Disposal of Clinical Waste

1.0Introduction

The Framework Directive on Waste (75/442/EEC), as amended by Directive (91/156/EEC) requires that Member States of the EU produce a National Waste Strategy setting out their policies on the disposal of waste. The Directive is implemented in the UK by the Environmental Act 1995, which sets out the objectives of the UK National Waste Strategy. Along with that legislation, the (Duty of Care) Regulations 1991, the Controlled Waste Regulations 1992, the Waste Management Licensing (WML) Regulations 1994, and the Special Waste Regulations 1996 provided the operational rules for businesses to work to.

Recently, the Hazardous Waste Regulations 2005 and the List of Wastes Regulations 2005 have replaced the Special Waste Regulations, which has meant subtle changes in the regulations concerning the disposal of “clinical wastes”. It puts limitations on who may dispose of certain materials, and the circumstances under which this may or may not take place. It is important that those working for and on behalf of Briarcare are aware of the limitations.

A definition of “clinical waste” may be found in environmental guidance document EN060. Briefly, during the course of their duties, the Carer is only likely to encounter:

  • Waste prescription drugs
  • Pads
  • Sharps – e.g. needles etc
  • Dressings
  • Contaminated clothing, including gloves and aprons

Further information may be found on controlled wastes in document EN025 and on hazardous wastes in EN026.

The essential message is that the Carer needs to be very careful about what they do or do not do with clinical waste.

Disposal of Clinical Waste

1.1Complexities of the law and clinical waste

Disposal – what is permitted ?

  • under the EPA1990, unless an organization has a waste management license (WML), it is unlawful to deposit, recover or dispose of controlled wastes, which will include clinical wastes. However, householders are exempt for their own waste. As Briarcare does not have a WML, it means the Carer must not take waste from a Service User’s home.
What about Waste produced in a private household?
  • If a patient is treated in their home by a community nurse or a member of the NHS profession, any waste produced as a result is considered to be the healthcare professional's waste. If the waste is non-clinical, and as long as it is appropriately bagged and sealed, it is acceptable for the waste to be disposed of with household waste. This is usually the case with sanitary towels, nappies and incontinence pads (known collectively as “sanpro” waste) which are not considered to be clinical waste when they originate from a healthy population.
  • If the waste is classified as clinical waste the healthcare professional can remove that waste and transport it in approved containers (i.e. rigid, leak proof, sealed, secured etc) and take it back to the trust base for appropriate disposal. Alternatively, the trust can make arrangements for the disposal of the waste with an appropriate waste contractor for which a charge may be made.
  • This is possible under the law because the healthcare professional's employers will have the necessary licenses and facilities to handle such waste, and suitable containers will be used
  • If a patient treats themself in their own home any waste produced as a result is considered to be their own. Only where a particular risk has been identified (based on medical diagnosis) does such waste need to be treated as clinical waste. In these cases, local authorities are obliged to collect the waste separately when asked to do so by the waste holder, but may make a charge.
  • Note that it’s the healthcare professional that makes the professional judgement as to a waste needing to be considered as clinical (ie hazardous) waste.

Disposal of Clinical Waste

What about large quantities of wastes ?
  • Human hygiene or “sanpro” waste can sometimes be produced in large quantities in some places such as residential homes. Although such wastes from these sources may be non-clinical, in quantity they can be offensive, cause handling problems, and the odour may be offensive. In these cases, where the premises generate more than one container of human hygiene waste over the usual collection interval, it is considered appropriate to store & package it separately from other waste streams.
What about “sharps”?
  • Sharps bins can now be obtained on prescription (FP10 prescription form) for the householder to use. There is a duty on local authorities to collect and dispose of household generated waste including clinical sharps waste from households. However, the specific collection of clinical sharps waste does not arise until a person requests such a service. Local authorities may then levy a reasonable charge on the waste holder for the collection and disposal of that waste.
  • Where the householder is being treated by a healthcare practitioner, sharps waste produced as a result of that treatment is deemed to be the waste of the healthcare professional, and may be removed by them for disposal
  • Again, this is possible under the law because the healthcare professional's employers will have the necessary licenses and facilities to handle such waste, and suitable containers will be used
  • Some GP practices may be able to accept sharps containers from the householder; the practices will need to be registered with the Environmental Agency if they handle more than 200 kg/year
  • Under those circumstances, it’s the householder that would arrange for the removal; those working for and on behalf of Briarcare must not offer to take the sharps container to the GP, as currently this would fall into a “grey area” of the law, and would probably break the WML regulations.

Disposal of Clinical Waste

What about waste pharmaceutical drugs?

  • Under the new hazardous waste regulations, most types of drugs are no longer considered as being hazardous wastes, though all pharmaceutical dugs fell under the older special wastes regulations
  • The only drugs that are now considered as being hazardous under the current hazardous waste regulations are cytotoxic and cytostatic drugs
  • Theoretically, most drugs other than the two hazardous categories, can now be disposed of by the householder in their normal external bin
  • In practice, many people prefer to return unwanted controlled drugs to their local pharmacy – The Misuse of Drugs Regulations 2001 both permits this and encourages it; this must be from households or individuals
  • Pharmacies may accept such drugs as they are allowed a (registered) exemption under the WML Regulations 1994, but only for drugs from households or individuals
  • Pharmacies are not allowed to accept industrial waste
  • Waste medicines from a care home that would have been classified as a nursing home (ie provides nursing care) are classified as industrial waste
  • It is unclear as to if residential homes would be treated as for nursing homes – this is a “grey” area of the law that would require the Environment Agency to provide guidance
  • Until such guidance becomes clear it is best for those working for or on behalf of Briarcare not to return drugs to a Pharmacy on behalf of a Service User.

2.0Objective:

To ensure that with all statutory and legal requirements regarding the safe disposal of clinical waste are complied with by those working for and on behalf of Briarcare.

3.0Procedure:

General

All working for and on behalf of Briarcare shall comply with all legislation and local regulations referring to the safe disposal of clinical waste.

Disposal of Clinical Waste

They shall also comply with all such regulatory requirements

Any waste disposal organisations used must be registered as competent with the local authority

Records must be maintained.

Local

Due to the high number of Service Users which necessitate the disposal of pads these should be disposed of the local Environmental Department has authorised the disposal of the waste as follows:

All pads should be placed in an available carrier bag and sealed as soon as possible.

All disposable gloves and aprons used during these personal care tasks should also be placed in these carrier bags.

Carrier bags should be sealed and disposed of in an external bin and not left in the Service users internal waste paper or kitchen bins.

Excreta, Blood And Body Fluids

If the clothing of the Service user or Carer becomes contaminated with blood or other body fluids

ΟThe item should be placed in a sealed polythene bag

ΟPlaced in the washing machine

ΟA sluice programme used if they have one

If the contamination is on such a scale that the item should be discarded, please ensure this is done with the Service User’s agreement and dispose of as you would if dealing with clinical waste.

Procedure OP 4.2.7 Infection Control

Disposal Of Sharps - This procedure is not to be carried out by a Carer but is put into this procedure for information purposes

After use, hypodermic needles should not be replaced in needle sheaths and, as with other single sharp objects, should not be replaced in their packaging, but put directly into a sharps container, which should be stored out of reach of Service Users and visitors.

Disposal of Clinical Waste

The containers should be sealed when about 3/4 full and taken to the local GP surgery for disposal by the householder

The householder should check first that the GP’s surgery is able to receive such waste; if not, the Local Authority is obliged to collect, though this collection must be requested of them.

Procedure OP 4.2.7 Infection Control

NOTE –

This procedure is not to be carried out by a Carer but is put into this procedure for information purposes

4.0Persons Responsible:

The Group Director is responsible for authorising this procedure

The Carer is responsible for the effective and safe disposal of waste at the Service User’s home

IMPORTANT

The Carer may not take waste away from the Service User’s home.

5.0Associated Documentation and References:

Documents

QM 4.2.2Disposal of Clinical Waste

OP 4.2.7Infection Control

EN025Controlled Wastes

EN026Hazardous Wastes

EN060Environmental Jargon

Legislation

EC Directive on Waste (75/442/EEC)

EC Amended Directive (91/156/EEC)

Environmental Protection Act 1990 (EPA1990)

Environmental Protection (Duty of Care) Regulations 1991 (as amended)

Disposal of Clinical Waste

The Controlled Waste Regulations 1992

The Waste Management Licensing (WML) Regulations 1994

Environmental Act 1995

UK National Waste Strategy

The Hazardous Waste (England and Wales) Regulations 2005 (SI 2005 No 894)

The List of Wastes (England) Regulations 2005 (SI 2005 No 895)

6.0Document History:

This section shows the approval and revisions of this document since its first issue. A vertical line in the left margin opposite the change will usually indicate changes from the previous version.

Version / Comments / Approved by / Date approved / Date of next review
01 / First issue of document / Q M / 08.07.05 / 08.07.06
02 / Updated to reflect hazardous waste regulations / Q M / 01.09.05 / 01.09.06

Text, graphics and pictures published in this document are the intellectual property of Briarcare Ltd. They may not be passed to other parties, either wholly or in part, except with the express permission of Briarcare Ltd

Br-SM/OP 4.2.2 Issue 01 Authorised By K Stokeld Page 1 of 7