Transcript Safe Management Healthcare Waste Guidance

‘Safe Management
Healthcare Waste
Guidance 2006
Sue Berry – RGN, Dip I.C, MPH
Why re-write the regs/guidance ?
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Changes in waste management regulation,
notably Landfill Waste Regulations 2002, &
Hazardous Waste Regulation 2005
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Changes in carriage regulations, notably
amendments to CDGTPE 2004 Regulations
(ADR 2005)
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Changes in waste segregation – the need to
segregate and identify waste destined for
different disposal routes.
In Summary
Definition
Pharmaceutical
Methodology
Waste
Key
Key
Changes
Changes
Colour
Waste
Streams
Coding
EWC
How do you Interpret the HWR
2005 & List Waste (England)
2005?
Interpretation of
Hazardous
Waste Regulations
Guidance on the interpretation and
classification of hazardous waste available
in one document: WM2
Available to download from:
http://www.environment-agency.gov.uk
How Does WM2 Work?
WM2 is Based on the EWC
•20 Chapters relating to ‘industry sectors’
For example:
Chapter 1
Wastes Resulting from Exploration, Mining, Quarrying,
and Physical and Chemical Treatment of Minerals
Chapter 2
Wastes from Agriculture, Horticulture, Aquaculture,
Forestry, Hunting and Fishing, Food Preparation and
Processing.
Chapter 20
Municipal Wastes (Household waste and similar
commercial, industrial and institutional wastes)
including separately collected fractions.
(Chapter 16
Wastes not Otherwise Specified on the List)
EWC Chapters
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The ‘List’ consists of 20 chapters.
They do not have equal priority.
Chapters 1-12 and 17-20 are source activity
related.
Chapters 13-15 are waste type related
Chapter 16 - wastes not otherwise specified
‘99’ codes.
EWC
The EWC is colour coded to
aid the identification of
hazardous waste.
Non-hazardous entries are
shown in BLACK text.
‘Absolute’ entries are shown
in RED text.
‘Mirror’ (or threshold entries)
are shown in BLUE text.
18 01 XX
Wastes from natal care, diagnosis, treatment
or prevention of disease in humans
18 01 01
Sharps
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
18 01 04
Wastes whose collection and disposal is not
subject to special requirements in order to
prevent infection, e.g. dressings, plaster casts,
linen, disposable clothing.
18 01 06*
Chemicals
substances.
18 01 07
Chemicals other than those listed 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.
consisting
of
dangerous
What Makes Waste Hazardous?
Hazardous Properties
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H1
H2
H3
H3
H4
H5
H6
H7
H8
H9
H10
H11
H12
H13
H14
Explosive
Oxidising
Highly Flammable
Flammable
Irritant
Harmful
Toxic
Carcinogenic
Corrosive
Infectious
Toxic for Reproduction
Mutagenic
Substances that release toxic gases
Substances capable of yielding substances listed above.
Ecotoxic
What has happened to
Clinical Waste
CLINICAL WASTE
CHEMICAL
NON HAZARDOUS =
MEDICINAL
HAZARDOUS =
INFECTIOUS
Definition of H9 ‘Infectious Waste’
…
•Not ‘new’ – originates from Hazardous Waste Directive in Annex III
•In WM2 – Joint Agencies Hazardous Waste guidance
Infectious:
“Substances containing viable micro-organisms or their toxins which are
known or
reliably believed to cause disease in man or other living organisms”.
•WM2 – provides additional guidance
Conflict with Segregation: Waste
Manager vs Clinician
Universal/Standard Precautions
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“Universal precautions are not intended to change waste
management programs previously recommended by
CDC for health-care settings (1). Policies for defining,
collecting, storing, decontaminating, and disposing of
infective waste are generally determined by institutions
in accordance with state and local regulations.
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Information regarding waste management regulations in
health-care settings may be obtained from state or local
health departments or agencies responsible for waste
management”.
Perspectives in Disease Prevention and Health Promotion Update: Universal Precautions for
Prevention of Transmission of Human Immunodeficiency Virus, Hepatitis B Virus, and Other
Bloodborne Pathogens in Health-Care Settings
(CDC MMWR Weekly June 24, 1988 / 37(24);377-388 )
How do we know when waste is
infectious?
Risk Assessment
Unified Approach to Segregation
Cyto…What?!
Defining Cytostatic Waste
Currently no UK definition for cyto static, But…
Proposed definition based on ‘tried & tested’ approach in
USA, based on hazardous properties of pharmaceutical
product:
H6
Toxic
H7
Carcinogenic
H10
Toxic for Reproduction
H11
Mutagenic
Cytotoxic and Cytostatic Waste
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Cytotoxic drugs:- predominately but not
exclusively :
-Chemotherapy, Rheumatoid Arthritis, BNF Chpt 8
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EWC Code
Description of Waste
18 01 08*
Cytotoxic and cytostatic medicines
18 01 09
Medicines other than those mentioned in 18 01 08*
Why Segregate Our Waste?
 Legislation
 Guidance
 Best
Practice
 Environmental
 Financial
Mixing of Hazardous Waste
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An establishment which produces hazardous
waste cannot mix
hazardous and non-hazardous waste
different categories of hazardous waste
hazardous waste with any other substance or
material
(does not apply if mixing is part of a ‘suitable
authorisation’ for a disposal or recovery
operation)
Duty to Separate Mixed
Waste
 The
holder of the waste has a duty to
separate mixed waste where…
 technically and economically feasible AND
 necessary to comply with the Waste
Directive conditions.
 Must be carried out in accordance with a
waste permit or exemption.
Better segregation
Infectious Waste …
Infectious Waste (Clinical Waste)
18 01 03*
Offensive Waste
Domestic Waste
EWC Code
18 01 04
18 01 04
20 03 01
Description of Waste
OFFENSIVE WASTE
Wastes whose collection and disposal is not subject to
special requirements in order to prevent infection, e.g.
dressings, plaster casts, linen, disposable clothing.
Types of Segregation
 Recycling
 Confidential
 Hazardous
 WEEE
Waste
Segregation and Colour Coding
Best Practice Colour
Coding
Colour
Description
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.
Cyto-toxic / Cyto-static 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
facilities.
Black
White
Domestic Waste
Minimum treatment / disposal required is landfill in a suitably licensed or
permitted site.
Amalgam waste
What is Hazardous and Non
Hazardous Waste
Segregation of waste
Anatomical waste
includes:
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Human tissue
 Limbs
 Diagnostic specimens
 Full/part used blood
bags
 Placentas.
© Catalyst Waste Solutions
Ltd.
Produced for Doncaster PCT
Segregation of waste
Clinical/infectious
waste includes:
 Dirty dressings
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Wipes
 Gloves/aprons
 Empty blood bags
(used on or from infectious
or potentially infectious
patients)
© Catalyst Waste Solutions Ltd.
Produced for Doncaster PCT
© Catalyst Waste Solutions Ltd.
Produced for Doncaster PCT
Segregation of waste
Offensive waste
includes noninfectious:
Dressings, wipes, gloves,
aprons
 Human hygiene waste
 Sanitary waste
 Nappies
© Catalyst Waste Solutions Ltd.
Produced for Doncaster PCT
Sharps waste
Orange Lidded =
Sharps not
contaminated with
pharmaceuticals
© Catalyst Waste Solutions Ltd.
Produced for Doncaster PCT
Sharps waste
Yellow lidded =
Infectious sharps
CONTAMINATED with
Non Cyto
pharmaceuticals
© Catalyst Waste Solutions Ltd.
Produced for Doncaster PCT
Sharps Waste
Purple lidded =
Sharps and other
items contaminated
with
cytotoxics/statics
Sharps safety
 Assemble
containers
properly- lid correctly fitted
 Dispose
of sharps
immediately after use
 Locate
containers
appropriately and safely
 Fill
3/4 sharps containers
 Complete
the label.
© Catalyst Waste Solutions Ltd.
Produced for Doncaster PCT
Pharmaceutical Waste
Blue Lidded Container
(not sharps bin)
General
pharmaceuticals
© Catalyst Waste Solutions Ltd.
Produced for Doncaster PCT
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Waste Handling
Have adequate supplies of
bags/containers and tags/labels
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Tie/seal and tag/label waste bags when
¾ full or less – swan neck clinical waste
bags.
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Re-bag split or leaking bags
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Handle bags by the neck only
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Don’t compress bags to fit them into
bins/storage areas.
In House Policy and Guidance
 The
Unified Approach can help formulate
the framework of the Trust policy, training
programmes and audits.
Transport Classification for
Infectious Waste
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Carriage of Dangerous Goods and
Transportable Pressure Equipment Regulations
2005 (CDGTPE 2005)
 Simplified classification of infectious
substances.
Category A
An infectious substance which is transported in a
form that, when exposure to it occurs, is capable of
causing permanent disability, life-threatening or fatal
disease to humans or animals.
Category B
An infectious substance which does not meet the
criteria for inclusion in category A.
Transport Classification for
Infectious Waste
Carriage (Transport) Classification
Infectious Waste
Human Healthcare
18 01 03*
CAT A
UN2814
Infectious Waste
Animal Healthcare
18 02 02*
CAT A
UN2900
CAT B
UN3291
CAT B
UN3291
Class 6.2
( Infectious)
Infected / Used Medical Devices
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Where implanted medical devices have been in contact with infectious
bodily fluids and have been assessed to be infectious, they should be
classified and treated as infectious waste.
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If the device contains hazardous materials or components including
nickel cadmium and mercury containing batteries. The description of the
waste on the consignment note must fully describe the waste and all its
hazards. For example an implanted device with a nickel cadmium battery
should be described as:
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18 01 03
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[Hazards: Infectious (H9) and Corrosive (H8)]
Infectious Waste containing Nickel Cadmium batteries
Notification of Premises
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Central notification point in Rotherham
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By Paper from the 18th April
£28 by cheque or BACS
By Phone from the 3rd May
£23 by credit or debit card.
By Internet from the 3rd May
By Batch File from the 9th June
£18 for electronic registration
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Site Notifications to the - EA
Where hazardous waste is produced at, or
removed from, any premises…the premises must
be be notified to the Agency.
Exceptions
•Domestic
•Fly
premises (except asbestos)
tipped waste
•Mobile
Service Operators
•‘Exempt’
premises
Notification lasts for 12 months.
The Agency will issue a premises code
Considerations
 If
you intend to, or do, produce more than
200kg of hazardous waste on a premises
in any 12 month period you must notify the
premises
‘if you’re not confused
 you’ve not been paying attention!’
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Tom Peters