SAFE MANAGEMENT OF HEALTHCARE WASTE

1. SAFE MANAGEMENT OF HEALTHCARE WASTE

2. Regulatory regimes Healthcare waste management Infection control and health and safety legislation Environment and waste legislation Transport legislation

3. Duty of care Statutory requirements Section 34 of Environmental Protection Act The Environment Protection (Duty of Care) Regulations Everyone who produces, imports, carries, treats or disposes of controlled waste is required to fully comply with duty of care

4. As producers of waste responsible for management and disposal In England and Wales, Hazardous Waste Regulations require that most premises producing hazardous waste must be registered with the Environmental Agency Premises are exempt from registration if they produce less than 500 kg of hazardous waste in any period of 12 months

5. Healthcare waste produced in a care home, residents with no nursing care. It is the responsibility of the producer, eg, district nurse to dispose of the waste.

6. Infection Control Code of Practice – key points to take account of: Risk from waste disposal properly controlled ● Assessing risk ● Appropriate policies ● Arrangements to manage risk ● Monitoring the way arrangements work ● Aware of legislative changes

7. Infection Control Code of Practice – key points to take account of: Precautions with handling waste: ● Training and information ● Personal hygiene ● Segregation of waste ● Use of appropriate Personal Protective Equipment ● Immunisation ● Appropriate procedures for handling waste ● Appropriate packaging and labelling ● Clear procedures for dealing with accidents incidents and spillages ● Appropriate treatment and disposal of waste

8. Systems in place to ensure that the risks to service users from exposure to infections caused by waste present in the environment are properly managed and that duties under environmental law are discharged most importantly are: ● Duty of care in the management of waste ● Duty to control discharges to sewers ● Health and Safety at work legislation ● COSHH

9. Pre acceptance audits Care homes providing nursing or medical care must complete a pre acceptance for the waste contractor by 1 July 2013 Subsequent audits completed and submitted every five years

10. What is a waste pre acceptance audit? Legally authorised waste disposal facilities are required to know the composition of the waste before they accept it. ● Check each room of your care home to see what waste containers are present ● Look in each in use waste container to see what is actually in them (this should be done visually, without putting your hands inside the containers); type of waste eg offensive ● Question your staff about how they would dispose of different items (understanding and practice can vary) ● It is also worthwhile checking your storerooms and cupboards to see if there are any pieces of equipment or reagents that you may not have considered.

11. Do we have to do it? There is a legal duty to provide the person (contractor) who takes your waste with information to enable them to decide if the plant can safely dispose of waste

12. What happens if I don’t do it? ● In breach of “duty of care” ● Environment Agency can take enforcement action against you ● Inform CQC ● Waste contractor can no longer collect your waste

13. Who can undertake the audit? ● Self audit (need to understand requirements) ● Employ a third party ● Your waste contractor may offer this as a service (may be a charge, not obliged to provide)

14. Importance of Waste Segregation What happens if I don’t do it? Segregation of different waste streams is necessary due to: ● In England and Wales, mixing of waste is prohibited by law ● Health and Safety – reduce needle stick injuries ● Environmental – potential for waste minimisation ● Financial – reduction of hazardous waste - carbon reduction – unnecessarily, treating non hazardous waste energy - duty of care – producer legally required to classify and describe their waste

15. Colour Coding System • Is not mandatory, best practice to aid identification and segregation

16. Container labelling Containers to be labelled to clearly identify the waste type. Eg, anonymous yellow bins used for medicines

17. Infectious waste – orange stream Waste must not contain chemicals, medicines or anatomical waste Orange clinical waste should not contain waste that is non infectious – domestic, offensive Orange stream is waste known or suspected to contain pathogens classified in Category B Orange waste stream is hazardous waste

18. Infectious liquid waste Placed in a rigid leak proof receptacle Not all treatment facilities are licensed to accept such waste Medicinal products – blue lidded receptacle Cytotoxic / cytostatic waste • Yellow with purple stripe or purple stream • Requires incineration • Ensure suitable medicinal receptacles / bags and colour coded sharps containers are available

19. Sharps waste Sharps are segregated and disposed of on the basis of medicinal contamination. The colour of the lid is based on contamination and how waste is treated and disposed of. Purple lid Sharps contaminated with cytotoxic and cytostatic medicines Yellow lid Contaminated with used in administration of non cytotoxic and non cytostatic medicines Orange lid Sharps not contaminated with medicines. Cannot intentionally discharge syringes with residual medicines to dispose in the waste stream

20. Offensive / hygiene yellow / black bags Waste that may cause offensive, eg, incontinence products

21. Large equipment and mattresses Equipment should be decontaminated prior to disposal. If no hazardous properties remain – eg, contaminated mattresses with pervious cover intact once item disinfected under specialist arrangements, can be disposed of as domestic waste

22. Waste transfer note Key element of duty of care is keeping track of the waste. When the waste is transferred from the producer to the transferee a transfer note must be completed. An annual transfer note can be used to cover all regular transfer of non hazardous waste. Copies of transfer notes must be retained by all parties for a minimum of two years.

23. Consignment notes Completion is the legal responsibility of the waste producer. Consignment notes must be completed for hazardous / special waste. Consignment notes must be kept by the waste producer for a minimum of 3 years from the date of collection.