HCWH’s FERRER praises the four government hospitals her group included in its documentation project for being able to employ alternative systems to minimize, manage, and dispose of their waste, while remaining faithful to DOH requirements. But she is particularly delighted at the various ways these hospitals are making the most out of their recyclable and reusable wastes that have in turn become effective income-generating activities.

At the 301-bed Heart Center in Quezon City, for example, Borja reports that last year, they were able to earn P642,000 from the sale of scrap paper, plastics, wood, and metals (including old elevator parts), up from just P156,000 the previous year. And in the first five months of 2007 alone, she says they had already earned P377,000 from selling recyclable trash.

	THE Philippine Heart Center's infectious waste storage area located at the back of the hospital. [photo by Mira Mendoza]

The waste trade is part of the “Trash to Treasure” program of the WMC, which was set up in 2001 to monitor and implement proper waste segregation and disposal practices through approved hospital and government guidelines. The income generated from the trash sales are then used to fund additional operating expenses of the hospital, which treats an average of 10,000 in-patients and 73,000 out-patients every year.

That’s not all. Out of the discarded empty cans of soda, milk, and nutritional supplements that Borja's committee is able to collect, the hospital gets to have wheelchairs for physically handicapped patients. This is made possible by an arrangement between the PHC and the Tahanang Walang Hagdanan Foundation, which fabricates wheelchairs out of recycled tin scraps. According to Borja (who is actually the head of the Heart Center’s Auxiliary Services Department), 220 kilograms of tin scraps can produce one wheelchair.

Even the hospital’s Christmas decorations have been made in the green spirit by the hospital’s very own nurses, who used recycled materials.

Over at the PCMC, a 200-bed government hospital in Quezon City that specializes in pediatric care, waste segregation has not only allowed the hospital to earn from recyclable non-biodegradable wastes, but also from food discards that are sold to piggery owners. (The discards do not include those from the communicable unit that goes to the infectious waste bin.)

In 2004, it reported earnings of about P12,000 from the sale of dietary slops alone. For the staff's waste segregation efforts, a profit-sharing scheme has been put in place so those directly involved could receive incentives, particularly for the sale of food wastes.

“Recycling and reuse have physically reduced our waste by 30 percent,” says Jara Corazon Ejera, deputy director of the hospital's support services who worked in tandem with Dr. Corazon Rivera, who was the Waste Management Committee head until she retired last April.

Even with Rivera's departure, Ejera says they have not made any deviations from their usual practices, except in the case of the disposal of disposable diapers, which they used to regularly compost. They had to abandon that practice, however, after erroneous media reports accused them of burying infectious waste within the hospital compound. Remarks Ejera: “What people don't know is that 60 percent of what makes up disposable diapers is compostable. The plastic portion is the only thing disposed.”

	SPACIOUS storage facility for recyclables at the San Lazaro Hospital. [photo courtesy of HCWH]

For a smaller hospital like Ospital ng Muntinlupa, which has limited financial resources, the sale of recyclable materials like newspapers, ink cartridges, aluminum cans, and plastic bottles has helped augment its waste management budget. The revenue is in fact covering the expenses of the housekeeping department, primarily for emergency purchases of supplies such as cleaning agents, additional trash bins, and doormats.

Built in 2001 and originally managed by a foundation, the 149-bed capacity hospital was turned over to the city government in April 2006. The transition from private to public operation, including abiding by the government procurement process, has proved challenging to the hospital administration and staff. But this has not deterred them from instituting a cost-efficient and resourceful waste management system that has even produced role models like Landré Jebone, housekeeping officer-in-charge who was recently awarded as “Huwarang Lider ng Muntinlupa” for waste management.

The 900-bed capacity San Lazaro Hospital, meanwhile, is demonstrating how waste management is possible on a large scale. The hospital, the DOH-designated referral center for infectious diseases, even has its own healthcare-waste management manual, based on the standards set by the health department, crafted by its Waste Management Committee.

THE STRENGTH of San Lazaro’s waste-management system lies in part in its training program. Hospital staff get regular waste management training for five days every quarter, during which they not only listen to lectures on proper waste handling, but are taken to ecological tours of landfills and waste treatment facilities. After completing the training course, selected participants are trained further as future trainers or facilitators.

Basic waste management principles FIRST, conduct an assessment of the volume, type, and source of waste. At the administrative level, set clear rules and policies to guide and encourage the staff to handle waste properly. Set up a Waste Management Committee that would establish baseline data and develop the facility’s health care waste management plan which should include a minimization plan, training, and written guidelines on waste management. Employ waste minimization strategies to reduce the quantity of health care wastes, so that the ultimate goal of safely and properly disposing infectious and hazardous wastes can be achieved even without incineration. Health Care Without Harm

As for the Heart Center, the HCWH says in its report that the key to its success is the “strong leadership of a very visible waste management committee” which has gained the active support of the hospital administration and most, if not all, of its 1,800 staff in implementing its waste management programs. This in turn has helped the hospital’s dedicated WMC to minimize waste to the lowest level possible. But one of its notable practices is the way it monitors infectious waste generated by each nursing unit, from both the staff and patients. A monthly bar chart is drawn to observe the trend in the volume of infectious waste produced. The unit that has the highest volume of wastes is then invited to attend the WMC’s meeting for clarification and recommendations on how to reduce waste.

“Similarly, the unit and the staff (that) have shown efforts to reduce their wastes through proper segregation are given a letter of appreciation in recognition of their support,” says Borja, happy to announce that last year's recipients of the special citation were the Operating Room and Renal Division.

Aside from the bar graph, compliance is also monitored through surprise waste bin inspections by WMC members. “If necessary, pictures will be taken and these will be shown as video materials during employee/patient orientation programs,” says Borja. Should admitted patients miss any session on the standard operating procedures arranged by the nursing staff, they are given on-the-spot instructions during inspection by the committee.

Some healthcare industry insiders estimate that of the total waste generated by local hospitals, only 10 percent is infectious waste. But aside from the fact that such waste can pose serious health and environmental risks, the special attention given to it by the Heart Center’s WMC is also because the hospital has to pay a service waste treatment provider, Chevalier Enviro Services Inc., between P20 to P25 per kilogram of pathogenic or infectious wastes. Big hospitals like the Heart Center generate some 200 kg to 400 kg of these kinds of waste per day, which means the PHC could be paying Chevalier a low of P1.4 million per year to a high of P3.65 million.

Yet precisely because of the potential hazards posed by infectious wastes, Borja says the WMC’s work does not end after the hospital has turned over its infectious wastes to Chevalier, as it continues to monitor their transport and off-site treatment by the private service contractor.

“The 'cradle-to-grave' responsibility of the hospital is assumed from the time the infectious wastes are generated, collected from the hospital, treated at the plant, and disposed to its landfill,” insists Borja.

As such, the committee requires Chevalier to submit permits, clearances, certificates of compliance, technology performance/efficiency tests, and other pollution-control requirements for inspection and validation. The waste treater is also required to attend monthly WMC meetings whenever there is a report of non-compliance from both parties.

For sure, there are still some lapses in waste management, due mainly to budgetary constraints, even among the PHC and the three hospitals that agreed to be part of HCWH’s documentation project. But Ferrer says of the four exemplary hospitals, “By taking part in the study, they did not only take steps to better their own facilities and share what they knew, they also showed how hospitals should be at the forefront of promoting proper waste management. We hope other hospitals would take the first step.”