waste except in a few private Health Care Establishments that segregate their infectious wastes
Some cleaners were found to salvage used sharps, saline bags, blood bags and test tubes for resale or reuse
Hassan, M., Ahmed, S., Rahman, K., Biswas, T. 2008. Pattern of medical waste management: existing scenario in Dhaka City, Bangladesh. BMC Public Health. 8:36

Review of Related Literature

Evidence showed that there are many flaws in the compliance, implementation and even in the construction of guidelines concerning hospital management in the Philippines and around the world
Several studies have recommended several steps that may be undertaken to address these flaws

Review of Related Literature

Recommendations:
establishment of directorates responsible for medical

waste management coordination of different ministries provision of adequate supplies and health education including encouragement of studies on different aspects of medical waste (creation of database information in different sectors, risk analysis and disposal methods)
Massrouje, HTN., 2001. Medical waste and health workers in Gaza governorates. Eastern Mediterranean Health Journal

Review of Related Literature

Case studies in the Philippines have only focused on

two distinct hospitals in Metro Manila

Should include the University of Santo Tomas Hospital

Methodology
Descriptive Study
Inclusion Criteria: Super Clean Services Exclusion Criteria: Waste Transporter Waste Treaters TSD facility

Methodology
Data Collection Semi Structured Interview of authorities and Personnel of Super Clean Services Visual inspection and Field investigation of collection, handling and storage of pathogenic waste Data Processing Flow Chart and narrative of collection, handling and storage of pathogenic waste

Week Week Week Week Week Week Week Week 1 2 3 4 5 6 7 8

Selection and planning of research topic Coordinating with UST Hospitals maintenance officer Workplace inspection Literature research Research methodology planning Data gathering Data evaluation Construction of research conclusion and recommendation Final research paper formation