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Health Care Waste Management Manual

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Health Care Waste Management Manual Department of Health Manila Foreword In these times of heightened environment consciousness, addressing the issue of proper health care waste disposal is of paramount concern not only for environmentalists or other members of the health sector but for the whole society as well, most especially for the agencies involved in the regulation of this very vital element. The Clean Air Act (CAA) of 1999 and the Ecological Solid Waste Management (ESWM) Act of 2000 which both push for reforms in the management of health care waste highlight the imperative to deal with this issue squarely. Thus, in order to widely disseminate the proper use of existing technology and knowledge on this particular concern, this revised Health Care Waste Management Manual was conceived and produced, in close collaboration with other government agencies, civil society, the academe and various professional groups. This Manual provides practical information regarding safe, efficient and environment-friendly waste management options. It also contains, in detail, safety procedures attendant to the collection, handling, storage, transport, treatment and disposal of health care waste. We hope that this will serve as a useful guide in the planning, implementation, monitoring and evaluation of the Health Care Waste Management Programs of hospitals, health centers, laboratories, pharmaceutical firms, blood banks and other health-related establishments. With the dissemination and strict adherence to the measures contained herein, we aim to promote the health and welfare of our people and protect them from the risks and hazards of exposure to health care waste. MANUEL M. DAYRIT, M.D., MSc Secretary of Health Acknowledgements The Department of Health is deeply indebted and express sincere appreciation to Dr. Desiree M. Narvaez, Engr. Elmer G. Benedictos and Engr. Gerardo S. Mogol of Environmental and Occupational Health Office for their active roles in bringing this revised manual from concept to reality. Special acknowledgment is given to Undersecretary Antonio S. Lopez and Dr. Myrna Cabotaje for their full support and guidance during the preparation of the manual. Equal recognition is due to the National Center for Health Facility Development led by Director Criselda Abesamis and Director Rebecca M. Peñafiel. Grateful thanks is expressed to the following government agencies, non- government organizations and professional groups who shared their insights and experiences during the series of workshops and public consultations whose struggles, debates and arguments have greatly influenced and contributed to the refinements of the Revised Health Care Waste Management Manual. • Asian Development Bank (ADB) • Bureau of Health Devices and Technology (BHDT) • Bureau of Health Facilities and Services (BHFS) • Capitol Medical Center (CMC) • CHD for Central Mindanao • CHD for Cordillera • CHD for Eastern Visayas • CHD for Northern Luzon • CHD for Northern Mindanao • CHD for Metro Manila • CHD for Southern Mindanao • Chinese General Hospital (CGH) • Delos Santos Medical Center (DLMC) • Department of Science and Technology (DOST) • Department of Environment and Natural Resources (DENR) • Dr. Jose Fabella Memorial Hospital (JFMH) • East Avenue Medical Center (EAMC) • Health care Without Harm (HCWH) • Health Policy Development and Planning Bureau (HPDPB) • Integrated Provincial Health Office of Sulu • Integrated Waste Management Inc. (IWMI) • Information Management Service (IMS) • Jose B. Lingad Memorial and Regional Hospital (JBLMRH) • Jose R. Reyes Memorial and Medical Center (JRRMMC) • Las Piñas District Hospital (LPDH) • League of Municipalities of the Philippines (LMP) • Lung Center of the Philippines (LCP) • Metro Manila Development Authority (MMDA) • National Center for Health Facility Development (NCHFD) • National Kidney and Transplant Institute (NKTI) • Paulino J. Garcia Memorial and Medical Center (PJGMMC) • Philippine Children Medical Center (PCMC) • Philippine Heart Center (PHC) • Philippine Medical Association (PMA) • Philippine Orthopedic Center (POC) • Philippine Nuclear Research Institute (PNRI) • Rizal Medical Center (RMC) • San Lazaro Hospital (SLH) • South Superhighway Medical Center (SSMC) • St. Luke’s Medical Center (SLMC) • Valenzuela General Hospital (VGH) The DOH also greatly appreciates the assistance of the Development Bank of the Philippines (DBP) in adding a section in financing health care waste management projects and in the lay-out and printing of this Manual. Acronyms AIDS Acquired Immune Deficiency Syndrome BOD Biochemical Oxygen Demand CHD Center for Health Development COD Chemical Oxygen Demand DBP Development Bank of the Philippines DENR Department of Environment and Natural Resources DNA Dioxy Ribo-nucleic Acid DOH Department of Health ECC Environmental Compliance Certificate EIA Environmental Impact Assessment EIS Environmental Impact Statement EISCP Environmental Infrastructure Support Credit Program EMB Environmental Management Bureau EOHO Environmental and Occupational Health Office EUFS Environmental User Fee System FIFO First In, First Out HCHO Formaldehyde HDPE High Density Polyethylene HEPA High Efficiency Particulate Air HVAC Heating, Ventilation, and Air Conditioning HWMC Health Care Waste Management Committee IEC Information, Education and Communication IEE Initial Environmental Examination IMS Information Management Service IRR Implementing Rules and Regulations IV Intravenous LGU Local Government Unit LLDA Laguna Lake Development Authority NaOCl Sodium Hypochlorite PD Presidential Decree PNRI Philippine Nuclear Research Institute PPE Personal Protective Equipment PVC Polyvinyl chloride RA Republic Act RPS Radiation Protection Section TSS Total Suspended Solids UV Ultraviolet WHO World Health Organization WMO Waste Management Officer Table of Contents Foreword Acknowledgment Acronyms 1. INTRODUCTION................................................................................................................... 2 1.1 BACKGROUND ................................................................................................................................. 2 1.2 COVERAGE ...................................................................................................................................... 2 1.3 OUTCOME........................................................................................................................................ 2 2. IMPACTS OF HEALTH CARE WASTE................................................................................ 5 2.1 PERSONS AT RISK........................................................................................................................... 5 2.2 EXPOSURE TO HAZARDOUS HEALTH CARE WASTE ..................................................................... 6 2.3 IMPACTS OF HEALTH CARE WASTE TO PUBLIC HEALTH AND THE ENVIRONMENT ..................... 7 3. HEALTH CARE WASTE .................................................................................................... 10 3.1 DEFINITION .................................................................................................................................... 10 3.2 CATEGORIES OF HEALTH CARE WASTE...................................................................................... 10 3.3 SOURCES AND COMPOSITION OF HEALTH CARE WASTE........................................................... 12 4. HEALTH CARE WASTE MINIMIZATION........................................................................... 16 4.1 WASTE MINIMIZATION................................................................................................................... 16 4.2 PRINCIPLES OF WASTE MINIMIZATION......................................................................................... 16 4.3 IMPLEMENTING WASTE MINIMIZATION STRATEGIES................................................................... 18 4.4 EXAMPLES OF POLICIES AND PRACTICES THAT ENCOURAGE WASTE MINIMIZATION.............. 18 4.5 BASIC STEPS IN THE DEVELOPMENT OF A WASTE MINIMIZATION PROGRAM ........................... 19 5. WASTE HANDLING, COLLECTION, STORAGE, AND TRANSPORT.............................. 23 5.1 WASTE SEGREGATION AND STORAGE ........................................................................................ 23 5.2 COLOR CODING SCHEME FOR HEALTH CARE WASTE ............................................................... 23 5.3 STORAGE....................................................................................................................................... 29 5.4 COLLECTION AND TRANSPORT OF HEALTH CARE WASTE ......................................................... 30 6. WASTE TREATMENT AND DISPOSAL SYSTEMS .......................................................... 39 6.1 HEALTH CARE WASTE TREATMENT............................................................................................. 39 6.2 WASTE DISPOSAL SYSTEMS ........................................................................................................ 44 7. WASTEWATER MANAGEMENT ....................................................................................... 49 7.1 CHARACTERISTICS OF WASTEWATER FROM HEALTH CARE ESTABLISHMENTS ....................... 49 7.2 ON-SITE TREATMENT OF WASTEWATER..................................................................................... 49 7.3 FACTORS TO BE CONSIDERED IN THE ESTABLISHMENT OF WASTEWATER TREATMENT PLANT ......................................................................................................................................................
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