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					HAZARDOUS WASTE PRESENTATION

   GENERAL PRACTICE & PCTs
            In Attendance


•David Storry
•Commercial Director SRCL

•Bernadette Morrison
•Regional Account Manager
                 Why is it important?


Waste management – why is it important?

    • To protect the health and safety of staff, patients
      and others
    • To protect the environment
    • To comply with legislation
    • To save money

These factors are all interlinked – a good system for
management will fulfil all these requirements
                   Duty of Care


The Environmental Protection Act places a duty of care on
everyone who produces or handles waste

If YOU produce or handle waste in any shape or form in this
trust, it is YOUR responsibility to ensure that you handle it
correctly.

The duty is intended to prevent pollution or harm from any
waste activities

Non-compliance can result in pollution, prosecution, fines
and bad publicity
                 Duty of Care


Identify and describe the waste correctly – ensure the waste
transfer note is correct, use EWC codes
Keep the waste safely – containerisation and storage,
packaging and labelling
Transfer to the correct person
      - registered waste carrier
      - suitably licensed disposal site
Make reasonable checks – Duty of Care audits
Keep records
ALL waste streams are covered by Duty of Care not just
hazardous clinical wastes
                 Categorisation and segregation of waste


Typical Disposal Costs


Domestic Waste      £30 to £90/tonne
Clinical Waste      Up to £1000/tonne
Confidential Waste £200/tonne
                      Sefton PCT GP’s
- £65,000.00 on Clinical waste per year.
- £22,779.00 on Hazardous Waste Fees per year.
Costs can be controlled by ensuring proper segregation
is in place.
                The Hazardous Waste Regulations 2005


These Hazardous Waste Regulations replace the Special
Waste Regulations 1996 and came into force on July 16th
2005. The regulations replace the term ‘special waste’ with
the term ‘hazardous waste
Hazardous wastes are defined within the European Waste
Catalogue.
Hazardous domestic waste is excluded from the Regulations
(i.e. waste that originates from accommodation used purely
for living) unless it is separately collected fractions
If waste generated in a patients home is brought back to the
trust then it is included in the Regulations
                 The Hazardous Waste Regulations 2005

                                    18 01 XX Wastes from natal care, diagnosis, treatment or
 Definition of Hazardous Waste of disease in humans
                          prevention

18 01 01           •sharps (except 18 01 03)
18 01 02           •body parts and organs including blood bags and blood
                   preserves except 18 01 03)
18 01 03*          •wastes whose collection and disposal is subject to special
                   requirements in order to prevent infection = H9 Infectious
18 01 04           •wastes whose collection and disposal is not subject to special
                   requirements in order to prevent infection (for example
                   dressings, plaster casts, linen, disposable clothing)
18 01 06*          •chemicals consisting of or containing dangerous substances
18 01 07           •chemicals other than those mentioned in 18 01 06
18 01 08*          •cytotoxic and cytostatic medicines
18 01 09           •medicines other than those mentioned in 18 01 08
18 01 10*          •amalgam waste from dental care
                 The Hazardous Waste Regulations 2005


Infectious waste 18 01 03*
The categorisation of infectious waste is based on a clinical
assessment i.e. by a healthcare professional.
WM2 leads towards categorising the majority of clinical wastes
as hazardous as it includes all wastes ‘which may cause
infection’. This is reinforced in the Health Technical
Memorandum 07.01 The Safe Management of Clinical Waste.

To reduce the extra costs associated with these regulations
requires a highly efficient level of segregation of clinical waste
from domestic waste.
                    Categorisation and segregation of waste


The definition of clinical waste from the Controlled Waste
Regulations 1992 remains unchanged
Clinical waste means:
•   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; syringes, needles or other sharp
    instruments which unless rendered safe may prove hazardous to any
    person coming into contact with it, and;
•   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.
                The Hazardous Waste Regulations 2005

Definition of hazardous waste - Medicines
POMs no longer exists as a term for classifying waste.
Medicinal products are included in the EWC as follows:
18 01 08* cytotoxic and cytostatic medicines - these are
hazardous wastes
18 01 09 medicines other than those mentioned in 18 01 08 -
these are not hazardous wastes – however they still require
disposal by incineration and must be correctly described on
the waste transfer note
18 01 10* Dental amalgam is hazardous, it must be stored in
a dedicated container and transferred to a specialist disposal
company
                 The Hazardous Waste Regulations 2005


Restrictions on mixing wastes and the duty to
separate waste
Hazardous waste must not be mixed with non-hazardous
wastes and different categories of hazardous wastes must
not be mixed together
Where hazardous waste is already mixed it should be
separated if safe to do so
For practicality and risk minimisation – segregate at source
                The Hazardous Waste Regulations 2005


Site Notification to the Environment Agency
The regulations introduce an annual requirement for
producers to notify their sites to the EA.
The Environment Agency will issue each producer with a
unique site notification code for each relevant site.
The movement of waste from premises that are neither
notified nor exempt is prohibited.
                The Hazardous Waste Regulations 2005


Consignment Arrangements
All movement of hazardous waste must be accompanied by
a consignment note and a fee paid to the EA.
The consignment note must accurately describe the waste
and include detailed information. Producers are responsible
for ensuring that consignment notes are correct and
complete, but others may do the paperwork
Records and Returns
All parties to the management of hazardous waste are to
keep records of waste movements for specified periods.
Producers must keep consignment notes and quarterly
returns in a site register.
                 The Hazardous Waste Regulations 2005

The Agency’s role
Inspections – the EA must carry out appropriate periodic
inspections of hazardous waste producers.
Offences
Certain offences attract fixed penalty notices – the option of
discharging liability to conviction by paying £300 within 28 days;
     • failure to notify premises
     • failure to complete consignment note or carriers schedule
       documents
     • failure to keep a site register of notes and consignee returns
Otherwise, fines of up to £50,000 or terms of imprisonment of up
to six months per offence are possible
                   Waste Handling


Best Practice Colour Coding
The ‘Safe Management’ colour-coding segregates waste on
the basis of it’s suitability for treatment options. For example,
some infectious wastes can be treated by incineration or
autoclave, but some types must be incinerated.
Body parts, cytotoxic wastes, medicinal products/residues
must be incinerated.
Soft clinical waste such as dressings can be autoclaved or
incinerated.
The chart refers to a minimum standard of treatment, waste
may be treated to a higher standard.
                      Best Practice Colour Coding


Best Practice Colour Coding
     Infectious Waste
     Minimum treatment/disposal required is incineration in a suitably licensed or
     permitted facility
     Infectious Waste
     Minimum treatment/disposal required is to be ‘rendered safe’ in a suitably licensed
     or permitted facility

     Cytotoxic/Cytostatic Waste
     Minimum treatment/disposal required is incineration in a suitably licensed or
     permitted facility
     Offensive Waste
     Minimum treatment/disposal required is landfill in a suitably licensed or permitted
     site. This waste should not be compacted in un-licensed/permitted sites

     Domestic Waste
     Minimum treatment/disposal required is landfill in a suitably licensed or permitted
     site.
                 Categorisation and segregation of waste


To make sure that segregation is efficient and safe it
must be done at source
The majority of wastes will fit into one of the following
categories
    • Clinical waste
    • Domestic waste               Waste must be correctly
                                  segregated to comply with
    • Confidential waste
                                 the law, to reduce costs and
                                  to ensure that the correct
                                    disposal route is used.
                 Categorisation and segregation of waste


What is infectious clinical waste?
EWC 18 01 03
Human tissue, disposable items, and materials that have
been used on/by patients and may be contaminated with
blood or bodily fluids e.g. dressings, wipes, gloves, masks,
tissues etc.

What is not clinical waste?
Paper towels from hand-washing, sterile packaging,
confidential materials, uncontaminated materials
etc.
                Categorisation and segregation of waste


Infectious waste 18 01 03
One item of hazardous waste in a clinical waste bag makes
the whole lot hazardous, so segregation is very important

                  Dispose of in a tagged and labelled clinical
                  waste bag. Orange is the Best Practice
                  colour for infectious waste which is suitable
                  for alternative treatment.
                Categorisation and segregation of waste


Sharps waste 18 01 03/09
Sharps (hypodermic needles, blades, scissors etc) which may
be contaminated with potentially infectious body fluids and
non-hazardous medicines


                       Dispose of in a sharps box. Yellow is
                       the Best Practice colour for infectious
                       waste which must be incinerated, in
                       this case because of the presence of
                       medicines.
              Categorisation and segregation of waste


Cytotoxic and cytostatic waste 18 01 08
Sharps and contaminated with cytotoxic and cytostatic
medicines.



                     Dispose of cyto-contaminated sharps
                     a purple lidded sharps box.
                 Categorisation and segregation of waste


What is Domestic Waste?
Similar to the type of waste produced in the home, e.g.
non-contaminated couch roll, paper, hand towels,
packaging materials, cardboard, plastic drink
containers.
What is not Domestic Waste?
Domestic waste is not items contaminated with body
fluids, medicines, confidential materials
Send materials for recycling or dispose of in a black or
clear plastic sack
                Categorisation and segregation of waste


What is Confidential Waste?
Any papers or non-paper items such as discs that contain
personnel information, patient information, legal or
commercially sensitive information.


What is not Confidential Waste?
Confidential waste is not any old envelope or packaging.
Shred these materials or send for confidential destruction
                  Bad Practice




Clinical bags containing domestic waste
Gap between bag and outer bin
                  Bad Practice




Overfull sharps box
Clinical waste in domestic bag
                 Good Practice



                                 Expect to see
                                 a changeover
                                 to orange
                                 bags




Clinical bin
Domestic bin
Both lidded and foot-operated
                  Good Practice

Waste Storage Areas
Under Duty of Care producers have to
ensure waste is stored safely.
The waste area should be:
    • secure
    • reserved for clinical waste only
    • kept clean and tidy
And there should be:
    • suitable containerisation to prevent risk of littering
    • no storage of inappropriate items
    • timely and practical arrangements for collection
                 Finally a reminder……..


It is a legal requirement to keep records
•Producers must retain Controlled Waste Transfer Notes for
two years.
•Producers must retain Hazardous Waste Consignment Notes
for three years.
•Producers must retain consignee (quarterly) returns for three
years.
                 References


Environment Agency Technical Guidance WM2 - Appendix C9
WM2; available on EA website; http:/www.environment-
agency.gov.uk
Duty of Care – a Code of Practice (available on DEFRA
website)
HTM 07.01; Safe Management of Healthcare waste July 2006
The HWRegs Interim guidance for the NHS Sector – Royal
Pharmaceutical Society
Pharmacy contractor briefing on waste - PSNC