Safe management of healthcare waste

1
Safe management of healthcare waste

• Consultation proposals

2
Introduction

• What is Healthcare/clinical waste
• Previous guidance
• Need for change
• New guidance
• CIWMs response
• Non clinical setting

3
Healthcare waste

• No legal definition
• The solid or liquid waste arising from healthcare
  (EU 1993)

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Clinical waste

• (a) any waste which consists wholly or partly of
  human or animal tissue, blood or other body
  fluids, excretions, drugs or other pharmaceutical
  products, swabs or dressings, or syringes,
  needles or other sharp instruments, being waste
  which unless rendered safe may prove hazardous to
  any person coming into contact with it and
• (b) any other waste arising from medical,
  nursing, dental, veterinary, pharmaceutical or
  similar practice, investigation, treatment, care,
  teaching or research, or the collection of blood
  for transfusion, being waste which may cause
  infection to any person coming into contact with
  it
• (Controlled waste Regulations 1992, Regulation
  1(2)

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Safe disposal of clinical waste

• First published 1992, second edition 1999
• Introduced concept of groups A-E
• Group determines how you manage that waste

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Groups A-E

• A Identifiable human tissue, blood, animal
  carcases and tissue from vets, hospitals and
  labs, soiled surgical dressings, swabs and soiled
  wastes. Other waste materials from infectious
  disease cases, excluding any in B-E
• B Sharps
• C Microbiological cultures and potentially
  infected wastes from clinical/research labs
• D Drugs or pharmaceutical products
• E Items used to dispose of urine, faeces and
  other bodily secretions or excretions not in
  group A
• Where risk assessment shows no infectious
  risk, group E wastes are not clinical waste.

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Now forget what you have just read!

• Need for change
• A-E doesnt tie up with EWC
• Changes from Special to Hazardous waste
  Regulations
• Tie waste and transport closer together

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Safe management of healthcare waste Key features

• Guidance mainly focussed on healthcare setting
• Removal of A-E
• Replace with new unified approach
• Colour coding scheme for segregation/packaging
• Offensive waste stream
• Sector guidance (to be produced)

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Unified approach
Does the waste pose a risk of infection
Infectious substance class 6.2 (Carriage)
Clinical waste
Hazardous waste
Yes
No
Waste is not infectious
Further guidance on how to determine if
infectious is provided in the guidance.
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The Unified approach

• If a waste poses a risk of infection then it is
  clinical waste
• It is therefore also hazardous waste
• H9 of EWC infectious substances containing
  viable micro-organisms or their toxins which are
  known or reliably believed to cause disease in
  man or other living organisms
• It is therefore infectious for transport and
  should comply with Carriage of dangerous goods
  legislation

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Colour coding system (packaging)

Infectious waste (incineration)
Infectious waste (alternative technology)
Cytotoxic/Cytostatic (Incineration)
Offensive wastes (suitably licensed facility)
Domestic waste (as above)
Amalgam waste (recovery)
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Cytotoxic/Cytistatic drugs

• Only medicine/drug that is defined as a hazardous
  waste on EWC HWR
• Any medicinal product that possesses one or more
  of the hazardous properties Toxic (H6),
  Carcinogenic (H7), Toxic for Reproduction (H10),
  or Mutagenic (H11), is classified as 'Cytotoxic
  and Cytostatic'. This may include drugs from a
  number of medicinal classes for example
  antineoplastic agents, antivirals,
  immunosuppressants, hormonal drugs and others.
• Under Special waste all POMs were Special
• Relying on healthcare practitioner to make call
  or requires info from manufacturer

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CIWMs thoughts on guidance 1

• Broadly welcome document as helpful guidance
• Suggestion that dedicated waste manager at each
  trust welcomed
• Colour coding system good
• Happy to loose A-E, but need changes to licence
  conditions (with no charge)
• Unified approach There may be wastes people
  want to send as if clinical on a precautionary
  basis, this should be allowed
• Difficulty in determining Cyctotoxic and
  Cytostatic drugs

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CIWM thoughts continued

• Sector guidance needed number of grey areas
  remain
• Especially where local authorities involved
• Clinical waste is household waste and therefore
  LAs should offer collection
• May make a charge under CWR 1992
• When is it the householders waste and when is it
  the healthcare practitioner
• Range in services currently offered by LAs, some
  offer no service some offering free service for
  clinical wastes in the household
• Other community settings? Nursing homes,
  nursery, church hall, schools, body modification
  (tattoo and piercing)
• CIWM to fill void?