Clinical Waste Management Policy
Harrow Primary Care Trust Clinical Waste Management Policy
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CONTENTS
1. Introduction 3
2. Roles & responsibilities 3
3. Classification of clinical waste 4
4. Segregation of Waste 5
5. Storage of waste on-site 7 6. Handling of Clinical Waste 7

7. Transport of Waste 8
8. Containers
9. registration
10. Spillages of Clinical Waste
11. Spillages of Mercury
12. Waste Produced in home setting 9
13. Clinical waste produced in schools and Special schools
14. Training
15. Monitoring/Audit
16. Bibliography/References
Harrow Primary Care Trust Clinical Waste Management Policy
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Review Date: December 2008
1. INTRODUCTION
This policy covers the segregation, handling, transport and disposal of clinical waste so as to minimise the risks to the health and safety of staff, patients, the public and the environment. Changes to legislation governing the management of waste, its storage, carriage, treatment and disposal have meant that guidance on clinical waste previously produced has had to be reviewed in order for the PCT to meet its legal obligations. The PCT and its employees have a responsibility for the safe handling, storage, transport and final disposal of waste produced in all areas of the PCT and in patient’s homes arising from care given by the employees of the PCT, as detailed in the Health and Safety at Work Act 1974 and the Environmental Protection Act 1990.
2. ROLES AND RESPONSIBILITIES
Under the Duty of Care all staff must ensure that all waste is disposed of correctly. All employees must ensure that they safeguard the health & safety of themselves and others by adhering to PCT waste policies. All staff coming into contact with clinical/sharps waste must be vaccinated against Hepatitis B.
The Chief Executive is ultimately responsible for ensuring that clinical waste is managed in compliance with relevant Health & Safety, Transport and Hazardous Waste Regulations.
The Waste Control officer or equivalent Responsible for ensuring that the PCT manages clinical waste disposal in accordance with its waste management policy, and in conjunction with the Infection Control Team for the revision of this policy.
Service Locality Managers Responsible for ensuring clinical waste is managed in accordance with this policy within their area of operational responsibility, and liasing with the waste control officer with regard to all matters arising from the application of this procedure.
Producers In line with this procedure, ensure: • Clinical waste is segregated and placed into the correct clinical waste container • The correct specification of bag and sharps container is used • Clinical waste bags are tagged with a code to identify the area from which the waste was generated • Clinical waste bags are sealed correctly when no more than 2/3 full • Sharps containers are sealed correctly when no more than 2/3 full • Sharps containers are tagged with a code to identify the area from which the waste was generated
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• Clinical waste bags and sharp containers are transferred to the waste collection point, and stored safely and securely.
Domestic Staff • Will ensure replacement, sealing, identification and removal of bags to waste disposal point. • Ensure that receptacles for clinical waste bags are kept clean
3. CLASSIFICATION OF CLINICAL WASTE
Waste group Type of clinical waste
Group A
An infectious substance which is transported in a form that, when exposure occurs, is capable of causing permanent disability, life threatening or fatal disease to humans or animals e.g. waste contaminated with pathogens presenting the most severe risk of infection such as Ebola virus. This waste must be treated by autoclaving on-site prior to removal to a disposal facility.
Category A Waste is unlikely to be generated in the community setting.
Offensive Waste
Offensive waste is waste that. • May cause offence due to the presence of body fluids. • Is not known or suspected to possess any hazardous properties. • Is not identified by the producer as needing disinfection, or any other treatment, to reduce the number of micro-organisms present.
Examples of offensive waste include the following if they are contaminated with a body fluid: continence pads, nappies, sanitary waste and other items which pose a minimal risk of infection such as empty catheter bags, plaster, protective clothing. Minimum treatment/disposal for offensive waste is land fill in a suitable licensed facility.
.
Sharps Waste
Sharps are items that could cause cuts or puncture wounds, including needles, scalpel and other blades, razors, knives, infusion sets etc, that have potential to cause infection.
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Care must be taken when assembling sharp containers to ensure the lid is securely in place. Sharps containers must be sealed labelled and replaced when ¾ full. If the sharps container is seldom used, it should be replaced after a maximum of 3 months regardless of the filled capacity. Therefore the sharps container must be signed and dated on assembly in order to identify when 3 months have expired. Sharps containers must always be kept at waist high on a level surface (or in a wall bracket) in a clinical area to prevent injury to children.
Liquid Waste
Any liquid clinical waste being placed within the clinical waste stream e.g. suction fluids or urine must be solidified with an appropriate gelling agent to prevent leakage, spillage and overflow and therefore reduce the risk of cross contamination. Where ever possible, pregelled suction liners must be used.
4. SEGREGATION OF WASTE
An assessment for chemical and medicinal hazards must first be carried out. If not contaminated with a chemical or medicinal hazard, then the following assessment must be followed.
Careful segregation of waste at source is vital to ensure: • Safety of those handling, storing and transporting waste • Safety of the public • Compliance with the law • Protection of the environment
To enable the correct segregation of waste at source the correct colour coded containers/ bags must be available for the variety of waste that is produced.
Table 1 showing segregation of waste Type of Waste (See definition above)
Receptacle Final disposal
Category A Infectious waste: Dressings (heavily blood stained or from infected wounds) Any soiled waste from a patient in isolation in bedded
Yellow Bag
Incineration
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areas. Any waste item with a soiled with an infected body fluid. (i.e. Continence pad with known U.T.I or gut infection) Used disposable instruments (Non sharp).
Category B If the waste is not contaminated with a disease causing pathogen
Orange Bag
Land fill
Sharps Waste: Scalpel/razor Needles Syringes must be disposed of as one unit
Purple lid cytotoxic/cytostatic contaminated sharps. Yellow Lid medicinally contaminated sharps (undischarged/partially discharged/fully discharged syringe) Orange Lid: Non medicinal contaminated sharps(e.g. lancets, scalpel blades, phlebotomy syringes, sharp disposal instruments)
Incineration
Offensive waste: Continence pad (i.e. no UTI or gut infection) Sanitary waste/nappies Dressing (with no wound infection. Plasters Soiled paper couch roll Empty catheter bags Empty stoma bags
Yellow and Black Striped bag
Landfill
Domestic Waste. Paper towels Packaging Used spacers/inhalers if patient is not infectious. Nonmedical glass e.g. crockery, bottles, aerosols
Black Bag Landfill
Recycling Waste: Cardboard Glass Plastic Tins Cans Paper
Green bin/bag
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5. STORAGE OF WASTE ON-SITE
Waste must not accumulate in corridors, wards or other places accessible to members of the public
Waste collection points shall be established throughout the PCT. Sufficient numbers of wheeled containers shall be sited at these points to accommodate waste produced locally without over spill. Each container/ store shall be locked, and wards and clinics issued a key for use by PCT staff or domestic contractors only. Storage areas must conform to the following:
• Allows physical segregation of clinical waste bags from household waste bags • Sited away from food preparation and general storage areas and from routes used by the public • Provided with access to first aid and washing facilities.
Where bulk storage is required the store should be sited on well-drained impervious, hard standing suitably constructed to provide containment allows ‘washing down’.
6. HANDLING OF CLINICAL WASTE
• When handling clinical waste appropriate gloves should be worn, at the time waste is produced [i.e. by the healthcare worker], disposable gloves are required. • Where waste is handled from the waste collection point, heavy duty (puncture proof) gloves are required. • Waste must be placed into an appropriate container at point of segregation Sacks must be replaced when 2/3 full. • Sacks must be sealed securely using an identity tag (this tag identifies the source of the waste to be traced to site, clinic or ward). • Transport the bag to the waste collection point and place into yellow wheeled container ensuring it is locked on completion. • Dispose of syringes, needles and cartridges intact into an appropriate sharps container Seal sharps containers when 2/3 full and attach an identity tag. • Keep in-use sharps containers out of reach of members of the public and away from direct heat sources. • All staff handling waste should be provided with protective clothing. • All staff handling waste must be offered immunisation against hepatitis B virus and tetanus • All staff handling waste must have received training in its safe handling and the appropriate action to be taken in the event of a sharps injury or spillage incident.
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7. TRANSPORT OF WASTE
7.1 Containers • Waste to be transported must be packaged in containers must meet the Approved Requirements in accordance with UN3291 and CDGCPL2. • Dedicated trucks, trolleys or wheeled containers must be used for clinical waste. These must not be used for any other purpose. • These containers must be in accordance with the appropriate UN and National regulations. • The containers must be cleaned at regular intervals sufficient to maintain cleanliness as well as after spillages/ leakages.
7.2 Registration The waste carrier must be registered with the Environment Agency for the collection, transportation and disposal of waste. The PCT must ensure that the contractor has a valid certificate. The Trust has a duty of care relating to the waste from generation, transport to ultimate disposal.
8. SPILLAGES OF CLINICAL WASTE
1. These must be dealt with promptly. The affected area must be secured from public access until it is made safe 2. Adequate protective clothing and equipment must be provided for those dealing with waste at Trust sites including: • Gloves, • Plastic aprons • Sturdy shoes or industrial wellington boots • Cleaning equipment including a hypochlorite or a chlorine granular compound such as ‘Presept’. 3. For major incidents sturdy shoes/ industrial wellington boots are to be provided. 4. The incident is to be reported in accordance with the Trust’s Health & Safety reporting procedure. An incident reporting form must be completed and the appropriate manager informed.
9. SPILLAGES OF MERCURY
Equipment containing mercury should not used. However if there is a spillage then each site should have access to a spillage kit (H & S Act 1974).
To remove spillages of mercury or mercury contained equpment then the contractor Grundon’s 01753 686777 Or Karraway 0208 236 0108 should be notified to remove.
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10. WASTE PRODUCED IN THE HOME SETTING
Such waste will be produced by community nurses, podiatrists, dental staff and phlebotomists caring out domiciliary visits. Where a healthcare worker (HCW) generates the waste, it is deemed as belonging to them and not the client or householder.
To accurately assess whether the waste generated is infectious, a risk assessment should be performed. This should be based on the professional assessment, clinical signs and symptoms, and any prior knowledge of the patient. |For example if a wound assessment indicates that the wound is infected, all associated contaminated dressings should be classified as infectious waste and packaged for appropriate treatment and disposal. This will usually be in an Orange bag.
If the assessment identifies that the waste is NOT infectious it can be placed in the domestic refuse e.g. small dressings and plasters, incontinence products etc. This type of waste must be wrapped in a plastic bag (which is not orange or yellow) and placed in the household waste in a solid dustbin/wheelie bin with lid to avoid any pest problems with split bags. If more than one bag is generated it must be placed in a yellow and black striped bag and removed by a contractor/healthcare worker (see 1 and 2 below)
Patient’s with MRSA Where a patient within the community has been diagnosed with MRSA and being cared for by a health care worker, the waste generated is not necessarily infectious. In assessing the risk of infection from waste produced by a patient with MRSA, the following should be considered: • If the patient is known to be colonised with MRSA, the MRSA status does not affect the assessment of the waste. • Orange waste bags are indicated only when infectious material is present in the waste generated (e.g. wound exudates).
PCT staff has the following options for disposal of infectious and offensive waste: 1. Local authority waste collections can be arranged in accordance with respective council department.
If the healthcare worker is leaving the waste in the home for collection by the local authority, they must ensure that the waste is in a secure place or container to ensure that there is no risk to the family.
2. The health care worker using a car and producing the waste can transport the clinical waste from the home environment back to base where there is a registered waste collection. A maximum of 20Kg of waste can be transported in a vehicle by a health care worker. However, a ‘transport document’ will have to be carried by the member of staff. The waste MUST be transported in a secure, leak proof rigid container that applies with packaging instruction P621 and UN approval. The HCW must
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ensure that it is kept in a rigid container in the boot of the vehicle to ensure that the waste is secure and hidden to prevent any spillage or theft.
Sharps generated by the HCW in a client’s home, can be transported in the vehicle of the HCW in a sharps container. If the HCW is travelling on public transport, on foot or bike, sharps waste produced by the HCW can only be transported back to base in the community sized 0.6 litre purple lidded UN approved sharps bin. All sharps bins Must be securely locked (where necessary using the temporary closing mechanism).
The PCT must comply with the Duty of Care including the requirement for document completion and transfer. In summary, the PCT bears full responsibility for the waste, its storage and packaging, arranging for its collection and preparing the required documentation.
Examples of waste generated by the HCW in client’s home.
Stoma/catheter bags: if a HCW is involved in the care of a stoma site, the waste from the stoma patient can be disposed of in a BLACK bag waste stream, unless more that a standard sized bag is generated a week. In this case it should be placed in a Yellow and Black striped bag. However if the person develops any type of gastrointestinal infection or the site becomes infected, all of the waste must be disposed of as infectious waste into the Orange bag waste stream.
Maggots: All maggots used for wound management must be secured in an air tight rigid container, and marked as UN 3291 and disposed of as supplier’s instructions.
Disposable Instruments: Metal disposable instruments must be placed into a Purple lidded community sharps bin.
Plastic disposable instruments pose no risk of sharps injury and can therefore be disposed of in the same way as any other clinical waste in the client’s home.
Lancets for blood sugar measurement/insulin syringe and needle: during a home visit these can be disposed of in a Purple lidded sharps bin.
11. CLINICAL WASTE PRODUCED IN SCHOOLS AND SPECIAL SCHOOLS
Waste contaminated with bodily fluids e.g. Nappies, incontinence pads etc need to be packaged and disposed of as per HTM07-01 and local council policy. It is the responsibility school welfare to arrange disposal by local council collections.
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Sharps used by school nurses for immunisation sessions: School nurses have a duty to ensure that sharps are disposed of safely following an immunisation session.
Empty sharps bins (UN 3291 Yellow Lid) are supplied by the employing Trust and will be taken to the school together with all other materials (vaccines, swabs, alcohol hand gels, plasters etc) by the school nurses.
Sharps bins must be no more than ¾ full, and then locked, signed and dated for disposal. Collection has to be arranged for the immunisation session by the school nurse and will be paid for by the employing trust. It is the responsibility of the school nurse to ensure that the sharps bins are stored safely, and preferably collected by the contractor at the end of the immunisation session and the contractor has access to the sharps bins at a pre-arranged collection time.
12. TRAINING
Clear information, instruction and training on categorising waste will be provide by staff in areas where clinical waste arises. Line managers will be responsible for ensuring that staff receive job specific training. Training will be included within the mandatory infection control training programme for the PCT.
13. MONITORING/AUDIT:
Waste audits are an essential tool in assessing composition of waste stream for the purpose of compliance with the PCT’s Duty of care and for monitoring waste segregation.
Waste audits will be carried out to monitor the effectiveness of waste segregation and minimisation to demonstrate compliance and where required to take action to remedy non-compliance. Feed back will be given to staff and management on outcomes of audits and respective managers will be responsible for any other follow – up action needed.
14. BIBLIOGRAPHY/ REFERENCES
1. Health Technical Memorandum HTM 2065 Healthcare waste managementsegregation of waste streams in clinical areas. 2. The Health and Safety at Work Act 1974 (HASAWA) 3. The Environmental protection Act 1990. 4. The Environmental Protection (Duty of Care) Regulations 1992. 5. Management of Health and Safety at Work Regulations 1999. 6. The Controlled Waste Regulations 1992 7. Control of Substances Hazardous to Health Regulations 1999 8. Carriage of Dangerous Goods (Classification, Packing and Labelling) and use of Transport Pressure Receptacles 1996 (CDGCPL2)
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9. The Special Waste (Amendments) Regulations 1997 10.The Carriage of Dangerous Goods by Road Regulations 1996 11.The Reporting of injuries, Diseases and Dangerous Occurrences Regulations 1995.
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New Clinical Waste Streams to comply with HTM 07:01
Community Setting
Examples
Waste Stream Colour Code Description and Method of Disposal
Examples of Containers
General waste. Personal Protective Equipment not contaminated with body fluids. Paper towels, disposable cups, newspapers, rinsed medicine tots, packaging from medication and uncontaminated dressings, bandages etc
Household Waste
Can go to
Landfill
Offensive Waste
Can go to deep
Incontinence pads, colostomy bags, urine bags dressings and PPE contaminated with body fluids NOT known to be infectious.
Landfill
Items KNOWN to be contaminated with infectious pathogens E.g. Dressings from known infected wounds, and other items that have been in contact with infectious body fluids
During confirmed outbreaks of infection dispose of contaminated incontinence pads, bedpans, gloves, aprons etc.
Infectious Waste
Can go to alternative
treatments such as
autoclaving then Landfill
Category A waste (Infectious waste – yellow bags) Sharps contaminated with drugs
Hazardous Waste
Must go for
Incineration
This is waste which contains specific drugs, such as hormones. Purple lidded containers will be issued from pharmacy if prescribed.
Cytotoxic/static Waste
Must go for Incineration