Various studies conducted by the academe found out that, generally, medical facilities in the Philippines pose health risks to the public and create serious environmental impact due to the absence of satisfactory and environment-friendly disposal facilities for hazardous hospital wastes.
Most of the existing treatment facilities (earlier, generally utilizing some form of burning the waste) are considered unsafe to the environment and insufficient for the proper disposal of the major part of medical wastes generated in the country.
A large volume of infectious wastes is disposed in burial pits located at hospital sites, and in municipal landfills, both practices of which pose significant risks to humans, including direct contact and contamination of surface water or groundwater. Furthermore, previous studies showed that majority of the hospitals is not practicing pre-treatment procedures for their infectious waste. Hazardous hospital wastes are being mixed with general medical waste in black plastic bags (which should only contain non-infectious solid wastes). The black bags are designated for delivery to landfills.
Common storage containers are plastic bags, and glass jars with temporary storage facilities such as bins, pits and rooms. The most common facilities used for storage of infectious waste are plastic bags, covered bins/trash cans, and glass jars with covers.
Health care wastes
Health care wastes are in the form of solid and liquid wastes generated in the diagnosis, treatment or immunization of human beings or animals; in medical research; or in production of vaccines or other substances produced from living organisms. They are commonly generated by hospitals, medical or research laboratories, clinics, offices of physicians and dentists, veterinarians, long term-care facilities (for example, nursing homes) and funeral homes.
These wastes represent a relatively small portion of the total solid waste stream, and are simple to identify, to separate, and to treat properly. Hospital wastes include sharps (for example hypodermic syringes, glass slide, and scalpels), human or animal tissue or excretion, medical products (including swabs and dressings).
Classification of hospital waste
The following classifications of waste were adopted by the Department of Health (Environmental Health Service) and promulgated as guidelines (Manual on Hospital Waste Management) for all hospitals and other health care facilities.
1. Pathological wastes consist of tissues, organs, body parts, human fetuses and animal carcasses; and most blood and body fluids.
2. Infectious waste contains pathogens in sufficient concentration or quantity that exposure to it could result in disease. This category includes cultures and stock of infectious agents from laboratory work, waste from surgery and autopsies on patients with infectious diseases, waste from infected patients in isolation wards, waste that has been in contact with infected patients undergoing hemodialysis (e.g. dialysis equipment such as tubing and filters, disposable towels, gowns and aprons, gloves and laboratory coats) and waste that has been in contact with animals inoculated with an infectious agent or suffering from an infectious disease.
3. Sharps include needles, syringes, scalpels, saws, blades, broken glass, nails and other items that could cause a cut or puncture.
4. Pharmaceutical wastes include pharmaceutical products, drugs, and chemical that have been returned from wards, have been spilled, are outdated or contaminated, or are to be discarded because they are no longer required.
5. Radioactive wastes include solid, liquid, and gaseous waste contaminated with radionuclides generated from vitro analysis of body tissues and fluids, in vivo body organ imaging and tumor localization, and therapeutic procedures.
6. Chemical wastes comprise discarded, solid, liquid, and gaseous chemicals, for example from diagnostic and experimental work, and cleaning, housekeeping and disinfecting procedures Chemical waste may be hazardous or non- hazardous. For the purpose of choosing the most appropriate waste handling method, hazardous chemical waste is considered to be waste when it is toxic, corrosive (acid of pH<2.0 and bases of pH>12.0), flammable -reactive (explosive, waster reactive, shock sensitive) and genotoxic (carcinogenic, mutagenic, teratogenic or otherwise capable of genetic material).
Effects
These hazardous wastes can affect the environment in different ways. An individual can experience multiple exposures through the food, air, and drinking water.
The effect on general population can mainly be through:
♦ Chronic exposure, when individuals are exposed over a prolonged time to small amounts of substances in ground water, the food chain, and the air; or
♦ Acute exposure: when individuals are exposed for a shorter period to larger amounts. This is mainly to be from occupational exposure, when waste handlers come into contact with significant volumes of infectious waste and any reaction products.
Laws and policies
Hospital Licensure Law (Republic Act No. 4226). The authority to license all hospitals in the Philippines is vested under Hospital Licensure Law dated January I5,l%5 to the Bureau of Medical Services (BMS) of the Department of Health (DOH). Upon the reorganization of DOH, this authority is now under the Bureau of Licensing and Regulations that took over the function from the defunct BMS. Under this law, hospitals are categorized as government or private hospitals.
Toxic and Hazardous and Nuclear Wastes Control Act of 1990. This law covers the importation, manufacture, processing, handling, storage, transportation, sale, distribution, use and disposal of all unregulated chemical substances and mixtures in the Philippines. It also covers the entry, even in transit, as well the storage and disposal of hazardous and nuclear wastes into the country for whatever purposes Under this law, pathogenic and infectious wastes are considered hazardous and therefore covered by this law.
This law provides that the Department of Environment and Natural Resources is responsible for the implementation by providing the powers to confiscate or impound the materials if prima facie evidence is present that said materials present unreasonable risk or injury to health or the environment. The law also defines the prohibited acts and provides for administrative and criminal penalties.
Mandated functions of institutions/agencies
The Department of Health (DOH). The DOH is mandated to monitor the management of hospital wastes through the following health services;
♦ Environmental Health Services
♦ Hospital Operation and Management Services
♦ Hospital Maintenance Services
♦ Health Infrastructure Services
♦ Radiation Health Service
♦ Bureau of Licensing and Regulations
DOH through the Bureau of Licensing and Regulations has the power to withhold or revoke licenses of hospitals in cases of violations of its orders, policies or guidelines.
Department of Environment and Natural Resources (DENR). This agency is mandated to regulate certain categories of hospital wastes under Republic Act No.6969 Therefore the DENR is responsible for regulating incinerators (design, operations, air emissions, and residue disposal). In principle, the DENR inspects hospital sites (and hospital incinerators) to ensure compliance with regulations promulgated under Republic Act no. 6969.(Edge Davao research)
