THESIS PROPOSAL:

Title: Health Care Waste Management

In Selected Secondary Clinical Laboratories In Quezon City
Christine Guerrero
Philippine Women University Graduate School

Title

Health Care Waste Management In Selected Secondary Clinical Laboratories In Quezon City
 Abstract

No other form of industrial pollution has had as an insidious detrimental effect on human
populations as health care waste pollution. Even though there are already new modifications and
improvements to the existing health care waste management practices, the small primary and
secondary clinical laboratories should be more proactive in the health care waste disposal
management. This is because most of the same modifications and improvements are not actually
being implemented for many reasons. An understanding of the effects of proper and improper
health care waste disposal may contribute to increasing compliance with the implementation of
health care waste management. This study investigates the reasons why the principles of health
care waste management is so little complied with in small primary and secondary clinical
laboratories, especially in privately owned laboratories. Attention shall also be paid on how to
rectify this situation in order to encourage compliance among privately owned commercial labs.

CHAPTER 1:

THE PROBLEM AND ITS BACKGROUND

Background of the Study

Statement of the Problem

Hypothesis

Significance of the Study

Scope and Limitation

Definition of Terms

Chapter 2:

REVIEW OF RELATED LITERATURE

Introduction
According to 1Rolando T. Soncuya et. Al Loida B. Matias et al Danilo G. Lapid (2007),
Hospital Waste Management in the Philippines, 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.

Even though there is lack of funding and resources and as well as inefficient campaign
about the waste management program in the free-standing diagnostic laboratories, there
should be a standard health awareness planning and program for health care waste
management in the secondary level clinical laboratories because of the hazardous threats to
the health of the community and as well to protect the health care personnels.

1. The Definitions of Health Care Wastes from the 2DOH Guidelines of Health
Care Waste Management Manual.

1.1 Health Care Wastes: Nature and Hazards and Disposal Management

1) General Waste - Comparable to domestic waste, this type of waste does not
pose special handling problem or hazard to human health or to the environment. It comes
mostly from the administrative and housekeeping functions of health care establishments
and may also include waste generated during maintenance of health care premises. General
waste should be dealt
with by the municipal waste disposal system.

2) Infectious Waste – This type of waste is suspected to contain pathogens (bacteria,

viruses, parasites, or fungi) in sufficient concentration or quantity to cause disease in
susceptible hosts. This includes:
 Cultures and stocks of infectious agents from laboratory work;
Waste from surgery and autopsies on patients with infectious
diseases (e.g. tissues, materials or equipment that have been in contact
with blood or other body fluids);

 Waste from infected patients in isolation wards (e.g. excreta, dressings from
infected or surgical wounds, clothes heavily soiled with human blood or other body
fluids);

•Waste that has been in contact with infected patients undergoing haemodialysis (e.g.
dialysis equipment such as tubing and filters, disposable towels, gowns, apron,
laboratory gown)

•Infected animals from laboratories; and Any other instruments or materials that have
been in contact with infected persons or animals.

3)Pathological Waste - Pathological waste consists of tissues, organs, body parts,

human fetus and animal carcasses, blood and body fluids. Within this category,
recognizable human or animal body parts are also called anatomical waste. This
category should be considered as a subcategory of infectious waste, even though it may also
include healthy body parts.
4) Sharps - Include needles, syringes, scalpels, saws, blades, broken glass, infusion
sets, knives, nails and any other items that can cause a cut or puncture wounds.
Whether or not they are infected, such items are usually considered as highly
hazardous health care waste.

5) Pharmaceutical waste - Includes expired, unused, spilt, and contaminated

pharmaceutical products, drugs, vaccines, and sera that are no longer required and need to
be disposed of appropriately. This category also includes discarded items used in
handling of pharmaceuticals such as bottles or boxes with residues, gloves, masks,
connecting tubing and drug vials.

6) Genotoxic Waste - Genotoxic waste may include certain cytostatic drugs, vomit,
urine, or feces from patients treated with cytostatic drugs, chemicals, and radioactive
materials. This type of waste is highly hazardous and may have mutagenic,
teratogenic, or carcinogenic properties.
Harmful cytostatic drugs can be categorized as follows:
• Alkylating agents: cause alkylation of DNA nucleotides, which leads to cross-
linking and miscoding of the genetic stock;
• Anti-metabolites: inhibit the biosynthesis of nucleic acids in the cell;
mitotic inhibitors: prevent cell replication
Cytotoxic wastes are generated from several sources and include the following:
•
Contaminated materials from drug
preparation and administration, such as
syringes, needles, gauges, vials, packaging; outdated drugs, excess (left over)
solutions, and drugs returned from the wards;
•
Urine, feces, and vomit from patients which may contain potentially
hazardous amounts of the administered cytotoxic drugs or of their
metabolites and which should be considered genotoxic for at least 48
hours and sometimes up to 1 week after drug administration.
7)
Chemical Waste
- Chemical waste consists of discarded solid, liquid, and gaseous
chemicals, for example from diagnostic
and experimental work and from cleaning,
housekeeping, and disinfecting procedures. C
hemical waste from health care may
be hazardous or non-hazardous.
Chemical waste is considered hazardous if it has at least one of the following
properties:
•
Toxic
•
Corrosive (e.g. acids of pH <2 and bases of pH >12)
•
Flammable
•
Reactive (explosive, water-reactive, shock-sensitive)
•
Genotoxic (e.g. cytostatic drugs)
Non-hazardous chemical waste consists
of chemicals with none of the above
properties, such as sugars, amino acid
s, and certain organic and inorganic salts.
Health Care Waste Management Manual
Health Care Waste
12
8)
Waste with high content of heavy metals
- Wastes with a high heavy-metal content
represent a subcategory of hazardous chemical waste, and are usually highly toxic.
Mercury wastes are typically generated by
spillage from broken clinical equipment
(thermometers, blood pressure gauges, etc.). Whenever possible, spilled drops of
mercury should be recovered. Residues from dentistry have high mercury content.
Cadmium waste comes mainly from discarded batteries. Certain "reinforced wood
panels" containing lead is still being used in radiation proofing of X-ray and diagnostic
departments. A number of drugs contain
arsenic but these are treated here as
pharmaceutical waste.
9)
Pressurized Containers
- Many types of gas are used in health care and are often
stored in pressurized cylinders, cartridges,
and aerosol cans. Many of these, once
empty or of no further use (although they may still contain residues), are reusable,
but certain types notably aerosol cans, must be disposed of. Whether inert or
potentially harmful; gases in pressuriz
ed containers should always be handled with
care; containers may explode if incinerated or accidentally punctured.
10)
Radioactive Waste
– Includes disused sealed radiation sources, liquid and gaseous
materials contaminated with radioactivity, excreta of patients who underwent radio-
nuclide diagnostic and therapeutic applications, paper cups, straws, needles and
syringes, test tubes, and tap water washings of such paraphernalia. It is produced as
a result of procedures such as in vitro analysis of body tissues and fluids, in vivo
organ imaging, tumor localization and treatmen
t, and various clinical studies involving
the use of radioisotopes. Radioactive health care wastes generally contain
radionuclides with short half-lives, which lose their activity in a shorter time.
However, certain radionuclides e.g. C-14 contaminated wastes have much longer
half-life, more than a thousand years, which need to be specially managed in a
centralized treatment facility for radioactive
wastes. The same is required for the
management of disused sealed radiation sources used for cancer tre
 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)
- genotoxic (carcinogenic, mutagenic, teratogenic or otherwise
capable of genetic material), for example cytotoxic drugs.

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.

1.2 Hazards for Health Care Personnel

1.3 Laws and Regulations Governing Health Care Waste

1.3.1 Diagnostic Laboratory Policy

1.3.2 Practices
1.3.3 Precautionary Measure
1.3.4 Acceptance of Sample

1.4 Waste Minimization

1.5 Health Care Waste segregation, Handling,Collection, Storage and Transport

1.6 Medical Waste Treatment System

1.7 Financing Option for Health care Waste Management

 1.8 Organization for Health Care Waste Management

1.9 Health and Safety Practices

2.0 Emergency Response

2.1 Communication and Training

Chapter 3:

METHODS AND PROCEDURES

Here, you should position your study in relation to the reviewed literature. Also, here you should
state your basic ideas about the topic. What has been overlooked in the existing studies and
theories in relation to the topic and the research problem of interest to you? Are there any new
factors, ideas, problems, concepts, etc. that you think should be considered and added to the
debate?

Chapter 4:

PRESENTATION AND ANALYSIS OF DATA

Questions:
Working Hypothesis:

Chapter 5:

SUMMARY, CONCLUSIONS, AND RECOMMENDATION

………………...
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APPENDICES