All organisations produce waste which must be removed from the premises and managed effectively within the scope of the law. Failure to deal with waste properly can lead to an unsightly accumulation of rubbish and problems such as pest infestation.
However, in addition to standard forms of waste, many health and social care organisations also produce clinical waste that may be hazardous to health. Such waste requires additional procedures and policies to be in place to ensure that it is disposed of safely and in compliance with regulations.
With the exception of medicines that are classified as non-hazardous, clinical waste is normally described as hazardous waste because it may cause infection or public health concerns if uncontrolled.
Any organisation that produces hazardous waste – anything with properties that are hazardous to health or the environment – has a duty of care under the Environmental Protection Act 1990 and Hazardous Waste Regulations 2005 to ensure that the waste is disposed of in a safe and correct manner.
According to the regulations, many producers of such waste may also have to register with the Environment Agency unless they are exempt.
Hazardous waste, including clinical waste, must be kept securely on site until collected for incineration by a carrier properly licensed by the Environment Agency. Failure to make such arrangements may lead to prosecution.
Under the regulations, clear records of waste transfer and disposal arrangements must be kept and in the case of hazardous waste a consignment note must be completed and handed to the carrier or authorised waste disposal body. It is very important to keep copies of all records.
Many health and social care organisations produce clinical waste, which is defined in the Controlled Waste Regulations 1992.
Clinical waste can be hazardous and may contain:
- human or animal tissue
- blood or other body fluids
- drugs or other pharmaceutical products
- used swabs or dressings
- used syringes, needles or other sharp instruments.
As a health risk, clinical waste should never be disposed of in general waste but segregated, labelled and controlled as with any other hazardous waste. Colour-coded receptacles should be used for each ‘stream’ of waste. The colours may vary but low-level clinical waste is commonly disposed of in sealed yellow plastic sacks for incineration.
All types of clinical waste must be collected by a licensed waste handler and organisations should refer to individual waste collection contractors or local authorities for specific colour schemes. Most councils operate free licensed clinical waste collection services to domestic households, while a charge is made for collection from nursing homes, residential homes and general practices.
While awaiting collection, full bags should be stored safely and securely away from the general public, animals and pests.
‘Sharps’ are a special category of clinical waste and include items such as used syringes and needles. Such waste is especially hazardous as injuries involving sharps can spread infection and illness.
All organisations that produce sharps waste should have effective policies and procedures in place and staff should be effectively trained in their application. Used sharps waste should be placed in purpose-built containers conforming to the appropriate British Standard and disposed of by an authorised waste collector. Special containers are required for cytotoxic/cytostatic wastes.
Sharps boxes should be puncture-resistant, leak-proof, suitable for incineration and designed with lids that can be closed in routine use and sealed securely when full.
Medicines and pharmaceutical waste
Another category of medical or clinical waste is out-of-date or unused drugs, or other waste pharmaceutical products. In the past these were returned to a pharmacy for disposal. However, since the Hazardous Waste Regulations 2005 came into force they must be disposed of via a licensed waste handler as with other forms of hazardous waste. Exceptions include care homes not offering nursing care and waste from home use, which may still be disposed of in appropriately registered pharmacies.
Staff health and accident procedures
Dealing with hazardous clinical waste, like any other work activity, can carry risks and all necessary safety procedures, policies and training should be in place. These should include appropriate first aid procedures, the reporting and recording of accidents and incidents and the adequate provision of personal protective equipment where needed.
All employees should be familiar with the safety procedures and should receive the necessary training and instruction to carry out their tasks safely.
All procedures involving handling, transport and storage of clinical waste should be such that no person is exposed to uncontained waste or suffers a penetrating injury with contaminated sharps.
All organisations where sharps waste is a possible issue should have a policy and a procedure to deal with injuries whereby a member of staff has their skin punctured by a needle or a sharp object which may be infected.
Clinical waste and the waste hierarchy
Waste regulations can be complex and are increasingly designed to protect the environment from problems caused by too much waste being produced in modern society. All modern organisations are therefore under increasing pressure to adopt environmentally sustainable waste management policies and to reduce the amount of waste that they produce.
A key element in doing this is to employ the waste hierarchy.
The waste hierarchy ranks the environmental effectiveness of different approaches to dealing with waste, including clinical or medical waste. It is designed to encourage organisations to manage their waste in as eco-friendly a way as possible.
The hierarchy, in order of effectiveness, is defined in the Waste (England and Wales) Regulations 2011 as follows:
- preventing waste
- other recovery (such as anaerobic digestion or incineration with energy recovery)
According to the Waste (England and Wales) Regulations 2011, the waste hierarchy must be considered and applied in a priority order whenever hazardous waste is transferred. Wherever possible, organisations should therefore consider all alternative materials and practices to reduce the amount of clinical waste they produce.
Further information can be obtained from the Department for Environment, Food and Rural Affairs (Defra) or the Environment Agency.
Use the following items in the toolkit to put the ideas in this article into practice:
- Policy - Sharps handling and waste (care homes)63.5 KB
- Form - Body fluids spillage checklist and audit tool (all providers)59.5 KB
About the author
Martin Hodgson MSc, PGCEA is a community psychiatric nurse by background, and has had a long career working as a senior manager in various health agencies, including mental health, primary and community care.
This article was first published in the July 2012 issue of Quality & Compliance Magazine.