Module 1: History of Medical Technology Profession History of Medical Technology in Global, Exams of Medical Physics

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Module 1: History of Medical Technology Profession History of Medical Technology in Global Context Hippocrates ➢ 300 B.C. ➢ Father of Medicine ➢ Author of Hippocratic Oath (urine taste testing) Galen ➢ Greek physician and philosopher ➢ Four Humors (blood, phlegm, yellow bile, black bile) ➢ Describe diabetes as “diarrhea of urine” Medieval Europe ➢ Diagnosis by “water casting” (uroscopy) was widely practiced ➢ Patients submitted their urine specimen in decorative flasks ➢ Physicians who failed to examine the urine were subjected to “public beating” 900 A.D. ➢ First book detailing characteristics of urine (color, density, quality) 11th Century ➢ Medical practitioners are not allowed to conduct physical examinations ➢ They relied on the patient’s description of symptoms and observations 18th Century ➢ Mechanical techniques and cadaver dissections were used to provide a more objective and accurate diagnosis and to understand the insides of the body. 19th Century ➢ Physicians began using machines for diagnosis or therapeutics and use of chemistry was pivotal (very important) in diagnosis of diabetes, anemia, diphtheria and syphilis ➢ John Hutchinson invented the “spirometer” — measures the vital capacity of the lungs ➢ Jules Herisson invented the “sphygmomanometer” — measures the blood pressure 1969 ➢ 80% of medical professionals were non-physicians ➢ Patients needed to be educated on the tests done to them Timeline: Breakthroughs in Medical Technology 1816 Stethoscope - first diagnostic medical breakthrough - invented by Rene Laennec - used to acquire information about the lungs and heartbeats 1840 Microscope - developed for medical purposes due to advances in lenses and lower costs - first practical microscope was devised by Antonie van Leeuwenhoek 1850 Ophthalmoscope - first visual technology invented by Hermann von Helmholz 1855 Laryngoscope - devised by Manuel Garcia - uses two mirrors to observe the throat and larynx 1859 X-ray - invented by Wilhelm Roentgen - discovered by accident that radiation could penetrate solid objects of low density - can view the insides of the body without surgery - used to diagnose pneumonia, pleurisy, and tuberculosis since WWII 1903 Electrocardiograph - developed by William Einthoven - use to measure electrical changes during the beating of the heart 1910 Kenny Method - serves as the pioneering work for modern physical therapy - devised by Elizabeth Kenny - treatment for polio (called Infantile paralysis) - Sylvia stretcher (invented in 1927 for transporting patients in shock) 1927 Drinker respirator - invented by Philip Drinker - help patients with paralytic anterior poliomyelitis recover normal respiration with the assistance of artificial respirator 1939 Heart-lung machine - first visual technology invented by Hermann von Helmholz 1941 Cardiac catheterization & Angiography - first operated by Forsmann in 1929 - developed by Moniz, Reboul, Rousthoi between 1930 and 1940 - discovered as safe method in humans by Cournand in 1941 - can see the heart, lung vessels, and valves through inserting a cannula in an arm vein and into the heart with an injection of radiopaque dye for X-ray visualization History of CEU - CMT ❖ Established in 1960 ❖ Initiative of the 2nd CEU President (CDL) and University Registrar (GDL) ❖ 1962 - first batch of graduates Deans of the CEU - CMT ❖ 1960-1963 - Ms. Purification Suaco - Organized and monitored the proper implementation of the Medical Technology curriculum ❖ 1963-1969 - Porfirio de Guia, MD - Former University Medical Clinic and the Dean of the College of Liberal Arts - Credited for the steady growth in the enrollment - Responsible for hospital affiliations ❖ 1969-1984 - Velia G. Trinidad, MD - During her term, additional hospital affiliations for the training of the increasing number of interns were established ❖ 1984-1989 - Fe N. Martinez, RMT, PhD - Review class inside CEU was established to monitor closely the students preparations for the board exam ❖ 1989-2006 - Priscilla A. Panlasigui, CLS, PhD - Curriculum enrichments to meet the demand of globalization - 1993 and 2001 (MT Program Accreditation) - Integration of the ff: ❏ EMT ❏ Pharmacology ❏ Cytology ❏ Medical Transcription ❏ Research ❖ 2006 - (Present) Dr. Charito M. Bermido, RMT, PhD - Level III re-accreditation in 2007 - Reforms were made especially in the areas of teaching, research, curriculum, and Board exam review Module 2: Defining the Practice of the Medical Technology Profession Nature of Medical Technology ❖ Designed to improve the detection, diagnosis and treatment of diseases. It has linkages with many other disciplines for specific diagnostic or therapeutic purposes. Medical Technology Practice Defined ❖ Governed and defined in section two (2) of R.A. 5527, also known as the Medical Technology Act of 1969. ❖ Section 2 of the Republic Act, as amended by R.A. 6132, P.D. 498 and P.D. 1534, defines the practice medical technology: ❏ Section 2.a. Practice of Medical Technology - A person shall be deemed to be in the practice of medical technology within the meaning of this Act, who shall for a fee, salary or other compensation or reward paid or given directly or indirectly through another, renders any of the following professional services for the purpose of aiding the physician in the diagnosis, study and treatment of diseases and in the promotion of health in general: 1) Examination of tissues, secretions and excretions of the human body and body fluids by various electronic, chemical, microscopic, bacteriologic, hematologic, serologic, immunologic, nuclear, and other laboratory procedures and techniques either manual or automated; 2) Blood banking procedures and techniques; 3) Parasitologic, Mycologic and Microbiologic procedures and techniques; 4) Histopathologic and Cytotechnology 5) Clinical research involving patients or human beings requiring the use of and/or application of medical technology knowledge and procedures; 6) Preparations and standardization of reagents, standards, stains and others, provided such reagents, standards, stains and others are exclusively for the use of their laboratory; 7) Clinical laboratory quality control; 8) Collection and preservation of specimens; Roles and Responsibilities of Medical Technology Professionals ❖ Perform Clinical Laboratory Testing ❖ Perform Special Procedures ❖ Ensure Accuracy and Precision of Results ❖ Be honest in Practice ❖ Ensure Timely Delivery of Results ❖ Demonstrate Professionalism ❖ Uphold Confidentiality ❖ Collaborate with Other Health Care Professionals ❖ Conduct Research ❖ Involvement in Health Promotion Programs Roles and Responsibilities of Medical Technology Professionals Pathologist ➢ A duly registered physician who is specially trained in methods of laboratory medicine Medical Laboratory Technicians ➢ A person certified by and registered and qualified to assist medical technologist Phlebotomist ➢ An individual trained to draw blood either for laboratory test or for blood donation Cytotechnologist ➢ A laboratory personnel who works with the pathologist to detect changes in body cells which may be important in the early diagnosis of diseases Histotechnologist ➢ Also referred to as “Histotechnician”, a laboratory personnel responsible for the routine preparation, processing, and staining of biopsies and tissue specimens for microscopic examination by a pathologist Nuclear Medical Technologist ➢ A person who works alongside nuclear physicians Toxicologist ➢ Studies the effects of toxic substances on the physiological functions of human beings, animals, and plants to develop data for use in consumer protection and industrial safety programs Module 4: Medical Technology Terminologies and Abbreviations Introduction Medical terminologies, just like any other words, are composed of a root word, a prefix and a suffix. By understanding the meaning of each word part, one can easily describe human body components, medical procedures, and processes. Medical Terminologies ❏ Most medical terms are derived from Greek and Latin words. ❏ A medical term has three parts: root word, prefix and suffix. The root word is the main part of the medical term that denotes the meaning of the word The prefix is found at the beginning of the term and it shows how meaning is assigned to the word. The suffix is found at the terminal portion or at the end of the term. It also denotes the meaning to the root word. Examples: Colo - colon Phlebo - vein Hemat - blood Aero -air Examples: a-/an = without, absence hyper = increased/above poly = many pre = before Examples: Megaly = enlargement Emia = blood Uria = urine Ostomy = to make an opening or mouth Rules to Remember If the suffix starts with consonant, a combining vowel needs to be used (usually the letter O). The combining vowel is added between the root word and the suffix. The plural form of medical term is made by changing the end of the word and not by simply adding S, which follows the rule for irregular nouns. Examples: hemat + logy = hematology - study of blood phlebo + tomy = phlebotomy - the process of cutting into the vein using a needle Examples: Singular → Plural bacterium = bacteria nucleus = nuclei thrombus = thrombi bacillus = bacteria ovum = ova spermatozoon = spermatozoa Number Prefixes Common Prefixes Common Suffixes Bi - two Hemi - half Mono - one Multi - many Nulli - none Poly - many Primi - first Quadri - four Semi - partial, half Tetra - four Tri - three Hetero - different Ex. Heterosexual, Heterozygous Homo - same Ex. Homosexual, Homozygous Hydro - water Ex. Hydrocephalus, Hydrolase Hypo - under, below Ex. Hypodermis In - not, inward Ex. Infertility, Inter - among, between Ex. Interstitial Intra - within, inside Ex. Intramuscular -algia = pain (Spondyalgia, Adominaglia) -cele = hernia, protrusion (Varicocele) -cyte = cell (Monocyte) -dynia = pain (Urodynia) -ectasis = dilatation (Bronchiectasis) -gen = that which produces (Hallucinogen) -genesis = produces, generates (Osteogenesis) -genic = producing, produced by (Carcinogenic) ABBREVIATIONS A AABB ACE ADH AFP AHG AIDS ANA ANCA ARF ASO American Association of Blood Banks Angiotensin converting enzyme Antidiuretic hormone Alpha-fetoprotein Antihuman globulin Acquired immunodeficiency syndrome Antinuclear antibody Antineutrophilic cytoplasmic antibody Acute renal failure Antistreptolysin O B BUN Blood urea nitrogen C CDC CEA CNS COC CSF CV Centers for Disease Control and Prevention Carcinoembryonic antigen Central nervous system Chain of custody Cerebrospinal fluid Coefficient of variation D DCT Distal convoluted tubule E EDTA Ethylenediaminetetracetic acid ELISA Enzyme-linked immunoabsorbent assay F FDA FISH FLM FOBT FTA-ABS Food and Drug Administration Fluorescence in situ hybridization Fetal lung maturity Fecal occult blood testing Fluoresent treponemal antibody-absorption G GFR GI GTT Glomerular filtration rate Gastrointestinal Glucose tolerance test H Hb HBV hCG HCO3 HDN HIV hpf Hemoglobin Hepatitis B virus Human chorionic gonadotropin Bicarbonate ion Hemolytic disease of the newborn Human immunodeficiency virus High-power field I IBS IgA IgG IgM IVF Irritable bowel syndrome Immunoglobulin A Immunoglobulin G Immunoglobulin M In vitro fertilization J K L LD LED LIS lpf L/S Lactate dehydrogenase Light-emitting diode Laboratory information system Low-power field Lecithin-sphingomyelin ratio M MS MSDS Mass spectrophotometry Material Safety Data Sheet N NaCl NRBC Sodium chloride Nucleated red blood cell O P PBS PCT PKU PPE Peripheral blood smear Proximal convoluted tubule Phenylketonuria Personal protective equipment Q QA QC Quality assurance Quality control Professional Courses ❏ Professional courses are taken for learners develop the knowledge, technical competence, professional attitude and values necessary to practice and meet the demands of the profession ❏ Critical thinking skills, decision-making skills, interpersonal skills, collaboration and teamwork are also developed ❏ Some of the Professional courses are: ❏ Principles of Medical Laboratory Science 1: Introduction to Medical Laboratory Science, Laboratory safety and Waste Management ❏ Principles of Medical Laboratory Science 2: Clinical Laboratory Assistance and Phlebotomy ❏ Community and Public Health for MT/MLS ❏ Cytogenetics ❏ Human Histology ❏ Principles of Medical Laboratory Science 1: Introduction to Medical Laboratory Science, Laboratory safety and Waste Management ❏ Principles of Medical Laboratory Science 2: Clinical Laboratory Assistance and Phlebotomy ❏ Community and Public Health for MT/MLS ❏ Cytogenetics ❏ Human Histology ❏ Histopathologic Techniques with Cytology ❏ Clinical Bacteriology ❏ Clinical Parasitology ❏ Immunohematology and Blood Bank ❏ Mycology and Virology ❏ Laboratory Management ❏ Medical Technology Laws and Bioethics ❏ Hematology 1 ❏ Hematology 2 ❏ Clinical Microscopy ❏ Clinical Chemistry 1 ❏ Clinical Chemistry 2 ❏ Seminars 1 and 2 ❏ Molecular Biology and Diagnostics Research Courses ❏ Research 1: Introduction to Laboratory Science Research ❏ Research 2: Research Paper Writing and Presentation ❏ Clinical Internship Training ❏ The intern is required to render 32 hours of duty per week not exceeding a total of 1,664 hours in One Year. Licensure Examination ❏ The Medical Technology Licensure Examination is conducted in order to identify graduates who possess the basic or minimum conceptual skills and technical competencies to perform with minimum errors ❏ The Professional Regulation Commission is tasked to administer licensure examinations to different professionals ❏ The Professional Regulatory Board for MT/MLS under PRC is tasked to prepare and administer the written licensure examinations Programs Goals and Learning Outcomes ❏ Demonstrate knowledge and technical skills needed to correctly perform laboratory testing and ensure reliability of test results ❏ Be endowed with the professional attitude and values enabling them to work with their colleagues and other members of the health care delivery system ❏ Demonstrate critical thinking and problem solving skills when confronted with situations, problems and conflicts in the practice of their profession ❏ Actively participate in self-directed life-long learning activities to be updated with the current trends in the profession ❏ Actively participate in research and community-oriented activities ❏ Be endowed with leadership skills ❏ Demonstrate collaboration, teamwork, integrity and respect when working in a multicultural environment Assessment ❏ Involves a planned, systematic and organized ways of testing, measuring, collecting and obtaining necessary information to gain feedback on student’s progress Types of Assessment ❏ Formative Assessment ❏ Summative Assessment ❏ Diagnostic Assessment Assessment tools ❏ Teacher-made written tests ❏ Reflection papers ❏ Portfolios ❏ Performance tasks ❏ Oral examinations and Presentations ❏ Rubrics Job Opportunities for the Graduate of the Program ❏ Medical Technologist ❏ Researcher/ research scientist ❏ Member of academe ❏ Molecular scientist ❏ Diagnostic Product Specialist ❏ Public Health Practitioner ❏ Health Care Leader Module 6: Basic Concepts on Laboratory Biosafety and Biosecurity Introduction Biosafety is the prevention of potential exposure of the laboratory worker, persons outside of the laboratory, and the environment to potentially infectious agents or biohazards. Laboratory biosecurity describes the protection, control and accountability for valuable biological materials within laboratories, in order to prevent their unauthorized access, loss, theft, misuse, diversion or intentional release. Brief History of Laboratory Biosafety ➢ Rooted in the US biological weapons program which began in 1943 as ordered by then US President Franklin Roosevelt and was active during the Cold War. ➢ In 1943, Ira L. Baldwin became the first scientific director of Camp Detrick (Fort Detrick) and was tasked with establishing the biological weapons program for defensive purposes. ➢ Eventually terminated by US President Richard Nixon in 1969. ➢ After Second World War, Camp Detrick was designated a permanent installation for biological research and development ➢ Newell A. Johnson designed modifications for biosafety at Camp Detrick ( Class III safety cabinets and laminar flow hoods) ➢ In 1984, formation of the American Biological Safety Association(ABSA) ➢ Arnold Wedum described the use of mechanical pipettors to prevent laboratory-acquired infections in 1907 and 1908. ➢ In 1909, a pharmaceutical company in Pennsylvania developed a ventilated cabinet to precent infection from Mycobacterium tuberculosis. ❏ BIOLOGICAL AGENTS: ❖ Human Immunodeficiency Virus ❖ Hepatitis B Virus ❖ Bacillus anthracis ❖ Yersinia pestis ❖ Salmonella spp. ❖ Toxoplasma spp. Biosafety Level 3 ❏ Exotic or indigenous organisms ❏ AEROSOL transmission ❏ POTENTIALLY lethal ❏ BSC II or higher plus an ANTE room/changing room ❏ BIOLOGICAL AGENTS: ❖ Mycobacterium tuberculosis ❖ Systemic Fungi (molds) ❖ Francisella tularensis ❖ Brucella spp. ❖ St. Louis Encephalitis virus ❖ Coxiella burnetii Biosafety Level 4 ❏ Dangerous, exotic or newly classified organism ❏ AEROSOL or unknown MOT ❏ LETHAL ❏ Highly trained technologists, SHOWER room and NON-RECIRCULATING ventilation system, BSC III, Positive pressure suit, LAB IS ISOLATED FROM THE INSTITUTION ❏ BIOLOGICAL AGENTS: ❖ Marburg and Congo Crimean ❖ Hemorrhagic Fever Viruses ❖ Arbovirus ❖ Arenavirus ❖ Filovirus ❖ Smallpox virus Module 7: Biorisk Management Introduction Biorisk management is the effective management of risks posed by working with infectious agents and toxins in laboratories. It includes a range of practices and procedures to ensure the biosecurity, biosafety, and biocontainment of those infectious agents and toxins. Biorisk Management and the AMP Model ➢ BIORISK MANAGEMENT (BRM) is a system or process to control safety and security risks associated with the handling or storage and disposal of biological agents and toxins in laboratories and facilities. ➢ (3) primary components: Assessment, Mitigation and Performance (AMP) ❏ Three Questions Asked: 1. What are the risks? 2. How can I reduce (mitigate) the level of risk? 3. How can I confirm that I have actually reduced the level of risk? ❏ Hazard - any object which can cause harm. ❏ Threat - is a person who has an intent or ability to cause harm to other people, animals, or the institution. ❏ Risk - can be based on either a hazard and or a threat. ❏ Biological hazard - biological agents (can be) potential hazards. ❏ Difference between Hazard and Risk: 1. Hazard - a biological agent may constitute a hazard. 2. Risk - working with a biological agent poses a risk. Concept of Containment ➢ Primary - protects the workers ➢ Secondary - protects the environment ❏ Controls that protect the worker: 1. Laboratory coat (PPE) 2. Gloves (PPE) 3. Mask (PPE) 4. Eyewear (PPE) 5. PAPR (PPE) 6. Biosafety cabinet (EC) 7. SOPs for Donning and Doffing (AC) ❏ Controls that protect the environment: 1. HEPA filters (EC) 2. SOPs for transport of biological agents (AC) 3. Effluent Decontamination System (EC) 4. HVAC System (EC) 5. Periodic Maintenance (EC) 6. SOPs for waste disposal (AC) Structured Risk Assessment - Is based on breaking down any process into Individual Operations. Key Components of Biorisk Management Risk Assessment ➢ Initial step in implementing a biorisk management process ➢ Process of identifying the hazards and evaluating the risks associated with biological agents and toxins, taking into account the adequacy of any existing controls, and deciding whether or not the risks are acceptable Steps in performing risk assessment: 1. Define the situation 2. Define the risks 3. Characterize the risks 4. Determine if risks are acceptable or not Mitigation Procedure ➢ Second fundamental component of the biorisk management model ➢ Actions and control measures that are put into place to reduce or eliminate the risks associated with biological agents and toxins ➢ There are five major areas of control or measures that can be employed in mitigating risk: Elimination, Substitution, Engineering Controls, Administrative controls, Personal Protective Equipments (PPEs) Risk Mitigation Procedure: Hierarchy of Controls (ESEAP) Elimination - can the hazard be eliminated? - total decision not to work with a specific biological agent or not doing the intended work Substitution - can the hazard be substituted by adopting an alternate strategy? - replacement of procedures or biological agent with similar entity Engineering Controls - can the specific engineering controls be put into place? - physical changes in work stations, equipment or relevant work environment According to Institutional Characteristic Institutional-based ➢ Clinical laboratory that operates within the premises or part of an institution. Free-standing ➢ Clinical laboratory that is not a part of an established institution. According to Ownership Government-owned ➢ Clinical laboratories are owned, wholly or partially, by national or local government units Anatomic Pathology ➢ Clinical laboratories are owned, established and operated by an individual, corporation, institution, association or organization According to Service Capability 1. Primary Category – services rendered include routine hematology, urinalysis, fecalysis, and Gram staining. 2. Secondary Category – services rendered include those of the Primary Category plus routine chemistry, blood typing, and crossmatching. 3. Tertiary Category – services rendered include those of the Primary and Secondary Categories plus donor selection and blood collection, special chemistry, and special hematology procedures. 4. National Reference Laboratory- government hospital designated by the DOH to provide certain special diagnostic functions and services for certain diseases Laws on the Operation, Maintenance and Registration of Clinical Laboratories in the Philippines Republic Act 4688: “An Act Regulating the Operation and Maintenance of Clinical Laboratories and Requiring the Registration of the Same with the Department of Health, Providing Penalty for the Violation Thereof, and for Other Purposes” Administrative Order No. 59 s. 2001: “Rules and Regulations Governing the Establishment, Operation and Maintenance of Clinical Laboratories in the Philippines.” Quality Assurance in the Clinical Laboratory Quality Assurance ➢ Encompasses all activities performed by a laboratory personnel to ensure reliability of test results ➢ It is organized, systematic, well-planned and regularly done with the results properly documented and consistently reviewed ➢ Major components: Internal Quality Assurance System (IQAS) and External Quality Assurance System (EQAS) Module 9: Professional Organizations Introduction To fully enjoy the benefits and privileges of being a registered medical technologist, you can be a member of an organization such as PAMET, the legitimate national organization of all registered Medical Technologists in the Philippines. Another organization related to Medical Technologists is the PASMETH, that serves as the national organization of all recognized schools offering Medical Technology in the Philippines. However, PASMETH also created an organization for the students of the said course known as PHISMETS, that serves as a transforming venue for the integral and holistic development of Medical Technology or Medical Laboratory Science students. Professional Organizations ➢ Assemblages of profession within a particular specialization or professional field ➢ Provides opportunities for professional growth and continuing education by offering workshops, trainings and seminars and by publishing research journals Types of Professional Organization Accrediting Organization ➢ Accredits curricular programs in educational institutions ❏ Example: PAASCU and PACUCOA Credentialing/ Certifying Organizations ➢ Provides certification examinations for professionals ❏ Example: AMT, ASCP, ISCLT, NCA Professional Societies ➢ Organizations that contribute to the continued development of a specific group of professionals ❏ Example: PAMET, ASCP Professional Journals ➢ Publications containing scholarly studies on specific professional fields ➢ Normally prepared by professionals in the field and are peer-reviewed by experts Example: ❏ Philippine Journal of Medical Technology ❏ Asia-Pacific Journal of Medical Laboratory Science ❏ International Journal of Science and Clinical Laboratory ❏ Laboratory Medicine PAMET ➢ The national professional organization of Registered Medical Technology in the Philippines ➢ It is non-stock, non-profit organization ➢ It was founded on September 15, 1963 through Crisanto G. Almario “Father of PAMET” at the Public Health Laboratory ➢ Organized it first national convention and election of officers on September 20,1964 at the Far Eastern University PAMET INSIGNIAS ➢ Circle - symbolizes the continuous involvement where practice and education must always be integrated ➢ Triangle - is the trilogy of love, respect and integrity ➢ Microscope & Snake-symbolize the science of Medical Technology profession ➢ Green- the color of health ➢ 1964- the year of first PAMET election Roster of President and their Contributions 1. Mr. Charlemagne Tamondong (1963-1967) ❏ House Bill No. 7682 ❏ Later enacted into law as Republic Act No. 5527, otherwise known as Philippine Medical Technology Act on June 21, 1969. 2. Mr. Nardito D. Moraleta (1967-1970) ❏ PAMET was registered with the Security Exchange commission on Oct. 14, 1969. ❏ Registration of PAMET to ASEAN Association of Medical Laboratory Technologists (AAMLT) 3. Mr. Felix Asprer (1970-1971 and 1973-1977) ❏ Approval of PD no. 498, an amendment of RA no. 5527 ❏ Accreditation of PAMET by PRC citing it as the professional organization of medical technologists (July 15, 1975) 4. Mr. Bernardo Tabaosares (1971-1973) ❏ 3rd week of September was declared the Medical Technology week 5. Ms. Angelina R. Jose 
(Jan. 1973-Sept. 1973) ❏ The 1st lady president of the association with the shortest term of office ❏ Approval of the Professional Tax of all registered medical technologists which amounted to seventy pesos (P70.00) yearly. The CPD Process ➢ Each professional has its own CPD Council composed of: ❏ A member from the Professional Regulatory Board as chair ❏ The president or officer of the Professional Organization (PAMET) as first member ❏ The president or officer of the national organization of deans or department chairpersons of school, colleges and universities (PASMETH) as second member ➢ CPD Providers need to apply their respective programs to the CPD Council at least 45 days prior to the conduct of the CPD activity. The CPD Council will evaluate the proposed activity and designate the number of units to be assigned to it. The CPD Process Example of CPD providers for medical technologists: ❏ Asian Hospital ❏ Bicol Sanitarium ❏ Centro Escolar University- College of Medical Technology ❏ Philippine Association of Medical Technologists, Inc. (PAMET) ❏ Research Institute of Tropical Medicine (RITM) Module 11: Health Care Waste Management Introduction Waste disposal is a huge issue here in the Philippines. These materials are considered hazardous to people's environmental health and issue. Hospital and clinical wastes are considered more dangerous than most ordinary garbage. In compliance with this issue, strict maintenance policies are adopted for waste disposal and management. Health Care Waste ➢ All solid or liquid waste generated by any of the following activities: ➢ Diagnosis, Treatment and Immunizations of humans; ➢ Research Pertaining to diagnosis, treatment and immunization of humans; ➢ Research using laboratory animals geared towards improvement of human health; ➢ Production and testing of biological products; ➢ Other activities performed by a health care facility that generates waste Categories of Health Care Waste 1. Infectious waste 2. Pathological and Anatomical waste 3. Sharps 4. Chemical Waste 5. Pharmaceutical Waste 6. Radioactive Waste 7. Non-Hazardous or General Waste Categories of Health Care Wastes Infectious Waste ➢ All waste suspected to contain pathogens or toxins that may cause disease to susceptible host and also includes discarded materials or equipment used for diagnosis, treatment and management of patient with infectious diseases Examples: ❏ Discarded microbial cultures ❏ Solid waste with infections (dressings, sputum cups, urine containers and blood bags) ❏ Liquid wastes with infection (blood, urine, vomitus and other body secretions ❏ Food wastes (liquid or solid) coming from patients with highly infectious diseases Pathological and Anatomical Waste ➢ Refers to tissue sections and body fluids or organs derived from biopsies, autopsies or surgical procedures sent to the laboratory for examination ➢ Anatomical waste is a subgroup of pathological waste that refers to recognizable body parts usually from amputation procedures Example: ❏ Internal organs and tissues used for histopathological examination Sharps ➢ Refers to waste items that can cause cuts, pricks or puncture wounds ➢ Considered most dangerous health care waste cause both injury and infection Examples: ❏ Syringes in phlebotomy ❏ Blood lancets ❏ Surgical knives ❏ Broken glasswares Chemical Waste ➢ Refers to discarded chemical (solid, liquid or gaseous) generated during disinfection and sterilization procedures and also includes waste with high content of heavy metals and their derivatives Examples: ❏ Laboratory Reagents ❏ X-ray film developing solutions ❏ Disinfectants and Soaking Solutions ❏ Used batteries ❏ Conc. Ammonia solutions ❏ Conc. Hydrogen Peroxide ❏ Chlorine ❏ Mercury from broken thermometers and sphygmomanometer ❏ Chemicals are considered hazardous when they are: ❏ Toxic (with health and environmental hazards) ❏ Corrosive (Acid of pH < 2.0 and bases of pH >12.0) ❏ Flammable (with a flash point below 60°C) ❏ Reactive (explosive with water) Pharmaceutical Waste ➢ Refers to expired, spilt, and contaminated pharmaceutical products, drugs, vaccines including discarded items used in handling pharmaceuticals. ➢ Includes antineoplastic, cytotoxic and genotoxic waste (drugs used in oncology or radiotherapy and biological fluids from patients treated with the said drugs Examples: ❏ Empty drug vials ❏ Medicine bottles containers of cytotoxic drugs (including materials used in preparation and administration) Radioactive Waste ➢ Refers to waste exposed to radionuclides including radioactive diagnostic materials or radiotherapeutic materials Examples ❏ Cobalt (Co 90) ❏ Technetium (99 Tc) ❏ Iodine (131 I) ❏ Iridium (192 Ir) ❏ Irradiated blood products ❏ All materials used by patients exposed to radionuclides within 48 hrs Non- Hazardous or General Waste ➢ Refers to waste that have not been in contact with communicable or infectious agents, hazardous chemicals or radioactive substances and do not pose a hazard ➢ Further classified: Recyclable Waste, Biodegradable waste and Non-recyclable/ non-biodegradable waste Examples: ❏ Plastic bottles ❏ Used paper products ❏ Office waste ❏ Scrap wood ❏ Food waste from non-infectious patients Legislation, Policies, and Guidelines Governing Health Care Waste International Agreements Pertaining to Health Care Waste Management 1. The Montreal Protocol on Substances that Deplete the Ozone Layer (1987) ❏ Adopted in Montreal, Canada on September 16, 1987 and came into force as agreed upon January 1, 1989 ❏ The Manual does not include provisions regarding the management of nuclear waste and composed of ten sections that discuss: 1. Classification of hazardous wastes 2. Waste generators 3. Waste Transporters 4. Storage and labelling 5. Treatment, Storage and Disposal (TSD) Facilities 6. Manifest system 7. Monitoring 8. Prohibited Acts 9. Schedule of fees 10. Import of recyclable materials containing hazardous substances and export of hazardous waste b. DOH - DENR Joint Administrative Order No. 02 series of 2005 dated August 24, 2005 “Policies and Guidelines on Effective and Proper Handling, Collection, Transport, Treatment, Storage and Disposal of HCW” Aims to: ❏ Provide guidelines to generators, transporters, and operators/owners of TSD Facilities on the proper handling, collection, transport, storage, treatment and disposal of Health Care Wastes (HCW) ❏ Clarify jurisdiction, authority and responsibility of DENR and DOH regard to health care waste management (HCWM) ❏ Harmonize the efforts of DENR and DOH on HCWM c. DOH Administrative Order 2007-0014 “Guidelines on the Issuance of Certificate of Product Registration for Equipment or Devices Used for Treating Sharps, Pathological and Infectious Waste” ❏ Requires the manufacturers, importers, and distributors including generators of HCW that sell and/or use equipment and devices treating sharps, pathological and infectious waste to secure a Certificate of Product Registration (CPR) from DOH through the Bureau of Health Devices and Technology 3. Republic Act No. 8749 “The Philippine Clean Air Act of 1999) ➢ Prohibits the incineration of bio-medical waste effective July 17, 2003 ➢ Promotes the use of state-of-the-art, environmentally-sound and safe non-burn technologies for handling, thermal destruction, utilization and disposal of sorted, unrecycled, biomedical and hazardous wastes 4. Republic Act No. 9003 “Ecological Solid Waste Management Act of 2000” ➢ Mandates the segregation of solid wastes at the sources including households and institutions like hospitals by using a separate container for each type of waste 5. Republic Act No. 9275 “The Philippine Clean Water Act of 2004” ➢ Pursues a policy of economic growth in a manner consistent with the protection, preservation and revival of the quality of the country’s fresh, brackish and marine waters 6. Presidential Decree 813 (1975) and Executive Order 927 (1983) “Strengthening the Functions of Laguna Lake Development Authority (LLDA)” ➢ Further strengthens the power and functions of LLDA to include environmental protection and jurisdiction over surface waters of the Laguna Lake basin ➢ Through E.O 927, LLDA is empowered to issue permits for the use of the surface waters within Laguna de Bay 7. Presidential Decree 856 “The Code on Sanitation of the Philippines- Chapter XVII on Sewage Collection and Excreta Disposal” (1998) ➢ Requires the approval of DOH in term of the following: a. Constructions of any type of toilet in every house and community which may be allowed for a group of small houses of light material or temporary in nature b. Plans of individual sewage or sewage system and the sub-surface absorption system or other treatment c. Location of any toilet or sewage disposal system in relation to a source of water supply d. Discharge of untreated effluent from septic tanks and/or sewage treatment plants to bodies of water e. Manufacture of Septic Tanks f. Method of disposal of sludge from septic tanks or other treatment plants A. Rules and Regulations Governing the Collection, Handling, Treatment and Disposal of Domestic Sludge and Septage (2004), a “Supplement to IRR of the Chapter XVII on Sewage Collection and Disposal and Excreta Disposal and Drainage of 1998” ❏ Require individuals, firms, public and private operators, owners and administrators engaged in desludging, collection, handling and transport, treatment and disposal of domestic sewage treatment plants/ facilities and septage from house septic tanks to secure environmental sanitation clearances from DOH B. Chapter XVIII of P.D 856 “The Code of Sanitation of the Philippines” on Refuse Disposal (1998) ❏ Require cities and municipalities to provide an adequate and efficient system of collecting, transporting and disposing refuse in their areas of jurisdiction ❏ Also require occupants of buildings, institution such as hospitals and residences to provide sufficient number of receptacles for refuse C. Operation Manual on the Rules and Regulations Governing Domestic Sludge and Septage (June 2008) ❏ Provides detailed procedures and forms which need to comply with the IRR governing the collection, handling, transport, treatment, and disposal of domestic sludge and septage ❏ Designed to guide private and public service providers as well as government regulators towards effective sludge and septage management program in the country D. A.O 2010-0033 “Revised Implementing Rules and Regulations of P.D 856 Code on Sanitation of the Philippines, Chapter XXI on Disposal of Dead Persons” (December 2010) ❏ Implemented a new restriction on open viewing of remains when the individual’s death was caused by certain communicable disease ❏ Explicitly States, “The remains shall be placed in a plastic cadaver bag or other durable airtight container at the point of death and a biohazard tag attached, provided that, this container shall not be opened for viewing or any other purpose prior to burial or cremation 8. Presidential Decree 984 “Providing for the Revision of R.A 3931, Commonly known as the Pollution Control Law and for Other Purposes” (1976) ❏ Governs the discharge of potentially polluting substances to air and water ❏ Provides basis for the DENR regulations on water pollution through its IRR, DENR A.O Nos 34 and 35 ❏ The IRR for air emission was initially set by DENR A.O No 14 but was later replaced by Clean Air Act of 1999 (R.A 8749) A. DENR Administrative Order No. 34 series of 1990 “Revised Water Usage and Classification/ Water Quality Criteria Amending Sections No. 68 and 69, Chapter III of the 1978 National Pollution Control Commission (NPC now EMB) Rules and Regulations” ❏ Classified bodies of water according to their designated uses and did not preclude use of the bodies of water for other purposes that are lower than the classification provided that such use does not prejudice quality required for such waters B. DENR Administrative Order No. 35 series of 1990 “Effluent Regulations” ❏ Lists their effluent regulations for the different levels of pollutants according to their water category/class C. DENR Administrative Order No. 26 series of 1992 “Amending Memorandum Circular No. 2 series of 1981: Appointment/ Designation of Pollution Control Officers” ❏ Requires the appointment/ designation of a Pollution Control Officer (PCO) and lists the qualifications, reporting requirements and duties and responsibilities of accredited PCOs. 9. Presidential Decree No. 1586 “Environmental Impact Statement (EIS) System” (1978) ❏ •Requires projects like construction of new hospital building or expansion of existing hospitals to secure an Environmental Compliance Commitment (formerly Environmental Compliance) Certificate (ECC) prior to the construction and operation of the facility ❏ • An ECC is required for the installation and operation of HCW treatment like pyrolysis, autoclave, microwave and other treatment technology including landfills 2. Waste Disposal- refers to discharging, depositing, or releasing any health care waste into air, land or water. Not all type of wastes require treatment Segregation, Collection, Storage and Transport of Health Care Wastes ➢ HCF are tasked to ensure that generated wastes are properly and safely managed ➢ HCW must be segregated, collected, stored and transported while considering risk and occupational safety and compliance with existing laws, policies and guidelines ➢ Segregation - process of separating different types of waste at the point of generation until their final disposal ➢ Color coding - to make it easier for personnel in a HCF to put waste in correct bins and maintain segregation during collection, storage, transport, treatment and disposal Guidelines for the proper labelling, marking and color coding for waste segregation in health care facilities Infectious Waste ❏ BIN Strong leak-proof bin with cover labelled “infectious” with biohazard symbol ❏ LINER Yellow plastic that can withstand autoclaving with 0.009mm thickness and labelled “Infectious Waste” with a tag indicating source and weight of waste and date of collection; may or may not have a biohazard symbol Pathological and Anatomical Wastes ❏ BIN Strong leak-proof bin with cover labelled “Pathological/Anatomical Waste” with biohazard symbol ❏ LINER Yellow plastic that can withstand autoclaving with 0.009mm thickness and labelled “Pathological/Anatomical Waste” with a tag indicating source and weight of waste and date of collection. Biohazard symbol is optional Sharps ❏ BIN Puncture-proof container with wide mouth and cover labelled “Sharps” ❏ LINER Not applicable Chemical Waste ❏ BIN Labelled “Chemical Waste”; For Liquid Waste, inside the bin is a disposal bottle made of amber-colored glass with at least 4 liters capacity that is strong, chemical-resistant and leak proof ❏ LINER Yellow with black band plastic with 0.009mm thickness and labelled “Chemical Waste” with a tag indicating source and weight of waste and date of collection Pharmaceutical Waste ❏ BIN Strong leak-proof bin with cover labelled “Pharmaceutical Waste” for expired drugs and drug containers and “Cytotoxic Waste” for cytotoxic, genotoxic and anti-neoplastic waste ❏ LINER Yellow with black band plastic with 0.009mm thickness and labelled “Pharmaceutical Waste” with a tag indicating source and weight of waste and date of collection Radioactive Waste ❏ BIN Radiation proof repositories, leak-proof and lead-lined container labelled with the name of radionuclide and date of deposition with radioactive symbol ❏ LINER Orange plastic with 0.009mm thickness and labelled “Radioactive” with a tag indicating name of radionuclide and date of collection General Waste ❏ BIN Optional recycle symbol for recyclable non-hazardous waste; varying sizes depending on the volume of waste ❏ LINER Black or colorless plastic for non-biodegradable and green for biodegradable with a thickness of 0.009mm with a tag indicating source, weight of waste and date of collection In the implementation of a color-coding system for HCW, the following practices should be observed: 1. Highly infectious waste must be disinfected at source 2. Anatomical Waste including recognizable body parts, placenta waste and organs should be disposed through safe burial or cremation 3. Pathological waste must be refrigerated if not collected or treated within 24 hours 4. Sharps must be shredded or crushed before they are transported to the landfill 5. Chemical and pharmaceutical wastes shall be segregated and collected separately 6. Radioactive waste has to be decayed to background radiation levels 7. All waste bins must be properly covered to prevent cross contamination 8. Aerosol containers can be collected with the general waste Treatment and Disposal of Health Care Waste ➢ Proper Waste Treatment to ensure that HCW do not pose harm to people and environment ➢ HCW can be decontaminated either by sterilization and disinfection ➢ Sterilization kills all microorganism while Disinfection reduces the level of microorganisms present in the material Methods Used in Treatment of HCW 1. Pyrolysis - thermal decomposition of HCW in the absence of supplied molecular oxygen in the destruction chamber where waste is converted to gaseous, liquid or solid form. 2. Autoclave - use of steam sterilization using pressure and heat (121°C in 15 psi for 15 to 30 mins) 3. Microwave - typically incorporates type of size reduction device (100°C or 237°F for at least 30 minutes) 4. Chemical disinfection - chemical like sodium hypochlorite, hydrogen peroxide, peroxyacetic acid and heated alkali are added to HCW to kill or inactivate present pathogens (generates chemical wastes from used chemical disinfectants) 5. Biological Process - uses enzyme mixture to decontaminate 6. Encapsulation - involves the filling of containers with waste, adding and immobilizing material and sealing the containers 7. Inertization - suitable for pharmaceutical waste that involves the mixing of waste with cement and other substances before disposal 8. After treatment, HCW are usually disposed of in landfills. Landfills is an engineered site designed to keep waste isolated from environment