2009-05!26!140651morones,Precilla Madel d

8/3/2019 2009-05!26!140651morones,Precilla Madel d.

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HOSPITAL SOLID WASTE MANAGEMENT

PRACTICES IN ZAMBOANGA CITY

A RESEARCH PAPER PRESENTED TO

THE FACULTY OF THE GRADUATE SCHOOL

ATENEO DE ZAMBOANGA UNIVERSITYZAMBOANGA CITY

IN PARTIAL FULFILLMENT

OF THE REQUIREMENTS FOR THE DEGREE OF

MASTER IN PUBLIC HEALTH

BY:

PRECILLA MADEL D. MORONES, MD

APRIL 2009


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iADZU-SOM RESEARCHES/MPH2009/MORONES,PRECILLA MADEL D.

APPROVAL SHEET

This Research Paper entitled HOSPITAL SOLID WASTE MANAGEMENT

PRACTICES IN ZAMBOANGA CITY prepared and submitted by Precilla Madel D.

Morones, MD, in partial fulfillment of the requirements for the degree Master in Public

Health is hereby accepted.

Dr. Ricardo N. Angeles

Thesis Adviser

________________________________________________________________________

Approved by the Oral Examination Committee with a grade of PASSED.

Dr. Rosemarie S. Arciaga

Chairman

Dr. Fortunato L. Cristobal Dr. Jocelyn D. PartosaMember Member

Dr. Servando D. Halili Jr.

Member

________________________________________________________________________

ACCEPTED in partial fulfillment of the requirements for the degree Master in Public

Health.

Dr. Servando D. Halili Jr.Dean, Graduate School

Ateneo de Zamboanga University


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iiADZU-SOM RESEARCHES/MPH2009/MORONES,PRECILLA MADEL D.

ACKNOWLEDGEMENT

I would like to extend my appreciation to

my thesis adviser, Dr. Ricardo N. Angeles

for lending me his time and expert advice on my study.

the hospital waste managers, nurses and orderlies of the hospitals in Zamboanga City

for taking time to participate in my study.

ADZU-SOM for generously supporting my study.

My deep gratitude goes to my batchmates especially

to Naezelle, Noreen, Putri, Sol and Kuya Mike

whose untiring and generous support in all my endeavors have cheered me on.

Most of all, to the Almighty Father for giving me strength and grace.

This work is dedicated to my family

-Mama, Lyn2x and MM-

without whose love and support all is meaningless.


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iiiADZU-SOM RESEARCHES/MPH2009/MORONES,PRECILLA MADEL D.

LIST OF FIGURES

Page

Figure 1. Conceptual Framework . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . 7

Figure 2. Flow of Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Figure 3. Practice and Methods of Waste Treatment . . . . . . . . .. . . . . . . . . . . 18

Figure 4. Solid Waste Flow of Hospitals in ZC . . . . . . . . . . . . . . . . . . . . . . . 20

LIST OF TABLES

Table 1. Practice and Method of Waste Segregation . . . . . . . . . .. . . . . . . . . . 16

Table 2. Healthcare Waste Disposal Practices . . . . . . . . . . . . . . . . . . . . . .. . . 17

Table 3. Transportation and Final Disposal of Waste . . . . . . . . . . . . . . . . . . . 19


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ivADZU-SOM RESEARCHES/MPH2009/MORONES,PRECILLA MADEL D.

TABLE OF CONTENTS

PAGE

APPROVAL SHEET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

ACKNOWLEDGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

CHAPTER

I THE PROBLEM AND ITS SETTING

a.) Background of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

b.) Related Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4

c.) Statement of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . 6

d.) Objectives of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

e.) Conceptual Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7f.) Significance of the Study . . . . . . . . . . . . . . . . . . . . . . . . . .. . 8

g) Delimitation of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . 8h.) Definition of Term . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

II METHODOLOGY

a.) Research Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 9b.) Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9c.) Study Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10d.) Sampling Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 10e.) Data Gathering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10f.) Research Instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11g.) Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

II PRESENTATION AND INTERPRETATION OF RESULTS 14

IV DISCUSSION AND IMPLICATION 22

V SUMMARY AND CONCLUSIONS 27


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vADZU-SOM RESEARCHES/MPH2009/MORONES,PRECILLA MADEL D.

BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . 29

APPENDICES

A. Observational Checklist Results of Hospitals . . . . . . . . . . . . . 30B. Survey Questionnaire for Hospital Waste Manager . . . . . . . . 31C. Survey Questionnaire for Orderlies . . . . . . . . . . . . . . . . . . . ... 33D. Survey Questionnaire for Nurses . . . . . . . . . . . . . . . . . . . . . . .. 36E. Observational Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 38

CURRICULUM VITAE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 40


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viADZU-SOM RESEARCHES/MPH2009/MORONES,PRECILLA MADEL D.

ABSTRACT

This study was conducted to determine current hospital waste management

practices in Zamboanga City. Twelve hospitals and 154 respondents participated in this

study. Data were gathered through survey using an interviewer- administered

questionnaire. Frequency distribution was used to summarize information from

respondents about hospital waste management. Results showed that hospitals generate

waste and use color- coding scheme and separate the different types of waste at the point

of generation to segregate these wastes. Infectious wastes are separated from non-

infectious wastes. There were 7 hospitals who practices treatment of infectious wastes

prior to disposal by means of acetylization (8.3%), encapsulation (41.7%) and burning of

sharps (8.3%). The disposal sites for infectious wastes such as sharps includes a septic

vault (33.3%)which is located within the hospital vicinity, a privately owned dump site in

Barangay Boalan (8.3%) and direct disposal to the city dumpsite (16.6%). On the other

hand, infectious wastes of hospitals with no treatment were directly disposed to a

compost pit (25%) located within the hospital vicinity and to the city dumpsite

(16.6%).Non-infectious wastes of hospitals were dispose to a compost pit (25%) located

within the hospital vicinity and to the city dumpsite (75%) which is the final disposal area

of healthcare waste located in Brgy. Lumbangan. Although wastes were properly sorted

in the hospital, the local government garbage truck collects the waste and disposes it in

the city dump site- a practice that defeats the purpose of waste segregation in hospitals.


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1ADZU-SOM RESEARCHES/MPH2009/MORONES,PRECILLA MADEL D.

CHAPTER I

THE PROBLEM AND ITS SETTING

Background of the Study

One of the problems Zamboanga City is facing today is the improper handling and

disposal of solid wastes. About 70% to 80% of generated solid wastes are collected in the city

and the balance is either left on the streets, dumped into storm drains, esteros, canals, creeks and

rivers. A large percentage of solid wastes mostly come from the industries (ZC Public Service

Office, 2000).

Hospital waste management is one of the biggest challenges our country is facing in

addressing the countrys growing garbage problem. Public concern over the past years has been

growing with regards to the disposal of wastes produced by health care facilities in the

Philippines. The DOH introduced a manual on healthcare waste management practices. The

manual provides practical information regarding safe, efficient and environmental- friendly

waste management options. It also contains in detail, safety procedures attendant to the

collection, handling, storage, transport, treatment and disposal of healthcare waste. According to

the Department of Health in 2003, hospitals generate an estimated 0.6 kg/bed/day of waste.

There are about 2,068 hospitals in the Philippines, including 71 hospitals under DOH, which

generate about 28 tons of waste per day. Most wastes generated from the hospitals are non-

hazardous general wastes. Hospital wastes are further classified by the Department of Health

(Environmental Health Service). The Manual on Hospital Waste Management contains the

following guidelines:

1. Pathological wastes consist of tissues, organs, body parts, human fetuses and animal carcasses;

and most blood and body fluids.


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2. Infectious waste contains pathogens in sufficient concentration or quantity that exposure to it

could result in disease. This category includes cultures and stock of infectious agents from

laboratory work, waste from surgery and autopsies on patients with infectious diseases, waste

from infected patients in isolation wards, waste that has been in contact with infected patients

undergoing hemodialysis (e.g. dialysis equipment such as tubing and filters, disposable towels,

gowns and aprons, gloves and laboratory coats) and waste that has been in contact with animals

inoculated with an infectious agent or suffering from an infectious disease.

3. Sharps include needles, syringes, scalpels, saws, blades, broken glass, nails and other items

that could cause a cut or puncture.

4. Pharmaceutical wastes include pharmaceutical products, drugs, and chemical that have been

returned from wards, have been spilled, are outdated or contaminated, or are to be discarded

because they are no longer required.

5. Radioactive wastes include solid, liquid, and gaseous waste contaminated with

radionuclides generated from vitro analysis of body tissues and fluids, in vivo body organ

imaging and tumor localization, and therapeutic procedures.

6. Chemical wastes comprise discarded, solid, liquid, and gaseous chemicals, for example from

diagnostic and experimental work, and cleaning, housekeeping and disinfecting procedures

Chemical waste may be hazardous or non- hazardous (DOH, 1997).

The distribution of hospital wastes in developing countries are 80 percent general

healthcare wastes, 15 per cent pathological and infectious waste, 3 percent

chemical/pharmaceutical wastes and 1 percent sharp wastes (World Health Organization, 2003).

With a rapidly growing population and lack of adequate disposal sites, medical waste, if

not properly managed, pose serious health risks not only to the personnel who are handling the


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wastes but also to the waste collectors, to those providing disposal or picking through the wastes

for recyclables, and scavengers.

There are currently fourteen existing hospitals in Zamboanga City and yet, no recent

publicly available data exists on how hospitals in the city dispose of their infectious and

hazardous wastes. In Metro Manila however, less than 50% of the 144 hospitals studied do not

have appropriate mechanisms for proper waste handling and segregation. Incineration and

landfill were used for final disposal of wastes. Only two out of five hospitals had an existing

waste management committee and a separate budget allocation for a waste management

program.

On August 2005, the Department of Environment and Natural Resources (DENR) and the

Department of Health (DOH) signed a Joint Administrative Order (JAO) outlining the

framework by which-hospitals and clinics can safely dispose their wastes. The signing was the

culmination of efforts of the two agencies that begun in 2003 to solve the growing volume of

hospital wastes in the country. Three laws have been framed to tackle the management of

hospital wastes Republic Acts 6969 or the Toxic and Hazardous Substances and Nuclear

Wastes Control Act of 1990, 8749 or the Philippine Clean Air Act of 1999 and 9003 or the

Ecological Solid Waste Management Act of 2000. (Environment, 2005)

Hazardous waste is responsible for spreading infectious and epidemic diseases. Thus,

generators of such waste products should take special care in handling and disposing of this kind

of waste. Improper management of waste generated in health care facilities cause a direct health

impact on the community, the health care workers and on the environment (WHO, 2004). This,

along with the lack of local data creates the need for the assessment of the hazardous waste

management in Zamboanga City.


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Review of Related Literature

Health care wastes are in the form of solid and liquid wastes generated by hospitals,

medical or research laboratories, clinics, offices of physicians and dentists, veterinarians, and

funeral homes. These wastes represent a relatively small portion of the total solid waste stream,

and are simple to identify, to separate, and to treat properly (DOH Manual, 2004).

Several studies have been done to assess the management of hazardous wastes in the

Philippines and abroad. Soncuya et al, (1997) conducted a study on hospital waste management

in Metro Manila. The results showed that hazardous medical wastes were not properly handled.

A large volume of infectious wastes is disposed in burial pits located at hospital sites, and in

municipal landfills. Majority of the hospitals is not practicing treatment procedures prior to the

disposal of their infectious waste and does not adhere to color-coding system required by

MMDA Ordinance No. 16. These practices pose significant risks to humans, including direct

contact and contamination of surface water or groundwater.

Another study on waste management practices of hospitals in Metro Manila conducted

for the Department of Health (DOH) revealed that although most of the hospitals perform waste

segregation, less than 50% of the 144 hospitals studied did not have the proper mechanisms for

proper waste handling and segregation. Incineration and landfill were used for final disposal of

wastes. Only two out of five hospitals had an existing waste management committee and a

separate budget allocation for waste management program (Molina).

In Sylhet, a study entitled Hospital Waste Management in Sylhet City; it was observed

that existing hospital waste collection, and handling and disposal practices of all the hospitals in

Sylhet involved transport of wastes by ward boys, maid nurses and other employees from the

point of generation to initial storage. Wastes are normally collected from small bowl or plastic


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bins provided for each bed and stored either in a large size plastic bag or bucket. These plastic

bags or wastes from buckets are then put in a pushcart and carried to the nearest municipal bins

for dumping without any segregation or treatment (Sarkar, et al, 2006).

In a similar study done in Dhaka City on Solid Waste Management, it was found out that

there were over 500 clinics and hospitals in Dhaka City and majority of the hospitals were not

practicing safe disposal of wastes. Waste is collected from small bowls or plastic bins provided

for each bed and emptied into larger containers. These containers are then conveyed by pushcart

to the nearest municipal bin for dumping. The municipal bins are located either within the

hospital itself or nearby outside. Municipal solid wastes are augmented by other hazardous and

toxic wastes from hospitals. Since these wastes contain toxic and infectious materials, they are

more dangerous than other types of wastes (Rahman, et al, 1999).

Bhatia (2003) did a study in Mumbai on Biomedical Waste Management:

Understanding our civic issues, health care institutions dump their infectious waste, along with

the rest of the non-infectious waste, in the municipal garbage systems, posing a serious risk to

public health as well as a risk of scavenging(Bhatia, 2003 ). Thus, poor management of

healthcare waste poses a severe threat to public health and may also damage the .environment.

Statement of the Problem

What is the current waste management practices of private and government hospitals in

Zamboanga City?

Objectives of the Study

General Objective

To describe waste management practices of private and government hospitals in Zamboanga

City.


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Specific Objectives

1. To determine methods of waste segregation within the hospital.

2. To determine methods of disposal of infectious and toxic waste within hospital setting.

3. To determine methods of disposal (transport) of infectious and toxic waste from the hospital to

the disposal site(s).

4. To determine treatment done (if any) to the waste before disposal.


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Conceptual Framework

Segregate

Treatment

Transport

Disposal

Figure 1. Conceptual Framework

Figure 1 shows that healthcare facility such as hospitals must have an appropriate

hospital waste management to ensure proper segregation, treatment, transportation, and disposal

of waste generated by the healthcare facility. Improper waste management of hospitals would

lead to an increase risk to public health threat and poor environmental sanitation.

Hospital generates

WasteDisposal

Improper WasteManagement

Proper WasteManagement

Public Health Risk


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Significance of the Study:

The result of the study can give us data on how hospitals in Zamboanga City today

manage their wastes. The paper will be presented to agencies concerned with environmental

sanitation for better implementation and improve programs on hospital waste management.

Moreover, this study hopes to invite other healthcare facilities to take measures towards

improving their waste management systems through conducting healthcare waste assessments in

their facility.

Delimitation of the Study

This research is confined only in describing practices of hospitals regarding solid waste

management. The assessment was based on interviews and on-site observation. Actual waste

management procedures were documented.

Definition of Terms

Hospital Solid Waste refers to all discarded waste materials from the hospitals, includes sharp

(syringes, disposable scalpels, blades, etc.), non-sharps (swabs, bandages, disposable medical

devices, etc.), blood and anatomic waste(blood bags, diagnostic samples, body parts, etc.),

chemicals(solvents, disinfectants, etc.), pharmaceuticals, and others, and may be infectious,

toxic.

Hospital Solid Waste Management refers to ways of handling solid waste, which includes

segregation, storage, collection, transportation, treatment and disposal.

Hazardous Waste- potentially infectious waste which includes dressings and swabs

contaminated with blood, pus and body fluids, sharps, which include needle, syringes, blades etc.

and blood and blood products.


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CHAPTER II

METHODOLOGY

Research Design

This is a cross- sectional study aimed to describe the government and public hospital

solid waste management practices in Zamboanga City. The respondents were selected using

purposive and convenience sampling. All respondents were hospital workers and were

interviewed to learn about actual waste management practices. An observation of 12 hospitals in

Zamboanga City was done regarding waste management practices performed by the different

departments of the hospital. The information gathered from this study was those which exist at

the time of the survey.

Respondents

The respondents of this study were:

Inclusion Criteria

Hospital workers of any of the following position:

Hospital Waste Manager Head nurses in the ward Orderlies/waste handlersExclusion Criteria:

Those who were absent during the conduct of the survey. Less than 3 year employeesThere are 14 hospitals in Zamboanga City. However, only twelve hospitals agreed to participate

in the study.


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Study Setting

According to the Regional Office of the DOH, there were 14 hospitals in Zamboanga

City with a 1,316 total number of beds. Eight of which are private hospitals and six are

government hospitals. No recent publicly available data on waste generation rates of these

facilities. Moreover, the city has no available data on how hospitals dispose their infectious and

hazardous waste and has no existing hazardous waste collector. There are six tertiary hospitals,

seven secondary hospitals and one primary hospital. Among the six tertiary hospitals, one is

public and five are private. The tertiary hospitals offer specialty care and are usually more

equipped. They have bigger bed capacities and therefore generate more hospital waste. In

general, private hospitals are more sophisticated and more equipped compared to public

hospitals. In the Philippines, it is expected that private hospitals are more organized compared to

public hospitals.

Sampling Method

Purposive sampling was used in the selection of hospital waste managers based on

inclusion criteria. Moreover, convenience sampling was utilized in the selection of head nurses

and orderlies based on inclusion criteria.

Due to the schedule of shift of the nursing staff and other hospital personnel, the ones

interviewed were those who were available during the visit, and at the same time, qualified in the

aforementioned inclusion criteria.


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Data Gathering Procedure

An interviewer-administered questionnaire (see Appendices) was employed by the

researcher among hospital staff from different department (head nurses and orderlies/ waste

handlers) who is in-charge in hospital waste management and handling. Person in- charge of

managing the hospital waste system which is the hospital waste managers were also interviewed

(see Appendices) by the researcher to learn more about actual waste management practices in

Zamboanga City.

Observational checklists were utilized to monitor hospital waste segregation, treatment,

transportation, and disposal methods. Walk- through observation allowed the documentation of

actual practices performed by the different departments of the hospital.

Research Instrument

Questionnaire

An interviewer- administered questionnaire for hospital waste managers, head nurses and

orderlies was formulated for this study. Questions for the hospital waste manager focused on

their functions for ensuring that healthcare waste are disposed of in accordance with the national

policies and guidelines. The questions were answerable by yes, no, and no idea. Each

correct answer was given 1 point with the highest possible score of 13 for hospital managers. All

questions were based on the guidelines set on healthcare waste management manual by the

DOH.

The questions for the head nurses and orderlies focused on waste segregation, storage,

collection and transport, off-site transport, and treatment and method of disposal of hospital

wastes. The questions were answerable with yes, no, and no idea. Each correct answer


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was given 1 point with the highest possible score of 16 for head nurses and 25 for orderlies.

Similarly, all questions were based on the guidelines set on healthcare waste management by the

DOH Manual.

The questionnaire was face validated by the Head of Sanitation Department of the DOH.

Modifications and corrections were done. Final questionnaire was reviewed by the researchers

adviser.

Observational Checklist

An observational checklist was utilized to monitor hospital waste segregation,

transportation, and treatment and disposal methods used in the implementation of hospital waste

management practices. There are eight items on waste segregation, seven items on waste

transportation, two items on waste treatment and six items on waste disposal. All items in the

checklists were based on the guidelines set on healthcare waste management by the DOH

Manual.

Data Analysis

The research data was processed using descriptive statistics i.e., frequencies, percentages

were used to summarize information from the respondents about hospital solid waste

management practices.


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Flow of Activities

Figure 2. Flow of Activities

Formulation of:

Questionnaires and Observational Checklists Questionnaire Modification

Implementation

Interviewer- administered Questionnaire Hospital Waste Manager Head nurses Orderlies/Waste Handlers

Observational Checklists Waste segregation, storage, collection, transportation and

disposal method.

Research Output

Data Analysis and

Interpretation


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CHAPTER III

PRESENTATION AND INTERPRETATION OF RESULTS

From January to March 2009, the researcher conducted a solid waste survey in order to

describe current private and government hospital waste management practices in Zamboanga

City. A total of 12 hospitals and 154 hospital personnel participated in the study. There were 12

hospital waste managers, 76 nurses and 66 orderlies/waste handlers were interviewed for this

study. Forty- seven nurses were from private and 29 nurses from government hospitals. Forty-

one orderlies were from private and 25 from government hospitals.

Appropriate healthcare waste management practices depend largely of the administration

and organization and require adequate legislative and financial support as well as the active

participation by the trained and informed staff (DOH Manual). All hospitals studied have an

existing waste management committee and have a designated a waste management officer to

supervise and coordinate the waste management plan. Out of the 12 hospitals surveyed, 83.3

percent (10) revealed that their facility kept an up to date waste management plan. Moreover,

91.7 percent (11) of hospitals carry out proper procedures in the implementation of their waste

management plan.

In developing a waste management plan, the waste management committee needs to

make an assessment of all waste generated in the healthcare facility. Only 5 hospitals or 41.7%

prepare an annual report for the disposal of healthcare waste which provides data on waste

generation, equipment requirements and its cost.


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Waste Segregation

Segregation is the process of separating different types of waste at the point of generation

and keeping them isolated from each other. By segregating waste, appropriate resource recovery

and recycling technique can be applied to each waste stream. Moreover the amount of hazardous

waste that needs to be treated will be minimized or reduced subsequently prolonging the

operational life of the disposal facility and may gain benefit in terms of conservation of resources

(DOH Manual).

As shown in Table 1, majority of the respondents, nurses and orderlies (95.7%) claimed

that they practice waste segregation. Approximately four percent of nurses and of orderlies said

that they do not practice waste segregation. However, a respondent (.8) admitted of not having an

idea regarding waste segregation.

Among those who practice waste segregation, majority of the respondents made use of

color- coding scheme and separating different types of waste at the point of generation.

However, out of the 12 hospitals surveyed, only 50% were observed to have color-coded waste

bins present in their facilities. In an interview with their hospital managers, it was found out that

the hospitals who were currently not using the color-coding system used to practice this.

However, they were not able to sustain it due to lack of supplies and budget. Nevertheless, they

were able to develop means on how to manage their healthcare waste through separation of

infectious waste from non- infectious waste.


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Table 1. Practice and Methods of Waste Segregation

Question Items Nurses and Orderlies

N= 142(%)

Practices Waste Segregation136 (95.7)

Methods of waste segregation

Color-coding SystemSeparate different type of waste at the

point of generation

Color-coding or separation of waste

13 ( 9.2)

21 (14.8)

108 (76.0)

The effective management of healthcare waste considers the basic element of waste

minimization. Hospital waste minimization is centered on the elimination or reduction of the

healthcare waste stream. Twenty- seven or 40.9% of orderlies/waste handlers practice waste

minimization and about 57.6% (38) do not practice waste minimization and 1.5% (1) do not have

any idea on waste minimization. Recycling is their main measure to achieve waste minimization.

On observation, majority of hospitals made use of recycled bottles or gallon as improvised

containers for their sharps.

Disposal of Healthcare Waste

Table 2 shows that 75% (9) of hospitals stated that all healthcare wastes are disposed to

the city dump site. Approximately 25% (3) of hospitals stated that their facility has a specific

disposal sites which is a compost pit located within their vicinity.

The disposal sites for sharps which is a hazardous type and infectious wastes include a

septic vault 4 (33.3%), or a compost pit 3 (25%) within the hospital vicinity, city dumpsite

4(33.2%) and a privately owned dump site in Barangay Boalan 1 (8.3%).


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Table 2. Healthcare Waste Disposal Practice

Question Items Hospitals

N=12 (%)

Disposal Site

City DumpsiteCompost Pit w/in the hospital

9 (75)3 (25)

Infectious and Sharp Waste Disposal Site

Septic Vault

Compost Pit

City Dumpsite

Privately owned dumpsite

4 (33.3)

3 (25.0)

4 (33.2)

1 ( 8.3)

On observation, there were 4 hospitals with septic vault and 3 compost pit within the

vicinity for the disposal site of their infectious and sharp waste. Three hospitals were noted of

practicing burning in a compost pit. There was no evidence of practice of incineration in all

hospitals in Zamboanga City.

Treatment on Healthcare Wastes Prior to the Disposal

The purpose of treating healthcare waste is to change the biological character of the waste

to minimize its potential to cause harm. Figure 3 shows that 71.2%% (47) of the orderlies/waste

handlers reported that they do not treat their healthcare wastes before disposal. However, 28.8%

(19) of orderlies claimed to practice healthcare waste treatment for their infectious wastes and

sharps.

Those who claimed to practice healthcare waste treatment for their infectious waste and

sharps, on-site waste treatment methods practiced include acetylization (12.1%), encapsulation

(13.6%) and burning of sharps (1.5%).


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Figure 3. Practice and Methods of Waste Treatment

An interview with the nurses revealed that 84.2% had the knowledge but did not practice

sterilization prior to the disposal of blood and body fluids and feces. Thirteen percent do not

have any idea how these wastes should be disposed. For those who do not practice sterilization,

they disposed their pathological wastes in their sewage. In addition, there were no sterilization

practices prior to the disposal of feces.

Transportation of Healthcare Wastes from hospital to disposal site

Transportation of waste within the establishment could utilize wheeled- trolleys,

containers, or carts that are dedicated solely for the purpose (DOH Manual). On the

transportation of waste within the establishment, table 3 below shows that 93.9% or 62

orderlies/waste handlers made use of wheeled trolleys and the other 6.1% just hand-carried it

because there was not much waste to carry.


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Based on the interview among orderlies/ waste handlers, 90.9% (60) stated that the local

government garbage truck collects the healthcare waste and 7.6% (5) revealed that they do not

need the garbage truck because they directly dispose their wastes in their compost pit within their

establishment.

Table 3 . Transportation and Final Disposal of Waste

Question Items Orderlies/Waste handlers

N=66 (%)

Means of Transportation w/ in the

hospitals

Wheeled-trolleyHand-carried

62 (93.9)4 ( 6.1)

Collection of HCW by the local

government truck 60 (90.9)

On observation, wheeled-trolleys are available for transportation of healthcare wastes in

11 hospitals. Majority of orderlies or waste handlers transporting healthcare waste were equipped

with personal protective gear such as latex gloves, boots and face masks. All healthcare waste

were collected daily and stored in waste storage area located within the establishment until

transported to a designate disposal site. There were 11 hospitals surveyed with storage areas

located within the establishment

Based on the interviews done among hospital managers, nurses, and orderlies, it was

found out that the city dump site is the final disposal area of healthcare waste, which is located in

Brgy. Lumbangan. It was observed that although wastes were properly sorted in the hospital, the

local government garbage collectors do not follow the proper segregation, transport and disposal.

Moreover, the Lumbangan dumpsite has no separate site for the disposal of hospital wastes

except for the sharps which are buried. This results in futile practice of proper waste disposal of

hospitals.


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Figure 4. Solid Waste Flow of Hospitals in Zamboanga City

Hospital Waste

N=12

Waste Segregation

N=12

Non- infectious Waste

N=12 100%

Infectious Waste

N=12 100%

Treatment Done

N=7(58.3%)

-Acetylization (1)8.3%-Encapsulation(5)41.7%

-Sharp- burning(1)8.3%

No Treatment Done

N=5 41.6 %

Septic VaultN=4 33.3%

City DumpsiteN=9(75%) Non-Infectious Waste

N= 2 (16.6%)Treated Infectious

Waste

N=2 (16.6%) Non-Treated

Privately OwnedDum site N=1 8.3%

Compost Pit

N=3 (25%) Non-treatedinfectious waste

N=3 (25%) Non-infectiousWaste

Direct Disposal

N=2 (16.6 %)

Direct Disposal

N=2 (16.6%)


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In summary, there were twelve hospitals surveyed in this study. Hospitals generate waste

and use color- coding scheme and separate the different types of waste at the point of generation

to segregate these wastes. Infectious wastes are separated from non-infectious wastes. There are

7 hospitals who practices treatment of infectious wastes prior to disposal by means of

acetylization (8.3%), encapsulation (41.7%) and burning of sharps (8.3%). The disposal sites for

infectious wastes such as sharps includes a septic vault (33.3%)which is located within the

hospital vicinity, a privately owned dump site in Barangay Boalan (8.3%) and direct disposal to

the city dumpsite (16.6%). On the other hand, infectious wastes of hospitals with no treatment

were directly disposed to a compost pit (25%) located within the hospital vicinity and to the city

dumpsite (16.6%).Non-infectious wastes of hospitals were dispose to a compost pit (25%)

located within the hospital vicinity and to the city dumpsite (75%) which is the final disposal

area of healthcare waste located in Brgy. Lumbangan.

Other data regarding hospital waste management practices would be found in appendix

A.


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CHAPTER IV

DISCUSSION AND IMPLICATION

Appropriate hospital waste management practices depend largely of the administration

and require adequate legislative and financial support as well as the active participation by

trained and informed staff (DOH Manual).

A prerequisite to a successful waste management system is the establishment of a waste

management committee. In Zamboanga City, all the hospitals being surveyed are aware of the

existing national policies and guidelines related to healthcare waste management. It shows that

they adhere to the policies and regulations of the government and through these they have

organized a waste management committee and have formulated a waste management plan. In

addition, hospitals are responsive in preventing the deleterious effect of improper waste disposal.

Segregation is the process of separating different types of waste at the point of generation

and keeping them isolated from each other. To improve segregation efficiency and minimize

incorrect use of containers, proper placement and labeling must be carefully determined (DOH

Manual).Waste segregation among hospitals is being practiced. Majority of the nurses and

orderlies claim to observe waste segregation. This implies that the administrators ensure the

adequate training of key staff members on waste segregation and disposal procedures. Moreover,

they monitor and supervise proper procedures in the implementation of their hospitals waste

management plan.

The most appropriate way of identifying the categories of healthcare waste is sorting the

waste into color-coded plastic bags and containers (DOH Manual). Out of the 12 hospitals

surveyed, 50% were noted of practicing color-coding scheme. In an interview with their hospital

managers, it was discovered during an interview with hospital managers that they used to


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practice the color-coding system, but was not able to sustain it due to lack of budget and

supplies. However, they were able to develop means on how to manage their healthcare waste

through separation of infectious waste from non- infectious waste. For example, sharps which

are considered as an infectious waste and a very hazardous class are segregated by having

specific containers where to dispose and therefore, not mixed up with general wastes.

Less than 50 percent of respondents practices waste minimization and recycling is their

main measure to achieve waste minimization. Waste minimization is centered on the elimination

or reduction of the healthcare waste stream. Recycling is collecting waste and processing it into

something new. Many items in the hospital can be recycled. Items such as organics, plastic,

paper, glass and metal can be recycled easily (DOH Manual). An effective healthcare waste

management considers the basic element of waste minimization therefore it is beneficial for all

hospitals in Zamboanga City to implement such measures.

The purpose of treating healthcare waste is to change the biological character of the waste

to minimize its potential to cause harm. Most common and approved technologies and processes

used in healthcare treatment are (1) Thermal process relies on high heat to destroy pathogens

(disease-causing microorganisms), (2) Chemical uses heated alkali to destroy tissues, organs,

body parts, and other pathological wastes that can be used to treat prion- contaminated animal

waste and cytotoxic wastes, (3) Biological Processes uses an enzyme mixture to decontaminate

healthcare waste and the resulting by- product is put through an extruder used to remove water

for sewage disposal, (4) Irradiation systems which treats waste containing potentially infectious

microorganisms (DOH Manual). A large percentage of the respondents do not practice waste

sterilization prior to the disposal of blood and body fluids and feces. This could pose a risk in

spreading diseases. When waste that has not been pretreated is being transported outside the


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hospital, or dumped openly, pathogens can enter the atmosphere. These pathogens can find their

way to drinking water, foodstuffs, soil, etc., or they can remain in the ambient air (Manyele,

2004). And also, pathogens present in waste can enter, and remain in the air within the hospital

for a long period, in the form of spores or as pathogens themselves. Patients and their attendants

also have a chance of contracting infections caused by airborne pathogens or spores.

As to transportation of hospital waste, it was found out that the local government

garbage truck collects the waste as confirmed by the orderlies/ waste handlers (90.9%). It was

observed that although wastes were properly sorted in the hospital, the local government garbage

collectors do not follow the proper segregation, transport and disposal. This results in futile

practice of proper waste disposal of hospitals.

And lastly, the final disposal of all healthcare waste including infectious wastes is in the

city dump site which is in Barangay Lumbangan. In Lumbangan dump site, there is no assigned

area for hospital wastes except for the sharps which are buried. The area is open to public access

which may pose a serious health risk to garbage handlers and scavengers. It is likely that these

people will become infected due to exposure to hospital waste. Therefore the spread of infectious

organisms through various means from hospital wastes can increase the risk of spread of

infectious diseases.

According to the Revised Rules Governing the Regulations, Licensures and Operation of

Hospitals and other Health Facilities in the Philippines there are required documents to be

accomplish before an initial licensed to operate can be issued. One of the requirements is the

proper management of waste and having a waste management plan in their facilities. Under

Section 13 all hospitals and other healthcare facilities shall be monitored regularly and records

should be made available to determine compliance with these rules and regulations. As part of


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monitoring the healthcare facilities, inspection of waste management practices is being done

quarterly. Hospitals are inspected if they do have a waste management program, presence of an

Environmental Compliance Certificate number, if solid waste is collected, treated and disposed

of in accordance with the Health Care Waste Management Manual of the Department of Health,

2004. In addition, hospitals are observed on practices of segregation, coding and labeling of

waste, treatment of solid wastes prior to disposal. Treatment of sharps includes at least the

following: Autoclave, Chemical, Disinfection, Ionizing, Radiation, and microwave. Treatment

of infectious and pathological wastes includes at least the following: Autoclave, Chemical

Disinfection, Ionizing Radiation, and Microwave. Treatment of hazardous chemical and

pharmaceutical wastes include: Delay to decay or Chemical Decomposition and if hospitals uses

proper methods of waste disposal in accordance with the Health Care Waste Management

Manual of the Department of Health, 2004: Municipal/City Collection and Disposal System

(General Non-Infectious Dry/Wet Chemical) Safe Burial on Hospital Premises

Septic/Concrete Vault (Sharps) or Private Waste Treaters (Sharps Infectious Pathological)

Memorandum of Agreement with Private Waste Treaters is available and updated. And

presence of protective equipment and clothing appropriate to the risks associated with the

handling, storage, and disposal of wastes are provided to and used by personnel.

It is essential that everyone concerned by healthcare waste should understand that

hospital waste management is an integral part of health care, and that creating harm through

inadequate waste management reduces the overall benefits of health care. Proper hospital waste

management is an important aspect in minimizing infection and saves the environment.


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CHAPTER V

SUMMARY, CONCLUSION AND RECOMMENDATIONS

In summary, the study determines the current hospital solid waste management practices

in Zamboanga City. Waste segregation among hospitals is being practiced through color-coding

scheme and separation of infectious waste from non- infectious waste. A small fraction of

hospitals practices healthcare waste treatment for their infectious wastes and sharps prior to the

disposal. Although wastes were properly sorted in the hospital, the local government garbage

truck collects the waste and disposes it in the city dump site - a practice that defeats the purpose

of waste segregation in hospitals.

The researcher recommends that hospitals develop a waste management plan aimed at

adequately managing hospital waste using simple, sustainable system, and is affordable that

minimizes the impact to the environment.

Other methods of waste segregation should be evaluated in lieu of the full

implementation of the color- coding system due to lack of budget. Some hospitals are already

doing this but it is not know whether this is either acceptable or effective.

Hospitals should conduct regular orientation on the hospitals waste segregation and

waste management policies to patients and new staff. Reactivate committees and hold monthly

meetings to discuss and address issues related to updates on waste management and

environmental health awareness. Dissemination of information through supervisors/managers of

each department and discussed to their members. Hold event such as Waste Management Week

or an Infection Control Week once a year.

Consider training of all those garbage collectors by the DOH, because there is a need for

education as to the hazards of improper disposal of healthcare waste.


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The city government should propose a separate dumpsite for all healthcare wastes and set

limit to public access to decrease the risk of epidemics of infectious diseases.

Other recommendation for future research would be to determine the waste generation

rate of hospitals in Zamboanga City.


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BIBLIOGRAPHY

Artajo, E. (2000). Retrieved November 6, 2008 from http:www.zamboanga.net

Bhatia, J. (2003).Biomedical Waste Management

Department of Health (DOH)(2004). Healthcare Waste Management Manual. Manila,

Philippines

Environment Issue (2005).DENR, DOH Issue Guidelines on Hospital Waste Management

Kazi, N.M. (1999). Solid Waste Management. Bangladesh Centre for Advances Studies

Mair, A.D., Gaac,G.J and Dinisco,M. (2003). Solid Waste Management in the Philippines: Asmall Island

Manyele,S.(2004).Effects of Improper Hospital waste management on occupational health andsafety.Arf Newslett on Occup health and safety 14:30-33.

Molina, Victorio (undated), Waste Management Practices of Hospitals in Metro Manila, College

of Public Health, University of the Philippines

Rahman, M. H., Ahmed, S. N. and Ullah, M. S. (1999). A study on hospital waste management

in Dhaka City. 25th

WEDC conference, Addis Ababa, Ethiopia. pp.342-345.

Rogers DEC, Molefe S, Gcwense Q, van den Bergh C, Kristiannsen T, and Otto JB, (2006)

Projections for health care risk waste management, prepared for Department of EnvironmentalAffairs and Tourism and National Department of Health, CSIR project 8600/HT4150 May,

report No. msm/ep/er/2006/0031/b, DEAT project 12/9/6

Sarkar, S.K., Haque, M.A. and Khan, T.A. (2006) Hospital Waste Management in Sylhet

City.ARPN Journal of Engineering and Applied Sciences Vol. 1 No 2

Soncuya,R.T.,Matias,L.D. and Lapid, D.G. (1997), Hospital Solid Waste Management:TwoCasse Studies in Metro Manila, Philippines. Center for Advanced Philippine Studies, Quezon

City, Philippines

Soncuya, R. and Villoria , L. (1993), Solid Waste Study of Mandaluyong and San Juan,

UNDP- Metropolitan Environmental Improvement Program (MEIP), Quezon City

World Health Organization (WHO)(1983). Management of wastes from hospitals, World Health

Organization, Regional Office for Europe, Copenhagen.

World Health Organization (WHO) (2004.)Safe Health Care Waste Management. Geneva,

Switzerland.


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APPENDIX A

Observational Checklist Results of Hospitals

Question Items Hospitals (N=12)

With Waste Management Committee12 (100%)

With Waste Management Officer

12 (100%)

With Written Waste Management Plan

12 (100%)

With System of Waste Segregation

(Infectious waste from noninfectiouswaste)

12 (100%)

Presence of Color- coding system

YesNo

6 (50%)6 (50%)

Presence of Sharps in other container

12 (100%)

Storage area within the vicinityYes

No

11 (91.7%)

1 (8.3%)

Presence of Practice of Burning in a HoleYesNo

3 (25%)9 (75%)

Presence of Practice of Dumping in a Pit

Yes

No

3 (25%)

9 (75%)

Does not Practice Incineration12 (100%)

Presence of latex gloves, boots and mask

as personal protective equipment for

orderlies/waste handlers

12 (100%)

Trolleys or carts are available for

transportation of HCW

YesNo

11 (91.7%)1 (8.3%)


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APPENDIX BSurvey Questionnaire for Hospital Waste Manager

Name: ______________________________

Questions Yes No No

idea1. Are you aware of the existing government policies, laws and

regulations related to healthcare waste management?

2. Does your facility form a waste management committee whodevelops a waste management plan for the facility?

3. Do you designate a waste management officer to supervise andcoordinate the waste management plan?4. Do you keep an up to date waste management plan?

Have you ever evaluated your management plan?

When? ___________

5. Do you allocate financial resources to ensure efficientoperation of the waste management plan?

6. Do you allocate personnel resources to ensure efficientoperation of the waste management plan?

7. Do you monitor proper procedures in the implementation ofyour waste management plan?

8. Do you appoint immediate successor in the event of personnelleaving key positions in the waste management committee ortemporarily assign responsibility to another staff member until

a successor can be formally appointed?

9. Do you ensure adequate training for key staff members onwaste segregation and disposal procedures?

How many personnel do you have trained in managing hospital

waste? _______________When they were last trained?________________

10.Do you designate staff responsible for coordinating andimplementing training courses on waste segregation and

disposal procedures?

11.Do you attend complaints and legal matters regarding existingand unforeseen problems arising from the implementation ofthe program?

12.Do you establish a good working relationship to other related


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agencies by proper referral, consultation and cooperation

concerning healthcare waste management?

Which agencies? __________

13.Do you prepare an annual report for the disposal of healthcarewaste which provides data on waste generation, equipment

requirements and its cost?

( Ask for a copy )


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APPENDIX C

Survey Questionnaire for Orderlies/Waste HandlersName: _______________________Age: _______Department: ___________Years of Service:

_________

Questions Yes No No

idea

1. Do you practice waste segregation?How? [ ] color- coding [ ] separate different type of waste at the

point of generation.

2. Do you practice waste minimization?How?

[ ] reduction at source [ ] use of reusable rather disposable products

[ ] Recycling waste and process it into something new [ ]composting of food discards and kitchen waste

3. Have you received training in the past year on healthcare wastemanagement?

4. Were you thought about the color coding for waste segregation?5. Are you applying the color coding system in your vicinity?6. What is the color of the bin for uncontaminated dry waste such as

office supplies? (answer: Black) ______________

7. What is the color of the bin for uncontaminated wet waste such asleftover food? (answer: Green) _______________

8. What is the color of the bin for contaminated disposable non- sharpequipments such as gloves?( answer: Yellow) _______________

9. What is the color of the bin for chemical waste including thosewith heavy metals?( answer: color yellow with black band)

__________________

10.What is the color of the bin for contaminated wastes which containradionuclides? (answer: orange) _________________

11.What is the color of the bin for sharps and pressurized containers?(answer: Red) ______________

12.Do you find needles and syringes and other sharp waste mixed withinfectious or general waste?


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13.Do you separate contaminated sharps such as needles and syringesfrom uncontaminated sharps such as broken glass and nails?

14.Are containers of sharps puncture-proof and fitted with covers?15.Are bags and containers for infectious waste marked with the

international infectious substance symbol?

16.Do you segregate radioactive wastes according to its physicalform?

17.Do you place appropriate containers or bag holder in all locationswhere particular categories of waste may be generated?

18.Are waste collected daily (or as frequently as required) andtransported to the designated central storage site?

19.Is there a storage area for healthcare waste which is enclosed and islocated within the establishment?

20.Do you replace colored garbage bags immediately with new onesof the same type after disposal of waste?

21.Does the establishment utilize wheeled trolleys, containers, or cartsin the transportation of healthcare wastes?

22.Do you use personal protective equipment in handling waste suchas heavy-duty gloves, boots, etc.?

If no, why? [ ] not available [ ] uncomfortable [ ] unnecessary [ ]

others ______

23.Are healthcare wastes transported to the municipal dump?If not, where is it thrown? ___________________

24.Is there an on-site treatment of healthcare wastes before disposal ofwaste?

If yes, how? ____________________________________

24. Does the local government garbage truck collect the hospital

wastes?

If not, who does? _____________________

25.What protective measures against personal injury are available?[ ] Personal protective equipment such as disposable gloves andboots

[ ] availability of soap and warm water [ ] immunization against


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hepatitis B and tetanus infection[ ] training on how to deal with injuries and exposure in handling

healthcare wastes


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APPENDIX DSurvey Questionnaire for Nurses

Name:____________________Age:___Department:_________Years of service:____

Yes No Noidea

1.Is there a person assigned in your facility that is responsible foroverseeing the hospitals waste management practices?

Who? ________________________

2.

Do you practice waste segregation?

How? [ ] color- coding [ ] separate different type of waste at

the point of generation.

3. Do you practice color-coding scheme for healthcare waste?4. Do you have separate containers for sharps?

What is the color of the container? (Ans:

Red)_______________________

5. Do you occasionally mix sharps with non-sharps?6. Do you dispose contaminated disposable non- sharp

equipments such as gloves in a specific container?

What is the color of the container? (Ans: Yellow)

_______________7. Do you dispose uncontaminated dry waste such as office

supplies in a specific container?

What is the color of the container? (Ans: black

)_______________________

8. Do you dispose uncontaminated wet waste such as leftoverfood in a specific container?

What is the color of the container? (Ans: Green)

_________________9. Do you dispose contaminated wastes which contain

radionuclides in a specific container?

What is the color of the container? (Ans:orange)_________________

10.Do you do any form of waste treatment prior to the disposalof infectious waste?

What methods? _______________________11.Do you have a storage area for wastes collected prior to

disposal?12.Are waste collected daily (or as frequently as required) and

transported to the designated central storage site?

When is the time of collection? ______________________

13.Does the establishment utilize wheeled trolleys, containers,or carts in the transportation of healthcare wastes?


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14.Do you practice sterilization prior to the disposal ofpathological wastes such as blood and body fluids?

If not, how are these being disposed? ___________________

15.Do you practice sterilization prior to the disposal of feces?If not, how are these being disposed? ___________________

16.Are bags and containers for infectious waste marked with theinternational infectious substance symbol?


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APPENDIX EObservational Checklist

Questions yes no comments

1. The facility has a waste management committeewho develops a waste management plan for thefacility.

2. The facility have a designated a waste managementofficer to supervise and coordinate the waste

management plan.

3. There are written guidelines or a written facilityplan on HCWM.

4. A system for segregation of hospital waste is beingpracticed.

5. Infectious waste is segregated from noninfectiouswaste.

6. Color-coded waste bins are present in all areas.7. All waste bins have appropriate colored bin liners.8. No sharps in other waste containers.9. Hospital wastes waiting for disposal stored in an

appropriate waste storage area located within theestablishment.

10.There is no evidence of practice of open burning onthe ground in the facility.

11.There is no evidence of practice of burning in a holeor in an enclosure in the facility.

12.There is evidence of practice of incineration in thefacility.

13.There is evidence of practice of burial in thehospital premises.

14.There is evidence of practice of dumping in a pit inthe facility.

15.There is evidence of practice of dumping in anunsupervised area in the facility.

16.Presence of maintenance problems with theequipment used for treatment and disposal.

17.Heavy duty gloves are available as personalprotective equipment for the waste handler.

18.Latex gloves are available as personal protectiveequipment for the waste handler.

19.Boots are available as personal protectiveequipment for the waste handler.

20.Goggles are available as personal protectiveequipment for the waste handler.

21.Masks are available as personal protective


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equipment for the waste handler.22.Apron is available as personal protective equipment

for the waste handler.

No available personal protective equipment for the

waste handler

23.Trolleys, containers, or carts are available fortransportation of healthcare wastes.

24.There is evidence of practice of sterilization prior tothe disposal of pathological wastes such as blood

and body fluids.

25.There is evidence of practice of sterilization prior tothe disposal of feces.


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CURRICULUM VITAE

PERSONAL INFORMATIONName: Precilla Madel D. Morones

Age: 25

Sex: Female

Civil Status: Single

Date of Birth : September 17,1983

Address : Sun St., Bamboo Drive, Tumaga Interior, Zamboanga City, Philippines

Religion : Christian

Father : Manolo B. Morones

Mother : Edelyn D. Morones

EDUCATIONAL BACKGROUND

GRADUATE

Degree : Medicine

School : School of Medicine, Ateneo de Zamboanga UniversityPlace : Zamboanga City, Philippines

Year of Graduation : 2008

COLLEGE

Degree : Bachelor of Science in Psychology

School : Ateneo de Zamboanga University

Place : Zamboanga City, Philippines

Year of Graduation : 2004

HIGH SCHOOL : Marian College, Ipil Zamboanga Sibugay Province

ELEMENTARY : Malangas Central Elementary School, Malangas Zamboanga Sibugay

Province

Documents

2009-05!26!140651morones,Precilla Madel d