Those in the commercial sector who provide clinical waste and related waste management services, and those in the healthcare sector responsible for ancillary and support staff, whether directly employed or as contracted out service providers, have a responsibility to ensure the safety and welfare of their staff.

Since the correct use of suitable PPE items and proper hand hygiene are essential precautions when handling wastes, this is an area where training and occasional reinforcement of that training, is absolutely essential. Additionally, provision must be made for new starters, including agency staff, from the start of day 1.

PPE use is a matter for training supported by constant management supervision, to crack the whip and ensure that policy is upheld. Managers too need to be trained.

Hand washing is a little more difficult. Are facilities provided or accessible? Waste stores and vehicles could be provided with sinks, soap and water, and paper towel but this rarely happens. In the healthcare environment, when a waste handler or ancillary staff member contaminates themselves, perhaps when handling an inappropriately packaged bag or waste overfilled with blood or body fluids in unsealed containers, then the probability of gaining access to a sink on the ward, or being invited into a GP surgery to wash hands is pretty slim.

Having presented many nurses with this scenario, the answer is always the same. No.

Alcohol (or alcohol-free) hand rubs are ineffective on soiled hands but can be a useful supplement if used with a one or preferably two generously sized hand wipes. Medicated wipes are unnecessary; baby wipes are freely available, contain the best detergents to clean hands, and bottoms, are suitably sized and conveniently packaged, and tough enough for the job. Importantly, they are usually far more moist than are hand wipes.

And then, to washrooms. Where these are provided, for example in the commercial waste facility there should be a rigorous approach to their use. Gloves taken off and left outside. A plentiful supply of warm water and liquid soap, hand towels or a good hot air dryer. And the facility needs to be properly maintained. It should be cleaned regularly, even if this seems like an uphill task, with plentiful supplies.

How many can honestly claimed to meet those standards?

Training and supervision is an important feature, that demonstrates above all a commitment to safety and hygiene awareness. These are services that might be considered in-house, and by Blenkharn Environmental.

Hand hygiene and PPE use are essential requirements in this activity. PPE items generally receive inadequate attention, especially when extended beyond boots, trousers and gloves. Training is inadequate, manifest by the poor standards of glove use by most waste handlers. Hand hygiene standards are even worse.

This needs to be addressed, since safety is compromised when PPE items are used incorrectly or not at all, and hand hygiene failures compromise protection against infection.

It can be fixed, though maintaining standards is difficult unless organisations are fully committed and embrace these simple but vitally important control measures into every part of their operation.

Nothing less will do.