There have been mutterings recently from the Scottish Parliament of sanctions to be held against healthcare professionals – doctors were singled out but this presumably embraces all – who fail on hand washing.

That would help, though how it might be managed is really beyond comprehension for all but the most serious breaches in hygiene precautions. However, stamping those out of the system would have a great impact and may reduce still further the rate of infection among hospital patients.

But what about more serious failings? Do not some of those pass unnoticed and with neither sanction of penalty? What about carelessly leaving a needle in among the patients bed linen, to strike a nurse or care assistant, a porter or laundry worker? What about the over-filled sharps box with needles and syringes protruding, or the bin left unsealed but tossed into a waste cart to spill some of its content?

There are still sharps bins left in inappropriate areas. On the floor of a clinic room is most obvious, in a location where a child may be attracted to put their hand inside, and every 2 or 3 months we report on the Clinical Waste Discussion Forum of such an incident. And of course those needles and other sharps discarded into soft walled sacks intended only for soft clinical wastes or worse into black bags.

And more generally, source segregation of wastes is still a persistent problem. It could be better (though it might be rationalised somewhat first) and yet those who fail to comply are not the ones who might be affected by any financial or other penalty. It simply passes unnoticed and, as a penalty, its value is negligible if non-existent.

Of course, penalties may apply as waste contractors may impose an additional fee but that is unseen by those responsible. In extremis, the Environment Agency or HSE may become involved, but once more their negotiations will centre on discussion with site waste managers and not have any impact on those responsible. Though such visits may prompt some additional training and a few extra posters, not much will change.

It’s a pity, since sanctions and penalties are among the most effective means of effecting change, in source segregation and safe management of sharps. However, like penalties and sanctions of breaches in hand hygiene there seems no likely remedy here, as much as we may like one.

Unless, of course, you know differently?