Health Care Waste Assessment Report: St.

Paul Hospital Tuguegarao, Cagayan

Health Care Waste

Assessment Report

S A I N T PA U L H O S P I TA L
Tuguegarao, Cagaya n
A Partnership with Health Care Without Harm
Southeast Asia
2 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

ACKNOWLEDGMENTS

Health Care Without Harm would like to extend its deepest gratitude to Saint Paul
Hospital Tuguegarao for giving us the opportunity to document its good practices on health
care waste management.
Our heartfelt thanks go out to the hospital management for their interest and support to
this project. We also thank all the nurses, housekeeping staff, maintenance personnel and
other hospital staff who shared their knowledge, expertise, experience and their valuable time,
to make this project successful. In particular, we would like to thank the following:
• Sister Arcellita Sarnillo, SPC, Provincial Assistant, SPC Health Care Ministry, Our
Lady of Chartres Convent, Antipolo City
• Sister Norma Patricio Manzano, Hospital Administrator
• Sister Melanie Guzman, SPC, Nursing Supervisor
• Sister Ma. Jessica Formacion, former Head, Waste Management Committee
• Ms Cristina Vidal, Quality Assurance Officer
• Ms Heidi Peralta, Human Resource Development Coordinator
• Ms Richael Batang, newly appointed Head, Waste Management Committee
• Waste Management Committee Members representing the different departments,
and
• Different Departments of Saint Paul Hospital Tuguegarao

Health Care Waste Assessment Report:

Saint Paul Hospital, Cagayan

A Partnership between Saint Paul Hospital Cavite and Health Care Without Harm-
Southeast Asia
This report was produced by Health Care Without Harm-South East Asia
December 2009 and revised in September, 2010
Maria Cristina Carganilla - Paruñgao, RMT, MBAH, Researcher and Author
Dino A.E. Subingsubing, Technical Editing / Layout
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 3

C o n te n ts
Page

I. Hospital Profile 4

II. Waste Management Structure and Policies 4

• Composition and Function of the Waste Manage- 4

ment Committee

• Current Programs on Waste Management 4

• Waste Management Policies and Procedures 5

III. Waste Management System 7

• Current Practices on Waste Collection, Segrega- 7

tion, Reuse and Recycling
• Current Practices on Waste Storage System 18

• Current Practices on Waste Documentation 21

• Current Practices on Processing of Health Care 22

Wastes
• Safety Practices on Waste Management 27

IV. Staff Development / Education Program on Waste Man- 28

agement
V. Areas for Improvement 29

VI. Future Plans of the Waste Management Committee 30

VII. Recommendations 30
4 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

I. Hospital Profile
Saint Paul Hospital Tuguegarao was blessed by Archbishop Diosdado Talamayan on
February 24, 1994. The health care facility was granted a license to operate as a 24-bed pri-
mary hospital by the Department of Health. It officially opened its doors and services to the
people of Cagayan Valley on August 24, 1994. With the support of several funding agencies,
funds were provided to purchase the needed hospital equipment and upgrade its facilities. In
1996, the Department of Health and Philippine Health Insurance Corporation (PHIC) accred-
ited the facility as a secondary hospital.

With the increasing number of patients and young medical specialists returning to Tu-
guegarao, the hospital opened more services based on the needs of its clientele and pur-
chased more advanced diagnostic equipment (CT scan, ultrasound, treadmill stress machines,
and an X-ray machine with fluoroscopic capabilities, etc.). In 2004, the facility was accredited
as a tertiary hospital by both the Department of Health and PHIC.

The construction of a new hospital building started in February 2006 with the goal of
accommodating more patients and provide better health care services to the residents of Ca-
gayan Valley and nearby provinces. The Sacred Heart annex, St Joseph annex and Wing A of
the ground floor were in full operation while other parts of the hospital are still being con-
structed.

Saint Paul Hospital Tuguegarao was awarded by the Department of Health- Center for
Health and Development Region I (Cagayan Valley) for Hospital Good Practices on Health
Care Waste Management last September 2008 and in July 2009 they were given a Certificate
of Recognition for Good Practices in Housekeeping and Health Care Waste Management. In
June 2009, the Department of Environment and Natural Resources (DENR) also gave the facil-
ity a Certificate of Recognition for Implementing an Efficient Ecological Solid Waste Manage-
ment program.

II. Waste Management Structure and Policies

A. Composition and Function of the Waste Management
Committee
The Zero Waste Management Committee was established on August 7, 2006
with members representing different departments of the hospital. The committee devel-
ops programs on proper waste management, 5S principles of good housekeeping and
staff development sessions on environmental-health issues. The committee is also re-
sponsible for the monthly monitoring and documentation of health care waste collection
and the sale of recyclable materials. It holds quarterly meetings to discuss issues and
problems related to the implementation of the hospital’s waste management policies.

B. Current Programs on Waste Management

SPC Hospital Tuguegarao implements different waste minimization strategies
such as waste segregation, composting, re-use and recycling of materials. All hospital
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 5

departments are encouraged to implement the 5 methods of (5S) good housekeeping.

The waste management committee conducts random rounds / visits to the different de-
partments to check if each department follows the 5S principles and proper waste man-
agement.
The waste management committee chairman schedules meetings or one-on–
one dialogue for personnel or departments who do not follow the 5S principles and pro-
cedures for proper waste segregation.
The committee also provides regular lectures and updates on proper waste dis-
posal, mercury and other environmental health issues to all the hospital personnel.

C. Waste Management Policies and Procedures

The hospital was able to develop its own Zero Waste Management Policies and
Procedures. It contains the following information:
• Organizational chart of the Zero Waste Management Committee, including
their duties and responsibilities
• General classification of wastes
• Guidelines for proper waste collection, segregation, disposal of all health
care wastes, including flow charts for easy recall of procedures.
The Zero Waste Management Policies and Procedures Manual serve as a refer-
ence for all hospital personnel and members of the housekeeping department.

1. Policy / system for reporting accidents related to waste

disposal
From 2006 to 2008, only six (6) cases of needle stick injury due to improper
waste disposal were recorded and referred to the Infection Control Committee for
proper referral.
The hospital developed its own protocol for reporting accidents for needle
stick injury. The injured staff reports or informs their supervisor and goes to the
emergency room for medical consultation and immediate treatment. The medical
doctor requests for necessary diagnostic procedures and provides anti-tetanus vac-
6 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

cine to the injured staff.

Injured staff are asked to fill up the incident report form and submits this to
their immediate supervisor for filing and proper action.
The Infection Control Committee was able to develop its Needle Stick Injury
Checklist to properly document such cases and also monitor the proper disposal of
sharps in the different wards/ stations. (Please refer to Annex A)

2. Policy for the use of mercury-free devices and polyvinyl

chloride (PVC)-free medical supplies
In 2007, SPC Hospital Tuguegarao started phasing out their mercurial ther-
mometers from their admission kits and mercurial sphygmomanometers from its
wards. As of this writing, the hospital fully implemented the phase-out of the devices
even before the signing and circulation of the Department of Health’s Administrative
Order #21 on Gradual Phase-out of mercurial thermometers and sphygmomanome-
ters in all health care facilities in the Philippines.

Mercury-free sphygmomanometers and thermometers are available in every nurse station and
department of the hospital.

Through lectures and information materials provided by Health Care Without

Harm, there was an increase in awareness at the SPC Hospital Tuguegarao started
on the hazardous effects of polyvinyl chloride (PVC) especially where DEHP is used
as an additive in medical supplies (plastic tubing, blood bags, IV bags, etc.) being
used in the hospital. The hospital management has been more conscious on choos-
ing PVC-free medical supplies.
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 7

3. Policy for use of environmentally-safe disinfectants and

cleaning agents
The Sisters of Saint Paul maximized the disinfecting properties of vinegar for
disinfecting comfort rooms, patient rooms, walls and floors of the hospital.

Starch is also being used as metal polish for stainless steel found mostly in
door panels, door handles, among others, in the different wards.

Sharps are being destroyed through the use of rock salt. Through experi-
mentation, it was found out that rock salt can readily oxidize the stainless portion of
the needles until it becomes completely rusted and totally decomposed.

IAll of these procedures are included in their health care waste management
manual and all housekeeping personnel are encouraged to use these environmen-
tally-safe materials in maintaining the cleanliness of the hospital.

III. Waste Management System

A. Good Practice for Waste Collection, Segregation, Re-
use, and Recycling
1. Healthcare Waste Collection and Segregation
Housekeeping personnel are assigned to different hospital wards and depart-
ments and are responsible for cleaning patients’ rooms, collecting and segregating
waste materials, cleaning trash bins and placing new liners in them.
All infectious wastes are immediately placed in the utility rooms where they
are soaked in specific bins with soaking solution. These rooms are located in every
floor of the hospital where housekeeping personnel prepare the soaking / disinfect-
ing solution, segregate infectious wastes and store housekeeping supplies.
Wastes are collected in three shifts (6am - 2pm; 2pm - 10pm; and 10pm -
6am). Housekeeping personnel are also responsible for segregating and transport-
ing the collected wastes to the garbage holding area.
Trash bins are labeled as “nabubulok” or for biodegradable wastes, “di-
nabubulok” or for non-biodegradable wastes and bins for plastics and paper
wastes. The bins for non-biodegradable wastes are lined with black trash liners
while bins lined with green trash liners are for biodegradable wastes. These bins are
located in the patient wards, nurse stations and visitor’s waiting areas.
Trash bins for infectious wastes are found only in the utility rooms. These
bins are further classified into: catheter, gauze or OS, cotton with blood, cotton balls,
plunger, gloves, tubings with blood, IV tubings, boxes for chemotherapy drugs and
collected vials. The soaking or disinfecting solution is a mixture of 1 gallon of so-
dium hypochlorite diluted in 9.6 gallons of water. All bins for infectious wastes are
half filled with the disinfecting solution and collected infectious wastes are soaked in
the appropriate bins for several hours.
8 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

Properly labeled trash bins are strategically

located in the nurse stations and patient
wards.

Trash bins for infectious wastes are found

in the utility rooms. Infectious wastes are
immersed in a prepared soaking solution
(sodium hypochlorite and water).
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 9

Sharps, vials, ampoules and plungers are collected in improvised containers

made of polyethylene terephthalate (PETE) plastic. These containers are properly
labeled and located in the nurse stations, emergency room, operating room, etc.
Once the containers are three-fourths (¾) filled the housekeeping personnel collect
them and transports them to the waste storage area.

Plastic containers of mineral water and chemical disinfectants are being used
as improvised sharps, vials and ampoule containers.

All non-biodegradable and recyclable wastes are weighed daily and tempo-
rarily stored in the garbage holding area or the materials recovery facility (MRF) of
the hospital. The assigned recyclers collect these wastes on a monthly basis.
Collected vials and ampoules are transported to the waste storage area and
scheduled for crushing.

a. Waste Collection in Offices

All offices have only two types of trash bins labeled as biodegradable and
non-biodegradable. Some offices have separate boxes for papers and cartons.

b. Waste Collection in the Laboratory

The laboratory department has several trash bins for: biodegradable
wastes, non-biodegradable wastes, infectious wastes, papers and plastics. There
are available containers for used slides, pipette tips and test tubes which contains
specified amount of disinfecting solution.
Improvised sharps containers and trash bin for used syringes are also
available in the blood extraction area.
Trash bins labeled as plastic ware for autoclaving, glassware for autoclav-
ing and Infectious wastes for autoclaving are available to segregate the materials
and wastes that need to be autoclaved. All infectious wastes are immersed in the
soaking / disinfecting solution prior to autoclaving.
10 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

The laboratory department has its own autoclave where all identified in-
fectious wastes are treated prior to disposal. This is particularly important since
used cultures and stocks can be some of the most infectious wastes produced by
the hospital.
Treated wastes are collected by the housekeeping personnel for disposal
through the municipal garbage collection system.

Used glassware, plastic wares and other infec- Trash bins for used syringes, plastics and
tious wastes are segregated prior to autoclav- cotton balls are available in the blood ex-
ing. traction area of the laboratory department.

Autoclave machine used for treating all infec-

tious wastes generated in the laboratory depart-
ment.
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 11

c. Waste Collection in the Pharmacy

The Pharmacy department conducts a monthly inventory of products and
supplies to monitor fast moving items and to anticipate requests for the purchase
of such items.
A supplies analyst assists in monitoring the movement of supplies and
projects enough stocks needed for at least one month. It has been the depart-
ment’s practice to purchase small quantities of medicines/ products based on
their hospital’s statistics, in the process averting the expiration of medicines and
other supplies.
The “first in, first out” policy is also being implemented and drug distribu-
tors / manufacturers are requested to have a “take back” policy for drugs and
supplies nearing expiration.
For expired ordinary medicines which cannot be returned to the supplier,
tablets are pulverized, capsules are emptied and mixed in a container with lots of
water and flushed down the sink. Most of the medicine nearing expiration are re-
turned to the supplier for proper disposal.
For non-pharmaceutical wastes, there are four trash bins, for: biodegrad-
able wastes, non-biodegradable wastes, papers/plastics and cartons. Papers are
given to the canteen for their scratch papers/ order slip while collected cartons
are re-used or sold to recyclers.

d. Waste Collection in the Diagnostic and Imaging Depart-

ment
Wastes collected in the diagnostic and imaging department are mostly
non-biodegradable and biodegradable wastes. There are also containers pro-
vided for sharps, vials and ampoules.
Spoiled x-ray films are stored and sold to recyclers. Used fixers and devel-
opers from the X-ray section are properly labeled with the date of the storage and
left to decay for six (6) months and disposed directly in the drainage.

e. Waste Collection in the Operating, Delivery and Recovery

Rooms, and in the Intensive Care Unit
The operating room (OR) has three (3) trash bins for biodegradable wet
wastes, non-biodegradable dry wastes, plastics and paper. All infectious wastes
are directly disposed of in the utility room in appropriate containers with disinfect-
ing solution. These containers are intended for used gloves, sharps, IV tubings
with blood, placenta, IV tubings without blood, plunger, among others.

There are also big plastic containers for used masks, doctors’ scrub suits,
caps, dry dirty linen and wet dirty linen. These are collected by housekeeping per-
sonnel and forwarded to the laundry department for disinfection and regular
washing.

Trash bins for non-biodegradable recyclable wastes for plastics, IV bot-

tles, papers, cartons, among other, are also provided in these rooms. These are
12 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

regularly collected by housekeeping personnel and transported to the garbage

holding area for weighing and temporary storage.

f. Waste Collection in the Emergency Room

There are six (6) trash bins for the following types of wastes: biodegrad-
able, non- biodegradable, vials, syringe caps, plungers, cotton balls and gauze.
The emergency room’s utility room has bigger containers for used gauze and cot-
ton balls, used gloves, tubings, vials, sharps, IV bottles, dry and wet linens,
among others. All receptacles for infectious wastes have sufficient amounts of
disinfecting solution and all infectious wastes collected for a particular shift are
soaked in the disinfecting solution for several hours.

g. Waste Collection in the Dialysis Section

There are eight (8) trash bins assigned in this section, intended for the
following wastes: biodegradable, sharps, plunger, papers, plastics, bottles of nor-
mal saline solution (NSS), tissue and failed dialyzers. Used gloves, sharps and
plungers are soaked in disinfecting solution. All wastes are collected and trans-
ported by the housekeeping personnel to the garbage holding area.

Since a dialysis treatment is very expensive, the hospital invested in a re-

processing machine for the dialyzers so that patient can reuse their dialyzers and
treatment cost will be more affordable. This machine is able to detect if the dialyz-
ers can still be reused by the same patient for approximately about 20-25 ses-
sions. If during reprocessing, the dialyzer shows a “failed” status, this means that
the patient can no longer reuse its dialyzer. The dialyzer is then disposed in a
trash bin containing disinfecting solution.

Trash bins available in the Dialysis Section

Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 13

A reprocessing machine is being used to reuse the dia-

lyzers up to a maximum of 20 times.

Personalized dialyzers which can be re-used

for the next dialysis session

h. Waste Disposal in the Kitchen and Dietetics Department

The dishwashing and preparation areas have two (2) trash bins for biode-
gradable and non-biodegradable wastes. There are also sacks for containers of
papers, plastics, broken glasses, bottles and cans. Recyclable wastes are col-
lected by the housekeeping personnel and transported to the garbage holding
area for weighing. These will eventually be sold to recyclers.

Vegetable and fruit peelings and other biodegradable wastes are placed
in the compost pit while left-over foods are used as hog / animal feeds.

Old sacks of rice were re-used as trash bags for non-biodegradable wastes in the
kitchen/ dietary area.
14 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

Old paint cans are re-used as containers

for composted vegetable and fruit peel-
ings from the dietary department.

i. Laundry and Linen Department

Linens and gowns with blood and those coming from patients with infec-
tious disease are separated from the uncontaminated linens. These are placed for
30 minutes in the soaking tub with disinfecting solution, which is composed of 10
milliliters of alkali or powder bleach mixed with 1 liter of water.
After 30 minutes, linens will be rinsed thoroughly and loaded in the wash-
ing machine for the regular cycle of washing.
Uncontaminated linens and gowns are rinsed thoroughly and loaded in
the washing machine for the regular cycle of washing. Washed linens and gowns
are dried and ironed prior to delivery in the linen section.

Soiled linens are soaked in disinfecting solution, thoroughly rinsed and machine washed.
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 15

B. Reuse and Recycling of Health Care Wastes

The following materials are being routinely re-used by the hospital:

Materials Reused as / for

Plastic containers (mineral water, Improvised containers for: sharps, vials, ampoules, other
chlorine bottles, containers for infectious wastes
chemical reagents, etc.) Water containers / receptacles

Dry plastic bags Containers for used operating room (OR) linen

Cartons or used boxes Containers / tray for medicines for each ward
Splints
Door / floor mats for hospital entrance during rainy days
Patient name tags (for patient charts and doors)

Office paper with single-side Reports, memos, laboratory print-outs, running bills, order
printing slips in the canteen, among others

Folders and envelops File containers for patient’s records, laboratory results and
other documents

Old and stained linen Flat sheets, cleaning rugs, aprons

Old blankets Doormats

Old towels Table rugs, hand towels

Vials Normally collected and crushed in the garbage site to pre-

vent reuse for fake drugs
Specific vials are autoclaved and used as specimen collec-
tion bottles for the laboratory or pathology departments

Test tubes and other glassware Clinical microscopy and microbiology sections (after disin-
in the laboratory fection and autoclaving)

Ink cartridges Printing of patient’s records and laboratory results (after

refilling)
Sold to recyclers

Intravenous Fluid (IVF) Bottles Drainage bottles (after washing and sterilization)

IVF plastic bottles Urine collectors

Plungers Sold to recyclers (after cleaning and disinfection)

Used and cleaned vials, am- Christmas decorations

poules, vacutainer caps
16 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

An old wire and cable reel being recycled into a table. The reel was repainted and scraps of tiles were
used to make the table presentable.

Old plastic gallons are re-used as contain-

ers of infectious wastes and sharps in the
different wards of the hospital.

Broken plates were re-used as decorative

materials in the canteen and kitchen areas.
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 17

Old paint can re-used as plant

Old or expired
medical sup-
plies are re-
used as
Christmas
décor.

Scraps of old
clothes are
made into door-
mats and are
used in the hos-
pital.
18 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

Reusing and recycling of supplies in the hospital promotes efficient use of resources,
encourages creativity among the staff and develops an attitude of being resourceful. The
hospital saves a lot of money through the reuse and recycling initiatives of the staff. A
significant amount of money comes from the sale of recyclable materials which the hos-
pital calls “Bio-Kita”, meaning income from recyclable wastes.

From January 2007 up to June 2009, the hospital was able to earn a total of
PhP 118,909.25 (US$ 2,584.98) from the sale of all the recyclable materials and earning
an average monthly income of PhP 3,129.19 (US$ 68.02).

During December of each year, income from the sale of recyclable wastes is
used to purchase groceries and appliances for raffle during the hospital’s Christmas
party; this is what they call their “Bundle of Joy”. Each staff is given a bag of groceries
and is entitled to win prizes from their Raffle Contest.

C. Current Waste Storage System Practice

The waste storage area is located at the back of the hospital, away from patients’
rooms, the dietary section and other offices. This area also serves as the Materials Recovery
Facility (MRF) of the hospital since most of the stored wastes are non-biodegradable and recy-
clable. There is only one shelf intended for temporary storage of materials used from chemo-
therapy. These materials are left to decay for about six (6) months and the boxes are properly
labeled with the storage and disposal dates.

Infectious wastes are stored in the hospital’s designated utility rooms and are not
stored in this area. After disinfection, chemically treated infectious wastes are disposed and
collected by the municipality. All biodegradable wastes are buried in the compost pit.
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 19

The waste storage area has concrete flooring, galvanized iron sheets as its roofing,
with adequate lighting and sufficient ventilation. The floor is actually made of re-used tiles that
can be easily cleaned, which are scraps from construction being done in the hospital. Roofs
are galvanized iron sheets, also excess material from construction of the hospital building. The
waste storage area is accessible to the hospital staff in charge of waste handling; it has no
locks and no appropriate signage.

There is a nearby source of water for cleaning the area and also for watering the orna-
mental plants as well as the vegetable garden.

Waste storage area for recyclable

wastes and chemotherapy drugs.
The floor is made from reused
scrap of tiles and roof is made
from old galvanized iron sheets.

Plastic bottles of mineral water

are collected and weighed prior
to sale to recyclers.
20 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

Sacks are re-used as containers

for broken bottles, cans, bottles,
among others.

Cartons are folded and piled up

for weighing and temporary
storage.

Materials used for Chemotherapy are placed in a properly labeled box with the date of storage and date
of disposal.
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 21

Crushed vials are mixed with cement and used as

pavement in the garden and parking areas
Equipment used for crushing vials and
ampoules

D. Current Waste System Documentation Practice

The Zero Waste Management Committee holds quarterly meetings to discuss prob-
lems, updates and other issues related to waste management. The members conduct random
rounds to observe proper waste segregation, disposal and orderliness in the wards and other
departments. Violations of policies and procedures on waste management are discussed dur-
ing the meetings. Minutes of meetings are properly recorded and can serve as reference for all
committee members.

All recyclable health care wastes collected from the different wards are weighed daily
and noted down in a logbook to properly monitor the total amount of recyclable wastes col-
lected in one month. The assigned personnel in the waste storage area, is tasked to schedule
the sale of the collected recyclable materials. The collected income is recorded and submitted
to the finance department.

From January 2007 to June 2009, the total recyclable wastes generated by the hospi-
tal amounted to 26,877.40 kilos. Plastic gallons and other plastic materials comprise 26.79%
or 7,201 kilos while cartons, cement bags and papers comprise 45.34% or 12,188.50 kilos.
Iron sheets, aluminum and metal scraps comprise 4.66% or 1,254.10 kilos while broken glass
has a weight of 1,899 kilos or 7.06%.

The collection, monitoring and sale of these recyclable wastes are the source of
“Bundle of Joy” of all the hospital staff (see previous section). Each one is encouraged to prop-
erly segregate their wastes not only inside the hospital but also in their respective homes and
communities.
22 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

Types of Recyclable Waste Generated

E. Current Health Care Waste Processing Practice

Collected health care wastes particularly non-biodegradable and biodegradable wastes
from patient rooms and different wards are segregated by the house-keeping personnel in their
trolleys, and further segregation takes place in the utility rooms. All infectious wastes are di-
rectly disposed in the appropriate bins with disinfecting solution located in the utility rooms. In-
fectious wastes are treated for several hours prior to disposal in the municipal garbage collec-
tion system.

Infectious wastes are directly disposed in designated containers with disinfecting solution. These
containers are found in the utility rooms.
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 23

Transport cart where all house- Housekeeping personnel assigned to clean rooms,
keeping materials and trash bins collect and segregate health care wastes.
for biodegradable and non-
biodegradable wastes are loaded.

Housekeeping personnel assigned to each floor are responsible for cleaning patients’
rooms, collecting wastes from the rooms and nurses’ stations, and transporting the collected
wastes to the hospital’s garbage holding / waste storage area. All bins are replaced with clean
bins containing new trash liners. Trash bins are also cleaned and washed in the utility rooms
located in each floor of the hospital.

All recyclable wastes are further segregated, weighed and documented in the logbook.
The Zero Waste Management Committee monitors the volume of recyclable wastes collected
and the amount of sales/ income generated.

Two years ago, the Saint Paul Sisters experimented with mixing rock salt and sharps to
speed up the process of oxidation of the stainless part of the needles, eventually decomposing
them. Sharps are pre-treated with disinfecting solution prior to composting. Approximately one
kilo of sharps are mixed with a kilo of rock salt and placed in a covered plastic trash bin. In
their observation, it took about six (6) months to totally decompose the sharps. The assigned
housekeeping personnel is responsible for observing the process of decomposition and results
are reported during the Zero Waste Management Committee meetings.
24 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

Sharps mixed with rock salt after six (6) months

of composting.

Sharps mixed with rock salt after three (3) months

of decomposition

Sharps mixed with sodium hypochlorite and salt

after one (1) month of composting
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 25

The Zero Waste Management Committee also experimented with another variation of
composting: a kilo of sharps with one kilo of rock salt and a kilo of sodium hypochlorite powder.
They observed that after one month of composting the sharps were already partially rusted.

When the researcher visited the facility during the first week of February 2010, the Zero
Waste Management Committee thought of experimenting with three sets of sharps composting
using only rock salt, only sodium hypochlorite powder and rock salt combined with sodium hy-
pochlorite powder. Results on the percentage of decomposition are due within six (6) months.

After one month, sharps started to de- A kilo of sharps mixed with a kilo salt
velop rust in the stainless part of the
needles.

One kilo of sharps mixed with a kilo of After one month, there are no visible signs yet of
sodium hypochlorite powder. rusting in the stainless portion of the needles.
26 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

A kilo of sharps mixed with a kilo of salt and After one month of composting, no visible signs
one kilo of sodium hypochlorite powder. yet of rusting.

The hospital also tried composting their collected placenta. A layer of soil is placed at
the bottom of the plastic trash bin and the pre-treated placenta is placed on top of the first layer
of soil and covered with a second layer of soil. The topmost layer is covered with dried leaves.
After two weeks, the placenta is totally decomposed and can already be used as organic fertil-
izer in the hospital’s garden, particularly for ornamental plants.

Total decomposition of placenta after two (2) weeks

Composting of placenta

Biodegradable wastes from the dietary and canteen sections are composted in a desig-
nated pit / area within the hospital’s garden. Old paint cans are used as compost bind for vege-
table and fruit peelings collected from the dietetics department. After two to three weeks com-
post can already be used for the hospital’s vegetable garden and ornamental plants.
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 27

F. Waste Management Safety Practices

Housekeeping personnel are provided with personal protective equipment such as
masks and heavy duty gloves during waste collection and segregation. Hepatitis B immuniza-
tion is also required for housekeeping personnel because they are exposed to handling various
types of infectious wastes.

Anti-tetanus vaccine is administered if personnel incur needle stick injury due to im-
proper disposal of sharps. The necessary protocol for such injuries is implemented based on
the Zero Waste Management Manual.
28 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

Housekeeping personnel with

masks and gloves during waste
collection

IV. Staff Development / Education Program on Waste

Management
Lectures on waste management, infection control and disaster management is part of
the orientation for newly hired personnel. Updates on other environmental-health issues are
also provided during general staff meetings and department meetings. Newly hired staff are
also invited to join the Nurses’ Assembly especially if they are not able to attend the orientation
on waste management.

Department heads are responsible for informing other personnel for other updates on
waste management, phase out of mercury devices and other issues related to proper disposal
of health care wastes.

The hospital management also encourages the staff to attend conferences and semi-
nars on their particular field of expertise, hospital management, public health and environ-
mental health.

The Zero Waste Management Committee also developed its information, education and
communication (IEC) materials on proper waste segregation and management of common dis-
eases such as signs and symptoms of flu. Lectures are given to patients, visitors and interns.
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 29

IEC materials on
proper waste seg-
regation and signs
and symptoms of
flu.

V. Areas for Improvement

Below are some of the problems raised during the focus discussion and some observa-
tions during the actual walk through within the hospital premises:
• Improve practice of segregation among staff, patients and patients’ visitors
• Improve utilities and utility rooms to make them cleaner and more organized
• Additional personal protective equipment (PPEs) for laundry personnel handling
soiled linens and housekeeping personnel assigned in handling health care wastes,
such as: rubber boots and tongs for waste segregation and handling of infectious
wastes
• Use of appropriate color of trash liners and trash bins for biodegradable, non-
biodegradable and infectious wastes
• Securing waste storage area

Yellow trash liners for infectious

wastes should be used instead
of green trash liners
30 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

Black trash liners for non-

biodegradable wastes should be
used instead of green trash liners.
Green trash liners are for bio-
degradable wastes.

Packaging of coffee placed in the infectious wastes bin

VI. Future Plans of the Waste Management Committee

Below are the future plans presented by the Zero Waste Management Committee:
• Regular monitoring of the implementation of policies and procedures on proper
waste segregation, collection and treatment of infectious wastes;
• Development of the hospital’s organic garden; and,
• Increasing the level of awareness of all hospital staff on other environmental-health
issues such as the use of polyvinyl chloride (PVC)-free medical supplies and prod-
ucts, climate change and the use other non-hazardous chemical cleaners / disinfec-
tants for the hospital

VII. Recommendations
Below are some of the recommendations that should be addressed by the hospital:

1. Waste Management Committee

The Zero Waste Management Committee should ensure proper documentation
and monitoring of composting of sharps using salt, sodium hypochlorite powder and the
combination of both so that it can be shared to other hospitals in the country who have
problems of managing and disposing of their sharps and other infectious wastes.
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 31

2. Waste Management Policies and Procedures

Aside from the Zero Waste Management Committee Manual, the Department of
Health’s Manual on Health Care Waste Management should also be available for easy
reference by hospital staff.

3. Training and Education

The hospital management should invest in and schedule quarterly seminars or lec-
tures on proper health care waste management to further increase the level of awareness
and improve compliance on proper waste segregation and disposal among hospital per-
sonnel.
Updates on the phase-out of mercury devices and compliance with Administrative
Order #21 should also be discussed during general staff meetings to inform the staff on
the initiatives of other hospitals in phasing out their mercury devices.

4. Documentation and Monitoring

a. Volume of infectious wastes, biodegradable wastes and non-biodegradable wastes
should be monitored on a monthly basis to determine the total health care wastes
generated by the hospital. Documentation of waste generated by the hospital will
provide significant data for the hospital management to study the cost of treatment
for the infectious wastes.
b. Continuous monitoring of monthly sale of recyclable wastes.
c. Continuous documentation of placenta composting and the use of rock salt and so-
dium hypochlorite powder in oxidizing and eventually decomposing needles/
sharps. Specify the state of the needles (partially rusted, completely rusted, etc.),
numbers of weeks or months before sharps/ needles are decomposed.

5. Segregation and Transport

a. Monitor strict compliance in segregating waste from source to maintain the hospi-
tal’s small volume of infectious waste. Continuous monitoring of monthly sale of re-
cyclable wastes must be done.
b. Identify a different route for transport of collected health care wastes to the hospi-
tal’s waste storage area.

6. Waste Storage / Segregation for Recyclable Wastes

a. Proper signage should be placed before the entrance of the waste storage area
(Materials Recovery Facility (MRF) or Waste Storage Area for Recyclable Wastes).
Continuous monitoring of monthly sale of recyclable wastes must be done.
b. Secure the waste storage area.
c. Proper signage should also be placed near the Chemotherapy boxes
(Biohazardous Wastes)

7. Waste Handling / Processing

a. Waste collectors and laundry personnel should also be provided with rubber boots
and always wear their available personal protective equipments (PPEs) for safety
and protection.
32 Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan

b. Discourage flushing of pharmaceutical wastes in sinks and toilets, such as expired

liquid medicines and pulverized tablets mixed in water.

8. Waste Water Treatment

The hospital management should seriously consider planning and allotment of
budget for the waste water treatment system of the hospital to ensure that waste water is
treated prior to release in the public sewage system.

9. Safer Chemical Substitutes

Promote use of safer chemicals for disinfection of medical instruments and for
cleaning. Encourage hospital management to purchase PVC-free medical supplies.
Health Care Waste Assessment Report: St. Paul Hospital Tuguegarao, Cagayan 33

Health Care Without Harm (HCWH) is an international coalition of

473 organizations in more than 50 countries, working to transform the
health care industry so it is no longer a source of harm to people and
the environment.

In the Philippines, HCWH Southeast Asia has laid the groundwork

for promoting its three main issues on environmentally responsible
health care: best practices in health care waste management,
mercury-free health care, and alternative technologies to incineration
of medical wastes.

In the five years that HCWH Southeast Asia has been in the country, it has done high pro-
file projects such as the documentation of the proper disposal of needles and syringes used in
the DOH Philippine Measles Eradication Campaign in 2004, the Health Care Waste As-
sessment Project in Four Tertiary Hospitals in Metro Manila in 2005 and the hosting of the first
ever Southeast Asian Conference on Mercury in Health Care in early 2006.
HCWH Southeast Asia has been visibly promoting its causes through seminars,
conferences, and training programs, and has made several contributions to various published
material concerning its key environmental issues. Most notably, HCWH is cited as one of the
contributors to the creation of the Philippine Department of Health’s Health Care Waste
Management Manual.

Health Care Without Harm-Southeast Asia

Merci V. Ferrer
Executive Director

Faye V. Ferrer
Program Officer- Mercury-Free Health Care Campaign

Maria Cristina Carganilla-Paruñgao, RMT, MBAH

Administrative Officer
Program Officer- Promotion of Best Practices Campaign

Ma. Sonia G. Astudillo

Communication Officer