Review of related literature
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REVIEW OF RELATED LITERATURE

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Review of related literature

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 92-29 “Hazardous Waste Management” of the Department of Environment and Natural Resources

REVIEW OF RELATED LITERATURE


Definition of hospital waste

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

Prüss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes

From Health Care Activities. World Health Organization, Geneva


Definition of hospital waste1

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

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., 1999. Safe Management of Wastes From

Health Care Activities. World Health Organization, Geneva

Mühlich, 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

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

Mühlich, 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

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

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


Hospital licensure law

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

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

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 philippines1

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 philippines2

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 philippines3

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

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 management1

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 management2

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 literature1

Review of Related Literature

  • Evidence 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 recommender several steps that may be undertaken to address these flaws


Review of related literature2

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 literature3

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


Thank you

Thank You


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