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 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., 1999. Safe Management of Wastes From Health Care Activities. World Health Organization, Geneva

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. 2004. Hazardous Waste Management. Procedural Manual Title III of DAO 92-29

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 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. 2003. Comparison of infectious waste management in European hospitals. Institute for Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Freiburg, Germany

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. 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 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. 1997. Hospital Waste Management in the Philippines, two Case Studies in Manila. WASTE. Urban Waste Expertise Programme

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 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 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 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 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 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 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. 1993. Pasig River Rehabilitation Program: Feasibility Report on Hospital Hazardous Waste Management in Metro Manila. Volume I

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 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 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 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 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 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.

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