The management of healthcare waste

 In Feature article, Regulations and Standards

The management of healthcare waste presents healthcare organisations with numerous challenges, including meeting complex legislative requirements and ensuring infectious or chemical waste is made safe. It also offers opportunities for waste minimisation (environmental and carbon impact), minimising the cost of waste handling, and ensuring the most appropriate treatment methods are used to recover resources (recycling).

Regulatory and best practice requirements must be followed to ensure safety and minimise adverse environmental impacts, and whilst there is some statutory variation across the UK, the key requirements are the same. Non-compliance of Waste Management and Health and Safety regulations carries the risk of severe penalties.

Key requirements for Healthcare Waste Management

  • Waste must be dealt with at the time and place of production;
  • Waste must be handled safely and appropriately, with minimal handling;
  • Sorted correctly and stored securely in labelled designated containers.
  • Appropriate records must be made and kept for two years (minimum)
  • Removal and transport of waste for disposal is only done by a licensed waste contractor

At the point of production, waste should be sorted and segregated into suitable and identifiable containers. All healthcare waste must be correctly classified and described. It is much simpler to comply with this requirement if the waste is not a mixture of several types.

Failing to handle the mixed waste correctly leads to its unauthorised disposal, for instance, the unnecessary incineration of general waste or the disposal of medicines and sharps on landfill sites. To identify the healthcare waste each container must be clearly and correctly labelled in accordance with the European Waste Catalogue (EWC) which specifies numeric waste codes. Colour codes are recommended as they are helpful for staff to identify and segregate waste. So a strip of unwanted paracetamol tablets should be placed in a blue-lidded medicinal waste bin labelled with the EWC code: 18 01 09, for incineration. The cardboard outer package is put into a general waste bin, usually, a colour-coded black sack and this waste can be recycled, incinerated or put into landfill.

Ashtons ‘Disposal of unwanted drugs’ forms should be used to record all unwanted or expired pharmaceutical waste. These forms need to be retained for two years. The waste contractor will issue waste transfer notes (WTNs) and hazardous waste consignment notes (HWCNs) and these will also need to be kept for statutory recording and must be produced on request to the regulators.

Unwanted medicines must never be put down the drain as they will not be removed by wastewater treatment plants or septic systems. They will pollute waters, impacting aquatic species, and contaminating food and water supplies. Empty medicine bottles containing any liquid residue should be disposed of via pharmaceutical waste containers, not rinsed and recycled.

Other examples of healthcare waste receptacles

  • Yellow-lidded sharps bins (EWC code: 18 01 09) should be used for sharps that are contaminated with non-cytotoxic and non-cytostatic medicines.
  • Orange-lidded sharps bins (EWC code: 18 01 03) should be used for sharps that are not contaminated with medicines (such as phlebotomy sharps or shaving razors).
  • Purple-lidded bins (EWC code: 18 01 08) should be used for cytotoxic and cytostatic medicines e.g. chloramphenicol eye drops or tamoxifen.

Disposal of controlled drugs (CDs) needs to be carried out in a particular way, so local policies and procedures must be followed. Stock schedule 2 controlled drugs can only be destroyed in the presence of authorised witnesses appointed by the Accountable Officer. Disposal of stock CDs must be recorded in the CD register, which needs to be retained for seven years.

All schedule 2, 3 and 4 controlled drugs need to be denatured prior to the disposal. Hospitals need to have a waste exemption Form T28, obtained from the Environmental Agency, to allow staff to do this. All healthcare waste must be kept securely, whether in a clinic room or in bulk storage externally. This means the waste must be prevented from escaping, e.g. by leakage, or by unauthorised access to prevent harm. Regulations do not specify the storage security requirements, so risk assessments should be used and a locked cupboard, room or wheeled bin could be options.

The appropriate management of healthcare waste must be everyone’s responsibility in order for regulatory compliance to be achieved.

For further information to improve practice and compliance please visit the government’s website.

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