Essay: Medical Waste Management

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  • Medical Waste Management
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CHAPTER II
REVIEW OF RELATED LITERATURE
The value of medical waste management in the protection of public health and the environment cannot be denied (Thakur and Ramesh, 2015). One concern in the society nowadays is the inadequate treatment and improper disposal of medical wastes in various medical facilities due to the harmful effects of such wastes and its potential to transmit contagious diseases, which may harm humans and the environment. Medical care is vital for one’s wellness, being, and most importantly, to one’s life but, the wastes extracted from various medical services and activities pose potential risks to patients, doctors, people around the hospitals, and sanitation workers who administer in medial waste treatment and disposal (Sutha, 2018).
As stated by Longe (2006), proper segregation, treatment, and disposal of medical waste, especially those that pose harm and infectious waste types is a key to achieving a safe and sound medical waste management therefore, a right step to health risk reduction. The ability of medical facilities to assess wastes based on their composition, type, and components can be of help in achieving a more sustainable way of medical waste management in the society. Furthermore, with the joint efforts of various medical staff and workers to administer in medical waste treatment, a greater possibility of decreased health hazards will come out as a result.

MEDICAL WASTE IN GENERAL
The World Health Organization (2007) states that, the waste produced by various health care activities includes a broad range of materials, such as used needles and syringes to soiled dressings, body parts, diagnostic samples, blood, chemicals, pharmaceuticals, medical devices and radioactive materials. Poor management of these medical wastes may potentially harm the health care workers, waste handlers, patients and the community to infection and other risk. It is also stated that it is important that all medical waste materials must be segregated, appropriately treated and disposed safely. In a study, the WHO also estimates the infection caused by injections using contaminated syringes and they found out that there were 21 million cases of hepatitis B virus by the year 2002, two million hepatitis C virus cases, and 260,000 HIV cases.
According to United States Environmental Protection Agency (2017), medical waste or health care waste is defined as the subset of wastes that may be contaminated by blood, body fluids and other potential infectious materials. These potentially infectious materials are often called as regulated medical waste that can be found at any health care facilities including hospitals, medical research facilities and laboratories, blood banks and clinics. In addition, The Medical Waste Tracking Act of 1988 defines medical waste as “any solid waste that is generated in the diagnosis, treatment, or immunization of human beings or animals, in research pertaining there to, or in the production or testing of biologicals.”
Another definition of medical waste given by Medical Waste Service (2018), medical waste is anything that is infectious or may cause infection. These wastes may contain body fluids and other contaminants. Sharps including needles, medical equipment and other broken glasses are also considered as medical waste. The waste may be produce during diagnosis, treatment, medical research and immunization.
The World Health Organization (2017) categorized medical waste into eight distinct types. First are the infectious waste, these are waste hat may be infectious or that may cause infection. This may include excreta, swabs, equipment, tissues and lab cultures. Next are the sharps. This includes needles, broken glass, razors, and other medical equipment that may puncture the skin. The third category are compose of human tissue, body fluids, blood and other animal carcasses these are called Pathological waste. Fourth are the radioactive wastes. These waste are made up of unused radiotherapy liquid, and other supplies and equipment that may be contaminated with lab research liquid or radiotherapy liquid. Next are the pharmaceuticals these may include any expired, unused and contaminated drugs and vaccines, antibiotics and pills. Chemicals belongs to the sixth category in which it is composed of solvents, disinfectants, batteries and any heavy metals that are found in medical equipment. Mercury from thermometers may also be included in this category. Next are the genotoxic waste these waste are considered as the most hazardous and is mutagenic, carcinogenic or teratogenic. Cytotoxic drugs that are used in cancer treatment also fall into this category. The last are the general non-regulated medical waste or the non-hazardous waste. These are the harmless waste that contains no blood or bodily fluid, including papers, kitchen waste and other miscellaneous trash.
According to Environmental Protection Agency (2017), medical waste can be identified into four categories the infectious, hazardous, radioactive, and general waste. First are the infectious wastes. These are waste that may cause harm to human being. This waste is associated or has something to do with medical equipment that is not properly disposed. In line with this category are the pathological wastes that contain pathogens and require methods to be treated. Next are the Hazardous waste that includes sharps or objects that may puncture the skin such as syringes, surgical equipment and glassware. Chemicals are also considered as hazardous waste and some infectious waste depending on how it is used. Old medicines and other chemotherapy agents are also sometimes considered as hazardous. Third are the radioactive wastes, these are waste that came from cancer therapies, nuclear medicine treatments and medical equipment that uses radioactive isotopes. Contaminated pathological waste also belongs to radioactive rather than infectious. The last category is general waste, which makes up at least 85% of medical waste. These are waste that is not different from household waste.

EFFECTS OF MEDICAL WASTES
According to Dr. Jeorge Emmanuel (2018), the burning of medical waste will result to a release of an unexpected high amount of extremely baleful pollutants such as Dioxins, a highly toxic compound for the environment. It is also known that these Dioxins will not only stay during our time but also to the lifespan of the future. If it were release due to incineration of medical wastes, the effects of dioxins include cancer, changes in the reproductive system of male and female and it affects the child development. Thus, Zafar S. (2016) added that medical waste like gloves, bandages and gauze that are used can affect the environment. Body fluids like blood can also be the cause to the contamination of habitat. These medical wastes, if not properly disposed, can pollute the air in which contaminated gases go airborne; water in which bodily fluids such as contaminated urines and blood contributes to the spread of diverse diseases; and even the soil wherein medical waste such as gloves and syringes that are thrown on the ground will not be decomposed when it goes underground, thus making the soil contaminated. Which then, affects all forms of life. Because of this, it can contribute to the growth of microorganisms such as bacteria and insects that carries different diseases that can lead to the transmission of diverse diseases.
Akter N., Hussainz., Trankier J., and Parkpian P. (2002) proclaimed that not only the people of the outside of the hospital can be affected but also the people who work inside the facilities due to unethical practice. When hospital staffs were interviewed, they are suffering from different types of diseases due to the improper segregation and handling of medical wastes such as skin diseases or allergy, hepatitis and diarrhea. Moreover, Mastorakis N., Bulacia C., Oprea T., and Philippe D. (2010) summarized that diseases, which can be spread through contaminated syringes and medical wastes are skin infections such as rashes, a red spot on the skin that reacts to unpleasant happenings; ring worm, a disease that appears to be a ring-shaped mark on the skin; lastly, scabies wherein it is a disease that caused by small insects that may lead to itching and red spot on the skin. These infections are caused by bacteria and parasites, which can be found through unsanitary medical components and through doorknobs of hospital restrooms. Another disease caused by these equipment is viral hepatitis A and B. Hepatitis A is a viral liver disease that causes apical illness of the subject. On the other hand, viral hepatitis B Is an infection that affects the liver that causes chronic diseases which spread through blood and bodily fluids. Moreover, diarrhea, another disease that is caused by unsanitary components, is an illness when the body secretes liquid feces instead of the solid form. Cholera, on the other hand, is a serious disease that makes a person vomit and often leads to death. Lastly, typhoid, a communicable disease from contaminated food and water.
According to Shikoska B., Shumanov G., Dimova C., and Vankovski V. (2016), medical wastes contain different types of disease or disease causing organisms that are completely transferable through the environment and the people in it. These type of wastes can be found usually in the hospital, private or public, clinics such as dental clinics and ENT clinics, nursing and residential care facilities and other medical equipment. It also covers the bodily fluids such as semen, blood, urine, mucus, and saliva. Nevertheless, Mathur P., Sangeeta P., and Shobhawat A. (2012), said that this will cause a huge increase at the amounts of rodents, insects and even worms. This will lead to the spread of different diseases such as typhoid, cholera, hepatitis, and aids. Furthermore, these wastes disposed around the hospitals may attract insects and even stray animals, which in the future will spread communicable diseases to the community.

HOSPITAL SANITATION WORKERS AND ADMINISTRATION
Sanitation workers play a vital role in a hospital. They are ensuring the safety and clean environment we rely on in hospitals. In addition, they are held liable for the proper conduct of all legal sanitation codes, which is highly expected, to local hospitals. Further, people who are suited for the job needs to be prepared for all circumstances as the duty relies on cleaning and maintaining the health facility that provides satisfaction to all their patients. Moreover, sanitation workers or personnel can be trained to sterilize medical equipment needed and disposal of used needles and those of which may impose a threat to all those near and even in the hospital itself. As Sanitation Worker, the responsibility of creating a healthy environment, keeping away potential harm to health such as medical wastes is a must. The level of responsibility in assuring the safety in terms of health around and in the hospital through the sanitation workers is at high (Murnaghan, 2018).
In addition, Azam, et. al. (2008) have stated medical waste comprises of materials that involve threat to human health. Further, potential environmental hazard segregation also may impose a threat as recent studies have found out that it has been mixed with municipal solid wastes. In addition, the understanding of the medical waste composition can provide background and knowledge to facilities and patients which can step them out of ignorance that can help minimize or reduce its threat to humanity.
But in the study conducted by Altrabshehb, et. al. (2006) in northern part of Jordan, the practice of medical waste management have less appropriate practice of disposal and handling of medical wastes. Also, guidelines or rules were not definite causing the personnel involved not to follow a systematic process in handling of such wastes. Thus, Abdulla et. al. (2007) that the need for training for personnel involved in medical waste management disposal in Jordan is a must for the study revealed that the threat to patients and other persons in the hospital is high for various medical waste types’ segregation is not properly conducted.
Moreover, countries around the world have different medical waste management that needs to be discovered and needs to have solution. One of the example include the country of Brazil, in the study conducted by Da Silva, et. al. (2004), they have interviewed 91 health care facilities that may provide information about the segregation and disposal of medical wastes, ethical considerations were observed as the researchers did not disclose information about a certain health care facilities that which, the result implied that health care facilities do not comply with the Brazilian Legislation when it comes to proper waste management disposal. An average rate generation of 3.245 and 0.570 kg/bed-day were recorded when it comes to the total of infectious-biological wastes.
In addition, the proper segregation of medical waste is a must factor in terms of choosing hospital have been thought of patients. In a study of medical waste management in Nanjing, China, about 77% of those being interviewed perceived proper waste segregation as a need when going to a certain hospital. A total of 15 hospitals, 200 patients and 3 disposal companies were involved in the study which then implies that there is insufficiency of public understanding of medical waste management as there are still remaining 20% unqualified staff in waste management of the hospitals. There are still a few percentage of which may impose a threat to the hospitals. Recommendations were suggested to those hospitals as their current situation can impose a hazard or risks and of that medical wastes can be properly disposed and threat to humanity may be minimized (Daweia, et. al., 2008).
Askarian, et. al (2003) explains that hospital wastes impose hazard and can be considered as dangerous as it may contain pathogenic agents and which can cause effects and can threat the human health and the environment itself. Further, the inadequacy of rules to be followed as like in the country of Iran further provides more threat and harms everyone. In addition, the survey have resulted that the training for proper waste management was considered as ineffective and cannot aid to the need of the country. Also, the enabling the law to act upon the certain issue can be of help to aid to the need of the entire society of Fars Province, Iran.
Moreover, sanitation personnel plays a vital role in maintaining the cleanliness of the hospital that of which implies that the formation and organization of sanitation team in hospitals provide an avenue to solve different problems with the regards to medical wastes. Furthermore, the inadequacy of employees training should as well be addressed which include on-the job trainings that can further enhance their skills which can improve the state of a certain medical facility or institution (Jiang, et. al., 2009).
In addition, operational machines needs to aid as well with the need of treatment of medical waste. Qualified staff should be fully aware of the conditions prevalent in the hospital so that they can cope with the underlying needs of the hospital. Moreover, the knowledge, attitudes and practices of the personnel, which are in the field of medical waste greatly affect the proper treatment and disposal of medical wastes. Thus, hospitals should give adequate training and motivation, which should suffice the need to set up, standardized rules of medical wastes segregation with that of the hospitals (Chauhan and Sharma, 2007).
Moreover, in the recent study conducted by Madhukumar and Ramesh (2012), it implies that the awareness of medical practitioners such as doctors and nurses regarding the medical wastes should be better and thus, they should be the key promoter of proper handling of as such. In addition, nurses and laboratory staff have found to have better ways of segregating and disposing off of medical wastes of the hospital in Bangalore. Lastly, the research have pointed out the massive need for training, as the study have found out that the lack of knowledge in terms of medical waste is highly observable for hospitals.
Also, the focus on health care should not as well be neglected as which in connection to the study being presented by Barach, et. al. (2015) that accreditation of a certain hospital still relies on the safety measures and procurement of those practitioners who establish safety and reliability in a management of medical wastes. Moreover, the adoption of such a certain guidelines helps increase the way in which medical staff can evaluate accreditation of certain hospitals. In addition, accreditation of as certain hospital is still implemented for medical practitioners and sanitation workers still do their job of maintaining the cleanliness and sanitation of hospitals.
Lastly, attitude as well can add up to the measures being determined. In a study being researched in Iran, it shows that the attitude of the personnel working can be associated with the way they work. Moreover, a dire need of education and increased awareness is suggested for it can still address and solve the issue of proper handling of services being rendered in a particular field like for example in is hospitals (Aminbaig, et. al., 2015).

STRATEGIES IN DISPOSING MEDICAL WASTES
Properly disposing medical wastes is important when it comes to sanitation procedures. If these wastes are not managed, it may cause various diseases to the living organisms. Many sanitation procedures have been implemented in different hospitals but their healthcare workers are not trained well. As a result, according to National Academy of Sciences (1989), before they hire healthcare workers, they make sure that they have the knowledge and they know the correct way on what are the sustainable ways on how those medical wastes can be managed. Disposing of medical waste materials especially the solid wastes should be put in sanitary landfills to secure the safety of people and the environment in terms of healthcare facilities. Another way of properly disposing medical waste is by means of incineration to lessen the amount of medical wastes of hospitals to prevent infections and contamination because many wastes especially those wastes coming from hospitals contains pathogens that can harm any people. Constructing ventilation exhausts is an effective way on how to protect microbiology laboratories from contracting with other bacteria. Contaminated wastes should be separated from non-contaminated one. Different working areas like rooms, laboratories and refrigerators should only be managed by the workers who have the knowledge on how these areas and equipment should be cleaned.
According to Obid (2006), disposing medical wastes is still a major problem in most 0f the countries. Even though there are technologies used for disposing wastes, facilities should first have the knowledge on how to manipulate those kinds of technologies and machines. The sources of medical wastes include hospitals, healthcare centers, laboratories and clinics. The reasons why many of the healthcare facilities are not managing their medical wastes is because of the lack of sufficient funding. One of the ways on how should medical wastes can be managed is creating a specified landfill cell for the hazardous wastes. In some countries like Europe and United States of America, they constructed their own incinerators for preventing and to lessen the amount of wastes, but there is also a side effect to its people because of the gas emissions coming from the syringes, thermometers and amalgam that are rejected as medical wastes. There are also mercury and dioxin emissions. These treatments can be a solution in disposing hazardous medical wastes properly. To sum up, the different treatments on how wastes are being managed are by means of incineration, thermal treatment and disinfection, disinfecting materials through the use of microwaves and more.
According to Mina (2012) in his book entitled, “Case Studies on Health Care Waste Management Practices of Selected Public and Private Hospitals in Metro Manila,” in order to minimize risks, hospital workers should segregate their wastes according to their types. Black container should only contain the non- infectious dry wastes, green is for non- infectious wets wastes, yellow is for the infectious and pathological wastes, yellow with black band is for the chemical wastes including the heavy metals, orange container is for the radioactive wastes and red container is for the sharp and pressurized containers. The way of disposing medical wastes are varied based from their types. For example, cytotoxic wastes must be collected in a leak- proof container, chemical wastes should be put in chemical- resistant containers and delivered to treatment facilities. Sharp equipment and wastes must be compiled together and the container must be puncture- proof and it is covered. Wastes that have heavy metals like mercury must be separated from other medical wastes. The aerosol containers should be collected together and should not be burnt or put into incinerators. Gases can be disposed through the use of vacuum lines direct outside the hospital. According to Revised Health Care Waste Management Manual in the year of 2005, storage areas should not be situated from food stores to prevent infections and the spreading of diseases. There should be water supply and drainage for wastes to prevent disinfection. Moreover, storage facilities should be restricted and has locks to prevent access by unauthorized people. If these things are being implemented in the hospitals, we can lessen the uncertainties that we might inherit.
Medical wastes should be disposed, separated, sterilized and identified accordingly depending on their types. They are being disposed according to how they are being used. Just like the wastes that are hazardous, they should be put on safer places. In segregating medical wastes, hazardous ones should be put in red bags and those wastes having contact with blood should be the first one to dispose (medprodisposal.com, 2016)
According to Curtis (1991), in his study entitled, “A Medical Waste Management Strategy,” it is essential to manage medical wastes properly because it may cause harm to the employees and to other people who are concerned with these kinds of wastes. Employees should be the one who will dispose medical wastes in a proper way. These medical wastes strategies are segregation, packing, in- house transport and storage of medical wastes to prevent infections and uncertainties.
“Failure to effectively manage medical wastes puts patients, healthcare and sanitation workers at risk in having various diseases” (Floridahealth.gov,n.d., 2017). When an infection happened on a certain hospital, it means that there is a problem in their sanitation procedures. Some of its reasons is the lack of preparedness or they are unaware on the effect of not disposing medical wastes properly. Occupational Safety and Health Administration (OSHA) constructs rules to be followed to make sure that the safety of the healthcare workers is being prioritized while they are working. (Saber, 2017)
Disposing medical wastes properly is the most essential thing that a hospital should do. If these wastes are not disposed properly, it will cause harm to their patients especially to the people around the vicinity of their hospitals. According to the United States Environmental Protection Agency (1988), there are three plans that should be implemented in all hospitals. First is to appraise information on the medical waste management, if they are implementing medical waste disposal practices. Secondly, is to determine the regulations that are connected in medical waste disposal and lastly is to stipulate applicable guidance, practices and education materials so that the facilities of the different hospitals will know the correct way in managing their medical wastes.

MEDICAL WASTE MANAGEMENT IN A LEGAL PERSPECTIVE
Medical Waste Management needs to be accompanied by laws and federal guidelines to be implemented properly. Medical facilities, hospitals, laboratories, clinics, and research centers are the leading producers of medical wastes and so; the stated establishments must abide the laws regarding the proper medical waste disposal to render quality services to the patients and ensure the safety of medical practitioners, the patients, and the people surrounding the vicinity of a particular medical facility. Currently, there are laws that strongly support the implementation of the proper medical waste disposal around the world.
According to the published research of Aquino, A., Deriquito, J., and Festejo, M. (2013), the mismanagement of waste in general poses risks and potential hazards to the community and to the environment. Mismanagement of waste paved way for Republic Act (RA) 9003 or the Ecological Solid Waste Management of 2000 to be crafted and serve as a milestone for environmental legislation in the Philippines. The law was implemented to regulate the production of garbage around the country and to mitigate its effects to the environment. RA 9003 states the policy of the state in adopting a systematized, comprehensive and ecological solid waste management program that highly regards the public health’s protection and the environment. Thus, it also declares the proper segregation, collection, transport, storage, treatment and the disposal of any solid waste by the adoption and formulation of best environmental waste management practices. RA 9003 supports the recycling of solid wastes to mitigate the effects of poverty in the society. The Philippine Congress passed ecological Solid Waste Management on the 20th of December 2000 and was subsequently validated by the Office of the President on the 26th day of January 2001. The law comprises of seven chapters and sub-divided into 66 sections for an effective solid waste disposal in the Philippines.
Along the same vein, there are also laws that truly support the correct practices on medical waste management besides RA 9003 or the so-called Ecological Solid Waste Management of 2000. Based on the South African Medical Journal (2014), the Constitution of the Republic of South Africa declares that everyone has the right to an environment that does not pose any harm to one’s health and well being. The illicit practice of improper waste dumping especially those that are hazardous may bring potential danger to the environment when pollutants interact to water sources and hugely cause the proliferation of infection and toxics, jeopardizing the environment and human health. To give effect to the Constitution, the safe disposal of hazardous waste is governed by legislation in South Africa. Cases of the illegal disposal of waste displays lack of awareness and practice in regard to the safe dumping of medical waste.
As per the Hazardous Substances Act, waste can be classified as general of hazardous waste based on the potential harm it may bring. General waste is characterized as waste, which does not give ant potential harm to public health and the environment. On the other hand, hazardous waste, however, may bring adverse effect, even in low concentrations to the community and the environment (South African Medical Journal 2014).
Stein, A. (2016), states that through the understanding of federal, state, and local medical waste management laws and regulations is key in the operation of an excellent medical business or facility. There are three federal acts in the United States of America that set the stage for today’s medical waste laws; these are Pharmaceutical Resource Conservation and Recovery Act, the Solid Waste Disposal Act of 1965, and the Medical Waste Tracking Act of 1988. In addition, some state regulated laws to monitor the production and disposal of medical waste.
Over thirty years ago the Pharmaceutical Resource Conservation and Recovery Act or the RCRA was authorized to shield human well being and the environment from conceivably perilous waste disposal strategies. The RCRA amended the Solid Waste Disposal Act of 1965 and set national objectives for lessening the fraction of waste created. Furthermore, Solid Waste Disposal Act of 1965; known as one of the primary government endeavors to enhance waste disposal strategies has been implemented, the Solid Waste Disposal Act was passed in 1965. Within this act, the Hazardous and Solid Waste Amendment passed in 1984, including more stringent laws hazardous waste management. In addition, the Medical Waste Tracking Act of 1988 is also present in the implemented regulations with regards to proper medical waste disposal. The Medical Waste Tracking Act of 1988 was basically devised to monitor and regulate the treatment of biomedical waste and sharps waste from their production, transportation, and final resort or disposal. This particular law prompted congress to approve the bill to amend the Solid Waste Disposal Act (Stein A. 2016).
All in all, laws and regulations regarding proper medical waste management must be implemented towards the state to supervise and monitor the production, release, and disposal of medical wastes. Through the laws and regulations being reinforced by the government, medical facilities will be able to render their service in a non-harmful way since they are knowledgeable about the guidelines posed by the state. Abiding the laws authorized by the government in accordance to medical waste management will ensure that every patient will receive services that are safe and under the provisions of the law.

PAST STUDIES AND RESEARCHES REGARDING MEDICAL WASTES
In all over the world, the management of hazardous wastes have received many attention due to its toxicity and infectious nature. It can affects not only human but also to the living things around the area. Hospitals and other healthcare facilities are responsible for the delivering the health care services to the patient. In the process of curing the disease of patient, healthcare waste is also produced. These menacing situation captured the attention of many researchers to study the different hospital wastes management. Many hospitals or health care facilities have faced financial difficulties and thus they have attempted to find cost-effective treatment and disposal methods of their medical wastes. In the past researches, medical waste was often mixed with municipal solid waste and disposed of in residential waste landfills or improper treatment facilities. In recent years, many efforts have been made by environmental regulatory agencies and waste generators to better manage the waste from healthcare facilities. Due to these problem, many alternative solution have been made like waste minimization and recycling, control of toxic air emissions at medical waste incinerators, and alternative treatment methods to incineration but these are regarded to be the major challenges in the future.
Longe and Williams (2006), based on a study and investigations, three out of the four hospitals gave high priority to the segregation of wastes from infectious and sharp wastes by the use of color coding system in their waste containers. Improper labeling and the multiple uses of black plastic bags for storing both infectious and regulated wastes are mostly the conspicuous problem. In some cases, where hospitals achieved the commendable level of segregation, medical wastes are incessantly mixed together by the garbage collectors during collection or at the dumpsites as revealed in some surveys and past studies.
According to Jang et.al (2005), majority of the healthcare facilities in Korea practiced the segregation of medical waste done at the point of generation. Human and animal tissues are placed in a red container either plastic, paper board or metal container, while pathological waste and discarded sharps are placed in yellow container. Placentas are commonly separated in a red container and then used for raw materials in pharmaceutical products. Recycling of any segregated wastes other than placentas is not currently being practiced on-site. All other wastes are placed in an orange container before shipment. All containers displayed and have a universal biohazard sign that is commonly used in many countries.
As stated by Soncuya et.al (1997), it shows that there are no safe way even in managing all the hazardous medical wastes that are currently produced in Metro Manila. 13 hospitals in MM were discovered to have incinerators, yet most of them were unrestrained and do not meet the Philippine and International standards for incineration of infectious waste and for safe managing methods.
Lee et.al (2003), revealed that hazardous hospital wastes are sometimes mixed with general medical wastes in the same container (black plastic bags) which should only contain non-infectious solid wastes. Past and recent studies revealed that majority of the hospitals is not observing pre-treatment procedures for their infectious waste and not applying the color-coded system required by MMDA Ordinance No. 16.
According to Health Care Global (2014), every hospital should have a specific location for a temporary waste storage. The plans and ideas in these parts (waste storage) are usually included in the design and construction of the hospital. The storage area must be completely locked and must be separated from the supply rooms and food preparation areas. Waste should always be monitored and must be removed in a timely manner even inside the storage. All waste containers should be clearly labeled and hazardous and non-hazardous wastes should never be mixed.
As asserted by Crean (2004), antiseptic wastes are usually disposed with some waste in sanitary landfill, or in some cases it is settled in to the sewer system. Ultimately, the expenses and regulation of these facilities have provoked organizations to hire contractors to collect, treat, and dispose of medical waste, and the percentage of medical organizations that perform their own treatment and disposal are anticipated to decrease.
SYNTHESIS
Medical waste management is one of the most common problem being faced among hospitals. There are different classifications and definitions being connected to medical wastes. World Health Organization (2017) classified eight distinct types of medical wastes that may pose threat when not being disposed and segregated properly. In addition, the United States Environmental Protection Agency (2017) also gave four types of as such that will also give a negative impact to the entire humanity. Medical wastes cover a broad aspect in which is needed to be chunked into pieces to fully understand effect it displays to the environment, as well as the people.
Further, improper medical wastes segregation imply lasting effect to different sectors in the world we step in. In fact, burning of as such will release toxic gases such as dioxins that will not only be visible in our time but also for the next years to come. Unethical practices might also lead to harmful diseases (Emmanuel, 2018). Also, Zafar (2016) pointed out the effects in the environment when the used medical gloves and the like will not be disposed in the way it should be. In addition, spread of contagious diseases might as well be observed as the chemical properties these wastes contain might be releases as improper practice had been followed. Moreover, people in and outside the hospital facilities are greatly affected to these unethical standards being implied (Akter N., et. al., 2002). Lastly, different diseases such as with regards to skin diseases, widespread of communicable diseases through carriers such as rodents, and diseases causing organisms will increase in number as the practice continues (Mathur, et. al., 2012).
Thus, with the studies and past researches it is clearly identifiable that sanitation workers play an essential role with regards to hospital administration. Sanitation workers must know the concepts and the way how to properly segregate wastes in accordance to the lawsuits being implemented by a certain place or by the laws in the hospital itself (Murnaghan, 2018). But with the researches being conducted, a very few knowledge with regards to medical wastes are observed to the people itself. Further, proper segregation was not observed to most of the hospitals giving a direct conclusion that the sanitation workers do not have a wide understanding and public knowledge on how to handle it. At the end, Madhukumar and Ramesh (2012) implies that trainings and seminars must be given to the workers. Thus, it briefly shows how the inadequacy of knowledge may also lead to diseases that which may lead to uncontrolled and cannot be solved epidemics of disease.
Various ways on how to clean such wastes are being explained. Thus, a common result have explained that most of the countries still cannot properly manage to handle as such wastes. Despite the fact that technologies are present as of the moment, it cannot assure and guarantee a complete and accurate process of disposing wastes properly (Obid, 2006). The value of properly handling of such wastes constitutes to health care protection among people. According to National Academy of Sciences (1989), hiring someone who is knowledgeable and capable enough of handling medical wastes must be the standard when it comes to choosing workers. Furthermore, understanding the techniques of handling wastes properly will lead to good facility working.
Further, different lawsuits have been created to protect the health of everyone, such law created contain objectives of promoting awareness to such wastes. Moreover, the implementation of laws that lets people become knowledgeable of the risks benefited most of the people for it contributed to new array of learning to everyone. Laws such as Ecological Solid Waste Management Act of 2000 of the Philippines and Foreign laws like Pharmaceutical Resource Conservation and Recovery Act (RCRA), Solid Waste Disposal Act of 1965, Medical Waste Tracking Act of 1988 was made into action. Lastly, the regulations being implemented helped not just to promote awareness but also to help people attain security among humanity.
All in all, medical waste play a huge impact on the society. In addition, the past studies suggests that training and seminars must work out among the sanitation workers. Thus, in addition, medical wastes must be properly segregated to attain healthy environment in and outside of the hospital. Hospitals provide health care protection, it is just ironic that hospitals might also give diseases as stated in the study, and so, public understanding, awareness and accurate measurements to address the issue must be stated and thus, will be of help for the next years to come and also to the future researchers that will have interest on the studies

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