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Slide 2 Introduction Hospital waste Focus lies mainly on biological hazards caused by pathogenic waste Has considerable repercussions human health Environment Slide 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 Slide 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 Slide 5 Definition of Hospital Waste Health care waste (WHO) all waste generated by healthcare establishments, research facilities, and health laboratories classified as 1. non-risk/general healthcare waste/domestic waste 2. hazardous waste Prss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva Slide 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 92- 29 Hazardous Waste Management of the Department of Environment and Natural Resources? Slide 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 92- 29 Hazardous Waste Management of Department of Environment and Natural Resources Slide 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 92-29 Hazardous Waste Management of Department of Environment and Natural Resources Slide 9 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 Slide 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 Slide 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 Slide 12 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 Slide 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 Slide 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 Slide 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 Slide 16 Environmental and Occupational Health Office (EOHO) initiated the revision of the existing Hospital Waste Management Manual (EHS-DOH, 1997) Slide 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 Slide 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 Slide 19 Definition of Hospital Waste Healthcare waste (WHO) all waste generated by healthcare establishments, research facilities, and health laboratories classified as 1. non-risk/general healthcare waste/domestic waste 2. hazardous waste Prss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva Slide 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 Department of Environment and Natural Resources. 2004. Hazardous Waste Management. Procedural Manual Title III of DAO 92-29 Slide 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 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 Prss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva Slide 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 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 Slide 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 Soncuya, Matias, Lapid. 1997. Hospital Waste Management in the Philippines, two Case Studies in Manila. WASTE. Urban Waste Expertise Programme Slide 24 Metropolitan Manila Authority (MMA) Ordinance No. 16 use four types of trash bags for easy identification of waste: 1) black trash bag for non-infectious dry waste 2) green trash bags for non-infectious wet waste 3) 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 4) 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 Slide 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 Slide 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 Slide 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. 1998. Hospital Waste Management in Four Major Cities. WASTE. Urban Waste Expertise Programme Slide 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. 1993. Pasig River Rehabilitation Program: Feasibility Report on Hospital Hazardous Waste Management in Metro Manila. Volume I Slide 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. 1998. Hospital Waste Management in Four Major Cities. WASTE. Urban Waste Expertise Programme Slide 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 Department of Environment and Natural Resources. 1993. Pasig River Rehabilitation Program: Feasibility Report on Hospital Hazardous Waste Management in Metro Manila. Volume I Slide 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., 2001. Medical waste and health workers in Gaza governorates. Eastern Mediterranean Health Journal Slide 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., 2006. A Preliminary Study of Medical Waste Management in Lagos Metropolis, Nigeria. Iran Journal of Environ. Health Sci. Eng., 3:2:133-139 Slide 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. 2008. Pattern of medical waste management: existing scenario in Dhaka City, Bangladesh. BMC Public Health. 8:36 Slide 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 Slide 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., 2001. Medical waste and health workers in Gaza governorates. Eastern Mediterranean Health Journal Slide 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 Slide 37 Methodology Descriptive Study Inclusion Criteria: Super Clean Services Exclusion Criteria: Waste Transporter Waste Treaters TSD facility Slide 38 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 Slide 39 Slide 40 Slide 41 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 Hospitals maintenance officer Workplace inspection Literature research Research methodology planning Data gathering Data evaluation Construction of research conclusion and recommendation Final research paper formation Slide 42