Infection Prevention & Control
Policy & Audit Tool
POLICY FOR THE MANAGEMENT OF WASTE IN THE
COMMUNITY
Date of Issue
March 2010
Date of Review
March 2013
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DOCUMENT HISTORY
Document Status:
Developed by:
Current
Health Records and Transport Manager, Dorset County Hospital
Foundation NHS Trust, Reviewed by Tracey Stevenson for GP,
Dentist and Care Home use
Policy Number
ID, Version 1.1
Date of Policy
March 2010
Next Review Date
March 2013
Health Records and Transport Manager,
Dorset County Hospital Foundation
Sponsor
NHS Trust
Approved by / on
Health, Safety and Welfare Group, Dorset
County Hospital Foundation NHS Trust
Consulted
Dorset Infection Control Forum Sept 2010
Version
Date
1.1
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Comments
CONTENTS
1.
POLICY STATEMENT .............................................................................................. 1
2.
INTRODUCTION....................................................................................................... 1
3.
CHANGES INTRODUCED IN THIS GUIDANCE ....................................................... 1
4.
LEGISLATION, REGULATIONS AND TRUST POLICIES ......................................... 2
5.
CATEGORIES, DEFINITIONS AND SEGREGATION OF WASTE............................ 3
6.
HAZARDOUS WASTE .............................................................................................. 7
7.
INFECTIOUS WASTES…………………………………………………………………….8
8.
ANATOMICAL WASTE BLOOD BAGS AND GEL AGENTS ................................... 11
9.
MEDICINAL WASTE ............................................................................................... 12
10.
PHARMACEUTICAL WASTE…………………………………………………………….13
11.
LIQUID WASTES .................................................................................................... 14
12
TOTAL PARENTERAL NUTRICIAN (TPN) ............................................................. 14
13.
AMALGAM HAZARDOUS WASTE ......................................................................... 14
14.
MERCURY WASTE ................................................................................................ 15
15.
OTHER DEFINITIONS ASSOCIATED WITH HEALTHCARE WASTE .................... 15
16.
LARGE EQUIPMENT .............................................................................................. 16
17.
HIGH TEMPERATURE PROCESSES (INCINERATION) ........................................ 17
18.
ALTERNATIVE TECHNOLOGIES........................................................................... 17
19.
LANDFILL ............................................................................................................... 17
20.
DISCHARGE TO SEWER ....................................................................................... 17
21.
ROLES AND RESPONSIBILITIES .......................................................................... 18
22.
STORAGE PRECAUTIONS .................................................................................... 19
23.
CLEANING OF BULK TRANSPORT ITEMS ........................................................... 20
24.
PERSONAL PROTECTIVE EQUIPMENT ............................................................... 20
25.
BASIC HYGIENE .................................................................................................... 20
26.
IMMUNISATION...................................................................................................... 20
27.
ACCIDENTS AND INCIDENTS ............................................................................... 21
28.
REPORTING OF INJURIES, DISEASES AND DANGEROUS OCCURRENCES
REGULATIONS (RIDDOR) ..................................................................................... 21
29.
TRAINING ………………………………………………………………………………….22
29.
AUDIT ..................................................................................................................... 22
APPENDIX A WASTE SEGREGATION CHART ................................................................ 26
APPENDIX B EUROPEAN WASTE CATALOGUE CHAPTERS ......................................... 27
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APPENDIX C CYTOTOXIC AND CYTOSTATIC MEDICINES ........................................... 28
APPENDIX D COMMUNITY CARE …… …………………………………………….31
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MANAGEMENT OF CLINICAL WASTE POLICY
1. POLICY STATEMENT
1.1
The management of healthcare waste is essential to ensure healthcare
activities do not pose a risk of infection as outlined in the Health and Social
Care Act 2008.
1.2
Care will be delivered without discrimination, regardless of gender/ transgender,
race, disability, sexual orientation, age, religion/belief or cultural practice.
1.3
Information will be given to all clients in a way in which they can understand it.
2.
INTRODUCTION
2.1
The Clinical Waste Management Policy provides guidance on the safe management
and disposal of all types of waste generated within the premises. The Policy specifies
how waste should be segregated, stored, handled, transported and disposed of
safely and efficiently. This is to reduce the risk of exposure to clients, staff, visitors,
refuse collectors and the general public.
3.
CHANGES INTRODUCED IN THIS GUIDANCE/POLICY
3.1
This policy utilises the guidance available in “Environment & Sustainability, Health
Technical Memorandum 07-01: Safe management of Healthcare Waste” which was
produced by the Department of Health in 2006 and is in line with the use of the
European Waste Catalogue (EWC) Codes which are now mandatory for all waste
transfer documentation
The biggest change between this and previous policies is the move away from the
use of waste categories A to E as it is felt that these no longer appropriately reflect
the segregation of waste for treatment or disposal and do not easily equate to the.
Does this above need to be in?
3.2
The policy outlines new methodology for identifying and classifying infectious and
medicinal wastes that complies with health and safety, carriage and waste
regulations. Compliance with the unified approach will ensure that producers comply
with and go beyond the regulatory requirements.
3.3
Changes detailed within the new policy include:

The definition and classification of infectious wastes in accordance with
hazardous waste regulation and associated guidance published by the
regulatory agencies;

The definition and classification of medicinal wastes, including cytotoxic and
cytostatic wastes, in accordance with hazardous waste regulation and
associated guidance published by the regulatory agencies;

Changes in carriage regulations brought in by the Carriage Regulations, as
amended in 2005;
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
A revised colour coded best practice waste segregation and packaging
system;

The use of European Waste Catalogue (EWC) Codes.
4.
LEGISLATION, REGULATIONS AND POLICIES
4.1
This Policy is designed to confirm safe handling, segregation, packaging and
disposal of waste laid down in the: 
Manual Handling Operations Regulations 1992

Personal Protective Equipment at work Regulations 1992

Health and Safety at Work Act 1974

Control of Substances Hazardous to Health Regulations 2002

Environmental Protection Act (EPA) 1990 (and subsequent amendments)

Radioactive Substances Act 1993

Safe Disposal of Clinical Waste, Health and Safety Executive 1999


Labelling) and Use of Transportable Pressure Receptacles Regulations 1999
– modified 2005

- Delivering a Quality Service 1996 and
associated regulations
4.2

Hazardous Waste Regulations (2005)

European Waste Catalogue

Environmental Protection (Duty of Care) Regulations 1991

EC Directive on Waste Electrical and Electronic Equipment (WEEE) and

EC Directive on the Restriction of the Use of Certain Hazardous Substances
in Electrical and Electronic Equipment (RoHS) – both of which will be phased
in during 2005/2006

Waste Management Licensing Regulations;

Landfill Regulations;

Waste Electric and Electronic Equipment Regulations;
The Manager will assess their compliance with this legislation through regular review.
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4.3
Other sources of further information include:
The Management of Health and Safety in the Health Services, produced by the
Health Service Advisory Committee (HSAC)
Biological Agents: Managing the Risk in Laboratories and Health Care
Premises, produced by the Advisory Committee on Dangerous Pathogens and
published on the Health and Safety Website (HSE).
Working with ADR – An introduction to the Carriage of Dangerous Goods by
Road, produced by the HSE and available on their website.
4.4
A full list of all current guidance can be found at the end of the Environment and
Sustainability, Health Technical Memorandum 07-01: Safe management of
healthcare
waste
which
can
be
found
at:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd
Guidance/DH_063274
4.5
DUTY OF CARE
4.6
One of the most far-reaching implications set out by the Environmental Protection Act
is the Duty of Care, (Section 34). The Duty of Care requires that as waste producers,
the premises ensure waste is not illegally disposed of, does not escape from a
person’s control, and is only transferred, with a transfer note, to an authorised
person4.7
In addition, Section 3, sub-section 1 of the Health and Safety at Work
Act, 1974 states that employers have “a duty to ensure, so far as is reasonably
practicable, that persons not in his employment who may be affected are not thereby
exposed to risks to their health and safety”. This is the piece of legislation used to
prosecute those who have endangered members of the public through poor methods
of clinical waste management.
5.
CATEGORIES, DEFINITIONS AND SEGREGATION OF WASTE
5.1
This section outlines the definitions and classifications used for healthcare waste in
the UK, Carriage (transport) and Health and Safety legislation. Waste regulation
requires the classification of waste on the basis of hazardous characteristics and
point of production.
5.2
For ease of use, this policy aims to cover within each subsection, the legal definition,
segregation, colour coding, packaging and disposal method applicable in each case.
In order to do so the policy will refer to the page in what? for the appropriate table or
diagram sited within this policy.
5.3
DEFINITIONS AND CLASSIFICATIONS FOR HEALTH AND SAFETY
5.4
Health and safety legislation does not contain any specific waste definitions or
classifications. However, the regulations (notably COSHH) require those dealing with
hazardous and potentially infectious materials, (including waste), to assess the risk to
both their staff and the public who may come into contact with the material. COSHH
specifically requires consideration of the biological agents that may be present and
hazard groups they belong to. Reference should be made to the COSHH Approved
Code of Practice and the Approved List of Biological Agents. Each premise will have
a COSHH lead that will be able to provide assistance in this matter.
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5.5
NATIONAL COLOUR-CODING APPROACH
5.6
Segregation of waste at the point of production into suitable colour-coded packaging
is vital to good waste management. Health and safety, carriage and waste
regulations require that waste is handled, transported and disposed of in a safe and
effective manner. The following colour-coded waste segregation guides represents
best practice and ensures, at minimum, compliance with current regulation. For an
overall picture please refer to the diagram in Appendix A
5.7
RECYCLABLE WASTE
5.8
To comply with environmental policies it is encouraged that all recyclable items are
separated i.e. plastic cups, cans and tins, glass, newspapers and magazines, clean
white used office paper (not confidential) and cardboard should be separated and
place in the designated containers for collection.
5.9
Refrigerators/Freezers, Fluorescent Tubes and Batteries. Advice needs to be
sought on the disposal of these products.
5.10
Foil and Printer Cartridges. Where possible these should be recycled.
5.11
COMPUTERS AND EQUIPMENT
5.12
When considering disposal of this equipment consideration should be given to see if
it can be repaired, re-used or recycled.
5.13
GENERAL WASTE DISPOSAL
5.14
General waste from offices and kitchens must be disposed of in a black plastic bag.
Each bag must be appropriately tied and will be collected by a local contractor to
remove it from the premises for disposal. This waste MUST be stored separately
from Clinical Waste.
5.15
CONFIDENTIAL WASTE
5.16
All employees are responsible for maintaining the confidentiality of information
gained during their employment.
5.17
Confidential information can be anything that relates to clients, staff (including noncontract, volunteers, bank and agency staff, locums, student placements) their family
or friends, however stored.
5.18
Confidential waste can take many forms including medical notes, audits, employee
records, occupational health records etc. It also includes company confidential
information.
5.19
Person identifiable information is anything that contains the means to identify a
person e.g. name, address, postcode (part or full), date of birth, NHS national
insurance number, even a visual image (photograph) is sufficient to identify an
individual.
5.20
Certain categories of information are legally defined as particularly sensitive and
should be most carefully protected by additional requirements. For example
information regarding sexually transmitted diseases, HIV etc.
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5.21
Confidential Waste should be placed in plastic locked containers provided by the
contractor or in green bags, which should be securely tied, which will be disposed of
by shredding.
5.22
ELECTRICAL WASTE
5.23
The majority of electrical equipment will now be classed as Electrical Electronic
Equipment (EEE) as defined by the Waste Electrical and Electronic Equipment
Directive (WEEE). All WEEE is defined as hazardous waste and should be disposed
of in an appropriate manner.
5.24
SPECIAL WASTE (HAZARDOUS WASTE)
5.25
Any waste that presents a risk of death or serious tissue damage following exposure,
e.g. radioactive and/or cytotoxic waste is classed as Special Waste. Some clinical
waste is also classified as ‘special waste’ e.g. prescription only medicines and
syringes contaminated with or still containing prescription only medicines.
5.26
CLINICAL WASTE
5.27
The definition of clinical waste has historically been used to describe those wastes
produced from healthcare and similar activities that pose a risk of infection or may
prove hazardous. Clinical waste should be segregated from other wastes and
treated/disposed of appropriately in suitably licensed facilities on the basis of the
hazard it poses.
5.28
The current legal definition of clinical waste in the UK is taken from The Controlled
Waste Regulations 1992, issued under the Environment Protection Act 1990. It has
remained unchanged since it was first issued under the Collection and Disposal of
Waste Regulations 1988, issued pursuant to the Control of Pollution Act 1974.
5.29
Clinical Waste is defined as:
“… any waste which consists wholly or partly of human or animal tissue, blood or
other bodily fluids, excretions, drugs or other pharmaceutical products, swabs or
dressings, syringes, needles or other sharp instruments, being waste 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.”
5.30
EUROPEAN WASTE CATALOGUE
5.31
Recent regulatory changes, notably the Landfill (England and Wales) Regulations
2002, The Hazardous Waste (England and Wales) Regulations 2005 and the List of
Waste (England) Regulations 2005, require producers to adequately describe their
waste using both a written description and the use of the appropriate European
Waste Catalogue (EWC) Code(s).
5.32
The EWC is a list of wastes produced by the European Commission in accordance
with the European Waste Framework Directive (75/442/EEC) to provide common
terminology for describing waste throughout Europe. The EWC list is reviewed
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periodically and incorporates the European Hazardous Waste List pursuant to the
Hazardous Waste Directive 91/689/Eec.
5.33
The EWC is colour coded to aid identification of hazardous waste. Absolute entries*
(shown in red) in the catalogue are deemed to be hazardous regardless of their
composition or concentration. Mirror entries (shown in blue) are those, which are
recognised as having the potential to be hazardous and require an assessment of
their composition and concentration. Non-hazardous wastes are shown in black. The
EWC categorises waste into 20 chapters; each chapter is linked to a production
sector.
5.34
Healthcare wastes are listed in chapter 18 of the EWC, however, producers should
be aware that healthcare premises produce a wide variety of wastes and reference
should be made to other relevant EWC chapters (the full waste catalogue chapters
can be found in appendix B).
5.35
Within each chapter wastes are described using 6 digit numerical codes, the first two
digits of the code relate to the EWC chapter, the second two digits relate to any subgrouping within the chapter and the final two digits are unique to the waste.
5.36
The table below provides a list of all Chapter 18 (Healthcare Waste) EWC Codes.
18 01 02 (black)
body parts and organs including blood bags and blood preserves
(except 18 01 03)
18 01 03* (red)
wastes whose collection and disposal is subject to special
requirements in order to prevent infection
18 01 04 (black)
wastes whose collection and disposal is not subject to special
requirements in order to prevent infection (for example dressings,
plaster casts, linen, disposable clothing, diapers)
18 01 06* (blue)
chemicals consisting of or containing dangerous substances
18 01 07 (black)
chemicals other than those mentioned in 18 01 06
18 01 08* (red)
cytotoxic and cytostatic medicines
18 01 09 (black)
medicines other than those mentioned in 18 01 08
18 01 10* (red)
amalgam waste from dental care
* Hazardous Waste List Entries
5.37
The use of the EWC has led to a change in the classification of infectious and
medicinal waste in the UK. A number of entries in chapter 18 of the EWC are
classified as hazardous waste.
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6.
HAZARDOUS WASTE
6.1
The Hazardous Waste (England and Wales) Regulations 2005 and the List of Waste
(England) Regulations 2005 define and regulate the management of hazardous
waste in England. These Regulations, amongst other things, require producers of
hazardous waste to notify (register) with the Environment Agency. The Regulations
do not provide comprehensive guidance on the classification of waste. However,
guidance is provided by the UK environmental regulatory authorities (WM2).
6.2
HAZARDOUS WASTE GUIDANCE WM2
6.3
The UK environmental agencies, i.e. the Environment Agency (EA), Scottish
Environment Protection Agency (SEPA), have produced a joint guidance document
on interpretation, definition and classification of hazardous waste, titled: WM2. This
document
is
available
on
their
website:
www.environmentagency.gov.uk/commondata/acrobat/1_haz_waste_intro.pdf.
6.4
WM2 provides guidance on the classification of absolute* and mirror entries in the
EWC in relation to the 14 hazard groups identified in the Hazardous Waste
Regulations 2005. The 14 hazard groups originate from the Hazardous Waste
Directive and are shown below.
H1
“Explosive”: substances and preparations which may explode under the effect
of flame or which are more sensitive to shocks or friction than dinitrobenzene.
H2
“Oxidising”: substances and preparations, which exhibit highly exothermic
reactions when in contact with other substances, particularly flammable
substances.
H3A
“Highly Flammable”
- liquid substances and preparations having a flashpoint of below 21°C
(including extremely flammable liquids), or
- substances and preparations which may become hot and finally catch fire in
contact with air at ambient temperature without any application of energy, or
- solid substances and preparations which may readily catch fire after brief
contact with a source of ignition and which continue to burn or to be
consumed after removal of the source of ignition, or
- gaseous substances and preparations which are flammable in air at normal
pressure, or
- substances and preparations, which, in contact with water or damp air,
evolve highly flammable gases in dangerous quantities.
H3B
“Flammable”: liquid substances and preparations having a flashpoint equal to
or greater than 21°C and less than or equal to 55°C.
H4
“Irritant”: non-corrosive substances and preparations, which, through
immediate, prolonged or repeated contact with the skin or mucous
membrane, can cause inflammation.
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H5
“Harmful”: substances and preparations which, if they are inhaled or ingested
or if they penetrate the skin, may involve limited health risks.
H6
“Toxic”: substances and preparations (including very toxic substances and
preparations) which, if they are inhaled or ingested or if they penetrate the
skin, may involve serious, acute or chronic health risks and even death.
H7
“Carcinogenic”: substances and preparations which, if they are inhaled or
ingested or if they penetrate the skin, may induce cancer or increase its
incidence.
H8
“Corrosive”: substances and preparations, which may destroy living tissue on
contact.
H9
“Infectious”: substances containing viable microorganisms or their toxins,
which are known or reliably believed to cause disease in man or other living
organisms.
H10(2) “Toxic for reproduction”: substances and preparations which, if they are
inhaled or ingested or if they penetrate the skin, may produce or increase the
incidence of non-heritable adverse effects in the progeny and/or of male or
female reproductive functions or capacity.
H11
“Mutagenic”: substances and preparations which, if they are inhaled or
ingested or if they penetrate the skin, may induce hereditary genetic defects
or increase their incidence.
H12
Substances and preparations, which release toxic or very toxic gases in
contact with water, air or an acid.
H13
Substances and preparations capable by any means, after disposal, of
yielding another substance, e.g. a leachate, which possesses any of the
characteristics listed above.
H14
“Ecotoxic”: substances and preparations, which present or may present
immediate or delayed risks for one or more sectors of the environment.
6.5
EWC 2002 states that “Toxic for reproduction” is considered to be in line with the
hazardous property H10 “Teratogenic” in the Hazardous Waste Directive.
6.6
Appendix C of the WM2 guidance provides comprehensive guidance on the
classification of waste in each of the hazard groups. The following sections provide a
summary of the WM2 guidance with respect to infectious, medicinal and amalgam
healthcare wastes.
7.
INFECTIOUS WASTES
7.1
The Hazardous Waste Regulations 2005 define infectious as:
H9
“Infectious”: substances containing viable microorganisms or their toxins,
which are known or reliably believed to cause disease in man or other living
organisms.
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7.2
The WM2 provides additional guidance on the interpretation of this definition in the
UK by reference to the need for specialist treatment of disposal, described in WM2
as ‘special requirements in order to prevent infection’
7.3
Waste defined, as clinical waste on the basis of the infection risk posed should be
considered hazardous infectious waste, as the waste requires specialist
treatment/disposal.
7.4
The relevant EWC codes is shown below:
18 01 03* (red) wastes whose collection and disposal is subject to special
requirements in order to prevent infection
7.5
Identification of infectious waste
7.6
Infectious waste is classified as waste, which may pose a risk of infection to a human
or animal. The classification of infectious waste does not rely on the use of pathogen
classification groups, and waste should be considered infectious even if the resulting
infection would be considered “minor”.
7.7
In order to help clinicians and carers identify potentially infectious waste at the point
of production, a simplified assessment has been introduced (see Table 1). The
assessment should be used to help staff undertake risk assessments and has not
been designed to replace risk assessment or clinical judgement.
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Table 1 Examples of infectious waste generated as a result of healthcare activities
Source
General
principles
Healthcare
premises
(hospitals,
veterinary
practices,
dentists,
nursing
homes)
Special requirements apply (hazardous by
H9)
Clinical (or animal healthcare) waste which
has not been subject to specific assessment
and segregation protocols to remove waste
subject to special requirements.
The specifically segregated “special
requirements” fraction
Clinical (or animal healthcare) waste arising
from a patient clinically assessed or known to
have a disease caused by a micro organism
or its toxin, where the causal pathogen or
toxin is present in the waste. For example:
 waste from infectious disease cases;
 waste from wound infections and other
healthcare-associated infections;
 hygiene products from patients in with
UTI infections;
 waste from patients with diarrhoea and
vomiting caused by infectious agents or
toxins, for example Clostridium difficile;
 blood-contaminated dressings from a
patient with HIV, hepatitis B, rubella,
measles, mumps, influenza or other
infection that may be present in the
blood;
 respiratory materials from patients with
Pulmonary tuberculosis, influenza, RSV
or other respiratory infections;
 contaminated waste from provision of
general healthcare to patients with known
or suspected underlying or secondary
microbial diseases
Special requirements do
NOT apply
Non-clinical healthcare
waste where the “special
requirements” fraction has
been removed following
item and/or patient specific
assessment and
segregation
Non-clinical healthcare
waste where the “special
requirements” fraction has
been removed following
item and/or patient specific
assessment and
segregation
Source: WM2
7.8
In general, only waste generated from healthcare practice undertaken by a suitably
qualified healthcare practitioner will be considered as infectious waste. Waste from
domestic minor first-aid and self-care, of a type that does not involve recourse to a
healthcare practitioner, is not included within the scope of this assessment. Similar
municipal-type waste from industrial and commercial premises is also excluded.
Therefore, soiled waste such as sanitary products and plasters are not considered to
be infectious unless a healthcare practitioner gives specific advice to the contrary.
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7.9
Colour Coding for Disposal and Disposal Method
7.10
Yellow
Infectious Waste which is to be disposed of through incineration (to be
consigned as 18 01 03*/09)
Minimum treatment/disposal required is incineration in a suitably licensed or
permitted facility. Yellow-lidded UN approved solid containers for anatomical
waste and blood products and gel agents. Yellow-lidded sharps bins for
sharps contaminated with substances, which may carry a risk of infection.
Orange
Infectious Waste which can be ‘rendered safe’
Minimum treatment/disposal required is to be ‘rendered safe’ in a suitably
licensed or permitted facility. Orange bags for ‘soft’ clinical waste such as
gloves, aprons, hand towels.
8.
ANATOMICAL WASTE BLOOD BAGS AND GEL AGENTS
8.1
For the purpose of this guidance document, the definition of anatomical waste
includes body parts or other recognisable anatomical items, which may be offensive
to those who come into contact with it.
8.2
The EWC lists anatomical waste with blood bags and blood preserves as shown
below:
8.3
18 01 02 (black)
body parts and organs including blood bags and blood
preserves (except 18 01 03)
18 01 03* (red)
wastes whose collection and disposal is subject to special
requirements in order to prevent infection
Colour Coding for Disposal and Disposal Method
Yellow
Anatomical waste may often be classified as infectious waste due to its
contamination with potentially infectious bodily fluids. This Policy states that
all anatomical waste including blood products MUST be disposed of in yellow
sealed containers, as this will ensure that they are disposed of by
incineration. If pre-wrapped in a clinical waste bag, prior to being placed
in the sealed unit, then this bag MUST also be yellow.
8.4
TEETH
8.5
It is recognised that the disposal of teeth is unlikely to cause offence and therefore
Dental Practitioners may treat this as a non-anatomical infectious waste. Dental
Practitioners must ensure that all wastes are treated appropriately and teeth
containing amalgam should be segregated and sent for appropriate
recovery/disposal
(see
http://www.defra.gov.uk/environment/waste/special/
index.htm).
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9.
MEDICINAL WASTE
9.1
The EWC has entries for medicinal wastes are shown below:
9.2
18 01 08* (red)
cytotoxic and cytostatic medicines
18 01 09 (black)
medicines other than those mentioned in 18 01 08
Medicinal wastes are classified into two categories:
Cytotoxic and cytostatic medicines;
Medicines other than those classified as cytotoxic and cytostatic.
9.3
Only cytotoxic and cytostatic medicines are classified as hazardous waste. However,
other (non-cyto) medicinal waste may require specialist treatment/disposal. Non-cytomedicinal waste should still be assessed for the other hazardous properties that it
may possess e.g. H3B Flammable, H4 Irritant, H5 Harmful or H14 Ecotoxic.
9.4
Definition of Medicinal Wastes
9.5
Medicinal waste includes expired, unused, spilt, and contaminated pharmaceutical
products, drugs, vaccines, and sera that are no longer required and need to be
disposed of appropriately. The category also includes discarded items used in the
handling of pharmaceuticals, such as bottles or boxes with residues, gloves, masks,
connecting tubing, syringe bodies and drug vials. There are a number of licensed
medicinal products that are not pharmaceutically active and possess no hazardous
properties (examples include saline and glucose). These wastes are not considered
to be pharmaceutical/medicinal waste for the purposes of this document.
9.6
Only cytotoxic and cytostatic medicines are considered to be hazardous waste. A
cytotoxic and cytostatic medicine is a medicinal product possessing any one or more
of the stated hazardous properties shown below:
H6
Toxic
H7
Carcinogenic
H10
Mutagenic
9.7
Remember: Non-cyto-medicinal waste should still be assessed for the other
hazardous properties that it may possess e.g. H3B Flammable, H4 Irritant, H5
Harmful or H14 Ecotoxic. This assessment is determined solely by assessment of
the medicinal products in the form supplied by the manufacturer or distributor, and
does not therefore consider the effects of any subsequent dilution that may occur
during routine use. Further guidance on the assessment of these hazardous
properties may be obtained from Hazardous Waste guidance: WM2.
9.8
Guidance should be sought from the manufacturers of medicinal products with regard
to their hazard characteristics. Material safety data sheets (MSDS) (sometimes
referred to as COSHH sheets or other product information in local pharmacy
practices) may be used to classify products.
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9.9
Colour Coding for Disposal and Disposal Method
9.10
Any individual patient medicine, other than Controlled Drugs, no longer required
should be returned to a Pharmacy in a secured container. The instructions given
below are for the disposal at premises level for sharps containing medicines and
used ampoules.
Cytotoxic/Cytostatic Waste (see Appendix C for a list of Cytotoxic and
Cytostatic medicines, See also British National Formulary chapter 8)
Purple with
Yellow
Yellow
Minimum treatment/disposal required is incineration
Medicinal Waste
This waste is disposed of using yellow-lidded UN approved containers.
Minimum treatment/disposal required is incineration.
This waste will be consigned as 18 01 03* /09 (red/black) to indicate that sharps
containing both medicines and possibly infectious substances (both
hazardous in nature) may be within the same container.
Yellow
Residual Medicinal Waste
Residual medicinal waste is waste pharmaceuticals no longer in their original
packaging. The waste should be placed in UN-compliant packages for
disposal by incineration.
If cytotoxic/cytostatic medicinal residues are present, the container should be
purple-lidded.
10.0
PHARMACEUTICAL WASTE
10.1
Pharmaceutical waste (or “Medicinal Waste”) includes expired, unused, spilt and
contaminated products, drugs, vaccines and sera that are no longer required and
need to be disposed of appropriately.
10.2
A risk assessment should be carried out in connection with the drug products and
also the act of discarding medicines on site.
10.3
For personal protection whilst disposing of pharmaceuticals, wear latex gloves and
apron during the process of sorting and disposing of waste. Basic personal hygiene
e.g. hand washing, is also important in reducing the risk from waste. Staff safety is
paramount and where it is unsafe or not possible to segregate pharmaceutical waste
it should all be consigned as hazardous waste.
10.4
Any outer inert packaging and Patient Information Leaflets may be placed into
ordinary paper/cardboard waste containers for recycling; however Patient-Sensitive
Information must be obliterated with permanent black pen before disposal. It
should be noted that there is no obligation to remove the cardboard outer packaging
for recycling but that doing so will reduce the volume of pharmaceutical waste.
10.5
The Environment Agency has confirmed that it supports the removal of a blister strip
from other outer packaging, so that the blister strip can be placed in the waste
container and the outer original packaging can be recycled.
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10.6
DISPOSAL OF PHARMACEUTICAL WASTE IN DOMICILLARY SETTINGS
10.7
Patients or their relatives should be encouraged to return unwanted medication to a
community Pharmacy (or Dispensing Practice) for safe disposal. The PCT contracts
with a waste carrier to make regular collections of pharmaceutical waste from these
settings and the pharmacy contract and Dispensing Services Quality Scheme include
mechanisms for checking that such waste is correctly handled. The waste service
provides separate bins for the disposal of hazardous waste and it is responsibility of
the Pharmacy or dispensing practice to ensure that appropriate segregation of
hazardous waste occurs.
10.8
Patient returned medication should not be accepted by GP practices or other
community based clinics. It should all be referred to community pharmacies (or
dispensing practices)
10.9
Community Pharmacies cannot accept sharps waste (or other as part of an
Enhanced Service Needle Exchange Programme). When a patient is prescribed
injectable medication or administration in their own home, the GP should prescribe a
sharps bin on an FP10 prescription. Sharps bins filled to the recommended level
should be sealed and returned to the GP practice for safe disposal.
10.10 It is the responsibility of the General Practices to ensure safe disposal of sharps
waste returned to their premises.
10.11 Pharmaceutical waste generated by a clinic GP practice or other healthcare
organisation such as home care with nursing must be disposed by that organisation
following national policy and cannot be accepted by community pharmacies.
10.12 DISPOSAL OF CONTROLLED DRUGS IN DOMICILLARY SETTINGS
10.13 Patient or their relatives should be encouraged to return any unwanted or unused
controlled drugs to their Community Pharmacy (or Dispensing Practice) where
appropriate record keeping and disposal facilities will be available.
10.14 All other community based settings where controlled drugs are held will require
witnessed destruction of controlled drugs as authorised by the Accountable Officer.
11.
LIQUID WASTES
11.1
Liquid waste or solidified liquid waste should be placed in a UN approved rigid leakproof yellow container for disposal. Under Landfill Regulations liquid waste cannot
be sent for disposal to a landfill site.
12
TOTAL PARENTERAL NUTRICIAN (TPN)
12.1
Bags containing nutritional products can be discharged to sewer. The emptied bags
can then be placed into the domestic waste stream (black bags).
13.
AMALGAM HAZARDOUS WASTE
13.1
The only entry for amalgam waste in the EWC is:
18 01 10* (red)
amalgam waste from dental care
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13.2
Colour Coding for Disposal and Disposal Method
13.3
Amalgam waste consists of amalgam in any form and includes all other materials
contaminated with amalgam. Amalgam waste should be placed in white rigid
containers with a mercury suppressant. Amalgam waste should be sent to suitable
licensed or permitted waste management facilities where the waste undergoes a
mercury recovery process prior to final disposal.
Amalgam Waste
White
For recovery
14.
MERCURY WASTE
14.1
All waste materials containing or contaminated with mercury are classified as
hazardous waste.
14.2
Colour Coding for Disposal and Disposal Method
14.3
There is no colour code for this waste stream. Items known to contain mercury to
MUST be safely disposed of by a properly licensed company.
15.
OTHER DEFINITIONS ASSOCIATED WITH HEALTHCARE WASTE
15.1
MAGGOTS (Larvae)
15.2
All maggots used for wound management must be secured in an airtight rigid
container and marked ‘for incineration’. It is recommended that this should be a
sealable UN approved yellow-lidded container.
15.3
MEDICAL DEVICES
15.4
Medical devices are defined in the Medical Devices Regulations as:
"An instrument, apparatus, appliance, material or other article, whether used alone or
in combination, together with any software necessary for its proper application,
which:
(a) is intended by the manufacturer to be used for human beings for the
purpose of:
(i) diagnosis, prevention, monitoring, treatment or alleviation of
disease,
(ii) diagnosis, monitoring, treatment, alleviation of or compensation for
an injury or handicap
(iii) investigation, replacement or modification of the anatomy or of a
physiological process, or
(iv) control of conception;
and
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(b) does not achieve its principal intended action in or on the human body by
pharmacological, immunological or metabolic means, even if it is assisted in
its function by such means, and includes devices intended to administer a
medicinal product or which incorporate as an integral part a substance which,
if used separately, would be a medicinal product and which is liable to act on
the body with action ancillary to that of the device.”
15.5
Infected/used medical devices
15.6
Where implanted medical devices have been in contact with bodily fluids and have
been assessed to be infectious, they should be classified and treated as infectious
waste.
15.7
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 classified as:
18 01 03* (red)
Infectious waste containing Nickel Cadmium batteries
[Hazards: Infectious (H9) and Corrosive (H8)]
15.8
The waste description should accurately describe the waste.
15.9
Disinfected/Unused Medical Devices
15.10 Disinfected medical devices should be classified as non-infectious healthcare waste.
The description given of the waste must adequately describe the waste and any
hazardous characteristics (even if the waste is not classed as hazardous waste).
15.11 For example a disinfected device containing a nickel cadmium battery should be
classified as:
16 02 13 (black)
Discarded equipment containing hazardous components other
than those mentioned in 16 02 09 to 16 02 12.
15.12 The waste description should accurately describe the waste.
15.13 Other classifications within subchapter 16 02 may apply to disinfected electrical
devices.
16.
LARGE EQUIPMENT
16.1
Where practicable, equipment should be decontaminated prior to disposal. Once
decontaminated, the waste is not subject to carriage or hazardous waste
management controls, however, it is still subject to the duty of care.
16.2
Where decontamination is not practicable, producers should contact their waste
management contractor to establish the best practice packaging and
treatment/disposal options.
16.3
Disposal of large electronic equipment will need to be in accordance with the Waste
Electrical and Electronic Equipment Regulations and, if hazardous, the Hazardous
Waste Regulations.
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16.4
Colour Coding for Disposal and Disposal Method
16.5
There is no colour code for this waste stream.
17.
HIGH TEMPERATURE PROCESSES (INCINERATION)
17.1
Pyrolysis
17.2
Pyrolysis involves the high temperature (545 to 1000°C) combustion of waste in the
absence of oxygen. In generating these high temperatures, the systems treat,
destroy, and reduce the volume of clinical waste.
17.3
Gasification
17.4
Gasification is similar to the process of controlled air incineration in that the waste
materials are thermally decomposed, but in an oxygen-starved (sub-stoichiometric)
atmosphere. The waste in the gasification process is ignited and reduced in a selfsustaining process. No support fuel is consumed save for that required to initiate
combustion. The decomposition results in the generation of volatile gaseous material
and, depending on the waste content, various vaporised tar oil fractions. The waste
gas is passed through a serious of scrubbers/filters and cyclonic separators to
provide a clean “producer gas”.
18.
ALTERNATIVE TECHNOLOGIES
18.1
Heat (thermal) disinfection systems – Autoclaves. In autoclaving, saturated
steam (steam holding water as a vapour) is introduced into a vessel.
19.
LANDFILL
19.1
Once the soft waste has been treated by autoclave it will ultimately be disposed of in
deep landfill.
20.
DISCHARGE TO SEWER
20.1
Any discharge to sewer, other than domestic sewage, must have the prior agreement
of the statutory responsible bodies. Anybody intending to dispose to sewer any waste
that may present a substantially greater risk than domestic sewage (such as
disposable items that are macerated) should first seek advice.
20.2
Known issues with regard to discharges are:

bodily fluids – blood and similar substances, for example from suction
canisters or wound drains, should not be discharged to foul sewer without
disinfection;

photochemicals (X-ray) – these are suitable for recycling, it is poor practice,
even if permitted by a discharge consent, to discharge this material to foul
sewer;

cardboard bed-pans and urine bottles – maceration and discharge of
shredded material to foul sewer is known to cause obstruction of the sewage
network. It is essential that the sewerage undertaker is aware of the presence
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of this material, and that it is permitted by the producer’s trade effluent
consent.
20.3
Radioactive waste may in certain circumstances (where the Certificate of
Authorisation for the Accumulation and Disposal of Radioactive Waste under RSA 93
permits) be disposed of to sewer.
21.
ROLES AND RESPONSIBILITIES
22
Managers
22.1
Managers have the ultimate responsibility for all aspects of waste management and
will ensure that an appropriate policy and procedure is in place for the discharge of
waste management requirements.
22.2
Managers have a responsibility to ensure that adequate training with regard to Waste
Disposal has been given to staff and ensuring that any appropriate safe handling
equipment is made available.
22.3
Managers are required to arrange collection of clinical waste from the site waste
station by a reputable company who can supply full accreditation by the Environment
Agency for the tasks they carry out on behalf of this organisation;
22.4
To ensure prior to disposal, the waste is stored in a safe and secure manner.
22.5
To ensure that the waste station is kept clean at all times.
22.6
To ensure that clinical waste is disposed of by the appropriate method, with due care
and with the Authorisation conditions of the Environmental Protection Act 1990.
22.7
To ensure that security arrangements of clinical waste are maintained throughout the
practise. This includes ensuring that all clinical Waste bins are locked at all
times.
22.8
Staff
22.9
All staff who may be required to move bags of clinical waste by hand within a
particular location should be trained to:
a) Check that the storage bags are effectively sealed and the origin of waste clearly
identified
b) Handle the bags by the neck only
c) Know the procedure in the case of accidental spillage and to report the incident
using the appropriate Risk Event Form
d) Check that the seal of any storage bag is unbroken when movement is complete
e) Understand the special problems related to sharps disposal.
f) Ensure that waste bags are not overfilled or too heavy
g) Ensure that the waste is correctly segregated at all times
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22.10 Note: ALL STAFF HAVE A RESPONSIBILITY TO ABIDE BY THE MANAGEMENT
OF CLINICAL WASTE POLICY BY USING THE DESIGNATED SHARPS
CONTAINERS/BAGS FOR CLINICAL WASTE ONLY. This responsibility includes
ensuring that clinical waste is contained safely in the designated collection points
thus minimising the risk of exposure to clients, staff or others. On no account are
bags or sharps to be placed in corridors or areas accessible to the public prior to their
collection.
22.11 These responsibilities must be undertaken with due diligence to ensure that no
member of staff or the public are exposed to any substances hazardous to
health.
22.12 Waste/Infection Control Lead (where available)
a) To be the area “expert” on clinical waste
b) To lead by example and promote a climate of continuous improvement
c) To identify and correct bad practice
d) To promote good practice
e) To be supportive and to give feedback appropriately and constructively
22.13 General Responsibilities
22.14 With regard to the infection risks to staff from handling clinical waste, the following
are required:
a) The bags are handled the least number of times, so far as is reasonably
practicable
b) Bags/sharps boxes and sealable bins are properly sealed. On no account must
orange bags be left unattended at any time whilst in transit on site
c) Adequate training is provided for all staff that handle clinical waste
d) Where appropriate staff are vaccinated for Hepatitis B
e) Adequate facilities are provided for washing hands
f) Adequate personal protective equipment and clothing is provided
g) Adequate facilities/guidance is provided for washing, changing storage and
laundering of contaminated clothing
h) Suitable storage units are supplied in which clinical waste is transported and
stored; these are to be decontaminated on a weekly basis.
23.
STORAGE PRECAUTIONS
23.1
Bags, sharps and sealable bins, when marked, should be taken to a collection point
and placed in a suitable dedicated container, i.e. a wheeled trolley or cart for
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transportation in a dedicated bulk container to a disposal unit. Such containers MUST
be kept locked at all times to prevent unauthorised access.
23.2
At all times where manual handling is involved, the necks of the bags should be
positioned to allow subsequent movement to be undertaken safely.
23.3
Trolleys and carts used for the movement of clinical waste within the premises should
be designed and constructed as 'fit for purpose'.
24.
CLEANING OF BULK TRANSPORT ITEMS
24.1
The wheeled bins belong to the waste contractor. The waste contractor will ensure
that they are thoroughly cleaned on receipt at the waste facility once emptied of their
contents. All empty bins deposited on healthcare sites will be clean or removed and
replaced with clean bins at the expense of the contractor.
25.
PERSONAL PROTECTIVE EQUIPMENT
25.1
COSHH Regulations require that risks to health be eliminated, prevented or, where
this is not reasonably practicable, reduced. Although the use of personal protective
equipment should be considered as additional to other control measures, it is likely
that even after all reasonably practicable precautions have been taken to reduce the
exposure of staff that handle, transfer, transport, treat or dispose of healthcare waste,
some personal protective equipment will still be required.
25.2
In such cases, the managers will ensure that these items are provided, used and
maintained. They must also make appropriate arrangements for storage and
cleaning.
25.3
Under the law, employees must cooperate with employers to ensure that their legal
duties are met.
25.4
Emergency situations, such as spillages, will also be addressed in any risk
assessments. This might include the need for protective equipment to prevent
exposure via routes such as skin contact (for example disposable aprons and gloves)
or inhalation (for example respiratory protection and/or face visors).
26.
BASIC HYGIENE
26.1
Basic personal hygiene is important in reducing the risk from handling healthcare
waste. The manager will ensure that washing facilities are conveniently located for
people handling healthcare waste.
27.
IMMUNISATION
27.1
Staff handling healthcare waste will be offered appropriate immunisation, including
hepatitis B and tetanus. Staff will be informed of the benefits (for example protection
against serious illness, protection against spreading illness) and drawbacks (for
example reactions to the vaccine) of vaccination.
27.2
Where vaccination has been identified, as a control measure required when working
with healthcare waste, manager will advise on access to vaccinations.
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28.
ACCIDENTS AND INCIDENTS
28.1
All incidents involving spillages damaged packaging, inappropriate segregation or
any incident involving sharps need to be reported to the manager or other suitable
individual, and be investigated by them. The investigation of these accidents and
incidents needs to establish the cause and what action needs be taken to prevent a
recurrence.
28.2
The analysis and investigation of incidents involving healthcare waste, whether
reportable or not, helps identify causes, trends, the level of compliance with current
legislation, the effectiveness of the precautions in place, and problem areas for which
satisfactory precautions have yet to be provided.
28.3
The depth of each investigation will vary depending on the nature of the incident. To
be worthwhile, however, any investigation needs to consider carefully the underlying
causes. Action after an accident will not be effective if it addresses only the
superficial and obvious causes and misses more significant issues.
28.4
The active and reactive monitoring of healthcare waste procedures is most effective
as part of an overall system of health and safety monitoring.
29.
REPORTING OF INJURIES, DISEASES AND DANGEROUS
OCCURRENCES REGULATIONS (RIDDOR)
29.1
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations
(RIDDOR) require certain accidents, work-related ill-health and dangerous
occurrences (such as an incident that results in, or could have resulted in, the
release of a biological agent that could cause severe human disease) to be reported
to the appropriate enforcing authority. For most healthcare premises, this is the HSE
(http://www.riddor.gov.uk).
29.2
Severe human disease includes diseases caused by hazard group (HG) 3 and 4
agents as well as some (HG) 2 agents (for example Neisseria meningitidis).
29.3
Social security legislation requires an accident book or something similar to be kept
and accessible to staff.
30.
Mercury
30.1
Departments who use mercury should carry out a risk assessment for dealing with
mercury spillages and produce written procedures. A spillage kit including disposable
plastic gloves, paper towels, a bulb aspirator for the collection of large drops of
mercury, a vapour mask, a suitable receptacle fitted with a seal, and mercuryabsorbent paste (equal parts of calcium hydroxide, flowers of sulphur, and water)
needs to be available. In no circumstances should a vacuum cleaner or aspiration
unit be used, as this will vent mercury vapour into the atmosphere.
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31.
31.1
TRAINING
Under Health and Safety at Work legislation, the Management of Health and Safety
at Work Regulations and COSHH, staff must receive information on:
a)
The risks to their health and safety, that is, the details of the substances
hazardous to health to which they are likely to be exposed; the significant
findings of the risk assessment;
b)
Any precautions necessary;
c)
The results of any monitoring carried out; and the collective results of any
relevant health surveillance.
31.2
Training on the management of clinical waste, (safe, handling, segregation and the
prevention of the spread of infection) should be provided. These sessions are
mandatory for all staff as are the annual updates.
31.3
In addition to this, segregation of waste in accordance with this policy will be
discussed with new staff members during their local induction.
31.4
Training records
31.5
Training records are kept at in personal files.
32.
AUDIT
32.1
The management of clinical waste within the premises will be audited using the tools
provided within the Infection Control Nurses Association document ‘Audit Tools for
Monitoring Infection Control Standards 2004’. These have been slightly modified to
meet standards set since that year.
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Audit – To be completed by Manager annually.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
17
18
19
20
21
22
23
24
25
26
Management Contractual Arrangements
and Documentation
There is evidence that the waste contractor is
registered with a valid licence (check records)
There is an appropriately designated Waste
Officer who has undergone training within the
last two years
(check Job Description and training record)
There are completed transfer notes detailing
final disposal details for waste collection over
the last 12 months
Completed consignment notes for hazardous
waste detailing final incineration details for
waste
collection over the last 12 months are available
There is annual audit monitoring of the
contractor. Check for evidence which includes
an audit trail of waste from the site to the
incinerator
All clinical waste must be transported in UN
approved rigid containers
There is a dedicated compound for the safe
storage of clinical waste, which is under cover
from the elements and free from pests and
vermin
All premises should have a clinical waste
storage area away from the public
Waste containers are locked and inaccessible
to the public
The compound is locked and inaccessible to
public
The compound has appropriate signs in the
area
Returned containers are clean
Containers are in a good state of repair
Clinical waste is stored separate to other
waste
Sharps boxes are correctly sealed
Sharps boxes are correctly labelled
Sharps boxes are safely stored
Biological agents are made safe by
autoclaving before leaving the laboratory for
final disposal
There are no inappropriate items in the
household or recycling bins
Spill kit & heavy duty gloves or alternative are
available
There is no storage of inappropriate items in
the waste compound
The area is clean and tidy (there are cleaning
facilities)
Clinical waste sacks are labelled and secured
before leaving the premises
A record is kept of the coded tags used for
each premises
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Yes No N/A Comments
27
28
29
30
31
32
There is no storage of waste in corridors,
inside/outside the premises whilst awaiting
collection
There is a system for transporting the waste
through the premises (i.e. which avoids
manual handling of waste)
Clinical waste is segregated from other waste
for transportation
All waste containers used for transport are
clean
All waste containers are in a good state of
repair
Supplies of mattress bags are available and
are used for contaminated mattresses ready
for disposal
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APPENDIX A WASTE SEGREGATION CHART
Soft Waste: Orange bag - e.g. gloves,
aprons, hand towels, cardboard etc
used for healthcare purposes where
there is a possibility that they may
carry infection
Sharps: All sharps in yellow lidded
sharps bins - blood or medicinal
contamination - except those used to
administer cytotoxic/cytostatic drugs
Cytotoxic/cytostatic: Sharps and other
items contaminated with
cytotoxic/cytostatic substances in
purple lidded bins
Anatomical Waste, Blood Products,
Gelling Agents and Larvae: Yellow
lidded sealable bins
Sensitive Products of Birth: Green
lidded sealable bins
Domestic Waste - black bag - e.g.
flowers, newspapers
Household glass and aerosols: Clear
plastic bags - e.g. coffee jars and air
fresheners
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APPENDIX B EUROPEAN WASTE CATALOGUE CHAPTERS
Chapter Number Production sector/Origin of Waste
Chapter 1 Waste from exploration, mining and quarrying, physical and chemical treatment of
minerals
Chapter 2 Waste from agriculture, horticulture. Aquaculture, forestry, hunting and fishing,
food preparation and processing
Chapter 3 Waste from wood processing and the production of panels and furniture, pulp,
paper and cardboard
Chapter 4 Waste from the leather, fur and textile industries
Chapter 5 Waste from petroleum refining, natural gas purification and pyrolytic treatment of
coal
Chapter 6 Waste from inorganic chemical processes
Chapter 7 Waste from organic chemical processes
Chapter 8 Waste from the manufacture, formulation, supply and use of coatings (paints,
varnishes and vitreous enamels), adhesives, sealants and printing inks
Chapter 9 Waste from the photographic industry
Chapter 10 Waste from thermal processes
Chapter 11 Waste from chemical surface treatment and coating of metals and other
materials, non-ferrous hydrometallurgy
Chapter 12 Waste from shaping and physical and mechanical surface treatment of metals
and plastics
Chapter 13 Oil and liquid-fuel waste
Chapter 14 Waste organic solvents, refrigerants and propellants
Chapter 15 Waste packaging, absorbents, wiping cloths, filter materials and protective
clothing not otherwise specified
Chapter 16 End of life vehicles from different means of transport and vehicle maintenance
Chapter 17 Construction and demolition waste
Chapter 18 Waste from human or animal healthcare and/or related research
Chapter 19 Waste from waste management facilities, off-site waste water treatment plants
and the preparation of water intended for human consumption and water for industrial use
Chapter 20 Municipal waste (household waste and other similar commercial, industrial and
institutional waste (including separately collected fractions)
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APPENDIX C CYTOTOXIC AND CYTOSTATIC MEDICINES
Altretamine capsules
Azathioprine tablets
Anastrozole tablets
Bexarotene capsules
Bicalutamide tablets
Busulfan tablets
Capecitabine tablets
Chlorambucil tablets
Chloramphenicol drops, capsules minims
Colchicine tablets
Cyclophosphamide tablets
Ciclosporin tablets, liquid
Dienestrol cream
Diethylstilbestrol tablets
Dinoprostone tablets
Dutasteride capsules
Ergometrine/methylerfometrine tablets, spray
Estradiol patches, implants tablets, gel
Estramustine capsules
Estrogens, conjugated tablets
Etoposide capsules
Exemestane tablets
Finasteride tablets
Fludarabine tablets
Fluorouracil capsules, cream
Flutamide tablets
Goserelin implants
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Hydroxycarbamid
Idarubicin capsules
Imatinib capsules, tablets
Leflunomide tablets
Letrozole tablets
Lomustine capsules
Megestrol tablets
Melphalan tablets
Mercaptopurine tablets, capsules
Methotrexate tablets
Mifepristone tablets
Mitotane tablets
Mycophenolate tablets, capsules
Nafarelin nasal spray
Procarbazine capsules
Progesterone capsules, pessaries, gel
Raloxifene tablets
Tacrolimus capsules, ointment
Tamoxifen tablets
Temozolomide capsules
Testosterone, patches, implants, capsules
Thalidomide capsules
Tioguanine tablets, capsules
Thiotepa eye drops
Torimefene tablets
Tretinoin, cream, gel, solution, capsules
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Valganciclovir tablets
Zidovudine capsules, suspension
30
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APPENDIX D COMMUNITY CARE
Community care can take many forms and occurs in various environments. It includes
healthcare workers (including emergency care practitioners (ECPs)) who provide
care and support to:
a) patients in their own homes;
b) residents of care homes (without nursing care);
c) householders who are self-medicating.
As a community practitioner, the following types of waste will be produced:
a) infectious;
b) sharps;
c) medicinal;
d) anatomical (for example placentas);
e) domestic.
Colour-coding
The colour of the waste receptacle will depend on how the waste should be treated and
disposed of:
Orange – sacks should be used for waste that can be treated to render it safe. In practice,
the vast majority of “soft” infectious waste such as dressings, bandages and some plastic
single-use instruments can be treated.
Yellow – yellow-lidded sharps receptacles and sealed units as appropriate should contain
waste that requires disposal by incineration only. A relatively small amount of waste
produced in the community will be disposed of in yellow containers; examples of waste
materials include anatomical waste (such as placentas) and sharps.
Yellow/purple –purple-lidded sharps receptacles should be used for waste that is
contaminated with cytotoxic and cytostatic medicinal products. In the community setting this
will include sharps used for the administration of chemotherapy, antiviral and/ or hormonal
drugs.
Black – used for mixed domestic waste – it should never be used for recognisable
healthcare waste.
Which type of packaging and what colour should you use?
Packaging
The type of packaging used will vary on the type of waste produced: if the waste is liquid or
contains free liquids (for example a partially discharged syringe), it should only be placed in
a package designed to take liquids, such as a plastic drum; if the waste is sharp it should
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only be placed in a sharps receptacle (see below); all other waste may be packaged in
flexible sacks (infectious waste bags).
It is not always practical for healthcare workers to carry lots of different types of packaging
with them. Therefore, healthcare workers must choose the most appropriate packages to
meet their needs.
Colour
Orange sacks
The vast majority of “bagged” infectious waste produced in the community will be placed in
the orange waste stream. Therefore, the use of orange sacks in the community is
recommended.
Small rigid leak-proof yellow receptacles
Where anatomical or other waste that requires incineration is being generated, it will be
appropriate for healthcare workers to carry yellow packaging. As most “incineration only”
waste is either anatomical or sharps and/or contains lots of free liquid, the use of small rigid
yellow boxes is recommended.
These should have purple lids if the waste is contaminated with cytotoxic/cytostatic
medicines (see below for appropriate colour-coding of sharps).
DISPOSAL OF PHARMACEUTICAL WASTE IN DOMICILLARY SETTINGS
Patients or their relatives should be encouraged to return unwanted medication to a
community Pharmacy (or Dispensing Practice) for safe disposal. The PCT contracts with a
waste carrier to make regular collections of pharmaceutical waste from these settings and
the pharmacy contract and Dispensing Services Quality Scheme include mechanisms for
checking that such waste is correctly handled. The waste service provides separate bins for
the disposal of hazardous waste and it is responsibility of the Pharmacy or dispensing
practice to ensure that appropriate segregation of hazardous waste occurs.
Patient returned medication should not be accepted by GP practices or other community
based clinics. It should all be referred to community pharmacies (or dispensing practices)
Community Pharmacies cannot accept sharps waste (or other as part of an Enhanced
Service Needle Exchange Programme). When a patient is prescribed injectable medication
or administration in their own home, the GP should prescribe a sharps bin on an FP10
prescription. Sharps bins filled to the recommended level should be sealed and returned to
the GP practice for safe disposal.
It is the responsibility of the General Practices to ensure safe disposal of sharps waste
returned to their premises.
Pharmaceutical waste generated by a clinic GP practice or other healthcare organisation
such as home care with nursing must be disposed by that organisation following national
policy and cannot be accepted by community pharmacies.
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Infectious waste
Waste classified as infectious waste due to its known or potential risk of infection should be
classified as hazardous infectious waste and should be packaged appropriately and sent for
suitable treatment and disposal.
Non-infectious dressing assessment
Where assessment has identified that the dressing is not infectious, the following should be
considered (noting that the type of dressings that are produced in the community by a
healthcare worker can vary greatly):
1. any recognisable item of non-infectious healthcare waste cannot legally be
disposed of in the black-bag waste stream and should therefore be disposed of in the
clinical waste stream;
2. however, mixed domestic waste does contain small amounts of plasters, small
dressings and incontinence products. Where the healthcare worker produces the
same or similar items, these – with the following considerations – can be placed in
the domestic refuse (with the householder’s permission). The following should be
considered:

the size of the dressing – small dressings no larger than a dressing pad
(that is, 130 mm × 220 mm) can be disposed of as domestic refuse;

the type of dressing – specialised antimicrobial types of dressing should be
disposed of as offensive/hygiene or medicinal waste as appropriate;

the quantity produced – where a number of small dressings are produced
regularly over a period of time, it may be appropriate to dispose of these as
offensive/hygiene waste. If, however, the amount produced is relatively small
and consistent with that likely to be found in the household waste stream, it
may be discarded in the domestic refuse;

packaging – where such waste is placed in the domestic refuse, the waste
should be wrapped in a plastic sack. The wrapping should not be yellow or
orange, as the waste is not deemed to be infectious – thin opaque plastic
sacks such as sandwich bags and bin liners are appropriate.
Miscellaneous infectious waste
Purple-lidded sharps receptacles. Community practitioners are likely to administer a wide
variety of medicinal products by injection. Some of these will be classified as cytotoxic and
cytostatic; therefore, the associated sharps and liquid residues of the medicinal products
should be placed in an appropriate yellow and purple leak-proof sharps box.
Yellow-lidded sharps receptacles. If you have determined that none of the products used
for injection is classified as cytotoxic or cytostatic, it is appropriate to use a yellow-lidded
sharps box.
For reasons of practicality, community nurses may seek to use a single sharps receptacle. In
this instance, it would need to be a yellow/purple leak proof sharps receptacle.
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Notes:
Sharps should never be discharged to allow disposal into a certain type of box.
Sharps boxes should be collected when three-quarters full and must never exceed the
permissible marked mass. If the sharps box is seldom used, it should be collected after a
maximum of three months regardless of the filled capacity.
Biological substances Category B (formally diagnostic specimens) are not considered to be
waste unless discarded at laboratory facilities. Diagnostic specimens should be placed in
specimen packs for transport (packaging instruction P650 and labelled UN3373). The
packaging used to transport the specimens does not require UN approval providing the
containers meet the requirements of P650.
Self-medicating patients and sharps disposal
Where the householder is a self-medicating patient who uses injectables (for example a
person with diabetes) with no healthcare worker involved in the administration, the GP or
healthcare worker should prescribe the householder the appropriate container (for example
a sharps box) and advise them of local disposal options.
The householder should be trained in how to use the sharps box before it has been
prescribed, to ensure that they understand its use and ensure it is correctly sealed and
labelled.
Once the sharps bin is three-quarters full, it should be sealed by the householder and taken
back to the GP surgery or to the local pharmacy for disposal.
Note:
It is no longer acceptable to advise self-medicating patients to dispose of their lancets into
the households black-bag waste stream.
Patients with MRSA
Where a patient in the community has been diagnosed with MRSA and is being cared for by
a healthcare worker, the healthcare waste generated is not necessarily infectious.
In assessing the risk of infection from waste produced by a patient with MRSA, the following
should be considered:
Is the patient colonised with MRSA but not receiving specific treatment for MRSA? If
the answer is “yes”, the MRSA status of the patient does not effect the assessment of the
waste. The healthcare worker should refer to the wound and dressing assessment given in
above.
Is the patient infected with MRSA and receiving treatment, and is the infection present
in the waste generated?
If the answer is “yes”, the waste produced should be classified as infectious waste.
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Disposable instruments
Disposable instruments are now commonly being used in the community by a number of
healthcare professionals. Disposable instruments can take the form of either plastic or metal
instruments.
Contaminated plastic disposable instruments – where there is no risk of sharps – can be
safely disposed of as infectious waste and put into the orange-bag waste stream.
Metal disposable instruments – where there is no risk of sharps and they are deemed to be
infectious – should be put into a rigid yellow container marked “for incineration only”.
Note:
Disposable instruments cannot legally be disposed of in the domestic refuse.
Stoma/catheter bags
If a healthcare worker is involved in the care of a stoma site, the waste from a stoma patient
can be disposed of in the black-bag waste stream.
If used in bulk, this becomes offensive/hygiene waste for disposal in black/yellow-striped
bags for deep landfill. However, if the person develops any type of gastrointestinal infection
or the site becomes infected, the bag must be disposed of as infectious waste into the
orange-bag waste stream.
If the householder is self-medicating with no healthcare worker involved, they are able to
dispose of their own waste in to the black-bag waste stream.
Wound vacuum drains
These should be treated as infectious waste and disposed of in the orange-bag waste
stream. They should never be placed in the domestic refuse.
Maggots
All maggots used for wound management should be secured in an airtight rigid yellow
container and marked as UN 3291.
Transporting the waste
Where a healthcare worker in the community generates waste, the healthcare worker is
responsible for ensuring that the waste is managed correctly; this is part of their duty-of-care.
Where the waste is generated in other premises, such as in care homes and private
households, the healthcare worker must ensure that arrangements are in place to ensure
that the waste is packaged and labelled correctly and transported for appropriate treatment
and disposal. Local options may vary, but in general the healthcare worker has two options.
Option 1
The healthcare worker producing the waste can transport the infectious waste from the
home environment back to base where waste collection and disposal arrangements are in
place. Where healthcare workers are transporting waste in their own vehicles, they should
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ensure that they are transporting the waste in secure rigid packaging, for example boxes or
drums (following packaging instruction P621). They should also have received appropriate
training either in-house or contracted out, which addresses the transporting of waste safely.
Option 2
The healthcare worker producing the waste can leave it in the home for collection by an
appropriate organisation, either a waste contractor or the local authority or healthcare
provider.
The healthcare worker has responsibility for the waste while it is being stored awaiting
collection, and for arranging that collection. While awaiting collection from the householder’s
home, the waste should be stored in a suitable place to which children; pets, pests etc do
not have access. It is not appropriate to leave the waste unsupervised on the pavement
awaiting collection.
Waste should be packaged and labelled appropriately and adequate instruction should be
given.
The party collecting the waste should be provided with the information required under dutyof-care requirements.
A completed consignment note should accompany the movement of the waste, as infectious
waste is classified as hazardous waste.
Note:
A consignment note is not required for the movement of hazardous waste from domestic
premises.
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POLICY APPROVED BY:
JOB TITLE
PRINTED NAME
SIGNATURE
DATE
Clinical Policy
Review Group
Signed by Chair on
Behalf of the Group
POLICY AUTHORISED BY
PRINTED NAME
AUTHORISING
MANAGER
(First)
Ian Brennan
Associate Director of
Community Health
Services
AUTHORISING
MANAGER
(Second)
Brian Goodrum,
Associate Director of
Mental Health
Services
SIGNATURE
AUTHORISING
MANAGER
(Third)*
DATE APPLICABLE
REVIEW DATE
PERSON
RESPONSIBLE
FOR REVIEW
* if applicable
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DATE