Operational Policy. November 2009

Transcription

1 Operational Policy Waste Policy November 2009 Printed copies of this document may not be up to date. Always obtain the most recent version from GOSH Document Library.

2 Document Control Information Lead Author Brian Wood Author Position Waste Manager Additional Contributor (s) James Fry Environmental Strategy Manager Approved By Peter Wollaston Approver Position Head of Corporate Facilities Ratified Management Board Document Owner Peter Wollaston Document Owner Position Head of Corporate Facilities Document Version 3.0 Replaces Version 2.0 First Introduced April 2002 Review Schedule Annual Date approved November 2009 Next Review November 2010 Who should know about this policy? All Trust Staff All Contracted Staff 2

3 Template Screening Form The author(s) of the policy should complete this form and use the information collected to decide whether a full equality impact assessment is required. When completed, the author should store the form along with the supporting information required for completing it in case it is needed in the future, either to answer a query or to aid the next updating of the policy or procedure. This form must also be submitted for inclusion in current and future equality schemes. Lead author, job title and contact details Brian Wood Waste Manager x 7890 Other author(s), job title and contact details 1] James Fry (Environmental Strategy Manager) x ] 3] Department Facilities Policy title Waste Policy Date of completion November 2009 Is this policy: New Updated x Step A: What are the aims, perceived benefits and suggested outcomes of the policy? The main aim of the Waste Policy is to advise, and train all Trust users of the procedures that are in place to ensure compliance to the legislation in relation to Waste Management Step B: Do you have any data showing how the policy has been received and whether it is successful? The Policy has been consulted on within the Trust and its users during its writing. Step C: Which equality strands could the policy potentially impact upon? Strand Notes NA Ethnicity Language Disability Gender Religion Age NA NA NA NA NA 3

4 Sexuality NA Full impact assessment required? Yes No x This will be conducted by: (date) A copy of this form must be sent to the Trust Administrator, for inclusion in current and future equality schemes 4

5 Table of Contents Document Control Information...2 Who should know about this policy?...2 Template Screening Form...3 Table of Contents EXECUTIVE SUMMARY AIMS OF POLICY RESPONSIBILITIES Chief Executive Authorised Officer Waste Monitoring Officer Directorate Managers, Ward Managers, Head of Departments and Supervisory Staff All Staff Working on GOSH Trust property (Trust Employed or Contractors) Contractors RECYCLING FUNDING/FINANCIAL ARRANGEMENTS MONITORING AND COMPLIANCE TRAINING AND STAFF AWARENESS FURTHER ADVICE POLICY REVIEW LINES OF COMMUNICATION CATEGORIES OF WASTE NON-CLINICAL (DOMESTIC) WASTE Segregation and Storage CLINICAL WASTE Classification Working Definition Segregation and Storage Storage Requirements Sharps Pharmacy Waste (Hazardous Waste EWC Ref ) OTHER DEFINITIONS ASSOCIATED WITH HEALTHCARE WASTE Medical Devices Infected/Used Medical Devices

6 14.3 Disinfected/Unused Medical Devices Radioactive Waste Solvents, Flammable Liquids & Associated Products Carcinogens and Associated Products HANDLING AND TRANSPORT Non-Clinical (Domestic) Waste Clinical Waste Hazardous Waste TRAINING POLICY APPENDIX 1: Guidance Notes on Waste Disposal APPENDIX 2: Equipment / Asset Decontamination & Disposal Document APPENDIX 3: Site Waste Management Plans APPENDIX 4: Cytotoxic Waste

7 1 EXECUTIVE SUMMARY Great Ormond Street Hospital for Children NHS Trust is committed to providing a comprehensive waste management service, whilst complying with ALL current and future legislation. Waste disposal is the generic term given to the whole spectrum of activities, associated with the Trust s waste management policy, including handling, storage and actual disposal, which continues right up until the final destruction of that waste. The Trust has a cradle to the grave responsibility and must ensure that the arrangements recognise this responsibility. All Heads of Department are reminded that the disposal of anything (paper, electrical, mechanical equipment, building debris, domestic and clinical waste etc) must be carried out by Environment Agency approved contractors and conform to the current disposal legislation with the responsibility for final disposal i.e. where will disposal takes place, how will it takes place and when has it taken place, remaining the responsibility of the Trust. The consequence of not conforming to disposal legislation may result in an investigation by the Environment Agency and possibly monetary fine and in extreme or repeated cases the potential of a custodial sentence. The Trust therefore employs an in-house Waste Team that must be contacted when the disposal of any Trust property other than appropriately bagged domestic and clinical waste is being considered (noting that donating Trust assets / property is seen to be a method of disposal.) The Waste Manager can be contacted on extension 7890 who will be able to advise on disposal and decommissioning prior to disposal noting that some assets e.g. computer hard-drives, clinical equipment may need special treatment prior to disposal 2 AIMS OF POLICY The Trust recognizes its legal and moral obligations in relation to waste and will make such arrangements, that whilst meeting the requirements of issued guidance, take into account any local constraints. It will meet its Duty of Care and ensure, so far as is reasonably practicable, that staff comply with the requirements of the waste protocols issued under cover of this policy. The policy was formulated in order to ensure compliance with all Statutory Acts and Regulations, with particular reference to those listed below: The Health and Safety at Work etc Act Environmental Protection Act Environmental Protection (Duty of Care) Regulations 1991 Controlled Waste Regulations 1992 Manual Handling Operations Regulations 1992 Radioactive Substances Act 1993 The Environment Act 1995 Waste Management Licensing Regulations 1996 Waste Minimisation Act

8 Management of Health and Safety at Work Regulations Medical Devices Regulations 2002 Waste Incineration (England and Wales) Regulations 2002 The Control of Substances Hazardous to Health Regulations The Hazardous Waste (England & Wales) Regulations 2005 List of Wastes (England) Regulations Safe Management of Healthcare Waste 2006 The Carriage of Dangerous Goods and use of Transportable Pressure Receptacles Regulations Domestic Waste Regulations 2007 The Site Waste Management Plans Regulations April 2008 The aim is to ensure correct segregation, handling, storage, transportation and disposal of all types of waste generated as the result of Great Ormond Street Hospital for Children NHS Trust activities, whilst promoting health & safety standards at work. In addition, Great Ormond Street for Children NHS Trust aims to reduce the volume of waste requiring disposal and is committed to ensuring that, where practicable and cost effective, waste is segregated to facilitate recycling. All staff involved in the segregation, handling, collection and transport of all categories of waste must undertake appropriate training. Refer to in Appendix I of this policy. 3 RESPONSIBILITIES Each employee has a responsibility to ensure compliance with this policy. 3.1 Chief Executive In line with the Trust s Health and Safety policy, the Chief Executive has the overall responsibility on behalf of the Trust Board for ensuring compliance with statute law. The Chief Executive will ensure that the requirements specified within this Policy and the Protocols, are resourced and implemented within the Trust. Responsibility for Implementing this policy is designated to the Head of Facilities, and specifically the Waste Manager 3.2 Authorised Officer The Waste Manager is the Authorised Officer and is responsible for ensuring that the day-today operational issues surrounding waste disposal within the Trust are conducted in line with the contracted arrangements (refer to Waste Contract). He/she will ensure that adequate facilities and resources are available or are supplied, as necessary, for the disposal of non-clinical (domestic), clinical and hazardous waste generated within the Trust, and that these comply with relevant legislation. He/she will also ensure that the Waste Disposal Contractor(s) complies with all relevant legislation and administers the central returns for licences, certificates and other formal paperwork required by law. He/she will ensure that proactive arrangements exist for the monitoring and policing of this policy and notify the Head of Facilities of areas of concern. 8

9 The Trust s Waste Manager reports to the Trust s Head of Facilities, who will receive reports on the monitoring and policing of this policy. The Head of Facilities reports findings to the Corporate Facilities Board, who then, if deemed a high risk, will report issues to the Clinical Risk Committee. 3.3 Waste Monitoring Officer The Environmental Services Assistant will be responsible to the Waste Manager for the day to day compliance with the requirements of this policy in relation to the disposal of non-clinical (domestic), clinical and hazardous waste. He/she will ensure that the Waste Disposal Contractor(s) supply the necessary paperwork required by legislation. 3.4 Directorate Managers, Ward Managers, Head of Departments and Supervisory Staff At operational level: It is Line Management responsibility to ensure compliance with this policy. Managers will ensure that all staff under their direct management are aware of the necessary details to deal with the type of waste most frequently produced within their respective work area (or activity) and comply with it. They must also be aware of what to do if other waste is encountered, even if it is some form of holding / emergency action. Department Heads will ensure that the necessary local resources, financial and others are available to ensure that all aspects of the policy can be met. If there are problems in this respect, then this must be drawn to the attention of the Waste Manger in the first instance. The Waste Manager and Environmental Services Assistant will monitor for compliance against this policy and ensure non compliance is communicated effectively. This will not absolve line management from their Duty of Care, in particular this will mean attention to local storage and staff handling arrangements. 3.5 All Staff Working on GOSH Trust property (Trust Employed or Contractors) All staff must identify any material that they are using or have used which is destined for the waste stream, and ensure it is segregated into its appropriate category as defined in the Policy and ensure it is disposed of in accordance with the requirements of the Policy. They will also act in accordance with the requirements placed upon them by the Health and Safety Policy and the Trust Infection Control Department. 3.6 Contractors All contractors employed by or working on behalf of the Trust, in or adjacent to Trust property will make the necessary arrangements to comply with this Policy. The Trust manager responsible for the contractor(s) is responsible for informing the contractors of their responsibilities. 9

10 4 RECYCLING The Trust is currently recycling office paper (including confidential waste paper), cardboard, toner cartridges, general paper (newspapers etc), plastic bottles, tin cans, batteries, electrical and electronic equipment, some metals, some plastics and redundant office furniture. Plans to expand this to include other waste streams and collection of the above in all areas of the Trust will be considered, but must not place undue pressure on the working practices of its personnel, space constraints, are cost effective and must have a positive environmental impact. For all construction work carried out on or around the Trust, it is the responsibility of the Trust s Manager to ensure that employed contractors adhere to the required recycling activity of construction waste in line with The Site Waste Management Plans Regulations (see Appendix 3) 5 FUNDING/FINANCIAL ARRANGEMENTS The cost of waste disposal non-clinical (domestic), clinical and hazardous waste is funded centrally, although it is recognized that some departments / areas will, from time to time generate an unusual quantity, or type of waste that will fall outside this normal funding. In these circumstances the Waste manager must be consulted and the waste producer may be required to fund the additional disposal costs. 6 MONITORING AND COMPLIANCE In practical terms, all managers have a monitoring and compliance role, and they must draw to the Waste Manager s attention any local instances of non-compliance whether this is due to poor working practice or lack of resources. The Waste Manager will monitor the Waste Disposal Contractor(s) for performance of the Waste Disposal Contract(s) and compliance against appropriate waste management legislation. In the case of radioactive waste, chemical waste and other waste types covered under specific departmental policies, this responsibility will be administered by the appropriately named personnel in the respective policy, who will report findings to Waste Manager. All staff should note that non-compliance with regulations made under Environmental Protection Legislation and the Hazardous Waste Regulations could result in individual prosecution. Deliberate non-compliance with this policy could result in disciplinary action. 7 TRAINING AND STAFF AWARENESS All staff must be trained in the operational requirements of this policy at induction and training reviewed on an annual basis. Please refer to section 16 of this document for specific details as to training responsibility and requirements. Basic information on the Trust s waste disposal arrangements will be provided by Waste Team in conjunction with the Infection Control Nursing Team, as requested. 10

11 8 FURTHER ADVICE Further advice on any aspect of waste disposal is available from the Waste Manager. Advice must always be sought in areas of uncertainty. Waste disposal is strictly controlled and the wrong decision could expose individuals to danger, and/or the Trust to prosecution and/or fines and/or a custodial sentence. 9 POLICY REVIEW This policy will be reviewed annually or when any changes in legislation or guidance occur. The Waste Manager will initiate this review and will present any amendments to Corporate Facilities Board for approval. 10 LINES OF COMMUNICATION For advice on any aspect of waste disposal within Great Ormond Street Hospital NHS Trust, please contact the Waste Team. Listed below are the details of Great Ormond Street Hospitals Waste Strategy Group. Waste Manager Environmental Services Manager Laboratory Manager Chief Pharmacy Technician Pathology Quality Manager DIPC (Director for Infection Prevention & Control) Pharmacist Facilities Manager Clinical Nurse Specialist Infection Control Procurement Manager Supply Chain Manager Modern Matron 11 CATEGORIES OF WASTE Waste that is produced during activities carried out within a health service environment has been categorised by the Department of Health as follows: Non-clinical (domestic) waste (Section 12) - normally destined for disposal at a registered Waste to Energy plant, but may also be disposed of in a registered landfill site. Clinical waste (Section 14)- destined for disposal at a licensed disposal facility, this includes both an incineration plant or an alternative treatment plant (e.g. autoclave system). Hazardous waste (Section 16)- disposal as directed by the appointed authorised officer. The following page includes a waste disposal guidelines poster that should be displayed in the department as a reminder of the various types of waste, please insure that ALL waste is placed in the correct bins, this will save the Trust money and help protect the environment. In addition to the above broad categories of waste the following will be generated by the Estates Department: Building Waste - Waste generated through the activities of the Trust s Estates and Works. These wastes are subject to the reuse and or recycling activity in line with The Site Waste Management Plans Regulations 2008 (see Appendix 2). 11

12 CATEGORIES OF WASTE Please note the domestic waste is now a clear bag with Domestic Waste printed on the front of the bag. Waste Receptacle Description Example Contents Minimum Treatment/ Disposal Healthcare waste contaminated with radioactive material Dressings, tubing etc from treatment involving low level radioactive isotopes Incineration in hazardous waste incineration facility subject to RSA 1993 Colour of Waste Bag Yellow bag with black symbol. Infectious waste contaminated with cytotoxic and/or cytostatic medicinal products Dressings/tubing from cytotoxic treatment Hazardous waste incineration Yellow bag with purple stripe. Sharps contaminated with cytotoxic and or cytostatic medicinal products Sharps used to administer cytotoxic products Hazardous waste incineration Yellow container with purple lid. Infectious waste requiring incineration anatomical waste Theatre waste Hazardous waste incineration Yellow bag. Amalgam waste Dental amalgam wastes Recovery White container. Residual medicines NOT in original packaging Waste tablets not in foil pack or bottle Hazardous waste incineration Yellow container with purple writing. Infectious and potentially infectious waste and autoclaved laboratory waste Soiled dressing Licensed/permitte d treatment facility Orange bag. Sharps not contaminated with cyto products Sharps from phlebotomy Licensed/permitte d treatment facility Yellow container with orange lid. Offensive waste Human hygiene waste and non-infectious disposable equipment, bedding and plaster casts Landfill Yellow bag with black stripe. Domestic waste General refuse, including newspapers, flowers etc Landfill Clear bag Stating Domestic Waste 12

13 12. NON-CLINICAL (DOMESTIC) WASTE Classification: Waste generated that is not contaminated and does not have any other special disposal requirements. Including: General office waste Waste generated in the residential accommodation Food waste Dead flowers Newspapers Glass / china etc (blue bags) Paper Cardboard Shredded confidential wastes Redundant furniture Glass (non-contaminated (e.g. coffee jar, bottles, etc)) 12.1 Segregation and Storage Type of Waste Clear Plastic Bags (Domestic Waste) Grey Plastic Bags Clear Plastic Bags * Recycling Waste (see above) * Confidential Waste Cardboard Method of Segregation and Storage Are used for the disposal of domestic waste. The bag should be removed when it is ¾ full. Clear bags (domestic) are supplied by the Domestic Contractor Ext The bag opening is to be sealed, by means of tying the bag with a secure knot. The knot should be applied as close as possible to the level of the contents of the bag, thus reducing the trapped air to a minimum. Are used for the disposal of non-contaminated glass waste. All glass for disposal should be placed in a grey bag and when the bag is three quarters full this should be sealed. Grey bags are available as normal ward stock item and should be order via the Materials Management service or Logistics on Line. Are used for the disposal of office paper that is for recycling. When the bag is three quarters full it should be sealed by tying the bag with a secure knot. Clear bags are available from PHL Logistics via the Logistics on Line ordering system or through the Materials Management System. The Trust is currently developing and increasing recycling activity to include plastics and general paper waste. This is a developing programme under the Carbon Management Carbon Reduction Programme and the Domestic Waste Regulations Further information can be obtained from the Waste Team. Day to day confidential waste paper only is collected in confidential waste paper consoles, which are emptied fortnightly for shredding by the contracted waste company. Additional bags can be supplied for one of disposal of extra confidential paper waste at a cost to the department producing the confidential waste. Other confidential waste items, such as CD s, tapes, X-rays and film are collected for destroying by the waste contractor, contact the Waste Team for information. Boxes should be broken down and placed separately for collection, as 13

14 Type of Waste Batteries Waste electrical and electronic equipment Food Waste Redundant Furniture/Equipment Disposal of Mattresses Method of Segregation and Storage cardboard is sent for recycling. There is a contract in place for the disposal of all batteries. Batteries should not be placed in the domestic waste stream as they are classed has hazardous waste. Biomedical Engineering (BME) control the contact and empty the green battery disposal boxes as and when required. Theses boxes should be available to all ward areas. Please contact the Waste Team for further information. All computers MUST have their hard drives removed by IT before they are disposed of. Any possibly contaminated equipment must be decontaminated before disposal. All electrical and electrical waste is removed from the Trust by an approved contractor. To have such equipment removed contact the MITIE help desk on 8282 who will arrange for its removal. Food waste should be disposed of in the non-clinical (domestic) waste, in a black bag. Care must be taken to ensure that food waste does not leak from the bag; special care must be taken with foods containing a high percentage of moisture. The disposal of unwanted old or broken furniture/equipment is managed by Corporate Facilities. Any Furniture or equipment from ward areas must be decontaminated before disposal will take place. When unwanted items require moving for disposal ring the MITIE helpdesk on 8282 to arrange. Patient mattresses must be consigned as clinical waste. Special arrangements need to be made for disposal ensuring compliance with the Hazardous Waste Regulations. Please contact the Waste Team. Mattresses from residences and or non-clinical areas can be disposed of via a domestic waste route. Please contact the Waste Team. Storage Requirements: In clinical areas bins for the disposal of non-clinical (domestic) waste should have a Clear (domestic waste) bag. Trust approved bins should be ordered via the Procurement department. The sealed bags are stored in an area (black wheeled bin in waste disposal rooms) that has been designated for non-clinical (domestic) waste, prior to collection by the waste porters. The waste disposal room and the black wheeled cart must be kept locked at all times. The waste porter s will then transfer waste bags to the compactor for final disposal. 13. CLINICAL WASTE 13.1 Classification Clinical waste is defined legally in the List of Wastes (England) Regulations Wastes from human or animal healthcare and or related research consisting of body parts and organs, including blood bags and blood preserves; medicines including cytotoxic and cytostatic medicines, swabs or dressings or 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 waste arising from medical, nursing, dental, veterinary, pharmaceutical or similar practice, investigation, treatment, care, teaching or research or the collection of blood from transfusion, being waste which may cause infection to any person coming into contact with it. 14

15 Healthcare wastes are listed in Chapter 18 of the European Waste Catalogue. All clinical waste must be accompanied by the relevant documentation and a satisfactory description and EWC code as listed below: CHAPTER 18- WASTES FROM HUMAN OR ANIMAL HEALTH CARE AND/OR RELATED RESEARCH (except kitchen and restaurant wastes not arising from immediate health care) wastes from natal care, diagnosis, treatment or prevention of disease in humans sharps (except ) body parts and organs including blood bags and blood preserves (except ) wastes whose collection and disposal is subject to special requirements in order to prevent infection wastes whose collection and disposal is not subject to special requirements in order to prevent infection (for examples dressings, plaster casts, linen, disposable clothing, diapers) * chemicals consisting of or containing dangerous substances chemicals other than those mentioned in * cytotoxic and cytostatic medicines medicines other than those mentioned in * amalgam waste from dental care 13.2 Working Definition The following items must be disposed of in yellow clinical waste bags Anatomical waste Products of conception Un-autoclaved waste from clinical laboratories Waste as directed by Infection Control. The following items MUST BE disposed of in Orange Clinical Waste Bags (To be introduced during 2009/10) All items contaminated with any body fluids All items contaminated with any bodily secretions All items contaminated with any body excretions Protective clothing as follows: Disposable gowns Disposable mask Disposable aprons Disposable gloves I.V. bags. All disposable medical devices that have been used to treat a patient (with the exception of broken Glass). N.B. This should be disposed of in a sharps bin. All medical sharps (Use a Sharps Container) Yellow lid (cytotoxic/cytostatic purple lid). 15

16 Cytotoxic/cytostatic that must be packaged in accordance with the waste chart and in any event ALL pharmaceutical waste must be returned to pharmacy for special disposal. The following items are not classed as Clinical Waste and should be disposed in a Black Domestic Waste Bin Used hand towels - (unless from isolation rooms) All packaging material from medical devices Overshoes - (unless contaminated with body fluids) Disposable Hats - (unless contaminated with body fluids) Non confidential paper waste (unless recycling is available in that area). All other waste (newspapers, flowers etc.) - unless from isolation rooms 13.3 Segregation and Storage Orange or Yellow Plastic Bags (See Waste Chart): Used for the disposal of all groups of clinical waste. Use only approved bags and containers supplied for this purpose by the Trust. All bags and containers must be U.N Approved and comply with the labelling and test requirements laid down in the Carriage of Dangerous Goods Regulations The Infection Control Policy must be adhered to at all times. The bag or container holding clinical waste should be removed daily, or when it is two thirds full, whichever is the sooner. The containers must not be placed in the yellow disposal carts and must be left in the designated area for a separate collection made by the waste porters. Body tissues, solids, or fluids collected in sealed disposable containers e.g., urine bags, and clinical waste resulting from intensive radiotherapy treatment should be placed in separate yellow rigid containers, e.g. Wiva bins. The orange or yellow bags are available from the domestic contactors. The yellow rigid containers/wiva bins complete with lids must be ordered through Logistics on Line. The bag and containers must be secured shut using the approved black bag seal. (fig. 1) This tag provides the required audit trail back to the waste originator. Please note the domestic contractors will NOT remove untagged waste. The domestic contractors control the issuing of the tags which are issued in batches to specific areas. It is important that they are only used in the area to which they were issued. The seal should be applied as close as possible to the level of the contents of the bag, thus reducing the trapped air to a minimum and a bag-carrying handle created above the seal (swan neck). (Figure. 1) Yellow/purple bags. (See Waste Chart): 16

17 Used for the disposal of all groups of clinical waste containing cytotoxic/cytostatic materials. (See appendix 4) Use only approved bags and containers supplied for this purpose by the Trust. All bags and containers must be U.N Approved and comply with the labelling and test requirements laid down in the Carriage of Dangerous Goods Regulations The Infection Control Policy must be adhered to at all times. The bag or container holding clinical waste containing cytotoxic/cytostatic materials should be removed daily, or when it is two thirds full, whichever is the sooner. The containers be placed in the yellow/purple bins left in the designated area for a separate collection made by the waste porters. The yellow/purple bags are available from the domestic contactors. The bag and containers must be secured shut using the approved black bag seal. (fig. 1) This tag provides the required audit trail back to the waste originator. Please note the domestic contractors will NOT remove untagged waste. The domestic contractors control the issuing of the tags which are issued in batches to specific areas. It is important that they are only used in the area to which they were issued. The seal should be applied as close as possible to the level of the contents of the bag, thus reducing the trapped air to a minimum and a bag-carrying handle created above the seal (swan neck). Rigid Containers (See Waste Chart): The rigid containers/wiva bins are to be closed, using the non-removable lid, and the container marked with the name of the department/area, from where the waste has been generated. An approved bag seal (fig.1) must be attached to the container. It is important that rigid containers/wiva bins are not overfilled as there are weight restrictions on the containers design and also Manual Handling Operations Regulations 1992, require that items must be able to be moved safely with out risk of injury. Full containers must not be more than 2/3rds full Containers found to be more than 2/3rds full will not be moved by waste portering staff Storage Requirements Clinical waste bins for the disposal of this waste type should be foot operated, and contain a UN approved yellow or orange bag. Trust approved bins should be ordered from the Procurement Department. The sealed bags must be stored in an area that has been designated for clinical waste, prior to collection by the waste porter s and transfer to the collection point; n.b. storage areas must be clearly indicated, kept clean and locked at all times. In all waste areas this collection point will contain a dedicated yellow coloured waste cart that is labelled Clinical Waste, and the sealed bags must be placed in this container. (N.B. not rigid containers/sharp bins) 13.5 Sharps Ward/Departments should use only the Trust preferred option of Daniels Sharps Containers, which must be ordered via the Materials Management System or seek advise from the Procurement Department. All containers must be U.N. Approved and comply with the labelling and test requirements laid down in the Carriage of Dangerous Goods Regulations The approved containers should be stored whilst being used in a purpose made wall bracket, or on a worktop/shelf, but must remain in easy reach of those requiring to dispose of waste into 17

18 the container, under no circumstances should they be stored on the floor or above shoulder height. Bins must not be within easy reach of children. These containers must be changed when no more than three quarters full. The container should be secured shut in accordance with the directions printed on the container, pay particular attention to the correct assembly and do not seal shut using tape, bins must be labelled and tagged as to origin i.e. Great Ormond Street, Robin Ward. One of the Trust s approved clinical waste bag seals must then be attached to the handle of the container, to facilitate the waste audit trail. The sealed container is to be stored in the designated area for collection by the waste porter s. The full containers MUST BE stored in the upright position to prevent any possible risk of leakage through the lid. Do Not place sharps containers into plastic bags for disposal. Do Not empty one sharps container into another. Further guidance in relation to sharp s procedures and what to do in the case of an accident is given in the Trust s Sharps Policy available on the Intranet Document Library Pharmacy Waste (Hazardous Waste EWC Ref ) Return all pharmaceuticals which are no longer required by the clinic or department to the Pharmacy. If the clinic or department has unwanted controlled drugs, then it is the responsibility of the Ward Manager/Sister to contact and consult with the Ward Pharmacist regarding disposal. Do not send EMPTY containers to the Pharmacy. Dispose of EMPTY contaminated glass containers as sharps waste. Dispose of EMPTY contaminated plastic containers as clinical waste. Any medicines no longer required for use must be returned in a secure manner to the supplying pharmacy/chemist for destruction. Following the implementation of waste disposal regulations, medicines must never be disposed of through the sewerage system (the only exception being wasted single dose). Cytotoxic waste must be disposed of in cytotoxic waste bin and collected by the designated pharmacy porter. Dispose of used or part-used syringes, vials and ampoules by placing them in an approved sharps container. Do not dispose of any pharmaceuticals down a sink or drain. NB: All residual medicines and Cytotoxic drugs are Hazardous waste and must not be disposed of with the General Clinical Waste. 14. OTHER DEFINITIONS ASSOCIATED WITH HEALTHCARE WASTE 14.1 Medical Devices Medical devices are defined in the Medical Devices Regulations

19 Medical devices are defined 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) (ii) diagnosis, prevention, monitoring, treatment or alleviation of disease, 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 (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 upon the body with action ancillary to that of the device Infected/Used Medical Devices 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. 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: Infectious Waste containing nickel cadmium batteries [Hazards: Corrosive (H8)] 14.3 Disinfected/Unused Medical Devices 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). It is important that a Decontamination Certificate (Appendix 2) is attached to any waste prior to disposal. For example a disinfected device containing a nickel cadmium battery should be described as: Non-infectious healthcare waste containing batteries [Hazards: Corrosive (H8)] 14.4 Radioactive Waste Radioactive/scintillation liquid wastes are controlled by the Radioactive Substances Act 1993 and supervised by the Environment Agency. Advice on all Matters concerning this type of waste should be sought from the GOSH Trust s Radiation Protection Advisor, available through the Medical Physics Department (Ext 5220) A store is provided for the storage of radioactive waste to allow it to be decayed to safe levels prior to disposal. 19

20 14.5 Solvents, Flammable Liquids & Associated Products All flammable liquids and chlorinated hydrocarbons shall be placed in an appropriate container and clearly labelled, permanently, on the outside of the container with the contents and any safety action that is required in the case of spillage or leak. The above container should then be securely stored in a well-ventilated area, preferably outside but protected from the natural elements. This storeroom must be appropriately labelled and also locked. The containers must be stored on single height racking, to ensure that they are not placed directly on the floor, and also to prevent the containers being stored one above the other. The secure storage area should have a sealed sump area, to contain any leak or spillage. This will ensure that there is no ingress of the waste liquid into the drainage. If any of the above waste liquids do escape into the drainage system, Thames Water must be notified immediately, on free phone (24 hours a day), of the type of liquid waste, and the quantity Carcinogens and Associated Products A list of the substances used within a department, which are known to be potent carcinogens, must be displayed in each department and available to all staff. It should be noted that these products cannot be rendered safe and shall be disposed of as hazardous waste. On no account are they to be disposed of via the drainage systems. Advice should always be sought from the Head of Department and they will advise on a suitable method of disposal. 15. HANDLING AND TRANSPORT 15.1 Non-Clinical (Domestic) Waste All staff responsible for bagging of non-clinical (domestic) waste will: a) Be fully aware of their responsibility to ensure that at no stage is there any risk of injury to themselves or others; b) Ensure that only clear plastic bags are used for the disposal of the waste; or grey bags if the waste is glass. c) When the bag is no more than 3/4 full, remove the bag from its holder and secure the opening with an appropriate seal and identification tag, reducing residual air to a minimum, creating a neck to assist in the carrying of the bag; d) Store bag in the area that has been designated for this type of waste; e) Be fully familiar with the procedure in the event of a waste spillage or accident. All staff responsible for the collection and movement to the central storage area, of nonclinical (domestic) waste will: a) Be fully aware of their responsibility to ensure that at no stage is there any risk of injury to themselves or others; 20

21 b) Wear the protective clothing (especially gloves, plastic aprons) provided. c) Check that the bags are correctly sealed and tagged. d) Handle the bags using the neck. e) Use only the dedicated equipment to transport the waste from the areas or origin to the central waste storage area. f) Be fully familiar with the procedure in the event of a waste spillage or accident. g) Be fully familiar with all the Trust s policies concerning waste management that relate to the duties being undertaken Clinical Waste All staff responsible for bagging of clinical waste will: a) Be fully aware of their responsibility to ensure that at no stage is there any risk of injury to themselves or others; b) Ensure that only the Trust approved, yellow/orange plastic bags, or yellow rigid containers (Wiva bins/sharps boxes), are used for the disposal of the waste. c) When the bag, or container is no more than 3/4 full, remove it from its holder or shelf and secure the opening using the approved plastic seal or lid, creating a neck to assist in carrying in the case of a bag; d) Check that the Wiva bins and sharps boxes have been correctly labelled with the area of origin of the waste, and dated. Do not remove any unlabelled bags or containers. e) Store the bag or container in the area that has been designated for this type of waste; f) Be fully familiar with the procedure in the event of a waste spillage or accident. (See GOSH Infection Control Operating Policy) All staff responsible for the collection, and movement to the central waste storage area, will: a) Be fully aware of their responsibility to ensure that at no stage is there any risk of injury to themselves or others. b) Wear the protective clothing (especially gloves and aprons) provided. c) Check that the bags and/or containers are correctly secured using the approved plastic seals, and/or lids, and in the case of rigid containers that they are labelled correctly with the origin of the waste. Do not remove unlabeled or untagged waste. d) Handle the bags using the neck created with the plastic seal, and the containers using the built in carrying handles. e) Be fully familiar with the procedure in the event of a waste spillage or accident, infection control operating policy. f) All clinical waste bags must be transferred to the clinical waste euro bins and locked after use g) Ensure that non-clinical waste is not mixed with clinical waste during storage or transportation. 21

22 Use only the lifts designated for use in waste collection Hazardous Waste Failure to correctly package and dispose of waste that falls under the remit of the Hazardous Waste Regulations 2005 will result in heavy penalties being imposed by the Waste Contractor. In addition, the Great Ormond Street Hospital for Children NHS Trust would also be open to prosecution by the Environment Agency for failure to correctly dispose of the waste. The Departmental Manager must ensure that:- a) Details of the waste to be disposed of will be required and the waste must be clearly identified as to its type and source and include the EWC Code or Code where by the process of production results in mixed waste of more than one category. b) The waste MUST BE contained in the appropriate container that is marked with the appropriate UN marking to identify the type of waste and its particular hazards. c) Bulk collections by the Trust s Waste Disposal Contractor of Pharmaceutical Waste are undertaken on a pre-arranged basis. d) They are fully familiar with all the Trust s policies concerning waste management that relate to the duties being undertaken. e) That clinical waste is not mixed with non-clinical waste during storage or transportation including removal to holding areas. f) Staff use only the lifts designated for use in waste collection. g) Under no circumstances is clinical waste moved by public transport, or in private cars. 16 TRAINING POLICY The Clinic or Department Manger has a duty to ensure that each department displays a poster at all appropriate sites depicting the Trust s Policy relating to the colour coding of Waste. All staff who are required to segregate, handle and transport any waste will be adequately trained in the safe procedures of the work, and the procedures to be followed in the event of spillage or other adverse incident. Directorate Managers for each department must ensure that all staff are trained in accordance with the Trust education programme, covering segregation, handling, and transport of waste, which is relevant to the area and staff concerned and that this training is undertaken as part of their induction and reviewed annually. The scope of the training will be dependent on the level of person s involvement with the waste. As a minimum all staff should be informed and instructed in the segregation of, the storage of, and the risk associated with all categories and classifications of waste. A record of all such training must be kept and be easily accessible for inspection. It is also essential that staff are familiar with the procedures for dealing with spillages, accidents or adverse incidents involving waste, reference should be made to the Infection Control Operating Policy. Staff who are involved with the segregation, handling, transfer and transport of all waste should be trained in the following areas: 22

23 a) Know the control measures, and how to apply them; b) Know what protective equipment to use, why and how; c) Know how to secure the disposal bags or containers using the approved plastic seal / lid; d) Know what type/colour of disposal bag or container is to be used for each of the different waste categories; e) Know the procedures in the case of spillage, accident and adverse incident. f) Know the procedure for cleaning and disinfection of the transportation equipment. g) Know how to correctly handle the waste in transit. The Waste Cycle 23

24 APPENDIX 1: Guidance Notes on Waste Disposal Clinical Waste (orange bags) (to be introduced on a ward by ward basis during 2009/10). Orange stream infectious and potentially infectious waste may be treated prior to final disposal by alternative technology. Orange stream waste will be ALL ward produced clinical waste (with the exception of sharps) that has been contaminated with bodily fluids and excretions or used to treat patients. Under no circumstances should newspapers, paper towels and flowers be disposed of in this stream. (N.B. exception can be made if the origin is from an isolation ward.) All orange bags must be tagged prior to disposal and will be consigned as hazardous as listed in the European Waste Catalogue as Clinical Waste (yellow bags/containers) Yellow bags or containers will form a known infectious waste stream and include all forms of anatomical waste and waste products that require incineration (e.g. un-autoclaved waste from clinical laboratories). It must be noted that yellow bags will only be used in ward areas on instructions of the Infection Control Department in circumstances where it is necessary to treat a patient in isolation. Yellow waste will be stored in the designated area of the clinical waste compound prior to collection. Yellow stream waste will be sent for incineration only and will be classified as , Sharps Boxes (with the exception of purple lidded bins) All sharps, with the exception of cytotoxic/cytostatic contaminated sharps, including needles, syringes (with needle attached), broken glass ampoules, scalpel and other blades, infusion sets (the sharps part thereof), should be placed in the Trust approved domestic sharps bins and tagged with a green waste tag, placed in the designated are in the waste holds for collection by the Trust s contracted waste porters. Yellow stream sharps will be sent for incineration consigned as hazardous waste classified as , , to reduce the possibility of residual medical products entering the incorrect stream. Cytotoxic/Cytostatic Sharps (purple lidded sharps boxes) All cyto sharps, including medicinal waste displaying hazardous properties H6 (toxic), H7 (carcinogenic), H10 (toxic for reproduction), H11 (mutagenic) or listed in the Safe Management of Healthcare Waste, will be tagged with black waste tags and collected from the designated areas in the waste holds by the Trusts contracted waste porters. This waste will be sent for incineration only and consigned as Cytotoxic/Cytostatic Waste (purple/yellow stream) Cytotoxic/cytostatic waste or medicine products from this treatment, including dressings, tubing and all aprons, gowns, gloves used, must be consigned as cyto waste through the yellow/purple stream. 24

25 Waste must be sent for incineration only and consigned as Offensive Waste Segregation of this waste stream is planned to take place during It will be consigned as EWC from clinical areas. Chemical/Flammable Waste This waste must be stored in the designated area for collection by the specialist contractor. Domestic Waste (clear bags printed with domestic waste) All domestic waste with the exception of will be disposed of via the black euro bins in the waste disposal area. All bags must be tagged with the correct waste tags and the euro bins will be transferred to the waste compactor. Domestic waste will be sent to a registered waste to energy site consigned as Food Waste: All food/wet waste should be placed in black bags. This waste will be transferred to the waste compactor and consigned as Confidential Waste Day to day confidential waste paper only is collected in confidential waste paper consoles, which are emptied fortnightly for shredding by the contracted waste company. Additional bags can be supplied for one of disposal of extra confidential paper waste at a cost to the department producing the confidential waste. The shredded paper is recycled by the waste contractor. Other confidential waste items, such as CD s, tapes, X-rays and film are collected for destroying by the waste contractor, contact the Waste Team for information. Toner Cartridges These are collected from VCB level1 on a regular basis by the Waste Team, details are published in the Newsletter. Office Paper Most areas of the Trust have paper recycling bins, the waste paper is recycled by Camden Council. There are plans to increase the amount of recycling of this waste stream Plastic Bottles & Drinks Cans Many areas of the Trust have recycling bins for plastic bottles and drinks cans; these are recycled by Camden Council. There are plans to increase the amount of recycling of this waste stream Redundant Office Equipment and Furniture Removal of large items is arranged via the MITIE helpdesk on ext Many items (or their components) are recycled by the general waste contractor Waste Electrical and Electronic Equipment All electrical and electronic items should be removed via the MITIE helpdesk on ext (Computers will need their hard drives removed by IT Dept first). The waste contractor recycles components and removes refrigeration gases for appropriate treatment. 25