1. A Descriptive Study on the Compliance of the University of Santo Tomas Hospital regarding the handling, collection and storage of Pathogenic waste in accordance to the Health Care Waste Management Manual of Department of Health and the Procedural Manual Title III of Dao “Hazardous Waste Management” of the Department of Environment and Natural Resources

2. Introduction Hospital waste
Focus lies mainly on biological hazards caused by pathogenic waste
Has considerable repercussions
human health
Environment

3. 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

4. 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

5. Definition of Hospital Waste
Health care waste (WHO)
all waste generated by healthcare establishments, research facilities, and health laboratories
classified as
non-risk/general healthcare waste/domestic waste
hazardous waste
Health care waste claassification:
non-risk/general healthcare waste - comparable to domestic waste
hazardous waste - has the potential to pose a variety of health risks
- includes infectious waste, pathological waste, sharps, pharmaceutical waste, genotoxic waste, chemical waste, waste with high heavy metal content, pressurized containers, and radioactive waste
Prüss, A., Giroult, E., Rushbrook, P., Safe Management of Wastes
From Health Care Activities. World Health Organization, Geneva

6. 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 “Hazardous Waste Management” of the Department of Environment and Natural Resources?

7. 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 “Hazardous Waste Management” of Department of Environment and Natural Resources

8. 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 “Hazardous Waste Management” of Department of Environment and Natural Resources

9. Definition of Terms Pathogenic waste: Infectious 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

10. 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

11. 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

12. Definition of Terms
Procedural Manual Title III of Dao 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

13. 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
There are guidelines in place
appraisal of the current situation regarding pathogenic waste management in the USTH is essential
in order to evaluate whether or not these guidelines are followed, and if there are any areas that require improvement.

14. 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
The management of health care waste in the country is driven by concerns about adverse health and environmental effects, uncertainty regarding regulations, and the negative perceptions by waste handlers. Althought significant progress has been made on health care waste management, 2 studeis indicated the need to introduce modifications to the existing health care waste management practices.

15. 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

16. Environmental and Occupational Health Office (EOHO) initiated the revision of the existing Hospital Waste Management Manual (EHS-DOH, 1997)

17. 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

18. 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

19. Definition of Hospital Waste
Healthcare waste (WHO)
all waste generated by healthcare establishments, research facilities, and health laboratories
classified as
non-risk/general healthcare waste/domestic waste
hazardous waste
Health care waste classification:
non-risk/general healthcare waste - comparable to domestic waste
hazardous waste - has the potential to pose a variety of health risks
- includes infectious waste, pathological waste, sharps, pharmaceutical waste, genotoxic waste, chemical waste, waste with high heavy metal content, pressurized containers, and radioactive waste
Prüss, A., Giroult, E., Rushbrook, P., Safe Management of Wastes
From Health Care Activities. World Health Organization, Geneva

20. 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
Pathogenic waste is classified under Miscellaneous Wastes which includes pathological wastes (tissues, organs, fetuses, blood, and bloody fluids) and infectious wastes, and sharps.
Department of Environment and Natural Resources Hazardous
Waste Management. Procedural Manual Title III of DAO 92-29

21. Effects on Health
All individuals exposed to hazardous health-care waste are potentially at risk
Certain infections, caused by more resilient agents, pose a significant risk to the general public and to hospital patients
Prüss, A., Giroult, E., Rushbrook, P., Safe Management of Wastes From
Health Care Activities. World Health Organization, Geneva
All individuals exposed to hazardous health-care waste are potentially at risk, including those within health-care establishments that generate hazardous waste, and those outside these sources who either handle such waste or are exposed to it as a consequence of careless management.
Certain infections, caused by more resilient agents, pose a significant risk to the general public and to hospital patients
For instance, uncontrolled discharges of sewage from hospitals treating cholera patients have been strongly implicated in cholera epidemics in some Latin American countries.
Mühlich, M. et. al Comparison of infectious waste management in
European hospitals. Institute for Environmental Medicine and Hospital
Epidemiology, Freiburg University Hospital, Freiburg, Germany

22. 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
HIV/AIDS and hepatitis B and C, health-care workers, particularly nurses, are at greatest risk of infection through injuries from contaminated sharps (largely hypodermic needles)
Other hospital workers and waste-management operators outside health-care establishments are also at significant risk
Also for individuals who scavenge on waste disposal sites (although these risks are not well documented)
Lower risk for patients and the public
Mühlich, M. et. al Comparison of infectious waste management in
European hospitals. Institute for Environmental Medicine and Hospital
Epidemiology, Freiburg University Hospital, Freiburg, Germany

23. 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
health care wastes are collected by the municipal waste collection service and transported for disposal with municipal waste. Apart from those wastes which are incinerated or buried on site at some hospitals, all types of wastes are mixed and transported, often along with municipal solid waste, to municipal landfills.
Soncuya, Matias, Lapid Hospital Waste Management in the
Philippines, two Case Studies in Manila. WASTE.
Urban Waste Expertise Programme

24. Metropolitan Manila Authority (MMA) Ordinance No. 16
use four types of trash bags for easy identification of waste:
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

25. 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

26. 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

27. 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 Hospital Waste Management in Four Major Cities.
WASTE. Urban Waste Expertise Programme

28. 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 Pasig River
Rehabilitation Program: Feasibility Report on Hospital Hazardous
Waste Management in Metro Manila. Volume I

29. 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 Hospital Waste Management in Four Major Cities.
WASTE. Urban Waste Expertise Programme

30. 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
8.5 tons/day for National Capital Region alone
Department of Environment and Natural Resources Pasig River
Rehabilitation Program: Feasibility Report on Hospital Hazardous
Waste Management in Metro Manila. Volume I

31. 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., Medical waste and health workers in Gaza
governorates. Eastern Mediterranean Health Journal

32. 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., A Preliminary Study of Medical Waste
Management in Lagos Metropolis, Nigeria. Iran Journal of Environ.
Health Sci. Eng., 3:2:

33. 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 Pattern of medical
waste management: existing scenario in Dhaka City, Bangladesh.
BMC Public Health. 8:36

34. 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

35. 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., Medical waste and health workers in Gaza
governorates. Eastern Mediterranean Health Journal

36. 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
After the completion of this paper, the authors are hopeful that recommendations appropriate for the University of Santo Tomas will be constructed and steps to improve hospital waste management may be instigated.

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

38. Methodology Data Collection Data Processing
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

41. Selection and planning of research topic
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Selection and planning of research topic
Coordinating with UST Hospital’s maintenance officer
Workplace inspection
Literature research
Research methodology planning
Data gathering
Data evaluation
Construction of research conclusion and recommendation
Final research paper formation

42. Thank You