HEALTHCARE WASTE MANAGEMENT IN THE

GOVERNMENT HOSPITALS OF

MOUNTAIN PROVINCE

______________

A Dissertation Proposal

Presented to the Faculty

of the Graduate School

Baguio Central University

Baguio City

______________

In Partial Fulfillment

of the Requirements for the Degree

Doctor of Philosophy in Administration and Supervision

_____________

Jane T. Layagan

March 2017
 2

APPROVAL SHEET

This dissertation proposal entitled, HEALTHCARE WASTE

MANAGEMENT IN THE GOVERNMENT HOSPITALS OF MOUNTAIN

PROVINCE, prepared and submitted by JANE T. LAYAGAN, in partial

fulfillment of the requirements for the degree, DOCTOR OF PHILOSOPHY IN

ADMINISTRATION AND SUPERVISION (PHAS), has been reviewed and

examined and is hereby endorsed for acceptance and approval for proposal defense.

CARLOS P. LUMA-ANG, Ed.D.

Professor 400A

PROPOSAL EXAMINATION COMMITTEE

_____________________________________
Chairman

______________________________ ____________________________
Member Member
 3

ACKNOWLEDGMENT

With heartfelt gratitude, the researcher wishes to convey her deep

appreciation and thanks to those who contributed to the completion of this humble

thesis proposal, without them, this piece will never have been realized.

The Good Lord, for bringing her into this world with a life equipped with

wisdom and overflowing opportunities to experience wonderful things in life.

Her family, especially her husband and children, for all the support,

understanding and unconditional love;

Members of the proposal committee,

____________________________________, for their comments, and suggestions

that helped the researcher to continually enhance and develop the study to be more

comprehensive;

Her other relatives and friends for their utmost support and words of

encouragement;

To the librarians of BCU for assisting and lending her the most related

references;

And to all those who, in one way or another, contributed in the completion

of this manuscript.

To God be the glory!

J.T.L.
 4

TABLE OF CONTENTS

Page No.

TITLE PAGE i

APPROVAL SHEET .. .. ii

ACKNOWLEDGMENT .. iii

TABLE OF CONTENTS .... iv

FIGURE USED ... vi

CHAPTER

1 THE PROBLEM

Background of the Study . 1

Conceptual Framework of the Study ... 5

Paradigm of the Study . 8

Statement of the Problem and Hypotheses ... 10

Scope and Delimitation of the Study .. 11

Definition of Terms 11

Significance of the Study . 14

2 DESIGN AND METHODOLOGY

Research Design .. 16

Locale and Population ... 17

Data Gathering Tool ..... 17

Reliability and Validity of the Research Instrument ... 18

 5

Data Gathering Procedure ...... 18

Statistical Treatment of the Data .... 18

REFERENCES ...... 21

APPENDICES

A. Letter to the Respondents ... 23

B. Questionnaire ....... 24

CURRICULUM VITAE........ 28
 6

FIGURE USED

Figure Page No.

1 Paradigm of the Study .......... 9

Chapter 1
 7

THE PROBLEM

Background of the study

Health is wealth, hospitals play a great role in the delivery of health care

services to the communities it serves, and it plays a vital role in its life saving

activities. However, procedures performed in healthcare facilities is one of the

prime sources of health care waste that can have an adverse effect or hazard to

health and environment if not properly handled, transported, treated and disposed.

Healthcare waste management should always consider health and occupational

safety. There are many potential hazards associated when dealing or handling

healthcare waste such as physical, chemical, and biological hazards as well as

ergonomic factors. All individuals exposed to hazardous health care waste are

potentially at risk, including those within the health care establishments that

generate hazardous waste, and those outside these sources who either handle such

waste or are expose to it as a consequence of careless management.

There are seven (7) categories of HCW generated in health care facility

(HCF). The Infectious, Sharps, Pharmaceutical Waste, Radioactive Waste,

Chemical Waste, Radioactive Waste, Non-Hazardous or General Waste

(Department of Health, 2012).

In addition, the Impacts of Healthcare Waste to Human Health and the

Environment was also discussed in the manual. The inadequate handling and
 8

disposal of HCW may lead to transmission of infectious diseases. The groups most

at risk are HCF workers, patients, general public, the community as well as the

environment. Therefore, the framework for management shall always consider first

and foremost patients health and HCF workers safety. There are many potential

hazards associated when dealing or handling HCW such as physical, chemical and

biological hazards as well as psychosocial and ergonomic. The HCF shall identify

all these specific potential environmental and occupational hazards during

handling, storing, treating and disposing of HCW.

A team consisting of trained industrial hygienist, safety officer, infection

control, waste management officer and other HCF professionals can work together

to identify potential hazards and ways to reduce if not to eliminate the hazard.

Apart from the risk to the patients and HCF workers, consideration must be given

to the adverse impacts of HCW to the general public and the environment. In

particular, attention shall be focused on the possible result of unmanaged waste to

air, water and soil, including the community. Minimizing the risk to public health

and the environment will require actions to deal with HCW within the HCF such as

proper waste segregation and minimization so that it does not enter the waste

stream requiring further treatment before disposal. While the HCF workers are at

greater risk of infection through injuries from contaminated sharps, other workers

and waste management operators outside of the HCF are also at risk. Certain

infection, however, spread through media or caused by more resilient agents, may
 9

pose a significant risk to the public. For example, the uncontrolled discharges of

wastewater from HCF such as field hospitals treating cholera patients are potential

source of cholera epidemic. However, the use of strong disinfectant shall be

minimized when there are alternatives as these can also chemically pollute the

water. Chemicals used in HCF are potential source of water pollution via the sewer

system. Chemical waste survey is a prerequisite to the development of an effective

waste management program. Any hazardous chemical waste generated shall be

dealt with by a proper chemical waste management system. For safety purposes,

always refer to the Material Safety Data Sheet (MSDS). Substituting chemicals

with substance that have lesser environmental and health impacts is a sound

practice. Accidental spillage within an HCF shall also be dealt with accordingly to

minimize impact on human health and environment. Pathogenic microorganisms

have limited ability to survive in the environment. This ability is specific to each

microorganism and is a function of its resistance to environmental conditions such

as temperature, humidity, ultraviolet irradiation, availability of organic substrate

material, presence of predators, etc. An example of this is the hepatitis B virus,

which is persistent in dry air and can survive for several weeks on a surface and

brief exposure to boiling water. It can also survive exposure to some antiseptics

and to 70% ethanol and remains viable for up to 10 hours at a temperature of 60oC.

The Japanese Association for Research on Medical Waste found out that an

infective dose of hepatitis B or C virus can survive for up to a week in a blood

 10

droplet trapped inside a hypodermic needle. In contrast, HIV is much less resistant.

It only survives for no more than 15 minutes when exposed to 70% ethanol and

only 3 to 7 days at ambient temperature. It can be inactivated at 56oC temperature.

Bacteria are less resistant than viruses, but less is known about the survival of

prions and agents in degenerative neurological disease (Creutzfeldt-Jakob disease,

kuru, etc.) which seems to be very resistant. In evaluating the spread or survival of

pathogenic microorganisms in the environment, the role of vectors (e.g. rodents and

insects) shall be considered. This applies to management of HCW both within and

outside HCF. Vectors such as rats, flies, cockroaches, which feed or breed on

organic waste, are well known passive carriers of microbial pathogens; their

population may increase dramatically where there is lack of waste management. In

addition, the public is very sensitive about the visual impact of anatomical waste,

such as, recognizable body parts and fetus. The present culture in the country does

not accept the disposal of anatomical waste inappropriately, such as in a landfill.

Person at Risk All individuals exposed to hazardous HCW are potentially at risk,

including those within the HCF that generate hazardous waste, and those outside

these sources who either handle such waste or are exposed to it as a consequence of

careless management. The main groups of people at risk to potential health hazards

associated with HCW are the following: HCF staff such as physicians, nurses,

healthcare auxiliaries and hospital maintenance personnel, Personnel and workers

providing support and allied services to HCF such as laundry, waste handling and
 11

transporting, Patients in HCF or those receiving home care, Visitors, comforters

and caregivers, Persons transporting hazardous HCW to treatment and disposal

facilities, Workers and operators of waste treatment and disposal facilities, the

general public. Exposure to hazardous HCW can result to disease or injury. The

hazardous nature of HCW may be due to one or more of the following

characteristics: it contains infectious agents, it is genotoxic or cytotoxic, it contains

toxic or hazardous chemicals or pharmaceuticals, it is radioactive, it contains

sharps.

Furthermore, the researcher had an observation that there are some practices

in government hospitals of Mountain Province that are inconsistent in the specified

policies and guidelines in the Health Care Waste Management Manual of the

Department of Health, hence this research is initiated. Proper waste management

has a big impact in health care and the environment, proper segregation, collection,

handling, transport, treatment and disposal will reduce or even eliminate health

hazard to the general public and the environment as a whole.

Conceptual Framework of the Study

Health Care Waste minimization , the HCW generated within a HCF

follows an appropriate and well identified stream from point of generation until

their final disposal, that is composed of several steps that includes waste

generation, segregation, collection, transportation (on-site and off-site), storage,

 12

treatment and disposal. The major tool of Waste Minimization is Resource

Development, which pertains to the 3Rs: Reuse, Recycle and Recover.

The underlying principle of Waste Minimization is rooted in the Hierarchy

of Controls which showed that prevention is very important, thus before producing

waste; the HCF shall investigate whether the amount of waste to be generated from

the daily operation of the HCF could be minimized in order to reduce the efforts in

subsequent handling, treatment and disposal operations. Waste minimization can

be done in two points of the healthcare waste handling. First, waste can be

minimized during the procurement procedure of materials needed by the HCF (Step

0). By purchasing environmentally friendly products, one can already minimize the

amount of waste that is to be generated. Second, waste can be minimized through

the process of segregation. In this process, the principle of the 3 Rs is applied,

thus, segregation effectively reduces the amount of waste to be treated or collected.

There is a correlation between waste minimization and environmental

management system (EMS) which provides a framework for managing an

organizations environment impacts. This program is being spearheaded by the

Environment Management Bureau (EMB) of the Department of Environment and

Natural Resources (DENR).

In Waste Minimization, the quantity of HCW generated shall always be

minimized and precautions must be taken during their handling. The critical point

in minimizing waste starts from the planning stage of the preparation of the Annual
 13

Procurement Plan (APP), which includes the list of items required for HCF

activities. The management of HCF must adopt the following strategies to

implement waste minimization: Establish an updated database for the waste

generation rates, current hazardous waste management strategies and current waste

management costs, Institutionalize waste minimization and sustain the program in

the long run, Have a written policy with established vision and mission to

implement Waste Minimization Program (WMP), Be aware of their specific role in

HCWM and be properly trained in waste minimization , Adopt the Green

Procurement Policy (GPP) pursuant to Executive Order 301, series of 2009.

Waste Minimization as the initial step aims at reducing as much as possible

the amount or quantity of HCW that will be produced by setting up an efficient

purchasing policy and having good stock management. The waste minimization

strategy shall be formally approved in writing by top management within the HCF

as a demonstration of their support and commitment to the program. Principles of

Waste Minimization Waste minimization is beneficial not just to the waste-

receiving environment but to the waste generators also. The cost for both the

purchase of goods and waste treatment and disposal are reduced and the liabilities

associated with the disposal of HCW is lessened. The extent to which a hazardous

waste minimization program is implemented depends upon the HCFs particular

operations and procedures. The principle of waste minimization applying the

following techniques: Green Procurement refers to waste prevention and reduction

 14

at source, Resource Development (3Rs) refers to reuse, recycling and recovery.

End of Pipe refers to treatment and disposal

Green Procurement, waste Prevention and Reduction at Source. Waste is

minimized even before its generation in a HCF through proper procurement

planning with the adoption of the Green Procurement Policy where items/goods to

be purchased will have minimum packaging and will generate less hazardous

waste; will utilize proper inventory of stocks and conduct Life Cycle Analysis for

equipment Waste Prevention through the Adoption of Green Procurement Policy

Pursuant to Executive Order 2004-31 A HCF, as part of its green procurement

strategy, can consider some of the following approaches: Supplier Focus (through

the supplier registration form with emphasis on environmental performance of

supplier); Product and Service Focus (including environmental specifications) ;

and, Life Cycle Analysis (internal analyses, or utilizing LCA completed by external

groups).

Production of goods is required to have less environmental impact to avoid

environmental contamination and harm to human health. Measures must be taken

to prevent hazardous substances from being released when products are used,

scrapped or disposed of to ensure that the production of goods does not contain any

substance that may cause damage to the environment or human health and to

promote greener design and disposal activities at any HCF. Thus, a HCF will

only procure goods from companies that fulfilled the following requirements:
 15

Producing goods that do not contain any substance included in the EMB-DENR list

of banned substances; and, Establishing a complete elimination program for banned

substances; and making a commitment to sustain the program.

Under these guidelines, a HCF can introduce measures to increase the

utilization of recycled materials and the purchase of more environmental friendly

equipment.

Waste Reduction at Source through Proper Segregation of Waste.

Segregation is an important step in HCWM. There are several reasons why it is

needed: Segregation minimizes the amount of waste that needs to be managed as

hazardous waste (since mixing non-hazardous waste with hazardous waste renders

the combined waste as hazardous); Segregation facilitates waste minimization by

generating a solid waste stream which can be easily, safely and cost-effectively

managed through recycling or composting; Segregation reduces the amount of

hazardous substances released to the environment through disposal of general

waste, Segregation makes it easier to conduct assessment of the quantity and

composition of different waste streams.

Safe Re-use. Re-use is not only finding another use for a product but, more

importantly, reusing the product over and over again for a given function as

intended. Promoting re-use entails the selection of reusable rather than disposable

products whenever possible. Re-use will also entail setting reliable standards for

disinfection and sterilization of equipment and materials for use. In general, the
 16

purchase and use of non-disposable items in a HCF shall be encouraged as much as

possible. When considering reuse it is important to make a distinction between

different types of products: Non-medical supplies, particularly disposable items

used in catering services, shall be avoided, Medical devices that pose no cross-

infection risk, e.g. blood pressure meters, Medical devices specifically designed for

reuse, e.g. surgical instruments.

Single use device such as syringes and hypodermic needles must not be

reused because of the risk of cross-infection. Where there is an option to purchase

a reusable device or to purchase a single use device, the former is always

preferable. Safe re-use may involve a combination or all of the sterilization

methods, such as cleaning, reconditioning, autoclaving, disinfection and

decontamination.

Recycling and Recovery. Recycling involves processing of used materials

(waste) into new products to prevent loss of potentially useful materials, reduce the

consumption of fresh raw materials, reduce energy usage, reduce air pollution and

water pollution (from land filling) by reducing the need for conventional waste

disposal and lower greenhouse gas emissions as compared to virgin production.

Recyclable materials include many kinds of glass, paper, metal, plastics, textiles

and electronics. Although similar in effect, the composting or other re-use of

biodegradable waste, such as food or garden waste, is not typically considered

recycling. Materials to be recycled are brought to a collection center or picked up

 17

from the curb side, then sorted, cleaned and reprocessed into new materials bound

for manufacturing. Through the use of the Life Cycle Analysis tool (LCA).

End of Pipe. Treatment and Disposal Waste treatment refers to the process

of changing the biological and chemical character of the waste to minimize its

potential to cause harm. Waste disposal refers to discharge, deposit, placing or

release of any health care waste into or on any air land or water. One common

strategy used is composting waste such as food discards, kitchen waste, cardboard

and yard waste. Sufficient land space for on-site composting, adequately distant

from patient care and public access area, would be needed. Food scraps can

provide most of the nitrogen, while bulking agents commonly found in HCF such

as cardboard and wooden chips could provide carbon. Composting techniques

range from simple un-aerated static piles to aerated windrows to vermin-

composting grounds Administrative Control Measures Green Procurement,

3 Rs and End of Pipe solutions can be achieved through, among others,

administrative control measures such as: Adopting Environmental Management

System (EMS), Systemized use of product first in, first out (FIFO) or first to

expire, first out (FEFO) for chemical and pharmaceutical products, Monitoring of

chemical flows within the healthy facility from receipt as raw materials to disposal

as hazardous waste, Elimination of medical supplies and equipment containing

hazardous chemicals like mercury, Using less hazardous method in cleaning such as
 18

steam disinfection instead of chemical disinfection, Checking the expiry date of all

products at the time of delivery and based on its optimum consumption rate.

Paradigm of the Study

Figure 1 illustrates the direction of the study.

The independent variables will include the following: 1.) Awareness of

employees on Health Care Waste Management; 2.) Management commitment in the

implementation of Healthcare Waste Management; 3.) Compliance of employees

on proper implementation of HCWM; 4.) Effect of activities conducted to monitor

and evaluate implementation proper waste management; and, 5.) Problems

encountered in the implementation of proper Healthcare Waste management.

1.) Awareness of employees on 1.) Level of awareness of the

Health Care Waste Management employees on Healthcare
Waste Management
Independent variables Dependent variables
2.) Management commitment in 2.) Extent of management
the implementation of commitment in the
Healthcare Waste Management implementation of healthcare
waste management
3.) Compliance of employees on 3.) Level of compliance of
proper implementation of employees on proper
HCWM implementation of Healthcare
Waste Management
4.) Effect of activities conducted 4.) Level of effectiveness of
to monitor and evaluate the activities conducted to
implementation proper waste monitor and evaluate the
management implementation of proper
waste management
5.) Problems encountered in the
implementation of proper 5.) Degree of seriousness of
Healthcare Waste management. the problem encountered in the
implementation of Healthcare
Waste Management.
 19

Figure 1

Paradigm of the Study

The dependent variables are the following: 1.) Level of awareness of

employees on Healthcare Waste Management; 2.) Extent of management

commitment in the implementation of healthcare waste management; 3.) Level of

compliance of employees on proper implementation of Healthcare Waste

Management; 4.) Level of effectiveness of the activities conducted to monitor and

evaluate the implementation of proper waste management; and, 5.) Degree of

seriousness of the problem encountered in the implementation of Healthcare Waste

Management.
 20

Statement of the Problem

This study aims to assess the healthcare waste management of the

government hospitals in Mountain.

Specifically, it sought to answer the following questions:

1. What is the level of awareness of employees on Healthcare Waste

Management?

2. What is the extent of management commitment in the implementation of

healthcare waste management

3. What is the level of compliance of employees on proper implementation of

Healthcare Waste Management?

4. What is the level of effectiveness of the activities conducted to monitor and

evaluate the implementation of proper waste management?

5. What is the degree of seriousness of the problems encountered in the proper

implementation of Healthcare Waste Management?

Hypotheses

The following are the hypotheses of the study:

1. There is no significant difference between the perception of medical and

administrative personnel on their level of awareness on health care waste

management.
 21

2. There is no significant difference between the perception of medical and

administrative personnel on the extent of management commitment in the

implementation of healthcare waste management.

3. There is no significant difference between the perception of medical and

administrative personnel on the compliance of employees on proper

implementation of Healthcare Waste Management.

4. There is no significant difference between the perception of medical and

administrative personnel on the effectiveness of the activities conducted to

monitor and evaluate the implementation of proper waste management?

5. There is no significant difference between the perception of medical and

administrative personnel on the degree of seriousness of the problems

encountered in the implementation of Healthcare Waste Management

Scope and Delimitation

The proposed study will focus on the implementation of Healthcare Waste

Management practices among the government hospitals of Mountain Province. It

will assess the awareness of employees, the commitment of the management,

compliance of employees on proper segregation, handling and disposal of waste,

effect of the activities conducted to monitor and evaluate proper waste handling,
 22

and the problems related to the implementation of healthcare waste management.

The respondents will include all the hospital employees with permanent and

temporary status employed for a minimum of six (6) months in the hospital. Thus,

there will be 372 medical personnel and 206 administrative personnel. The

questionnaire will be the main data gathering tool for this study.

Definition of Terms

For consistency of meaning and for the guidance of the readers, the

following terms are defined conceptually.

Administrative personnel. It refers to employees who are not directly in

contact with healthcare waste products but they are required to comply with the

implementation of healthcare waste management program in their respective

hospitals.

Chemical Waste. Discarded chemicals (solid, liquid, or gaseous) generated

during disinfecting and sterilizing procedures, includes wastes with high content of

heavy metals and their derivatives

Healthcare facilities (HCF). These are government institutions/

facilities/hospital that contribute to the improvement of the health status of an

individual.

Healthcare waste (HCW). It includes all the solid and liquid wastes

generated as a result of any of the following: Diagnosis, treatment or immunization

of human beings; Research pertaining to the above activities; Research using

 23

laboratory animals for the improvement of human health; Production or testing of

biologicals; and Other activities performed by health care facility (HCF).

Highly infectious waste. It includes microbial cultures and stocks of highly

infectious agents from Medical Analysis Laboratories and biofluids from patients

with highly infectious diseases. (These require disinfection at source).

Infectious. These are all the waste suspected to contain pathogens (or their

toxins) in sufficient concentration to cause diseases to a potential host. Discarded

materials or equipment used for diagnosis, treatment and prevention of disease of

patients with infectious disease

Medical personnel. It refers to employees who are directly involved in

healthcare waste products -the physicians, nurses, midwives, nursing attendants,

medical technologies, radiology technicians, dentist, dental aids, physical therapist.

Non-Hazardous or General Waste. These are waste that has not been in

contact with communicable or infectious agents, hazardous chemicals or

radioactive substances, and does not pose a hazard, like papers, cardboards, empty

bottles, tetra packs, scrap materials, pressurized containers, office wastes, food

waste and other materials of patients with noncommunicable disease, x-ray plates.

Pathological and Anatomical. It refers to tissue sections and body material

derived from biopsies or surgical procedures that are then examined in the

laboratory. Anatomical waste is a subgroup of pathological waste. This type of

waste refers to recognizable human body parts such as amputated body parts,
 24

placenta, internal organs, tissues used for diagnostic procedures such as biopsy,

blood, fetus.

Pharmaceutical Waste. It refers to expired, spilt and contaminated

pharmaceutical products, drugs and vaccines. Also refers to discarded items used in

handling pharmaceuticals. It include antineoplastic, cytotoxic, and genotoxic waste.

Drugs usually used in oncology (antineoplastic drugs) or radiotherapy units have a

high hazardous mutagenic or cytotoxic effect.

Radioactive Waste. These are wastes exposed to radionuclide. Residues

from shipment of radioactive materials and unwanted solution of radionuclides

intended for diagnostic or therapeutic use. Liquids, gas and solids contaminated

with radionuclides whose ionizing radiations have genotoxic effects.

Significance of the Study

As a health professional, it will be interesting and of great help on the part

of the researcher to understand the level of awareness, the compliance,

commitment, effect, and the problems/ challenges encountered in the

implementation of healthcare waste management in government hospitals so as she

could arrive to possible suggestion for improvement/modifications of the current

practice.

For the healthcare workers/employees, the information that will be gathered

in this study will also help to encourage and support health professionals to
 25

increase their awareness and commitment to enhance the implementation of an

effective and proper healthcare waste management practices.

For the patients/clients, they will be free from exposure to hazardous

healthcare waste, and avoid the risk of hospital acquired infections.

This study will not be for the benefit of present researcher only, but it will

serve as an inspiration to other researchers to conduct more study on healthcare

waste management.

Chapter 2

Design and Methodology

This chapter presents the research design and methodology, locale and

population of the study, data gathering tool and procedure, and treatment of data.

Research Design

The descriptive-comparative design through survey method will be

employed to look into the practices of healthcare waste management among the

government hospital of Mountain Province. Descriptive research design is a

scientific method which involves observing and describing the behavior of a

subject without influencing it in any way. Many scientific disciplines, especially

 26

social science and psychology, use this method to obtain a general overview of the

subject (Shuttleworth, 2008). It is also comparative since it aims to compare the

perceptions between the administrative and medical personnel among the

participating institutions.

Locale and Population of the Study

The study will be conducted in the government hospitals of Mountain

Province as shown in Table A. Total enumeration will be used to determine the

number of administrative and medical personnel.

Table A
Distribution of Respondents
Administrative Medical
Hospitals
Personnel Personnel
Luis Hora Memorial Regional
94 242
Hospital
Bontoc General Hospital 50 89
Barlig District Hospital 20 14
Besao District Hospital 22 14
Paracelis District Hospital 20 13
TOTAL 206 372

Data Gathering Tool

The researcher will gather data using a questionnaire checklist which is

divided into two parts. The first part will include a letter address to the respondents.

The second part will a questionnaire which will contain all the queries along the

following topics: Level of awareness of employees on Healthcare Waste

Management; Extent of management commitment in the implementation of

 27

healthcare waste management; Level of compliance of employees on proper

implementation of Healthcare Waste Management; Level of effectiveness of the

activities conducted to monitor and evaluate the implementation of proper waste

management; and, Degree of seriousness of the problem encountered in the

implementation of Healthcare Waste Management.

Validity and Reliability of the Data Gathering Tool

The questionnaire was based from previous researches related to the study.

The content validity of the questionnaire will be subjected for review to the

researchers adviser for further improvement.

The reliability of the questionnaire will be established after a pre-test to 10

administrative and 10 medical personnel who are not part of the actual number of

respondents utilizing the Richard-Kuderson Formula 21.

Data Gathering Procedure

First, an authorization to conduct study will be secured from the Dean of the

Graduate School. Afterwards, the researcher will also sought permission to float

copies of the questionnaire from the Medical Director and Chief Nurses of the

participating institutions. After approval, the countersigned letter to float copies of

the questionnaire by the officer in charge will be shown to the respondents of the

study.

Statistical Treatment of the Data

 28

The responses will be treated in a 3-2-1 Likert scale with their respective

statistical limit and descriptive equivalents.

f
WM =
N

Where:
WM = Weighted mean
= summation
f = frequency
N = total number of Respondents

The responses will be treated with a three-point Likert scale with their

respective statistical limit and descriptive equivalents.

1. Level of awareness of employees on Healthcare Waste Management

NUMERICAL STATISTICAL LIMITS DESCRIPTIVE SYMBOL
VALUE EQUIVALENT
3 2.35 3.00 Fully Aware FA
2 1.68 2.34 Moderately Aware MA
1 1.00 1.67 Least Aware LA
2. Extent of management commitment in the implementation of healthcare
waste management

NUMERICAL STATISTICAL LIMITS DESCRIPTIVE SYMBOL

VALUE EQUIVALENT
3 2.35 3.00 Highly Committed HC
2 1.68 2.34 Moderately Committed MC
1 1.00 1.67 Least Committed LC

3. Level of compliance of employees on proper implementation of

Healthcare Waste Management

NUMERICAL STATISTICAL LIMITS DESCRIPTIVE SYMBOL

VALUE EQUIVALENT
3 2.35 3.00 Fully Complied FC
2 1.68 2.34 Moderately Complied MC
1 1.00 1.67 Least Complied LC
 29

4. Level of effectiveness of the activities conducted to monitor and evaluate

the implementation of proper waste management

NUMERICAL STATISTICAL LIMITS DESCRIPTIVE SYMBOL

VALUE EQUIVALENT
3 2.35 3.00 Very Much Effective VME
2 1.68 2.34 Moderately Effective ME
1 1.00 1.67 Least Effective LE

5. Degree of seriousness of the problem encountered in the implementation of

Healthcare Waste Management

NUMERICAL STATISTICAL LIMITS DESCRIPTIVE SYMBOL

VALUE EQUIVALENT
3 2.35 3.00 Very Serious VS
2 1.68 2.34 Moderately Serious MS
1 1.00 1.67 Least Serious LS

In conclusion, for the difference of responses among the medical and

administrative, independent sample t-test (Adanza, Bermudo, & Adanza, 2011)

will be applied with the formula of:

X - X2
t=
X + X2 1 + 1
N + N2 - 2 N N2

Where:

X = mean responses of the first group

X2 = mean responses of the second group
X = summation of the processed responses of the first group
X2 = summation of the processed responses of the second group
X = summation of the squares of the processed responses of the first group
X2 = summation of the squares of the processed responses of the second group
N = number of respondents of the first group
 30

N2 = number of respondents of the second group

References

Adanza, E.G., Bermudo, P.V., & Adanza, J.G. (2011). Statistics: Support for

research. Intramuros, Manila: Mindshapre Co. Inc.

Shuttleworth, M. (2008). Descriptive research design. Retrieved

from Explorable.com:https://explorable.com/descriptive-research-design
 31

APPENDIX A

BAGUIO CENTRAL UNIVERSITY

#18 Bonifacio St., Baguio City

Graduate Program

Dear Respondent,

The undersigned is conducting a study entitled, HEALTHCARE WASTE

MANAGEMENT IN THE GOVERNMENT HOSPITALS OF MOUNTAIN

PROVINCE. In this connection, she earnestly requests your cooperation in

 32

answering the herein attached questionnaire. Rest assured that all data gathered

through the questionnaire will be treated with strict confidentiality.

Your cooperation and kind consideration of this request is highly

appreciated.

Very truly yours,

Jane T. Layagan
Researcher

APPENDIX B

QUESTIONNAIRE
 33

CURRICULUM VITAE

PERSONAL INFORMATION

Name : JANE TUFAY LAYAGAN

Birth date: November 25, 1975
Birthplace: Dalican, Bontoc, Mountain Province
Status : Married
Spouse: Alvin Manochon Layagan
Children: Aaron Graell T. Layagan Aronchay
Lehjane Krisel T. Layagan Likey
Jethro Daniel T. Layagan Palos
Alvin Jericho T. Layagan Aje
Loraine Gib-an T. Layagan
Parents: Mr. Jaime Aroy Tufay (+)
Mrs. Linda Kadlosan Tufay Addamey
 34

EDUCATIONAL BACKGROUND

Post Graduate: Doctor of Philosophy in Administration

and Supervision
Baguio Central University
March 2013

Master of Arts in Nursing

Baguio Central University
March 2013

Masters in Public Administration

Mt. Prov. State Polytechnic College
Nine Units

College: Bachelor of Science in Nursing

Baguio Central University
March 1998

Secondary: Mountain Province General

Comprehensive High School

Bontoc, Mountain Province

March 1993 (with Special Award)

Elementary: Dalican Elementary School

Dalican, Bontoc, Mt. Province
March 1989 (Valedictorian)

PROFESSIONAL ELIGIBILITY

Licensure Examination for Nurses: May 1 & 3, 1998

PRC Baguio City

WORK EXPERIENCE

Nurse III
November 02, 2016 to Present
Luis Hora Memorial Regional Hospital
Abatan, Bauko, Mt. Province
 35

Nurse II
June 01, 2009 to November 01, 2016
Emergency Room and Out Patient Department
Luis Hora Memorial Regional Hospital
Abatan, Bauko, Mt. Province

Nurse I
March 14, 2001 to March 2009
Luis Hora Memorial Regional Hospital
Abatan, Bauko, Mt. Province

Community Affairs Officer I

January to March 13, 2001
National Commission on Indigenous People
Sabangan, Mountain Province

Staff
September, 1998 to December, 2000
Congressional District Office of Congresswoman
D.C.Dominguez
Bontoc, Mt. Province

Volunteer Nurse
Philippine national Red Cross
Mountain Province Chapter

Volunteer Nurse
July to August, 2008
Bontoc General Hospital
Bontoc, Mountain Province

SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES

TITLE OF SEMINAR/
INCLUSIVE DATES NUMBER
CONFERENCE/WORKSH CONDUCTING OF
OP/ AGENCY TRAININ
SHORT COURSES From To G HOURS

Luis Hora Memorial

1. IHOMIS ORIENTATION 09/21/2016 8
Regional Hospital
 36

2. Integrated TB Information
Department of Health
System (IT IS) users' 09/06/2016 09/07/2016 16
IT IS
Training
3. Regional Rabies
Prevention and Control DOH, CARO 08/16/2016 8
Program Meeting
4. Hospital DOTS Program Philippine Coalition
07/21/2016 07/22/2016 16
Implementation Review Against TB
5. Care for Small Babies
Luis Hora Memorial
Orientation and Lactation 06/07/2016 06/09/2016 24
Regional Hospital
Managem,ent
6. Team Building Workshop Luis Hora Memorial
05/26/2016 05/28/2016 24
and Educational tour Regional Hospital
7. Training on Trainers for
Integrated Management
DOH, CARO 05/02/2016 05/06/2016 40
Childhood Illnesses
(IMCI)
8. Nationwide Mass Training
Luis Hora Memorial
on Cardiopulmonary 04/25/2016
Regional Hospital
Resuscitation
Cordillera
9. Governance and
Administrative
Management of 03/11/2016 03/12/2016 16
Regional Cooperative
Cooperatives
Union
10. Roll Out Orientation on
Provincial Health
OPV Switch/IPV for 02/11/2016 8
Office, Mt Prov.
Heaqlth Workers
Cordillera
11. Managing Credit and Administrative
10/02/2015 10/03/2015 16
Consumers Cooperative Regional Cooperative
Union
12. Role of Medical Adhesive
in Patient Safety Wound
Care Mngt & Surgical Site
Health Care Academy 09/24/2015 8
Infecrtion Udpdate
Peripheral IV
Complications
13. Gender and Sensitivity Luis Hora Memorial
09/17/2015 4
Orientation Regional Hospital
Cooperative
14. Labor Summit 05/05/2015 8
Development Authority
15. Product Presentation/
RMG Hospital Supply,
Demo of Medical Gas 02/17/2015 4
Inc.
Piping Systems
16. MACRO VISION
17. IS O 9001: 2008 CONSULTANCY
9/28/14 9/29/14 16
INT ER NA L AU D IT TRAINING AND
TR A IN ING CONSULTANCY
18. NUR S IN G NTIONAL LEAGUE 10/ 14/ 14 8
 37

LEA DER S H IP IN OF PHILIPPINE

TR ANS FOR MATIO- GOVERNMENRNME
NA L TIM ES NT NURSES, Inc.
LUIS HORA
19. LAC TATION
MEMORIAL 08/ 06/ 201 08/ 08/ 201
MANAGEME NT 16
REGIONAL 4 4
TR A IN ING
HOSPITAL
CORDILLERA
20. HUMAN RES OUR C E ADMINISTRATIVE
07/ 11/ 201 07/ 12/ 201
MANAGEME NT REGION 16
4 4
COOPERATIVE
UNION
CORDILLERA
21. CR ED IT AND
ADMINISTRATIVE
C O LLEC T IO N 06/ 06/ 201 06/ 07/ 201
REGION 16
MANGEMENT 4 4
COOPERATIVE
UNION
22. LAU NC H IN G O F
THE S EARC H FOR JUNIOR CHAMBER
03/ 14/ 201
OUTS TANT IN G INTERNATION 8
4
FAR MER S OF THE PHILIPPINES
P H ILIP P IN ES
LUIS HORA
23. SEM INAR ON 5 'S MEMORIAL 10/ 18/ 201
5
REGIONAL 3
HOSPITAL
LUIS HORA
24. R E-EC HO S EM IN AR
MEMORIAL
AND UP D ATES ON 8
REGIONAL
WC P U
HOSPITAL
CORDILLERA
25. HOW TO WR ITE
ADMINISTRATIVE
M IN UTES AND 09/ 14/ 201
REGION 8
BOAR D 3
COOPERATIVE
R ES O LUT IO NS
UNION
CORDILLERA
26. R EC OR DS ADMINISTRATIVE
MANAGEME NT REGION 9/ 13/ 201 8
COOPERATIVE
UNION
27. HAR NES H ING
PARTNER S H IP S
DEPARTMENT OF
W ITH P ED IATR IC
HEALTH AND
S OC IET IES AT THE
PHILIPPINE 08/ 15/ 201
LOC A L LE VE L. 4
COALITION 3
C ONNEC T ING THE
AGAINST
DOTS . P art 2 (P R E
TUBERCULOSIS
C ONVENT IO N
SEM INAR )
 38

DEPARTMENT OF
28. ACC E LER ATIN G TB
HEALTH AND
C ONTR O L:
PHILIPPINE 08/ 16/ 201
S H IFT IN G GE ARS 12
COALITION 4
AND NEW
AGAINST
PAR AD IG MS
TUBERCULOSIS
29. IS O 9001 2008
FOR MU LATIN G BENITO C.
07/ 09/ 201
QUA LITY P O LIC Y CASTILLO Jr. AND 8
3
AND QUA LITY ASSOCIATE (BCJA)
OBJ EC T IV ES
30. DOC UMENTATIO N
SEM INAR AN D
WR ITNG
BENITO C.
WOR KS HOP W ITH 07/ 10/ 201 07/ 11/ 201
CASTILLO Jr. AND 16
EFF EC T IV E 3 3
ASSOCIATE (BCJA)
DOC UMENT AND
R EC OR DS
C ONTR O L
31. R OOT C AUS E
ANA LYS IS W ITH BENITO C.
07/ 12/ 201
EFF EC T IV E CASTILLO Jr. AND 8
3
C OR R EC T IV E ASSOCIATE (BCJA)
AC T IO N
32. TR A IN ING O F
TAINER S IN THE
R EC OGN IZ ING , DOH (NATIONAL
R EC OR D ING , CENTERFOR
06/ 03/ 201 06/ 05/ 201
R EP ORTING, ANM D DISEASE 16
4 4
R EFER R IN G (4R s) PREVENTION AND
OF WOMEN AND CONTROL
C H ILD R EN AB US E
C AS ES
33. C OMP R EHENS IVE
QUA LITY
BENITO C.
MANAGEME NT 05/ 28/ 201 05/ 31/ 201
CASTILLO Jr. AND 32
MANAGEME NT 4 3
ASSOCIATE (BCJA)
S YS TEM AUD IT
TR A IN G
34. Sust ai ni ng R esil i en c y PHILIPPINE
Am i dst Ne w HOSPITAL
05/ 23/ 201 05/ 24/ 201
Chal l en ge s i n INFECTION 16
3 3
Inf ec t i on P revent i on CONTROL SOCIETY,
and C ont rol INC.
CORDILLERA
ADMINISTRATIVE
35. P arl i am ent ar y
REGION 05/10/2013 05/11/2013 16
P rocedur es
COOPERATIVE
UNION
 39

COOPERATIVE 02/ 21/ 201

36. St rat egi c P l anni ng
UNION OF BAGUIO 3 02/22/2013 16
CITY