Handling and Disposal of Healthcare Waste Policy

Transcription

1 SH NCP 47 Handling and Disposal of Healthcare Waste Policy Summary: This policy sets out the requirements for the safe handling and disposal of healthcare waste within Southern Health NHS Foundation Trust. This policy supports HTM Regulations and Health & Social Care Act regulations. Keywords (minimum of 5): (To assist policy search engine) Waste, clinical, segregation, consignment notes, infectious waste orange bags, medicines, offensive waste tiger bags, domestic. Target Audience: Modern Matrons, Site Managers, Facilities Management Staff, Cleaning Providers under Service Level Agreement or Contract Next Review Date: March 2020 Approved & Ratified by: Health & Safety Forum Date of meeting: 5 Date issued: Author: Sponsor: Sally Banbery, Contracts and Project Manager Tracy England, Senior Contract PFI/LIFT Manager Associate Director of Estate Services 1

2 Version Control Change Record Date Author Version Page Reason for Change 27/03/13 Sandra Grimes Changed to Southern Health NHS Foundation Trust Format 14/01/14 Sandra Grimes 2 12 Section 7.40 removed September Sandra Grimes 3 26 Policy Review Tracy England/ Rob Harris Tracy England/ Rob Harris Sally Banbery / Robert Harris Sally Banbery/ Tracy England Sally Banbery/ Tracy England Sally Banbery/ Tracy England Sally Banbery/ Tracy England All T28 Exemption Definition added for clarification 4.4 T28 Exemption Definition paragraph updated Appendix xx added for list of recycling waste Disposal of Vaccines addition Loose Medicines Disposal 5.12 HAZMAT Hazardous Materials addition Recycling Waste - Appendix 9 Change of Estates and Facilities Management to Estates Services 5.5 added wording to ensure containers are locked shut 5.5.4/5.5.5 paragraphs merged changed to and addition of wording loose/unrecognisable medicine disposal 11. Waste generated away from Health Care Premises section updated to separate clinic/home collection procedures 14.1 Training updated to confirm training by e- learning Appendix 6 Home Patients Collection form included Updated key words, author, sponsor information Section 1.1 HTM wording update Health Technical Memorandum. 1.2 wording Safety changed to Safe. 1.4 wording updated 3.2 wording Safety changed to Safe. 3.4 paragraph 2 removed as registering sites as clinical waste producers is no longer required by EA as from 1 April removed as repeat of 3.4, 3.8 not requirement removed 3.13 removed due to legislation changes 3.14 Tonnes changed to 5000kg wording added that denature controlled drugs. 4.1 paragraph amended due to legislation, removed due to legislation change. 4.3.removed as covered in Contracts team added wording amended 4.53 EA Registration removed 4.8 section updated to include completed consignment notes Section revised and amended revised and amended 11.3 patients home collection, contacts updated address updated Appendix 8 WEEE waste guide and request forms added Amendment to Hazardous Waste Regulations 2005 on cease requirement to register sites with the Environment Agency removal of reference to quarterly returns as they are now part E of the consignment note Part A Domestic Waste non-infectious sanitary/nappy waste can be placed in the domestic waste stream. 6 9, 13, Tags to be used for sealing all waste bags and 19,22, sharps/medicine bins. 2

3 Date Author Version Page Reason for Change Sally Banbery/ 6 17 Medicine pots to be placed in blue top medicine bins Tracy England Sally Banbery/ 6 36 Transporting waste streams within Trust premises Tracy England Sally Banbery/ 6 45, 48 Addition of Appendix 11,13 and 14 Tracy England Tracy England 6 19 Disposal of anatomical waste for patients in the community Reviewers/contributors Name Position Version Reviewed & Date Sandra Grimes Commercial Contracts Manager & Project Manager V1 27 th March 2013 Jane Horlock FM Quality and Audit Compliance Officer V1 27/03/13 Dave Barber FM Quality and Audit Compliance Officer V1 27/03/13 Tracy England Senior Contract and PFI/LIFT Manager V3 September 2014 Alison Edmundson Compliance Assurance Manager V3 October 2014 Ricki Somal Equality and Diversity Lead V3 October 2014 John Micklewright Counter Fraud Lead V3 October 2014 Steve Mennear Senior Clinical Pharmacist V4, / Theresa Lewis Lead Nurse Infection Prevention and Control V4, Robert Harris Service Improvement Manager V Tracy England Senior Contract PFI/LIFT Manager V Sally Banbery Contract and Project Manager V Tracy England Senior Contract PFI/LIFT Manager V Jackie Hunt Infection Control Lead V Jane Horlock Estate Services Quality & Audit Compliance V Officer 3

4 Quick Reference Guide The aim of this policy is to ensure that the Trust is exposed to minimum risk relating to handling and disposal of waste. All staff are aware of the procedures to follow in order to manage all types of waste generated by health care services. This policy provides guidance on waste types, legal requirements, duties and responsibilities of staff to be able to manage waste provision safely and appropriately. 4

5 CONTENTS Page 1. Introduction 6 2. Scope 6 3. Definitions 7 4. Legal Requirements Of The Safe Management Of Healthcare 8 Waste 5. Safe Handling And Disposal Of Healthcare Waste According To 12 Descriptions 6. Other Waste Types Healthcare Waste Classification Segregation, Colour Coding And 22 Storage 8. Waste Electrical And Electronic Equipment (WEEE) Batteries Mercury Waste Generated away from Health Care Premises Patient s 24 Homes/Clinics 12. Guidance for the Removal of Spillages of Healthcare Waste within 26 Trust Premises 13. Duties / Responsibilities Training Requirements Monitoring Compliance Policy Review Associated Documents Supporting References 29 Appendices 1 Health & Social Care Act Extract: Safe Handling and Disposal of 31 Waste 2 Healthcare waste: examples and breakdown of clinical and 32 hazardous in line with regulatory definitions. 3 Category A Pathogen List 33 4 EWC Codes that apply to waste produced from healthcare and 35 similar municipal sources 5 Transporting Clinical Waste 36 6 Home Patients Collections of Clinical Waste 37 7 Standard Operational Procedure Bag Tying 38 8 Waste Electrical and electronic equipment waste (WEEE) 39 9 Recycling of Waste Signage for individual internal waste bins List of Hazardous Medicines Equality Impact Assessment (EqIA) Waste Stream Disposal in Hospital Settings and Health Centres Waste Stream Disposal in home setting Training Needs Analysis 58 5

6 Waste Policy 1. INTRODUCTION 1.1 This policy sets out the requirements for the safe handling and disposal of waste, including healthcare, within Southern Health NHS Foundation Trust. This policy supports The Health Technical Memorandum (HTM) regulations and Health & Social Care Act regulations. 1.2 The Health Technical Memorandum 07-01: Safe Management of Healthcare Waste deals March 2013 with healthcare waste and the changes that the Hazardous Waste (England and Wales) Regulation 2005 (as amended by the hazardous waste (England & Wales) Regulations 2009) made to the management of these waste types. 1.3 All Healthcare Wastes now have a unique European Waste Catalogue (EWC) number that identifies the waste streams to be found within healthcare settings. These coded streams have to be disposed of in a variety of ways, such as autoclave prior to disposal or incineration. 1.4 Training for all Healthcare Staff and contractors supporting healthcare functions plays an important part in ensuring that the HTM processes and procedures are correctly followed. 2. SCOPE 2.1 This policy covers the handling and disposal of Healthcare waste produced by the Trust locations and its operations. To promote safe handling and disposal of healthcare waste by the Trust staff: To ensure compliance with the Environmental Protection Act 1990 Section 34 Waste Management the Duty of Care, Hazardous Waste Regulations 2005 latest amendments. The Controlled Waste Regulations The Hazardous Waste Directive 2011 (regulation 13) from 1 January To enable the trust to meet its legal obligations concerning the disposal of waste. 2.2 All latest amendments are referred to in a range of subsequent guidance documents produced by the Health Service Advisory Committee, Health and Safety Executive, The Department of Environment and Rural Affairs, Environment Agency and as local Control of Infection Guidelines. This policy is based upon the main following relevant statutory provisions and guidance: Environmental Protection Act 1991 latest amendments Hazardous Waste Regulations 2005, latest amendment Controlled Waste Regulations 2012 Landfill (England & Wales) Regulations 2007, latest amendment 2012 Radioactive Substances Act 1993, latest amendments Medicines Act 1968, latest amendments List of Waste (England) Regulations 2005 Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations 2011 Waste Electrical and Electronic Equipment Regulations

7 Health and Safety at Work Act 1974, latest amendments Control of Substances Hazardous to Health Regulations 2004 The Misuse of Drugs Act 1971, amendment order 2017 Controlled Drugs Regulations 2012 This document applies to all directly and indirectly employed staff within the Trust and other persons working within the organisation in line with the Trust s Equal Opportunities Document. 3. DEFINITIONS 3.1 Environment Agency: (EA) This is the regulatory body responsible for environmental regulation (including waste) in England a Wales. 3.2 Health Technical Memorandum 07-01: Safe Management of Healthcare Waste Provides a framework for good practice to all producers of healthcare waste on the development, management, and arrangements for the safe and economic disposal of healthcare waste. This document was produced in conjunction with the NHS, Health & Safety Executive, and Environment Agency and is to be regarded as a code of practice. 3.3 European Waste Catalogue (EWC) Waste in Europe is categorised using the European Waste Catalogue (EWC). This has been transposed into English law through the List of Wastes (England and Wales) Regulations The aim of the EWC is to provide a precise and uniform European-wide definition of hazardous waste and to ensure the correct management and regulation of such waste. Under the List of Wastes (England) Regulations 2005 each type of waste is provided with a specific six digit waste code which should be used on Hazardous Waste Consignment Notes. Codes should be used to describe each fraction of waste present in a single load, The EWC also specifies which wastes are potentially hazardous by denoting the European Waste Code with an asterisk (*). Such wastes are further characterised by Actual hazardous wastes and Mirror entries, which only become hazardous when certain criteria are met. See Appendix Environmental Protection (Duty of Care) Regulations 1991 this sets out the requirement on the person/company transferring the waste for disposal to ensure it is correctly described, transported by a registered carrier and is disposed /treated by a facility that is licensed to deal with that type of waste. 3.5 Supporting Evidence Hazardous Waste Regulations (England & Wales) 2005, Amendment Regulation 1 April 2016 controls the handling and disposal of Hazardous waste. Cease requirement to register sites with the Environment Agency. 3.6 List of Wastes (England) Regulations 2005 This set of regulations lists the process and waste generated from that process. The regulation lists the accepted Europe wide definitions of the waste and a code. Items marked with an * are hazardous, other coded can become hazardous depending on their concentration. 3.7 Health Technical Memorandum 2065 Segregation of waste streams in clinical areas Provides guidance on the development and management arrangements for the safe economic disposal of clinical waste. This document has been superseded in a number of section by the above and changes in legislation. 3.8 Waste (England & Wales) 2013: a guide to hazardous waste regulations record keeping. 7

8 3.9 Confidential Waste Is defined as any personal information that can be used to identify individuals, including their name, address, contact numbers or any financial data as defined by the Data Protection Act This can be in many forms such as patient records, contract information, and budgetary information. All confidential waste paper must be either shredded to British Code of Practice (BS 8470) on site or passed to a secure and specialist contractor for shredding. This means that paper is cross-shredded to an agreed size of between 12mm and 4mm width Other Hazardous Waste The following covers Hazardous Waste as listed in the List of Waste Regulations. This document has already referred to Hazardous Wastes that are routinely generated by Trust s/locations in addition other material will be Hazardous due to their makeup. The key categories identifying waste as hazardous are: Explosive, Oxidising, Highly Flammable, Flammable, Irritant, Harmful, Toxic, Carcinogenic, Corrosive, Infectious, Teratogenic, Mutagenic, Eco toxic, Substances that release a toxic substance when in contact with water, air, bases, and substances which yield another substance containing the properties listed at disposal. These categories can be identified via material Safety Data Sheets. Examples of common substances that will be hazardous: - Mercury, solvents, paints, acids and alkaline. Locations identifying that there is the requirements to dispose of Hazardous Materials, will require an individual consignment note to be raised Clinical Waste Pre-Acceptance Audits The Environment Agency has imposed a legal requirement within the terms of Environmental Permits for clinical waste disposal sites to ensure that producers carry out audits of their waste before it can be accepted. These are known as pre-acceptance audits. Any site producing over 5000kg of clinical (hazardous) waste is required to undertake an audit annually. If the individual sites produce less than 5000kg of clinical waste then they are audited every 5 years and the deadline for the first audit depends on the type of site Waste Exemptions - T28 Sort and Denature Controlled Drugs for Disposal This exemption allows Pharmacies and other similar places to comply with the requirements of the Misuse of Drugs Regulations 2001 by denaturing controlled drugs (making them unsuitable for consumption). This includes all Trust sites that denature controlled drugs. 4. LEGAL REQUIREMENTS OF THE SAFE MANAGEMENT OF HEALTHCARE WASTE At all times the guidance given in the Health Technical Memorandum 07-01: Safety Management of Healthcare Waste must be used as the primary reference document when producing Standard Operating Procedures/Protocols for the management of healthcare waste. The following identifies the legal requirements for the Trust to take into account following a review of The Health Technical Memorandum 07-01: Safety Management of Healthcare Waste document and associated Health, Safety and Environmental legislations. 8

9 4.1 Notification of Premises From 1 April 2016, premises no longer need to register as hazardous waste producers. This change affects the entire hazardous waste control system. 4.2 Documentation A key element of the duty of care is keeping track of waste. The holder of the waste is responsible for: Taking adequate steps to ensure that the waste is managed safely and kept secure: and Transferring it only to an authorised or exempt person Managers with this responsibility must maintain records of waste movements via copies of waste transfer notes and consignment notes for a period of 3 years Hazardous waste regulations require records of the premise registration reference and consignment codes are kept to ensure no duplication of consignment codes The Manager responsible for all hazardous waste movements from a site must keep a record of all codes issued for hazardous waste movements and hold in the site waste folder. 4.3 Waste Exemptions - T28 Sort and Denature Controlled Drugs for Disposal This is a free exemption obtained from the environment agency and is required for sites that denature controlled drugs. This is required for the building not for individual services / departments. However if you do denature controlled drugs please make this known to the site manager/clinical lead who will contact Estate Services Contracts and Compliance Team to ensure the T28 exemption has been applied for. Site Managers to obtain the copy of the T28 exemption for their site and hold in the site waste folder. Waste code Type of waste Medicines from natal care, diagnosis, treatment or prevention of disease in humans Medicines from research, diagnosis, treatment or prevention of disease involving animals Medicines separately collected as municipal waste 4.4 Identification To enable traceability of healthcare waste, sharps, medicines, clinical and offensive waste is required to be packaged in the correctly colour coded receptacles, sealed and tagged, and where there is a label this must be dated and signed and that it identifies the building and department that produced the waste at the point of origin The cleaning contractors and in house cleaners will provide the Trust premises with identity tags at the locations that they support and will maintain a master record of the tag numbers they have received and issued to each ward / department if applicable. 9

10 4.4.3 The Site Manager is responsible for keeping on the premise a folder for waste documentation, this must include: Waste transfer notes (see section 6 below) Hazardous Waste Consignment notes (see section 7 below) T28 exemption if applicable (see section 4.4 above) NOTE: that if premises wish to keep the waste documentation folder anywhere other than the site that produced the waste, this must be agreed in writing with the environment agency. 4.5 Waste Transfer Notes used for the transfer of Non Hazardous waste Documentation is required each time non hazardous/inert waste is transferred between legal entities. The document describes the waste, who holds it and who is taking it away (the carrier) to a disposal site. These have to be kept for 3 years from the date of transfer When waste is transferred from one party to another, the person handing the waste on (the transferor ) must complete a transfer note. The transferor and the recipient (the transferee) sign the note; both parties retain a copy. An annual transfer note may be used to cover all movements or regular transfer of the same Non- Hazardous Waste between the same parties Copies of the Annual Transfer Note for all domestic and recycling waste produced on Trust sites are kept centrally with the Estate Services Contract Team. This will be kept for a minimum period of 3 years Any other transfer notes must be kept on site for a minimum period of 3 years and are liable for inspection by the internal auditor and/ or external Environment Agency. 4.6 Consignment Notes used for the transfer of Hazardous waste Document required each time hazardous waste is transferred between legal entities describes the waste and who holds it, and is taking it away to a disposal site with details of the disposal site. These have to be kept for 3 years from the date of consignment Consignment notes are required when transporting Hazardous Waste. The completion and accuracy of the waste classification, description and composition of the waste on the consignment note is the sole legal responsibility of the waste producer and is used to track the movement and ensure that safe disposal of hazardous waste Copies of the Consignment Note must be kept for a minimum period of 3 years from the date the waste left the premise, and are liable for inspection by the internal auditor and/ or external Environment Agency 4.7 Producer Returns Each consignee (the designation site where the carrier takes the waste) is required to send a record of the final disposal of the waste. This information is provided in Section E on each completed consignment note. These are sent electronically to each site manager/nominated person. Copies must be placed in the relevant premise waste documentation folder. These returns must be present to ensure the 10

11 register is legally complete. If the consignment notes are not being received please contact the Estate Services contracts Copies of the completed consignment notes must be kept for a minimum period of 3 years, and are liable for inspection by the internal auditor and/ or external Environment Agency 4.8 Waste Definitions and Classification The European Waste Catalogue (EWC) contains codes that apply to waste produced from healthcare and wastes similar to municipal sources. The codes applied to waste streams are defined by the individual item placed in a receptacle; they are never determined by the type of receptacle used Where possible each waste has been given its waste code in full or chapter reference in the List of Wastes (England) Regulations (2005). 4.9 Regulatory Definitions and Classifications Non-Hazardous Waste This type of waste is normally referred to in the Trust as Domestic (Housekeeping) and consists of general waste. A. Domestic Waste Black Bag This waste is similar to waste from households, is assumed to be non-infectious and normally non-hazardous and consists of cleaning waste, couch rolls, flowers & fabrics, hand towels and materials that cannot be recycled. This waste generated by normal day-to-day housekeeping activities is to be collected into black bags or boxes for non-clinical glass. This waste must be stored in black domestic bags which must be placed into nonhazardous waste containers for disposal. This will vary from dustbins, compactors or skips. A Waste Transfer Note issued by the carrier to the Trust s/location for a period of up to 12 months must cover the transfer of this waste. Following HTM any soiled waste managed by health facilities such as sanitary products, nappy waste, minor dressings and plasters are not considered to be infectious and can be placed in the domestic waste stream. Incontinence waste is to be placed in tiger stripe waste stream. B. Materials for Recycling Clear Bag Materials identified for recycling examples are paper, cardboard, tin cans, plastic bottles, etc. should be disposed of in clear plastic bags and placed into mixed recycling waste containers for disposal, this will vary from bins to skips. (Appendix 9) At no time must the Trust s waste be put into community recycling collection containers. For both domestic and recycling waste: The containers will be picked up by a registered waste carrier to be taken to licensed waste disposal facility. 11

12 A Waste Transfer Note issued by the carrier to the Trust for all premises for a period of up to 12 months for the transfer of this waste. This document will be held centrally by Estates Services. Copies of transfer notes MUST be kept for a minimum period of 3 years and are liable for inspection by the internal auditor and/ or external Environment Agency. C. Materials for Reuse In the event of the requirements to dispose of Materials/Equipment that may have a further use, care must be taken as in law they are waste. So as not to require duty of care the items must be disposed of as functioning units examples being tables, chairs, filing cabinets and as such must meet the requirements of the Sale of Goods Act. An example of this would be that furniture meets the current flame retardant requirements is fully serviceable. It is recommended that materials be only sold onto recognised dealers with the requirements that they take the responsibility of establishing serviceability and not directly to members of the public including staff. The Trust waste contractor will remove reusable items for reuse, please contact waste contractor for any charges and collection arrangements D. Inert Waste This type of waste is made up from building waste materials, examples of which are brick, stone, concrete, soil (mixed construction waste) generated from activities from a site or building and has to be segregated from the above. Care must be taken not to contaminate this type of waste with material such as wood, plasterboard, and vegetation. In the event of works being carried out at a location generating non-hazardous waste not directly related to day to day housekeeping a separate waste container/skip will be required, and a Waste Transfer Note issued by the carrier to the premise location to cover the transfer of this waste must be raised Hazardous Waste This waste is defined as waste that is a danger to human health and to the environment and the types are listed in the European Waste Catalogue. Examples of this type of waste, infectious healthcare wastes, mercury, cytotoxic and cytostatic drug waste, dental amalgam, oils, and chemicals. This waste may be hazardous; examples are: - electrical equipment, chemicals, asbestos and fluorescent tubes see section on Waste Electrical Electronic Equipment. 5 SAFE HANDLING AND DISPOSAL OF HEALTHCARE WASTE ACCORDING TO DESCRIPTIONS 5.1 Waste from Human Healthcare (Clinical) The definition of clinical waste is provided by the Controlled Waste Regulations 2012 issued under the Environmental Protection Act

13 Clinical waste is defined as: contains micro-organisms or their toxins which are known to cause disease to humans or other living organisms contains or is contaminated with a medicine that contains a biologically active pharmaceutical agent is a sharp, or a body fluid or other biological material (including human or animal tissue) that contains or is contaminated with a dangerous substance, as defined by EU legislation (e.g. toxic substances which pose acute or chronic health risks) 2. The categories of dangerous substances defined by 67/548/EEC are explosive, oxidising, easily flammable, flammable, toxic, harmful, corrosive, and irritant. Clinical waste examples: Infectious healthcare waste, sharps waste, anatomical waste, cytotoxic waste, and pharmaceutical. Refer to Appendix 2: Examples and break down between the definition of clinical waste and hazardous waste. The following documents should be referred to in association with this section. Health Technical Memorandum 07-01: Safety Management of Healthcare Waste and List of Wastes (England) Regulation 2005, (List of legal definitions). Where possible each waste has been given its waste code in full or chapter reference in the List of Wastes (England) Regulations (2005). As a guide the following list of chapters from the List of Wastes is provided but guidance must be sought from the waste contractor or internally to establish the full code. Type of waste List of Wastes Regulations chapters X ray-photochemical 9 and 20 Electrical equipment 16 and 20 General domestic waste (black bag) 20 Some hygiene waste 20 Packaging waste 15 Office waste 20 Construction waste 17 NOTE: When transferring waste for disposal it must be correctly described and the correct waste list code used on the waste transfer note. 5.2 Infectious Waste * Wastes whose collection and disposal is subject to special requirements in order to prevent infection Yellow Infectious waste stream is used for waste that is infectious, but which has an additional characteristic and must be incinerated in a suitably licensed or permitted facility. This will be placed into yellow bags. This will not normally be generated by the Trust as it would contain Category A pathogens which are managed the Dangerous Goods Regulations. Refer to Appendix 3 of the policy. 13

14 The known examples are: Anatomical waste; this must be placed in yellow or red UN approved rigid containers with Red lids. Chemically contaminated samples and diagnostic kits Medicinally- contaminated infectious waste Category A Pathogens An infectious substance which is carried in a form that, when exposure to it occurs, is capable of causing permanent disability, life threatening or fatal disease to human or animals Ebola or high possibility or confirmed cases of VHF infection For patients suspected as HIGH POSSIBILITY VHF infection, all waste is classified as Category A infectious waste on the basis that is it known or contaminated with pathogens presenting with the most severe risk of infection. All waste including gloves and paper towels should be autoclaved or incinerated place in YELLOW bag. These waste bags must be double bagged. Waste (including sharps receptacles) must be placed in a solid container (60 litre one way burn bin) and then held within another solid container (770 litre bin) and quarantined in a secure area. The 770 Litre bin should be labelled as EBOLA waste and should not be used for any other clinical waste. Both sharps and bagged waste should be placed inside this bin. A reputable and licensed waste contractor must undertake transport to the incinerator. Prior to collection by the contractor, waste must be stored securely and access restricted to authorised and trained personal. Refer to Standard Operating Procedure for Ebola Identification Category A Minimum treatment/disposal required is incineration in a suitably licensed or permitted facility. This waste must be placed into two Yellow bags, (double bag) labelled on closure and must be placed into 360 / 770 waste receptacles for disposal in bulk storage areas. Refer to Appendix 3 for further breakdown of Category A Pathogens Orange Infectious waste stream is used for waste that is an infectious substance which does not meet the criteria for inclusion in Category A and has no additional characteristics as mentioned above in This waste requires minimum treatment/disposal to be rendered safe in a suitable licensed or permitted facility. This waste must be placed in an Orange bag and when filled sealed by tying appropriately, see Appendix 7, and an identity tag attached. Waste contaminated with blood from isolation areas must be disposed of within this waste stream in an orange bag. See Clause for disposal of sanitary waste. 14

15 This waste stream must not contain chemicals, amalgam, medicines or anatomical wastes. The orange clinical waste stream should not contain waste that is noninfectious (for example domestic, offensive, medicinal) Copies of the Consignment notes MUST be kept for a period of 3 years and are liable for inspection by the internal auditor and/ or external Environment Agency. This waste must be stored in Orange bags, and tagged on closure and must be placed into 360 / 770 waste receptacles for disposal in bulk storage areas Non Hazardous Offensive waste (No known source of infection) Offensive waste is non-clinical waste that s non-infectious and doesn t contain pharmaceutical or chemical substances, but may be unpleasant to anyone who comes into contact with it. It is not known or suspected to possess any hazardous or infectious substances. Where there has been identified there is a risk of infectious waste in clinics such as leg ulcer, sexual health the hazardous waste stream (orange bags) must be used. Offensive waste is defined as: is not clinical waste contains non-infectious body fluids, secretions or excretions This waste must be placed in a Yellow and Black Tiger Stripe bag and when filled sealed and an identity tag attached. Management of Offensive waste: If a site has produced more than 7kg of offensive waste, or has more than one bag in a collection period, it must be segregated from any other waste streams and treated as offensive waste. However, if a site has produced less that 7kg (one bag) per collection this waste stream can be disposed of by using the domestic waste ( black bag ). Use classification code As an example, this will apply to office only sites, staff only or sites that have small outpatient facilities. Offensive waste examples in clinical areas include: Nappies, Sanitary waste, Incontinence pads Protective clothing, which has not been used in a non-infectious environment Single use instruments (no risk of sharps) e.g. tongue depressors Disposable personal protective equipment, which do not pose a risk of infection, including non-infectious gowns/ aprons, masks and gloves etc. Wrongly consigning non-hazardous waste as hazardous is a breach of the Hazardous Waste Regulations Yellow and black striped bags (tiger bags) must be used for the offensive waste stream. Copies of the Consignment notes MUST be kept for a minimum period of 3 years and are liable for inspection by the internal auditor and/ or external Environment Agency. 5.3 All Sharps and Medicinal Waste Streams and Containers Sharps are items that could cause cuts or puncture wounds. They include hypodermic needles, syringes with needle attached, scalpels, infusion sets (sharps part), used medicine vials, broken glass ampoules and other blades. This waste will 15

16 be treated as Hazardous Waste and must be kept separate from other healthcare waste and regarded as infectious. Every container must be labelled and the label completed when brought into use. The labels should clearly identify the waste type present within the container, identify the individual producer, i.e. ward/department and signed and dated when closed. Sharps containers must be locked shut when it is two thirds full OR after been in use for three months and the date of shut down recorded on the label Sharps Yellow Container & Yellow Lid /09 Sharps contaminated with medicinal products, partially discharged sharps and those used to administer medicines. At no time must sharps be placed in to blue container for medicinal items Disposal of Vaccines Equipment used for vaccination including vials, ampoules and syringes should be disposed of by placing in proper puncture resistant sharps box. If they have been used or opened then the vaccines should be placed in the yellow lidded sharps container. If the vaccine has cytotoxic/cytostatic properties these must be classified as hazardous and disposed of in purple lidded approved rigid container. Unused vaccines, including intranasal flu vaccines can be returned to the Pharmacy by agreement. Or, to be disposed of via the blue medicinal waste stream or purple if cytotoxic/cytostatic. If there is any doubt for disposal methods for vaccines please contact the Medicines Management Team Non-medicinally contaminated sharps /03 Sharps that are NOT infectious or contaminated with medicinal products for example phlebotomy sharps and blood sample vials must be disposed of in Yellow UN approved rigid containers with Orange lid and Sharps that are contaminated with medicines must be disposed of in Yellow UN approved rigid containers with Yellow lid. Where wards and departments have mixed sharps that are both not infectious and contaminated the yellow container with the Yellow lid should always be used Cytotoxic & Cytostatic Yellow Container & Purple Lid * and * Pharmaceutical waste & sharps, which are contaminated with cytotoxic or cytostatic products, must be disposed of in Yellow UN approved rigid containers with Purple lid. Items such as Sharps, syringes with needle attached, medicine vials & ampoules contaminated with cytotoxic & cytostatic medicines/products. See Appendix X below. This definition is no longer linked to the British National Formulary Chapter 8 and will classify ANY medicine that is: Carcinogenic, or Mutagenic, Toxic for reproduction or Toxic 16

17 Medicines waste in this group must be kept separate from Medicines for disposal. For advice on the medicines involved contact the Trust Chief Pharmacist. These must be stored in yellow UN containers with purple lid prior to disposal by incineration. These containers must be placed into designated locked storage area within building or 770 waste bins for disposal in bulk storage areas, accessible only by authorised staff Medicines Non Hazardous Yellow/Blue Containers with Blue Lid EWC This description covers ALL medicines covered by the Medicines Act 1968 latest amendments other than those in and includes the primary packaging and empty medicine pots as these will have been contaminated by medication (empty blister packs, and bottles etc) around the medicine, expired, unused drugs, vaccines etc. Medicines should not be removed from the inner layer of packaging, for example foil blister strips. This significantly reduces the potential for reaction. Therefore, waste medicines should, as far as possible be disposed of in their original packaging. Uncontaminated outer packaging should be disposed of in the recycling waste stream. This waste will be treated as Non Hazardous waste but will require separate disposal and destruction by incineration and must be kept separate from other clinical waste and stored in waste medicines containers Yellow/Blue containers with Blue lid prior to disposal by incineration. For the purpose of transport/carriage regulations, medicinal waste will come in two types: solids (pills and powders) and liquids (oral liquids). The medicinal containers whilst in use or closed down must be placed into a locked storage cupboard within a locked room within the building or 770 waste bins for disposal in bulk storage areas. Accessible only by authorised staff. Medical products not pharmaceutically active and possessing no hazardous properties (examples saline glucose and feeds) are not considered medicinal/pharmaceutical waste. Residues must be discharged to foul sewer before empty bag is disposed of in offensive waste stream. All unused in date medicines in unopened packaging (as supplied) must be returned to the supplying Pharmacy if not required. If not practical, arrangements must be made for the pharmacy to collect the materials in an approved container. The containers must be kept in a secure area when in use and awaiting collection. Hospital pharmacies will only receive back medicines, which they have supplied. NB Specific procedures apply to controlled drugs, see 5.6. All waste medicines that are part used or redundant out of date (e.g. half-used tubes, partly filled bottles and blister strips, medicines that are recovered from patients due changes of medication or returned by Community Nurses). Including primary packaging from medicines that is dispensed to the patients must be placed into a container (30/60 litre container with self-locking lid) provided for this purpose and located in a secure area. 17

18 Loose Medicines Where the pills are loose or the liquids container has lost its closure (stopper/cap) a suitable receptacle that is compatible with the product should be used. Once a suitable receptacle is found the procedure for disposal above should be followed. For loose and unrecognisable tablets/capsules wrap into a disposable medicine administration pot before disposal in blue lidded medicine container. At no time must sharps be placed in to medicine container. Note: Under no circumstances must medicines (in date or out of date) be accepted by any trust premise from any patient for disposal unless in their direct care. Patients must be directed to local chemist that holds an appropriate licence. Containers (bottles, ampoules, vials etc) used for liquid medicines and powders are normally contaminated with residual quantities of those medicines. Inner packaging used for tablets may or may not be contaminated. If contaminated, containers should be classified and disposed of as waste medicines. Only if rinsed out, in accordance with a trade effluent consent, may they be disposed of as packaging (for example glassware for recycling). Medicines in aerosol formulation cannot be cleaned and should be classified as waste medicines (not aerosols). It is not acceptable to discharge liquid medicines to sewer. Medicines must not be placed in domestic or clinical healthcare waste bags. 5.4 Medicines Controlled Drugs including illicit drugs Controlled drug (CDs) is any drug identified within the Misuse of drugs regulations 2012 and Misuse of drugs (safe custody) regulations Unused CDs must be denatured using a Trust approved kit under Trust, Medicine Control, Administration, and Prescribing Policy (MCAPP) in the presence of a registered nurse and authorised Trust pharmacist. Denaturing should be undertaken using a method consistent with the guidance from the Royal Pharmaceutical Society of Great Britain (RPSGB). Details for the disposal of CDs is within the MCAPP, Ref 4 & Appendix N, the denatured CDs within the kit must be placed into the designated blue lidded medicinal bins. 5.5 Amalgam and mercury waste * and Amalgam from dental care Dental Amalgam and mercury non-infectious including spent and out of date capsules, excess mixed amalgam, teeth with amalgam fillings and contents of amalgam separators. All dental amalgam generated from dental clinics must be collected and dispose of as hazardous. Amalgam must not be released into the foul drains and separators must be fitted to all dental facilities to prevent this occurring. These units collect the amalgam and are removed as a sealed unit for recycling with amalgam collected from day to day operations. All items must be segregated into their own UN approved rigid containers supplied by waste contractor. These must be stored in containers provided by contractor in a locked designated area within the building prior to disposal, until collection by waste contractor. 18

19 This waste must be treated in a metal recovery centre which must be a suitably Licensed or permitted facility. The clinics must collect the materials in an approved container for disposal kept in a secure area, either via amalgam separators fitted to the chairs or separate containers for other generation routes. Locations requiring dental amalgam to be disposed of will need a hazardous waste consignment note. A separate consignment note will need to be generated for each transfer of amalgam waste. Copies of hazardous waste consignment notes MUST be kept for a period of 3 years and are liable for inspection by the Environment Agency. At no time is Dental Amalgam to be placed in healthcare waste bags 5.6 Anatomical waste Yellow Bag/Rigid Container with Red Lid /03 Anatomical waste is defined as any recognisable body parts, placentas, toes, blood transfusion bags and blood preservatives. Anatomical waste must be segregated from other wastes, contained in rigid sealed containers, and identified as for high temperature incineration only Non-infectious anatomical waste Anatomical waste from no known infectious source or where items have been screened such as blood transfusion bags infectious anatomical waste Anatomical waste from known or suspected infectious source. Anatomical waste should be stored in yellow bags or rigid containers and frozen on the ward or designated facility, dedicated for limbs only, transferred to red lidded placenta bin for disposal, labels must be completed and bin must be tagged on opening using identity tag (as per section 5.3) and must be placed into designated locked storage area within building or in freezer located in bulk storage areas. Must be high temperature incinerated in a suitably licensed or permitted facility All items must be segregated into their own Yellow leak proof lidded leak proof UN approved rigid containers with Red lid. Please note: If chemicals are present in either non-infectious or infectious anatomical waste then a further EWC needs to be added of to the waste consignment note. For any patients requiring disposal of anatomical waste in the community, nursing staff should use the red UN approved rigid containers with Red lids and follow the patients home collection procedure in 11.3 for appropriate disposal. 5.7 Radioactive Healthcare Waste is waste contaminated with low- level radioisotopes. This waste requires disposal in suitable facilities normally by Incineration, appropriate packaging is required for radioactive waste in line with the transport regulations 5.8 Hazardous Waste Non Clinical - Chemicals /07 Chemical consisting of dangerous substances * The full definition of the concentration of hazardous substance is given in the List of Waste (England) Regulations and is referred to as properties containing health risks H1 to H8 and H10 to H15. Further information can be found in the Manufacturers Safety Data Sheet (MSDS) of the substance. 19

20 Examples might include sphygmomanometers and thermometers that contain mercury which are toxic, anatomical or pathological specimens or samples preserved in chemicals (for example formaldehyde, alcohol), sample vials or diagnostic kits containing chemicals, sharps or other clinical waste items contaminated with therapeutic or laboratory chemicals and materials used to clean up biological spills that are contaminated with chemical disinfectants. The full definition of the concentration of hazardous substance is given in the List of waste and is referred to as H3 to H8, H10 or H11. Further information can be found in the manufacturer s safety data sheet Control of Substances Hazardous to Health (COSHH) Sheet of the substance and advice must be sought if there is any doubt, a separate container must be used for each different chemical disposed (do not mix). These must be stored in containers provided by the contractor prior to disposal. Chemical waste can be treated by neutralisation and by using other chemical solutions to break down the Hazardous properties in the waste stream, which must be by a suitably licensed or permitted facility. Staff to contact the Site Manager to arrange collection and disposal of the waste contaminated with chemicals through Trust waste contractor. 5.9 Chemicals (Non Hazardous) ( ) Further information can be found in the manufacturer s safety data sheet Control of Substances Hazardous to Health (COSHH) Sheet of the substance and advice must be sought if there is any doubt. A separate container must be used for each different chemical disposed (do not mix). These must be stored in containers provided by the contractor prior to disposal. Site Manager notified to arrange disposal through Trust waste contractor. Chemical other than those mentioned in This covers chemicals that do not meet the criteria of above and are classified as Examples of this waste group can be diluted acid, or quantities of unwanted cleaning materials. If the item does not possess a chemical hazardous property (i.e. H1 to H8, H10 to H15), the waste is not a clinical waste (i.e. H9) nor a hazardous waste (i.e. as described in 4.2) it should be classified as These must be stored in containers provided by waste contractor prior to disposal. Please Note: Any X-ray facilities that use fixers and water based developers are classified as and respectably; solvent-based developers are classified as Photographic film and paper containing silver or silver compounds is classified as , Photographic film and paper free of silver or silver compounds is classified as All chemicals must be stored separately in containers provided by contractor prior to disposal. If there is any doubt advice must be sought from Trusts Health and Safety and / or compliance teams. 20

21 Copies of the Consignment notes MUST be kept for a period of 3 years and are liable for inspection by the internal auditor and/ or external Environment Agency HAZMAT (hazardous material) Contaminated Clothing and Personal effects Clothing, valuables and personal items removed from self-presenting casualties must be considered as contaminated and expert advice should be sought prior to their return to their owner (e.g. Public Health, HPS, and GDS) or as to the appropriate means for disposal. It should be noted that, in those cases where there has been an incident, such items of clothing may be required by the Police as criminal evidence. Any equipment that cannot subsequently be decontaminated effectively and economically should be disposed of as contaminated waste. The final disposal of this waste should only be undertaken after the hazard has been identified and specialist advice taken on the safest disposal options to prevent further contamination or harm. Transportation of HAZMAT Contaminated Waste Depending on the type of contaminated waste, advice must be sort from Public Health. A reputable and licenced waste contractor must undertake transport to the incinerator. Prior to collection by the contractor waste must be stored securely and access restricted to authorised and trained personal. To arrange waste collection please contact the waste supplier General Transportation of Waste Streams The transportation of waste is a process that should begin at the area of generation of the waste stream, where infectious, offensive and domestic waste has to be appropriately collected and segregated in specific receptacles. Refer to Appendix 5. 6 OTHER WASTE TYPES 6.1 Large Equipment Rubbish that is too large / bulky to dispose of in a black domestic waste bag. Such as, medical devices, tables, chairs, beds, walking aids etc. Where practicable all equipment must be decontaminated prior to disposal. All medical devices must be decontaminated prior to disposal. Once decontaminated and there are no hazardous or infectious properties remaining the item may be disposed through the appropriate route. This will be via the Trust waste contract where an ad-hoc collection can be arranged by request through Estates Contracts or the Waste Providers Helpdesk. It is noted that the service will be required to fund the activity and will be required to provide the cost code for recharge. If the equipment cannot be decontaminated contact must made with site manager who should seek guidance from the contractor, the equipment will need either direct disposal via clinical waste or decontaminated at the contractors plant. 6.2 Mattress If a mattress is contaminated, services should order a mattress disposal bag from NHS Supply chain, order number MVN 003. The mattress should be placed in the bag in the external waste compound inside a 770 litre clinical waste bin and tagged as HT , or should be positioned next to the 360 litre clinical waste bin. The 21

22 waste contractor must be informed prior to collection via the Contractors helpdesk and the cost code must be given for the recharge for the collection of the mattress. Note: under no circumstances must a sprung mattress be disposed of via the clinical waste route please contact waste contractor for disposal instructions if this event occurs by using the Estate Services Contracts . If the item contains electrical or electronic components (air mattress) it will need to be disposed of in accordance with the WEEE regulations and, if hazardous, the hazardous waste regulations (See WEEE section below 4.3.4). The Medical Device Contract Manager will advise on disposal documentation, contact the Estate Services Contracts HEALTHCARE WASTE CLASSIFICATION SEGREGATION, COLOUR CODING AND STORAGE Each container must be labelled in accordance with the details of the legal requirements for transporting and packaging the waste. The container label should clearly identify the waste type present within, the ward/department, date and signature. The purpose of this is to ensure that waste such as anatomical wastes and medicines are not moved in anonymous yellow bins that may lead to subsequent mismanagement. In addition the container MUST be tagged and the label completed in a manner that identifies the individual producer. (Refer to Section 4.5 Identification above) The bin holding the waste bag in a ward and department should be of the appropriate type to the related service. Bins should have a corresponding sign to confirm which type of waste i.e. domestic, offensive and a brief description of the applicable waste allowed. See Appendix xx for signs. 7.1 Medical Devices The service is to arrange a collection for disposal of medical equipment. The cost of the disposal should be factored into the funding on purchase of new equipment if being replaced. Staff to contact the Estate Services contract for advice. Depending on the equipment materials and the infectious properties various disposal methods are available such as landfill or municipal incineration / energy recovery facilities, recycling, alternative treatment, or incineration all processes must be at a licensed or permitted facility. It is the responsibility of the service to fund the disposal of medical equipment and provide the cost code for recharge on the WEEE waste form request. See Appendix Inert Waste Types of inert waste are sand and concrete. The building contractor producing the waste is responsible for its classification, segregation, storage and disposal. Copies of Waste transfer notes must be made available to Projects team / Estates Services maintenance team. Depending on the materials and the hazardous properties various disposal methods are available such as landfill, recycling / reuse, all processes must be at a licensed or permitted facility. 8 WASTE ELECTRICAL AND ELECTRONIC EQUIPMENT (WEEE) HTM Waste Electrical & Electronic Equipment (WEEE) is any item that is powered by mains, battery or electricity. WEEE must be segregated from other waste in 22

23 accordance with the WEEE Regulations This includes household and commercial items containing electrical and electronic parts / components including medical equipment. All items listed below should not be placed in normal waste containers, as they are not permitted to be landfilled. Some items will need to be treated as hazardous waste under the Hazardous Waste Regulations 2005 and these will require separate disposal. This will be highlighted by the Estate Services contract team following submission of the WEEE waste request form to the contractor. List of common WEEE items Large /small household appliances (i.e. washing machines, cookers, toasters, irons, hairdryers, fridges) Consumer equipment (i.e. TVs, videos, hi-fis) Lighting equipment (i.e. fluorescent lamps, excluding filament light bulbs) Electronic and electrical tools (i.e. lawnmowers, drills) Toys, leisure and sports equipment (i.e. video games, bike computers) Monitoring and control instruments (i.e. smoke detectors, thermostats) Automatic dispensers (i.e. drinks dispensers, chocolate dispensers, ATMs) Medical Equipment If you have any of the above items to dispose of please following Appendix 8, WEEE Waste Disposal Request procedure. A WEEE waste request form will need to be submitted to the Estate Services Contract for quotation. It is the responsibility of the service to fund the disposal of WEEE waste and provide the cost code for recharge on the WEEE waste form request. IT and telephony equipment must be disposed of via the Trust IT Department. Please contact the IT Helpdesk, either via or telephone, the contact number can be found on the Trust Intranet. 9 BATTERIES Lead, Ni-Cd and Mercury-containing batteries must not be disposed of in the normal domestic waste and should be segregated into battery recycle bins. Recycling of batteries should be managed locally on site and will need a separate container for disposal. If you do not have a local arrangement please contact the Estate Services contract team Estateservices-contracts@southernhealth.nhs.uk to arrange for a quotation via the contractor. It is the responsibility of the service to fund the disposal of batteries and will need to provide the cost code for recharge. 10 MERCURY Mercury is used mainly in sphygmomanometers. Each premises and/or ward using equipment containing liquid mercury should have available a kit for the collection and disposal of spilled mercury. Mercury spillage kits are available from the Supply chain. If a mercury spillage occurs the spill kit must be used as per manufactures instructions The major risk in using the instruments lie in dealing with breakage and the resulting spillage of mercury (These kits contain instructions on the collection and disposal of spilled mercury). Mercury spillages should be cleaned up immediately; the resulting waste must be disposed of as Hazardous Waste. 23

24 The premises/support service manager or designated person must be informed and shall be responsible for arranging the removal of waste spillages within the Trust premises and grounds through the Trust waste contractor. The premise manager must be informed and is to contact contracts and compliance to arrange a collection for disposal. Must be treated in a metal recovery centre which must be a suitably licensed or permitted facility 11 WASTE GENERATED AWAY FROM HEALTH CARE PREMISES - PATIENT S HOMES/CLINICS Local Authority has primary responsibility for disposing of any waste generated in the patient s home (by the patient). Disposal of healthcare waste generated when Trust staff visits patients at home will still normally be the Trust s responsibility. The requirements for disposal of clinical waste from patient s homes are detailed below. Staff must ensure that they and the patient is aware of the procedure for disposal of the waste Disposal of Non-Hazardous Waste (Offensive, Tiger Stripe) The disposal of clinical waste in a patient s home, where the patient is treated by a community nurse or a healthcare professional, is the responsibility of the nurse / healthcare professional giving the treatment. Community staff need to ask permission from the home owner prior to disposing of waste into their rubbish bin. The Community teams will carry out a patient specific basis risk assessment to establish what waste will be produced during treatment, sharps (cytotoxic or medicinally contaminated), infectious, (patient known or suspected to have a potential risk of infection) or non-infectious waste (shows no clinical symptoms of having an infections), and the quantity generated. If the waste is classified as non-hazardous, (non-infectious) and as long as it is double bagged in a small translucent / white bag and sealed, it is acceptable for the waste to be disposed of with household waste. This is usually the case with plasters, small dressings, sanitary towels and incontinence products. Offensive waste produced at Social Care Sites, i.e. incontinence pads would be disposed of in the normal domestic waste streams Disposal of Hazardous Waste (Infectious, Sharps, Orange bag) If the waste is classified as hazardous in the patient s home the healthcare professional can remove that waste and transport it in approved containers (i.e. rigid, leak proof, sealed, secured etc.) and take it back to the Trust s base for appropriate disposal. Alternatively, the Trust can make arrangements for the disposal of the waste with an appropriate waste contractor for which a charge will be made. In Social Care sites where there are sharps waste generated, these would either be returned to site by the community nurses or arrangements would need to be made with the waste contractor for collection. See Staff must bring back the clinical waste to the healthcare professionals designated base, and dispose of with the site waste following the correct procedures for the type of waste. Staff must ensure that all waste is transported safely within the boot of the car in its segregated fractions. In appropriate UN approved containers to ensure any 24

25 spillages are contained, without contaminating other waste streams. Waste must be disposed of at their own base as soon as reasonably practicable. Staff should obtain the: Daniels red community nursing container via NHS Supplychain, code FSL262 to hold the appropriate containers or bag. Flat packed bio-bins for the appropriate waste streams, via NHS Supplychain/SBS. NHS Supplychain code FSL694 (for infectious waste) 5 litre cardboard, rigid, orange. Contact Procurement for further advice if required Patients Home Collections Staff can make an arrangement for the disposal of waste, including anatomical (see para 5.6) by contacting the Trust clinical waste contractor s helpdesk. A home patient collection form can be requested from the Estates Services Contract Team EstateServices-Contracts@southernhealth.nhs.uk The Trust is required to ensure that the waste provider receiving communication information and documentation is compliant with information governance requirements. The patient collection form will included patient details, address and waste stream information, frequency of collection and this form must be ed by secure mail with cost code to Southern@medisort.co.uk If staff have further queries regarding the home collection service they will need to contact the clinical waste provider directly. Contact telephone number Staff must ensure that the patient or their representative gives permission for the waste to remain in their home in a safe place (away from children and or animals) awaiting collection by the clinical waste contractor. NOTE: Do not in any circumstances place orange or tiger bags in the patient s household waste bin Community Clinics/Teams Services operating from community clinics should ensure that there is an agreement with the Landlord or Trust for the removal of all their waste streams. If a large volume of waste is expected, community clinics must not be set up in locations where there are no clinical/hazardous collections. In the exceptional circumstances where staff work at outlying community clinics or outside of Trust locations, i.e. community halls where there is no clinical/hazardous waste collections, or facilities staff will need to transport clinical waste at the end of each session. Staff must bring back the clinical waste to the healthcare professionals designated base, and dispose of with the site waste. Staff must ensure that all waste is transported safely within the boot of the car in its segregated fractions. In appropriate UN approved containers to ensure any spillages are contained, without contaminating other waste streams. Waste must be disposed of at their own base as soon as reasonably practicable. Staff should obtain the: 25

26 Daniels red community nursing container via NHS Supplychain, code FSL262 to hold the appropriate containers or bag. Flat packed bio-bins for the appropriate waste streams, via NHS Supplychain/SBS. NHS Supplychain code FSL694 5 litre cardboard, rigid, orange (for infectious waste). Contact Procurement for further advice if required. The transport containers will need to be cleaned after the end of each shift or after a spillage occurs. If there is no visual contamination clinell wipes should be used. If contaminated with blood, staff should clean with a chlorine based disinfectant. Site managers must be informed of the types of waste that is being brought back to base to ensure there are correct disposal points available. If the amount of waste generated is considerable, staff should contact the waste provider to arrange an ad hoc collection with at least seven days notice with the Veolia Helpdesk on : Telephone number or the Waste Contractor Veolia on: uk.veolia.solentandsouthernnhs.mailbox@veolia.com Note: all liquid waste and bag waste (clinical and offensive) must be brought back to base at the end of each shift / day Medicines and sharps waste must not be removed from patients home by the healthcare professional if they are surplus to requirement they should be returned to the local pharmacy by the patient or their representative Patients receiving treatment from acute and other hospitals The following applies: Separate instructions should have been issued to patients on the requirements for the return to the dispensing department of the waste generated from the administration and handling of these substances by the Patient, Community Nurse either at home or Practice Nurse at a treatment room. It is the responsibility of the patients or patient s representative to return the wastes generated to the dispensing department in accordance with the instructions issued by the Hospitals Trust Departments. This type of waste MUST NOT be put into the Trust s waste stream If patients treat themselves in their own home any waste produced as a result is considered to be their own. Only where a particular risk has been identified (based on medical diagnosis) does such waste need to be treated as hazardous waste. In both cases, local authorities are required to collect the waste separately when asked to do so by the waste holder, but may make a charge 12. GUIDANCE FOR THE REMOVAL OF SPILLAGES OF HEALTHCARE WASTE WITHIN TRUST PREMISES Accidents that occur on ward areas, in consulting/examination rooms, treatment/clinical rooms. The clinical/nursing staffs after ensuring they are using the correct PPE (i.e. gloves, aprons) are to complete the initial removal and repacking of the healthcare waste in a replacement container. The domestic staff will then carry out action to render the area clean as soon as is reasonably practical. 26

27 Accidents that occur in shared circulation, community-waiting areas, sanitary areas, office and/or external areas. Housekeeping/clinical staffs will remove/repack the waste spillage and then render the area clean. In the absence of clinical/domestic staff on site, the premises/ support service manager or designated person will take responsibility to ensure the area is safe for patients and staff. The cleaning/housekeeping supervisor where applicable, should be contacted if assistance is required, the housekeeping staff will assist with the repackaged waste where required and complete the clean to maintain a pleasant environment. The site service manager or designated person shall be responsible for arranging the removal of waste spillages within the Trust premises and grounds and generate Standard Operating Procedures to cover this eventuality. 13. DUTIES / RESPONSIBILITIES 13.1 The Chief Executive or their designated deputy will be responsible for ensuring that individual staff are identified and given responsibility for the development, implementation and subsequent monitoring of comprehensive operating procedures to ensure that the risks arising from waste generation and disposal within the Trust comply with the requirements of this policy. The Chief Executive will ensure that sufficient resources are provided to enable the policy to be implemented and to remain effective All Trust Managers will be responsible for ensuring that the requirements of this policy are complied with. They will ensure that personnel receive instruction on the correct methods of waste management to premises under their control. Senior managers and all line managers of staff generating or handling such waste also have a legal responsibility to ensure that the correct training and equipment is supplied and that the agreed procedures are followed. Any new or replacement equipment that is required to transport waste should be purchased through the Trust procurement department Estate Managers, Support Services Managers, Premises Managers and responsible persons both clinical and non-clinical will establish Approved Codes of Practice (ACOP) for the premises, locations and services they have responsibility for, to cover, the handling, storage and disposal of waste to ensure that it is done safely and legally. They are responsible for maintaining records of all movements both consignments and waste transfers ensuring unique and consecutive consignment codes are issued. These records must show the quantity, nature, origin and destination e.g. consignment note in appendices these documents must be checked and filed. They also have a responsibility ( Duty of Care ) to ensure that any waste generated is handled and disposed of in a secure manner. This is a legal responsibility All Trust Staff shall follow the ACOPs that are in place. Anyone who generates, handles, transports and/or disposes of waste has a legal responsibility to ensure that it is done correctly. See Appendix 13 and 14 for a list of waste types and their appropriate waste disposal stream. Senior managers and all line managers of staff generating or handling such waste also have a legal responsibility to ensure that the correct training and equipment is supplied and that the agreed ACOPs are followed. All Trust staff have a responsibility ( Duty of Care ) to ensure that waste they generate is handled and disposed of in a secure and correct manner. 27

28 13.5 All Estates Services Staff will ensure that they are fully conversant with the policy and ACOPs and shall ensure that any work undertaken in the Trust premises complies with these requirements. They will give specific instruction to consultants and contractors designing or working in the Trust s premises to ensure that they are aware of the requirements and that they must comply with this policy in all respects. Estates Services staff shall ensure that the Associate Director of Estate Services is informed on any exceptional reporting on aspect of works involving waste removal Associate Director of Estate Services of the Trust will provide assistance in the implementation of this policy. They will be suitably qualified and competent to advise on the requirements outlined in this policy, relevant statutory regulations and/or codes of practice. They will assist in the development of detailed ACOPs for the management of waste. 14. TRAINING REQUIREMENTS 14.1 Education and Training Line managers will be responsible for ensuring that all appropriate staff receive instructions in waste segregation. Training needs vary depending on the responsibilities and job function and must be carried out at Induction and then Job Specific. The Trust will comply with the requirements guidance within the Healthcare Technical memorandum 0701 in the Safe Management of Healthcare Waste. The appropriate waste training for all appropriate Trust staff will be monitored by LEAD as part of the induction and annual training for clinical staff and three yearly training for non-clinical staff. Due to the extent and nature of waste produced by the Trust it is important that all staff receive appropriate training on the handling, segregation, transportation, storage and disposal of all waste produced. Every member of staff involved in the production, handling and disposal of waste has a responsibility to ensure that they are aware of the contents of this procedure. Initial training on the Hazardous Waste Regulations, segregation, handling and storage of waste will be provided to nominated staff as part of the Trust e-learning via infection prevention control. 15. MONITORING COMPLIANCE 15.1 Monitoring Policy Effectiveness The Trust management will audit the policy and operational effectiveness on a regular basis with assistance from the Estates Services department in accordance with the requirements of the Safe Management of Healthcare Waste document Chapter 6 Waste Audits. This policy applies to all staff and managers working within Trust and failure to comply with this policy could result in disciplinary action being taken by the Trust and may result in prosecution of the Trust and or its management. It is accepted that there may be exceptional circumstances if there is any doubt, please refer to your line manager in the first instance. 28

29 The Associate Director of Estate Services will ensure that the policy is reviewed in the light of new/changes to legislation and or guidance Waste Audits Under Duty of Care legislation the Trust, as a waste producer, has a cradle to grave responsibility for the control, management and ultimate disposal of its waste. Waste audit are managed as follows in line with pre-acceptance audit requirements: o o Annual audits are undertaken on sites that produce over 5000 kilos of clinical waste 5 yearly audits undertaken for individual sites producing between 500 and 4999 kilos Waste audits will be conducted by the Site Managers in conjunction with the Estate Services team in conjunction with departments, wards and colleagues as appropriate. Departments / Service units will also be required to undertake selfassessment using a specific audit tool on a regular basis. The audit and instructions can be found in the Site Managers Handbook on the Trust Intranet Queries Any queries regarding this policy should be addressed to the EstateServices- Contracts@southernhealth.nhs.uk POLICY REVIEW This policy may be reviewed at any time at the request of either staff side or management, but will automatically be reviewed after twelve months and thereafter on a bi-annual basis. 17. ASSOCIATED DOCUMENTS The current policy links to the following existing Trust policies: SHFT Medicines Control, Administration and Prescribing Policy SHFT Health and Safety Statement of intent SHFT Sharps and Inoculation Management SHFT Disposal of Illicit Substances SHFT SOP, HAZMAT/CBRN 18. SUPPORTING REFERENCES The Waste (England & Wales) Regulations 2011 Environmental Protection Act 1990 Control of Pollution Act 1974 Environmental Protection (Duty of Care) Regulations 1991 Controlled Waste Regulations 1992 Hazardous Waste (England & Wales) Regulations 2005 List of Wastes (England) Regulations 2005 Landfill (England & Wales) regulations 2005 Control of Pollution (Amendment) Act 1989 Carriage of Dangerous Good and use of transportable Pressure Equipment Regulations 2005 (the carriage Regulations) A Guide to the Hazardous Waste Regulations, Site Premises Registration 29

30 (Notification) Guide Safe Management of Healthcare Waste Version 1 Health and Safety at Work Act 1974 Management of Health & Safety at Work Regulations Control of Substances Hazardous to Health Regulations 2004 (COSHH). 30

31 APPENDIX 1 Health & Social Care Act Extract: Safe Handling and Disposal of Waste The risks from waste disposal should be properly controlled. In practice, in relation to waste, this involves: assessing risk developing appropriate policies putting arrangements in place to manage risks monitoring, auditing and reviewing the way in which arrangements work and being aware of statutory requirements; legislative change and managing compliances Precautions in connection with handling waste should include: training and information (including definition and classification of waste) personal hygiene segregation and storage of waste to use the appropriate personal protective equipment immunisation appropriate procedures for handling such waste appropriate packaging and labelling suitable transport on-site and of-site clear procedures for dealing with accidents, incidents and spillages; and appropriate treatment and disposal of such waste Systems should be in place to ensure that the risks to service users from exposure to infections caused by waste present in the environment are properly managed, and that duties under environmental law are discharged. The most important of these are: duty of care in the management of waste duty to control polluting emissions to the air duty to control discharges to sewers obligation of waste managers collection of data and obligations to complete and retain documentation including record keeping; and requirement to provide contingency plans and have emergency procedure in place. 31

32 APPENDIX 2 Healthcare waste: examples and breakdown of clinical and hazardous in line with regulatory definitions 32

33 APPENDIX 3 CAT A Pathogens Carriage Information: Category A pathogen List The table below shows the carriage regulations Category A pathogen list. The Carriage Regulations define Category A as: An infectious substance which is carried in a form that, when exposure to it occurs, is capable of causing permanent disability, life threatening or fatal disease to humans or animals. (See details of Category A Substances in the ADR regulations.) Indicative examples of infectious substances included in Category A in any form unless otherwise indicated ( ) UN Number and name UN 2814 Infectious substances affecting humans Microorganism Bacillus anthracis (cultures only) Brucella abortus (cultures only) Brucella melitensis (cultures only) Brucella suis (cultures only) Burkholderia mallei Pseudomonas mallei Glanders (cultures only) Burkholderia pseudomallei Pseudomonas pseudomallei (cultures only) Chlamydia psittaci - avian strains (cultures only) Clostridium botulinum (cultures only) Coccidioides immitis (cultures only) Coxiella burnetii (cultures only) Crimean-Congo haemorrhagic fever virus Dengue virus (cultures only) Eastern equine encephalitis virus (cultures only) Escherichia coli, verotoxigenic (cultures only) Ebola virus Flexal virus Francisella tularensis (cultures only) Guanarito virus Hantaan virus Hantavirus causing haemorrhagic fever with renal syndrome Hendra virus Hepatitis B virus (cultures only) Herpes B virus (cultures only) Human immunodeficiency virus (cultures only) Highly pathogenic avian influenza virus (cultures only) Japanese Encephalitis virus (cultures only) 33

34 UN Number and name Microorganism UN 2900 Infectious substances affecting animals only Junin virus Kyasanur Forest disease virus Lassa virus Machupo virus Marburg virus Monkeypox virus Mycobacterium tuberculosis (cultures only)ª Nipah virus Omsk haemorrhagic fever virus Poliovirus (cultures only) Rabies virus (cultures only) Rickettsia prowazekii (cultures only) Rickettsia rickettsii (cultures only) Rift Valley fever virus (cultures only) Russian spring-summer encephalitis virus (cultures only) Sabia virus Shigella dysenteriae type 1 (cultures only)ª Tick-borne encephalitis virus (cultures only) Variola virus Venezuelan equine encephalitis virus (cultures only) West Nile virus (cultures only) Yellow fever virus (cultures only) Yersinia pestis (cultures only) African swine fever virus (cultures only) Avian paramyxovirus Type 1 Velogenic Newcastle disease virus (cultures only) Classical swine fever virus (cultures only) Foot and mouth disease virus (cultures only) Lumpy skin disease virus (cultures only) Mycoplasma mycoides Contagious bovine Pleuropneumonia (cultures only) Peste des petits ruminants virus (cultures only) Rinderpest virus (cultures only) Sheep-pox virus (cultures only) Goatpox virus (cultures only) Swine vesicular disease virus (cultures only) Vesicular stomatitis virus (cultures only) ª Nevertheless, when the cultures are intended for diagnostic or clinical purposes, they may be classified as infectious substances of Category B. Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations Carriage of Dangerous Goods and Use of Transportable Pressure Equipment (Amendment) Regulations 2011 Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations (Northern Ireland) Carriage of Dangerous Goods and Use of Transportable Pressure Equipment (Amendment) Regulations (Northern Ireland)

35 APPENDIX 4 EWC Codes that apply to waste produced from healthcare and similar municipal sources The codes applied to waste streams are defined by individual items placed in a receptacle. They are never determined by the type or receptacle used. Table below includes some of the codes that may apply individually or in groups to waste streams from medical practices. EWC code Description of code 09 Wastes from the photographic industry Wastes from the photographic industry * Water-based developer and activator solutions * Water-based offset plate developer solutions * Solvent-based developer solutions * Fixer solutions * Bleach solutions and bleach fixer solutions * Wastes containing silver from on-site treatment of photographic waste Photographic film and paper containing silver or silver compounds Photographic film and paper free of silver or silver compounds 18 Wastes from human and animal health care and/or related research (except kitchen and restaurant wastes not arising from immediate health care) Waste from natal care, diagnosis, treatment or prevention of disease in humans Sharps except * Body parts and organs including blood bags and blood preserves (except *) * Waste whose collection and disposal is subject to special requirements in order to prevent infection Waste whose collection and disposal is not subject to special requirements in order to prevent infection, e.g. dressings, plaster casts, linen, disposable clothing * Chemicals consisting of or containing dangerous substances Chemicals other than those listed in * * Cytotoxic and cytostatic medicines Medicines other than those mentioned in * * Amalgam waste from dental care Waste from research, diagnosis, treatment or prevention of disease involving animals Sharps except * * Waste whose collection and disposal is subject to special requirements in order to prevent infection Waste whose collection and disposal is not subject to special requirements in order to prevent infection * Chemicals consisting of or containing dangerous substances Chemicals other than those listed in * * Cytotoxic and cytostatic medicines Medicines other than those mentioned in * 20 Municipal wastes (household waste and similar commercial, industrial and institutional wastes) including separately collected fractions Separately collected fractions (except 15 01) * Cytotoxic and cytostatic medicines Medicines other than those mentioned in * Other fractions not otherwise specified (used for offensive waste) *Hazardous wastes can be: absolute hazardous entries (in which case they are always hazardous highlighted red in the Table) or mirror entries (which can be either hazardous or non-hazardous depending on their properties highlighted blue in the Table). 35

36 APPENDIX 5 Transporting Waste Streams within Trust Premises Standing Operating Procedure Any one responsible for the removal and transportation of waste bags, sharps boxes, pharmacy waste containers and placenta containers must adhere to this Standard Operational Procedure. The transportation of waste is a process that should begin at the site of generation where infectious (orange bag), offensive (tiger stripe bag) and domestic (black bag) waste has to be properly collected and segregated in specific receptacles. All staff that handles waste must ensure that the correct PPE is worn when handling and transporting any waste stream. All trolleys or equipment to transport waste must be appropriate for the use, clean and in working order at all times. The housekeeping staff/site manager/porter are to ensure that the trolley is checked for cleanliness after every use, cleaned if required and ensure that all equipment has the periodic deep clean as per National Standards of Cleanliness. Waste bags must never be transported in the same cart / trolley at the same time as Sharps boxes, pharmacy waste containers (blue lidded bin) or placenta containers (red bin), as the hard containers are likely to split the plastic bags. All waste streams when being transported must be segregated at all times to ensure no contamination. A separate trolley/collection is required for each waste stream. Sharps boxes, Pharmacy waste containers, and placenta containers can all be transported together in the same cart / trolley at the same time. With the exception of Community teams under no circumstances must waste of any classification be removed from the premise it was generated this includes, domestic, recycling, offensive, clinical, sharps, cytotoxic / cytostatic, pharmacy waste, anatomical (placentas), electrical and electronic, inert (building materials) etc. Note: this is ILLEGAL and can result in the driver being prosecuted. 36

37 APPENDIX 6 Home Patients Collections of Clinical Waste ACCOUNT NAME: Southern Health NHS Foundation Trust Home Patients NAME OF STAFF REQUESTING COLLECTION: COMMUNITY TEAM / LOCALITY: TELEPHONE NUMBER: DATE REQUEST SENT: Please supply nhs.net address for contractor to confirm receipt and date of first collection: Budget holder name: Budget code: PATIENTS NAME: Home Collection PATIENTS ADDRESS: Appendix C Variations + Change Control Document for Waste Contract POSTCODE: PATIENT CONTACT NUMBER: CCN-Waste-V1 Blank.doc APPROXIMATE QTY BAGS: APPROXIMATE QTY SHARPS CONTAINERS: FREQUENCY OF COLLECTION: One off/ Weekly / Fortnightly/ 4 weekly * (*Delete where appropriate) LOCATION OF WASTE/ SPECIAL INSTRUCTIONS: - Please send completed form to: Southern@medisort.co.uk Alternatively Fax Form:

38 APPENDIX 7 Standard Operational Procedure Bag Tying Any one responsible for the removal and closure of waste bags must adhere to this Standard Operational Procedure Clinical and Offensive waste bags All clinical waste bags and Offensive waste bags must be tied using the swan neck method shown. In the event that a swan neck cannot be achieved due to overfilled bags, the contents must not be removed and the bag should be suitably sealed ensuring no contents can escape. If this cannot be achieved then the whole bag must be placed into a larger bag and a swan neck method used to tie the bag. If a swan neck tie cannot be achieved report overfilled bags to clinical lead of the area concerned. All Clinical waste and Offensive waste bags must be sealed with a unique identity tag to ensure the waste can then be tracked back to its original location. Domestic waste bags Domestic waste bags must be suitable sealed / tied to prevent the contents escaping Glass waste bags must be transported separately and not mixed within domestic waste bags Bags must be replaced with the same colour as the one removed unless requested by Clinical leads or domestic supervisors. When transporting waste bags domestic and offensive waste these must be segregated at all times. Clinical waste must never be transported with either offensive or domestic waste bags. 38

39 APPENDIX 8 Waste Electrical and electronic equipment waste (WEEE) WEEE waste is subject to its own HTM 07-05: The treatment, recovery, recycling and safe disposal of waste electrical and electronic equipment. The broad aim of this new legal framework, is to address the environmental impacts of Electrical and electronic (EEE) at end of life, and to encourage its separate collection, subsequent treatment, re-use, recovery, recycling and environmental sound disposal. To put this into perspective: The UK generates almost two million tonnes of electrical and electronic equipment (EEE) waste, and this volume is rising every year. Traditionally, much of this equipment has been sent for disposal in landfill. For some time, however, it has been recognised that this approach is unsustainable and that action was needed to address the problem. The action came in the shape of the European Waste Electrical and Electronic Equipment (WEEE) Directive, which was agreed at EU level in The WEEE Directive has now been transposed into UK law as the Waste Electrical and Electronic Equipment Regulations These regulations will impact on any healthcare organisation that uses EEE. They will control the disposal of such equipment and dramatically reduce the volume sent to landfill. The WEEE Directive is one part of a much larger policy mechanism within the EU that is aimed at introducing producer responsibility. It makes producers of EEE legally responsible for the recovery and recycling of their products when they are finally disposed of. Another piece of legislation that affects electrical and electronic products is the Restriction of the Use of Hazardous Substances in Electrical and Electronic Equipment Regulations (RoHS). These regulations limit the amount of certain materials that can be used in new EEE. This will affect the way in which products can be repaired and maintained in the future. By introducing guidelines and requirements such as the provision of information for recycling and the designing of products to aid re-use, recovery and recycling, the WEEE and RoSH Directives together aim to improve the environmental performance of all operators in the life-cycle of WEEE, that is, producers, distributors/retailers, customers and recyclers. 39

40 WEEE Waste Request Guide If you have any items of electrical equipment or furniture that require disposal, you will be required to complete a WEEE waste request form. The WEEE Waste Request form is to be requested via the Contracts Team, it is also available to download in the I would like to section on the waste contract page. WEEE waste requests can be submitted by ing Estateservices- Contracts@southernhealth.nhs.uk If you have any WEEE waste queries you can also telephone the Estate Services Contract Team on Tel: or WEEE Waste Request Process Once the request has been submitted, the requestor will be sent a quote to approve. Once this has been agreed the Waste Contract Manager will then approve the job request. The waste contractor will then arrange the collection and you will be notified of the collection date. Please ensure that either the requestor or nominated member of staff is available on the collection date. Please note that the cost of transport is on average 30 + Haz waste note 30. Please bear this in mind when submitting a request and ensure it is viable. The Contracts Team will work with the Contractors and aim to have your assets collected within 12 working days. 2. WEEE Waste Request Process 3. Funding WEEE Disposal It is the responsibility of the service to fund the disposal of medical equipment and WEEE waste and will need to provide a cost code for recharge and obtain approval from the budget manager prior to submission of the form. 40

41 WEEE Waste Disposal Request Form All requests must be completed in full with cost centre for recharging and returned to Request No (contract team only) Part 1 Requester Name Department / Ward Full Address Inc. Postcode Budget Holder Approval Print Name: Contact Tel No Cost Centre Number Requester Details Part 2 Equipment Details Equipment for disposal Qty Asset or serial Department number or ward Cost code Person Contact to Tel Number Cost (waste contra ctor) Part 3 Are the Medical Devices Contaminated? Yes / No / Don t Know / NA Type of contamination (blood, body fluids, respired gases, pathological samples, chemicals including cytotoxic drugs, radioactive material or any other hazard) Provide full details or NA Has the item been decontaminated? Yes / No / Don t Know / NA What method of decontamination has been used? Cleaning / Disinfection / Sterilisation Decontamination Declaration These items have been prepared to ensure safe handling and transportation? Yes / No / Don t Know / NA 41

42 Part 4 Total Asset Costs Transport Costs Hazardous Waste Note Cost TOTAL QUOTE Part 5 Request Quote Veolia / Spinnaker Quote Authorisation I approve the quote and agree for the cost to be charged to the appropriate cost centre budgets Request Approved Y/N Request Manager: Date: 42

43 Appendix 9 Recycling of Waste 43

44 APPENDIX 10 Signage for individual internal waste bins These can be obtained by contacting the Estate Services Contract 44