There are millions of glucose test lancets used daily, to test the blood sugar levels of individuals with diabetes. I use them daily.

They are used in hospitals – where several incidents have occurred of disease transmission caused by a careless, probably criminally irresponsible, failure to use a new needle or lancet for each patient and to sanitise the lancet holder between patients – and widely used in the community, by every patient with insulin-dependent diabetes and many others with Type II diabetes controlled by drugs and/or diet.

How to dispose of these lancets? In hospitals and other healthcare premises, it should be a straightforward issue of dropping them into a sharps bin immediately after use. At home, matters are less easy. We might hope that insulin-injecting diabetics have been given a sharps bin for their used needles and insulin pens, and the blood test lancets can be placed into these. For others, the change of a GP issuing a sharps bin alongside a blood testing kit are rather slim, if not impossible. And, of course, no straightforward procedure for disposal once a bin has been filled.

Four primary school children in Tasmania have cause a health scare after pricking each other with a needle from a glucose testing kit.

The children at a school in the Derwent Valley, northwest of Hobart, underwent infection tests as a precaution after the needlestick incident on 9 May. “The incident involved four primary school students who used one or more needles from a diabetic test kit to prick each other,” Tasmania’s acting director of public health Dr Mark Veitch said in a statement.

The risk is perhaps small, but not so small as to be discounted and these children will need follow-up over several months. The psychological impact, for the children and more so for their patents, cannot be overstated.

And kids will be kids. Strangely, a discarded needle can be in some way attractive and pierce inquisitive little fingers. That message must reach each and every user of hypodermic needles and blood testing lancets to ensure safe disposal at all times.

 

 

Sounding more like a tale from some Transylvanian horror, Polish prosecutors say they are questioning a man suspected of burying body parts and other clinical (medical) wastes instead of delivering them for incineration.

A prosecutor in Chorzow, in southern Poland, Marta Zawada-Dybek said Friday that the man, identified as Marek M., has confessed to burying body parts, syringes, bandages and other waste on a plot of land that he owns.

His firm that has contracts with some 300 hospitals and private surgeries to professionally dispose of the waste. But he allegedly buried it rather than pay for its incineration, Zawada-Dybek said. The man’s two brothers work in the firm.

The man is already serving a 16-month prison term for dumping medical waste at a local refuse dump.

 

 

In many parts of the world, the treatment of clinical (medical) wastes amounts to little more than open burning with incineration using modern technology having all of the relevant emission control technologies.

This open burning, on surface beds or in burn pits has a profound effect on air quality but until now the impact on soils has not been tested. In a new study from Nigeria by Ephraim, Akpan and Obiajunwa (Investigation of soils affected by burnt hospital wastes in Nigeria using PIXE. http://www.springerplus.com/content/pdf/2193-1801-2-208.pdf) studied the fate of burnt hospital waste and its effect on agricultural soil.

Eleven elements – Si, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Zr and Pb were detected at an elevated concentration when compared with the control. Perhaps not surprisingly, the highest concentrations were obtained for Fe. Moderate enrichment factors for Si, K, Ca, Ti, Cr and Zr were obtained. The level and the fate of these elements especially Cl and Pb is of serious environmental and health concern owing to the fact that there are intensive subsistence agricultural practices at and near the sites of the study. A future investigation to quantify dioxin and furan that is associated with the geochemistry of Cl is essential owing to the toxicity of these compounds.

These are important observations with great relevance to public health implications from this previously unquantified level of soil contamination. When used for agriculture, as an enrichment, the presence of this diversity of contaminating metals may result in uptake into and contamination of subsequent food products, with potentially long-term effects on health and well-being.

 

 

Once again, we can report of the success of one of the very many drug waste take-back schemes operating in communities in the US.

The Clark County Sheriff’s Office, the federal Drug Enforcement Administration and other local agencies collected 819 pounds of medical waste at a drug take-back event Sept. 29 in Fisher’s Landing. The event collected 10 pounds of inhalers used for asthma.The most recent have occurred in Washington State, netting 420 pounds of medical waste during a four-hour take-back event organised by the Battle Ground Police Department [great name!] which included 267 pounds of controlled substances which will be shipped to the Drug Enforcement Administration for destruction.

The event was sponsored by the DEA in partnership with the Clark County Sheriff’s Office, Clark County Environmental Services, PREVENT! Coalition, and Prevent Together: Battle Ground Prevention Alliance.

The intention of the drug take-back event was to keep medications out of the hands of kids, while also safely disposing of them and preventing them from seeping into landfills and water supplies.

Medications can still disposed of at the Battle Ground Police Department office, thus promoting regular safe disposal without stockpiling, and offering a disposal option that improves on placing unwanted drug waste into the domestic waste stream or down the toilet thus improving environmental protection. Continue reading “Community drug waste collections” »

We are well aware of drug take-back schemes, widely used in US and elsewhere to encourage safe disposal of unwanted prescription and other medications that might otherwise enter the domestic waste stream or be flushed down the toilet. Regrettably, in the UK it just doesn’t happen and that is a great shame.

But it doesn’t always go well. In Northampton, Mass, Northampton’s Solid Waste Management Director was charged this week with drug charges.

Kathy Bouquillon was holding a sharps collection at Saturday’s Drug Take Back event on April 27th, and got a bit too involved in her work when take back became simply take!

A day later, she was arrested after she struck a tree with her car. The Court heard how she had numerous drugs in her car that were not prescribed to her following charges of possession of drugs, OUI (operating under the influence) and possession of a can of unregistered pepper spray.

 

 

 

The recent UK Marine Conservation Society’s fight against marine litter with the Big Beach Clean-up is a great contribution to marine and beach hygiene, collecting vast quantities of litter including invariably a lot of clinical wastes.

It’s not just a UK initiative. Worldwide, many environmental groups operate similar schemes, to assist communities clean their beaches of discarded litter, flotsam and jetsam.

But in America, things are always bigger and better. Cleaning up US beaches, an environmental group’s annual sweep of New Jersey’s 127 miles of beaches recovered much waste and some medical (clinical) wastes, but also explosives!

Thousands of volunteers took part Saturday in the clean-ups organized by Clean Ocean Action, which has been doing beach sweeps for 25 years. Congratulations to each and every one of them.

But among other wastes, an unexploded ordnance was found Raritan Bay Waterfront Park in South Amboy. The state police bomb squad unit and other law enforcement agencies responded to the scene, and no injuries were reported.

 

 

The volumes of sanitary/offensive wastes are vast, and growing steadily with the down-regulation of much additional soft clinical wastes. What are the options for its treatment and disposal?

So far, the Environment Agency has encouraged – effectively forced but with no legitimacy to that heavy-handed approach to ‘regulation’ – landfill disposal which in every conceivable respect is environmentally sound.

Since the primary argument is that any energy-dependent process used to treat these wastes would itself be wasteful (of energy) and thus environmentally unsound, the only option would be a hole in the ground. But that is a mindset which is predicated to impede technological development, to use these sanitary/offensive waste as a resource and develop commercial-scale processes that provide an environmentally sound solution. Continue reading “Sanitary/offensive wastes: Poopy power rocks?” »

There seem to be plenty of tattooists in the UK but perhaps that really isn’t enough to go around, or they are too expensive.

As a – very poor – alternative, it seems that many illegal tattooists are in operation, unregistered and thus unsupervised. The great risk is of bloodborne virus (BBV) infection, and pyogenic infection of those brave enough to have a tattoo.

http://www.bbc.co.uk/news/uk-22320300

But it is the bloodborne virus risk that is our primary concern, since that extends beyond the process of tattooing and may continue as sharps wastes are disposed. The unregistered and unlicensed operation implies a failure to adhere to required standards of hygiene, and therefore to standards of waste management also. Is it likely that an unlicensed tattoo outfit would bother with safe sharps disposal into a suitable sharps bin? Continue reading “Bloodborne virus warning over illegal tattooists” »

Clinical waste company SRCL has announced it is aiming to meet a zero waste to landfill target by the end of the year.

SRCL also revealed that 60% of the waste which is processed through its alternative technology is being used as RDF fuel.

http://www.edie.net/news/5/Clinical-waste-firm-aims-for-zero-waste-to-landfill-/

That figure would be higher, and spread more evenly across other clinical waste treatment companies, if The Environment Agency hand not been so obstructive in its approach to disposal of clinical waste ATT treatment residues. Most can go to W2E or materials recovery but the restrictions placed on disposal options by EA limit this for all but the larger operators and actually encourage landfill disposal, which remains the preferred end for much low grade sanitary/offensive waste that would be far better processed elsewhere, to recover energy by AD, perhaps with an initial recovery of paper fibre. The technologies exist but EA are still belligerently obstructing their commercial development.

Interestingly, SRCL is noted in this report to claim that the company claims to be the largest clinical waste business in the UK, collecting material from around 70% of NHS trusts and has more than 20 energy recovery facilities sites throughout the country. That 70% is one hell of a slice of the action.

Good luck to them, but what was all that nonsense several years ago about the need for competition in this industry, and the provision of choice for the NHS, that was the focus of much attention by The Competition Commission?

Many if not all of the rulings were effectively circumvented, and the whole thing seemed to be a glorious waste of public money.

In the meantime, zero waste is an admirable goal, for SRCL and for everyone else. Let’s hope that they succeed, and support other operators by sharing information on best approaches in order to deliver widespread improvement in waste and resource management.

 

 

Once again, this week (22nd to 28th April 2013) is the highlight of the Marine Conservation Society’s fight against marine litter with the Big Beach Clean-up.

Over 110 beaches across the UK and Ireland are going to see volunteers coming together to do a beach clean and litter survey which will highlight the issues of beach litter around our coastlines.

http://www.mcsuk.org/foreverfish/index.php

Hosted by your local M&S store team – and all credit to Marks and Sparks for their sponsorship of this valuable quarterly event [let's hope they bring some of their lovely sandwiches] - the beach clean and survey will last a couple of hours, leaving the rest of the day free for you to enjoy the beach. Continue reading “This septic isle?” »

In a landmark case involving reversal of a no liability finding for needlestick injury that occurred in a Queensland holiday apartment the circumstances of injury, and the legal wrangles, send shivers down the spine.

Wright v KB Nut Holdings Pty Ltd [2013] QCA 66

The Queensland Court of Appeal has held a hotel manager liable for a needlestick injury that a guest sustained while staying in a short-term rental apartment, reversing the original decision of no liability.

The trial judge had not been satisfied that a more competent cleaner or system of cleaning would have led to the discovery of the needle (which was in the crease of a stairwell and was dislodged by the guest when she was cleaning the apartment). He did not consider it reasonable to expect an apartment manager or cleaner to search and discover a concealed needle.

The Court of Appeal reversed this decision, finding that:

    1. it is likely a cleaner using normal skill, diligence and equipment would have detected the needle;
    2. it was probable that the needle was obscured from the guest’s vision as a direct result of the unclean state in which the apartment was handed over to her;
    3. the hotel manager knew or should have known of the risk of injury; and
    4. the build-up of ‘filth’ in the apartment increased the risk that dangerous objects would not be seen until after they were stood on or touched, which may have been with bare feet or hands.

The hotel manager was ordered to pay compensation of $494,759.38, plus interest.

This decision confirms the importance that rental property owners need to place on implementing thorough systems of regular cleaning and inspections.

Quite right too. But isn’t it a warning also, that if you arrive at a rental apartment or hotel room, the immediate response when finding it dirty is to walk back out again and go somewhere else – its not your job to get down and clean it!

And of course, we wish the injured guest well, with the medical and psychological implications of that sharps injury.  AS$494,759.38 (about £330.000) should help.

 

 

Yahoo Answers is not something that I recommend, though no doubt it has its uses and many people find it particularly useful. When I’m teaching, I instruct students in no uncertain terms that written work drawn from Yahoo Answers or from Wikipedia score zero marks – it’s lazy and of a poor is non-existent standard – and may irritate me sufficiently to impact on future marks!

But Yahoo Answers does have a following, and today I visited it for the first time ever. The item that caught my eye was a question, posed by someone from the South West, that I will reproduce in full here:

How to address a carer burning clinical waste in the garden? Continue reading “What would you do?” »

Some time has passed since this paper by Green and Griffiths was published. Unsurprisingly, the professional journals and magazines, and the trades union RCN are up in arms about the impact to nurses, and separately to surgeons and physicians. Quite right too.

But the paper, which investigated the psychological welfare of 17 individuals having sharps injury. Only 5 of these five (29%) were in “the health sector (nurses and paramedics)” while the remainder fell into a category of ‘other occupations’ which involved police officers, porters, cleaners, a builder, a manager and one unemployed person.

Of the 3 brief case individual reports included in the paper, only 1 was a healthcare worker. This lady was injured while working in an accident and emergency department. Perhaps a nurse, or possibly a support worker/cleaner, we are not told, the lady was emptying a clinic bin and was replacing a bag when a needle, which had been incorrectly disposed of, pierced her leg. The remaining 2 cases involved a coach driver and postal worker respectively.

Leaving aside the serious issue of a healthcare professional incorrectly placing a used needle into a soft-walled clinical waste sack, the occupations of those involved in this sharps injury series requires further consideration. With so much noised from the medical and nursing professions, about the risks and impact of sharps injury that they may face, it seems that it is the ancillary worker and others who are at real risk.

We at Blenkharn Environmental and at the Clinical Waste Discussion Forum and are doing all we can to highlight the risks of waste handlers and ancillary and support staff. Perhaps the waste and services sectors simply have no voice. At least, they could shout a little louder.

“While Tanzania’s leading health facility, the  Dar-es-Salaam Muhimbili National Hospital (MNH) boasts of having a well-managed system for disposing infectious medical waste, The Citizen on Saturday has discovered that the situation elsewhere in the country is rather appalling.

“Environmental health experts have confided to this newspaper that most of the lower level health facilities are grappling with poorly managed systems of handling the dangerous garbage, posing serious environmental and human health risks as a consequence.

‘’Hospital waste management is still a big problem in the country to date’’ Prof Samuel Manyele confirmed this week – which is about three years after he published a series of studies that exposed poor health care waste management in Tanzania. Continue reading “Clinical waste management in Tanzania” »

We all use antimicrobial soaps. They are ubiquitous in every hospital, clinic and care home, and across the waste industries though in this latter sector getting workers to wash their hands properly and at a suitable frequency remains a challenge.

Antimicrobial soaps rid our hands of the nasty bugs that may cause infections, in ourselves or others. They protect.

Or do they?

If you test the standard formulations of antimicrobial soap against a cheap and cheerful non-antimicrobial equivalent the number and types of bugs remaining on skin is the same whichever product is used. Indeed, if you use just plain water – and this is NOT a recommendation – then the reduction in bugs on hands can be just as good.

This forms the basis of a series of experiments I use in teaching nurses, to highlight the importance of good handwashing technique. It I this which removes the bugs, with soaps providing useful lubrication and detergent activity that additionally removes oils and greases. Of course, soap makes a difference, especially on heavily soiled hands, but it is technique alone, of rubbing one hand vigorously against the other aided by the lubricating action of soap, that removes bacteria.

Continue reading “Antimicrobial soaps” »

Pupils of the Mandal Praja Parishad primary school at Achayyapeta have found some new “toys” to play with. During the recess and after school , the boys and girls run to the garbage dumps less than 350 meters away and search and pick up used injection syringes and IV fluid sets and start playing by filling them up with water.

Their parents, mostly away from the village rearing sheep or working on fields, are genuinely worried about the children contracting diseases. For the villagers, who are fighting all out to stop the Anakapalle Municipality from dumping the town’s garbage in their village, the threat to their children’s health appears to be the immediate major problem even as they wait for the High Court to give them a favourable verdict. The medical waste is part of garbage forcibly dumped on a site allotted to the municipality as a dumping yard on March 20 after chasing away the protesting villagers and arresting 20 of them.

more at http://www.thehindu.com/news/cities/Visakhapatnam/students-play-with-medical-waste-at-achayyapeta/article4609569.ece

 

There are several, perhaps many, W2E plants popping up. Indeed, with a sometimes indecent hast to capture a slice of the market the number of plants under construction and in planning seems to be in excess of need. Additional feedstocks may make a big difference, though few new waste sources are really available that haven’t been exploited already.

It is a small though nonetheless useful addition to process by W2E conversion the treated floc from ATT processed soft clinical wastes. In reality, and already tested in some island communities where the proposal has been accepted and successfully applied.

The chemical composition of soft clinical wastes is quite permissible for W2E conversion. Moreover, the relatively low risk of the bulk of EWC 18 01 03 clinical wastes is modest except for those coming into direct contact with them, and perhaps then no greater that for the mass of domestic wastes found in the tipping hall of a busy W2E plant, the question is obvious.  Since soft clinical wastes are clearly identified in brightly coloured bags, why not tip these directly to the pit of a W2E plant and reduce or remove the costly process of prior ATT processing and post-process shredding? Continue reading “W2E gasification plants – is there a place for clinical wastes?” »

Thanks to those nice people at practicegreenhealth.org, the following information from the US EPA Hazardous Waste Pharmaceuticals Wiki Team will be of great interest to all of those involved with or concerned by the hazardous waste pharmaceuticals.


EPA has developed a “Hazardous Waste Pharmaceuticals Wiki” as a platform to facilitate the sharing of expertise among the healthcare industry and other stakeholders to help make accurate hazardous waste determinations for waste pharmaceuticals and increase compliance with hazardous waste regulations among the healthcare community.

In addition to information about which pharmaceuticals are hazardous waste, the Hazardous Waste Pharmaceuticals Wiki will help users find guidance documents, state-specific information, manufacturer’s information, and more. We encourage all healthcare stakeholders to share their expertise, and state-specific approaches in making hazardous waste determinations for pharmaceuticals.

The Hazardous Waste Pharmaceutical Wiki can be viewed by anyone at: http://hwpharms.wikispaces.com (no registration is necessary to view)

Experts who wish to contribute or edit content for the Wiki can register by sending an e-mail request to HWPharmsWiki@epa.gov. Please use a professional email address, not a personal email address, when contacting EPA to request access to the Wiki. Your email address will not be made public.

Please help us spread the word by forwarding this information to other interested parties.

Hazardous Waste Pharmaceuticals Wiki Team
http://hwpharms.wikispaces.com
HWPharmsWiki@epa.gov
US EPA

 

“London’s Evening Standard reports that medical (clinical) waste including syringes, blood-filled tubes and pig snouts is being dumped on the pavement by Harley Street firms.

“Westminster council today issued a public safety alert as it accused a “handful” of clinics of failing to dispose of potentially hazardous waste safely.

“It came after council street wardens on routine patrols in the area discovered plastic refuse bags whose sides were punctured by used syringes.

“Other discoveries included a sack of pig heads – apparently used by medics to practise on, due to similarities between pig skin and human skin – and bags of used drips, vials of medicine and bloodied tissues.

“Two firms have already been successfully prosecuted and five others are being investigated by the council, with one due in court later this month in what has been a growing problem since the start of the year.

http://www.standard.co.uk/news/london/scandal-of-dumped-harley-street-medical-waste-8564308.html

 

Westminster Council has a deserved reputation for tough dealing with waste and other issues, so its no surprise that these civil enforcement fines have been imposed, and prosecutions have followed. Presumably, the issue was that wastes were presented at the wrong time, since sooner or later it would have to be left on the curtilage for collection. In Harley Street and surrounding street there are no gardens and front doors open almost directly to the pavement so there can be no question about where the wastes were placed, only when.

The picture, reproduced from the Evening Standard, is confusing. Why red bags? Why syringes – and we might assume needles also, in waste sacks. But if the needles had been separated, why breach now universal safety rules to dismount needles instead of placing them intact into a sharps bin? And why so many pig snouts, commonly used for basic surgical training when there is no training establishment in the area?

 

 

Right across Africa properly managed, or indeed any other, clinical waste treatment facilities are few and very far between.

News that the construction of a new modern healthcare risk waste (HCRW) facility has been put on hold by the City of Windhoek. Apparently, the City is having second thoughts about building the facility because the proposed site is too small to accommodate the entire facility. A new and larger area will have to be identified before the project can continue.

http://allafrica.com/stories/201304051013.html

Allafrica.com reports that the full project comprises a healthcare risk waste dumping area, a new fuel depot with a total fuel capacity of 78,000 litres and offices. The waste facility will process clinical (medical) waste from hospitals in Rehoboth, Okahanja and Windhoek. It is also intended that the same service be made available to private hospitals and clinics as well as serving as a back up for other medical centres, as and when required.

Sounds good, though the use of the term ‘dump’ for these waste sounds a little worrying, but presumably this has been properly designed and will be properly managed, and a need has been identified.

Whether this really is an issue of planning and a better, larger site is really necessary is not clear. Perhaps two sites, the Windhoek site and one other will be a better option. Getting on and doing something is, in these circumstances, better than talking about the plan until such time as it becomes so old it quietly fades away and never materialises.

Good luck

Regulators and those who follow on their every word continue to be exercised by the question of pharmaceutical residues from clinical wastes. Of course, bulk pharmaceutical wastes from the pharmacy department or drug manufacturing facilities must be managed with great care and their disposal must be properly controlled. There is, however, great confusion between this and the trace residues that might be present in soft clinical wastes and even in sharps bins filled with empty, or near entry, syringes.tablets and capsules

A recent conversation with colleagues in the US brought this issue once more to the fore. The proposal was that there exists serious environmental impact from empty syringes and the occasional tablet of IV bag in an orange (red) sack.

Taking this further, the conversation turned to the problem of scavenging of drug residues from clinical waste. When asked, that too was an environmental hazard since those drugs would end up in the environment, without control or proper disposal and treatment. The response perhaps bears repetition here:

 

Have you really swallowed the tale about the dire impact of drug residues from clinical wastes endangering the environment? That a few pharmaceuticals misappropriated from some insecure or unscrupulous waste management facility might precipitate environmental disaster? Or that outflows from domestic sewerage and/or solid wastes into which unwanted prescription drugs have been tipped will change the world?

Though it is no reason to ignore these sources completely, the impact is, without doubt, infinitesimally small when compared with excretion of the administered dose.

We cannot dispute that what goes in will come out, and actually quite quickly. On average, in excess of 95% of the administered dose of any drug is excreted unchanged, with some varying amount and range of metabolites. Half-lives change but most drugs begin to be excreted within a matter of hours and a single dose is usually eliminated within 24-36 hours.

We pass that into sewerage systems designed by Victorians to remove biological hazards but not pharmaceuticals. Yet when we find drug residues in natural water sources we get over-excited about a few street drugs and ignore the obvious.

Wastewater treatment processes are being considered for some hospitals, to reduce the burden of drug residues in their outflow. Quite right. But just why is this being done? Many regulators are taking the rather myopic view that this because hospitals are poor at segregation of pharmaceutical wastes. Yet they ignore completely, or simply cannot comprehend, that those same hospitals are full of patients receiving medications, defecating daily and urinating several times each day thus contributing a massive drug load to the sewer that conventional wastewater treatments cannot address. We make it worse still. Hospital staff are not immune from the need for drug treatments, from a simple cold remedy or painkiller, through to hormone-based contraceptives. And still regulators and those who hang on their words bang a drum for what are effectively the most minute contributions to the global environmental burden of pharmaceuticals, their metabolites and their degradation products.

To broaden the rather gloomy horizon still further, this is not restricted only to prescription pharmaceuticals but to OTC products also, though at least in the UK, and it seems elsewhere too, regulators cannot stretch their mind to this even greater pool of potential environmental contaminants but only to those prescription medicines defined by law and thus satisfying a naïve, or is it brainless, tick box mentality. Cleaning agents too, which though not considered in the same classes as pharmaceuticals share many similarities in biological and ecological impacts, in addition to more direct eco-toxicities.

Improvement in community wastewater treatment facilities may be advantageous, and particularly for outflows deriving from hospital ‘hotspots’. However, let’s not place blame squarely on the Victorian sewage treatment facility since globally many are lacking this basic public health resource and have to rely on cess pits, soak-aways or worse.

If that seems like a dipartite situation separating the have’s and have not’s, consider the veterinary and agricultural (livestock) use of pharmaceuticals . Globally, this is massive. It is largely unspoken as many developing countries use increasing but often undeclared amounts of drug additives to increase profitability in the global food markets.

At least some of us have the option to use a toilet. In the animal kingdom, mans intervention in the intensive livestock industries has not changed the inevitability of excretion directly to land.

Make your own mid up.

There should be concern about drug residues in the environment. When we stop over-prescribing, and curtail the sales of PTC (non-prescription) products, when we make arrangements for the collection of unwanted pharmaceuticals from households, when we stop passing out thousands of tonnes of pharmaceutical residues in urine, and start treating wastewaters accordingly, then there will be some significant reduction in the level of drug residue found in natural waters. The contribution from clinical wastes, and from drug litter, is infinitesimally small and regulators would do well to consider the science, and the logic, of the situation and divert their collective attention to the heart of the problem instead of making mischief around the periphery where their interventions will make little if any difference.

 

 

It’s the bane of many waste treatment facilities. Blue spun (non-woven) polypropylene wrap often ties its way around the best of shredders causing many hold-ups and some equipment damage during shredding of autoclave floc, and in automated feed systems for autoclaves, augers, microwave and incinerator plant.

Used for surgical drapes, the wrapper for sterile instrument packs, and for many single use disposable gowns used in theatre, radiology, in laboratories, and as the now universal disposable replacement for bed curtains that are found on every hospital ward, the material might be ideal for material recovery if separated effectively.

A new resource recovery service promises to do just that, but only for non-contaminated wrap. Strangely identifying itself as an environmentally aware non-profit .org organisation but nonetheless a limited company, Alternative To Landfill Ltd aims to be at the fore front of the recycling industry, concentrating on the recovery of waste for reuse, recycling and seeks alternatives for material that would otherwise end up in landfill sites.

Good for them. We are of like mind and would be happy to support their ideals. However, restricting the operation to accept only non-contaminated material is a serious drawback. Clearly aiming for the lower fruits, and avoiding the regulatory framework that might conflate operations that may then include wastes considered more accurately as clinical wastes, the problems that this may cause make the business model difficult to accept.

Chosen waste volumes must be low, especially since source segregation will permit recovery of non-contaminated feedstock for this operation only from the largest and most dedicated environmentally-aware surgical centres. They may be found centred around only the larger conurbations, leaving the logistics operation to bring together sufficient waste for a cost-efficient operation looking a little thin.

And of course, there is the thorny problem of source segregation. Will it be good enough? Will an item of miscellaneous plastic make a difference, or some stray sheets of paper? Probably not. But the ‘what if’ of contamination with some contaminated or bloodstained material is more difficult to predict.

How much contamination is necessary to define a contaminated load?

What about the contamination that is not visible? How hard should we look, among a skip full of compressed wrappers?

And once identified as contaminated, will the entire batch comprising multiple collections be rejected? And what becomes of that rejected material, since rejection must accept reclassification as clinical waste, consequentially bearing a high cost for disposal.

Mush spun or non-woven polypropylene drape and gown material finds its way to clinical waste treatment, and quite rightly so. The recovery of this fraction from autoclaved clinical wastes, after sterilisation and either before or after shredding, would be a major advance.

The developments of  Alternative To Landfill Ltd are an important step forward and, at least in theory, looks to be of value though there are practical and operational matters of concern that may impact upon profitability and overall success. It’s a good idea, and if the regulatory framework permitted should be extended to seek the development of technologies to capture other non-woven wastes from ATT treatment floc.

 

 

 

Residents in a street in Aylesbury are fearful that they are living in what has been dubbed ‘cancer street’.

Families are living in fear of developing cancer on a housing estate just yards from a hospital after seeing loved ones and neighbours struck down by the disease. So far, a total of 15 people living in 22 homes around a green have died while another six have beaten the disease during the past 30 years.

This strange ‘outbreak’ of cancer comes just weeks after a national newspaper revealed a cancer epidemic in a single street on the outskirts of Oxford earlier this month. In that case, a total of 16 people have died with two more beating the disease in just 80 homes during the past decade. Some residents fear asbestos contamination has caused the cluster of cancer cases in Mickle Way, a cul-de-sac of council homes in the village of Forest Hill on the outskirts of Oxford.

With such a high cancer risk, rumours and speculation are rife. An asbestos risk is high on the list of possibilities since much of the housing stock, at both locations, had some asbestos in their fabric. Making this worse, both sites were situated close to hospitals where old clinical waste incinerators were demolished with possible release of asbestos fibres from insulation materials and boiler coatings. Other possibilities are dioxins in the soil, leaching from contamination secondary to incinerator operation and later demolition into fruit and vegetables grown in nearby gardens and allotments.

Whatever the cause, if indeed there is one single cause at all, the public belief that there is no such thing as a good incinerator will remain entrenched.

http://www.express.co.uk/news/health/388336/Aylesbury-residents-fear-they-are-living-in-a-cancer-street

http://www.express.co.uk/news/uk/381737/Britain-s-street-of-death-Cancer-kills-residents-again-and-again

 

 

Various items of clinical waste, predominantly used sharps, can be found on the streets of London. But today’s news report from the BBC is of a placenta found by London dog walker – perhaps more likely found by the dog than the walker – on a footpath near Tooting Bec Athletics Track, south London.

Police are now concerned that a vulnerable woman has given birth and may require medical assistance. Police believe the tub was partially buried before being unearthed by an animal, and is up to 2 weeks old.

http://www.bbc.co.uk/news/uk-21985948

The issue of waste disposal may seem rather trite in circumstances where we might opine of a woman, alone and frightened, seeking to conceal a birth. But equally is the persistent trend toward retention of a placenta after delivery – is it part of the earth mother thing? - where mothers ask to keep the placenta, to bury in the garden or elsewhere as if completing the earthly circle. Others like to eat it, consuming its nutrients as a paté or sautéed with some garden herbs, butter and garlic!

So, is this a tragic story of a concealed birth, and possibly of infanticide? Or some idiot mother who wanted to go with the flow and keep her placenta, but was then stuck when it started to decay? In the latter case, there are disposal issues, and possibly accusations of littering that might offend many but serve its purpose by dissuading others from doing likewise.

 

 

A 12 year old Sunbury, Australia, girl faces an anxious wait after falling onto a discarded needle.

The girl slipped and fell playing in a park near Gibbons St Sunbury, cutting her arm on the hidden needle. She did not tell parents until later, when the arm became sore and swollen and they got medical help.

“I remember running towards the slide when I slipped and fell, landing on my left arm,” she said.

“I felt a sharp pain … and saw the needle, which I picked up and put in the bin.

“I wasn’t very happy about it at the time but I was too scared to tell my parents in case they blamed me.”

Her angry father has hit out at whoever discarded the needle, labelling it “irresponsible and dangerous”.

http://www.heraldsun.com.au/leader/north/agonising-wait-for-12-year-old-sunbury-girl-after-she-fell-on-a-discarded-needle/story-fnglenug-1226605528310

Understandably, this is the cause for great distress, for the child and her parents and family. Not just today, but for the many months of follow-up that will follow, and possibly beyond. The impact is profound, and we wish them well.

Regrettably, stories like this are not uncommon. They serve to highlight the considerable risks from discarded needles, that seem far more common in recreational areas than elsewhere.

 

File:Coat of arms of Shetland.jpgNHS Shetland is launching an investigation after a Vidlin resident found a medical waste bag in the ditch near her home last week.

The bag was labelled NHS Grampian and bore a hazard symbol. The lady finding it was understandably angry that nearly a week later the bag was still there.

It was labelled ‘path­ology dept.’ and ‘cytology unit’ on it and ‘clinical biochemistry/hae­ma­tology’ and ‘danger of infection’ in big letters.

After something of a run-around between NHS Grampian, Orkney, the Gilbert Bain Hospital there were promises that it would be removed, and some uncertainty whether it was a sample bag or a clinical waste bag.

With what seems to be an attitude of deny it first, then investigate, the official response was that it was a sample bag of the type that might be sent by post – not that that is permitted by Royal Mail so I guess that was bunkum. Moreover, the lady reporting the find said it was “about the size of a pillowcase”, and a waste sack comes to mind rather than something fallen of the back of the Postie’s bicycle!

http://www.shetlandtimes.co.uk/2013/03/22/health-service-investigation-after-bag-full-of-medical-waste-found-in-ditch

 

But it’s Shetland. There is some wild weather and it’s not impossible that a stray bag blew away from an insecure location. Then again, it may have been a laboratory sample bag, however unlikely. But that too should not have been blowing across the island.

It’s not the end of the world, is it. At least not until someone takes the trouble to report it, gets a whole lot of bullshit in return, and it takes days to deal with the problem.

 

 

Litter officers are investigating how bottles of prescription medicines, unused syringes and packets of past-use-by-date pills have ended up in the North Island New Zealand Hutt River.

A resident who noticed the medical waste on the river bank and in the river 150 metres north of Ewen Bridge phoned Hutt City Council at about 1.45pm today. Environmental Officer Alan Pope was there within 10 minutes.

Some of the foil packs of pills and bottles of medicine were still in half a dozen supermarket bags but other waste was strewn along a 20-metre stretch.  Among the bottles was what appeared to be patient notes and prescriptions.  Labels on containers were from pharmacies all over the Hutt Valley and from the district health board’s pharmacy department.

http://www.stuff.co.nz/dominion-post/news/local-papers/hutt-news/8430920/Medical-waste-dumped-in-Hutt-River

No doubt investigation will track back the to the patient or carer involved, or to the clinic, pharmacy or family physician prescriber. Either way, it seems likely that there is plenty of information for easy investigation.

The description paints a picture of a patient dumping their own wastes – why else would it be in a number of carrier bags. containing the case notes of just one patient?

But why blame that patient? The problem surely lies in the lack of a suitable support service for domiciliary patients who receive care without the infrastructure to provide suitable waste containers and a collection service or collection points, including sufficient information to tell everyone just what is available, where it is, and how to access those services.

It’s the same the world over.

 

 

“An international group of scientists, including the young Chelsea Rochman and Mark Anthony Browne from California, with the support of the veteran marine scientist Richard Thompson from the UK and a host of others from the USA and Japan, has called on policy-makers to classify plastic waste as hazardous waste.

Their argument, published in the latest issue of Nature, states that classifying plastic waste as hazardous waste is not only a more accurate description of its toxic activities, but will also allow effective action to be taken against such harms. Note that they are not calling for the end of plastics – though they target PVC, polystyrene, polyurethane and polycarbonate as the most hazardous of the hazards – but for a more rigorous infrastructure that comes with a new classification.

http://discardstudies.wordpress.com/2013/02/15/scientists-call-to-classify-plastic-waste-as-hazardous-waste/

Plastics waste is clearly hazardous when it finds its way to an inappropriate place. That should never happen, but of course it does, in vast quantities and seemingly without any sign of reduction. Once ‘out there’, perhaps unseen save for the “witches knickers” flapping in the wind, we tend to forget, to turn our eyes away from the problem and carry on regardless. This cannot continue.

Any possibility for new or improved legislation that may move toward classification of plastics waste as hazardous waste will cause widespread concern and almost certainly increase costs, though the justification for those cost increases might be rather difficult to justify.

The problem is one of focus. How to constrain and, if necessary to punish, the offenders without impeding the activities of those who are happy to segregate their plastic waste for kerbside collections and others who perform well at any stage in the disposal chain through treatment to reuse or recycling, even to disposal where unavoidable?

How does this impact on the clinical waste sector? Separation and recovery of plastics from ATT-treated wastes is still resisted by individuals at the Environment Agency who seek to maintain an existing and unsteady playing field, tinkering with matters entirely outwith their scope of responsibility. Leaving that aside, at least temporarily, careless crafting of future legislation may impact greatly on those processing clinical wastes and seeking to landfill mixed plastic-rich floc.

Landfill should be avoided. There are several alternatives – cement kilns are the most frequently quoted option but this rarely happens as the amount of waste is too small. Now, with the rapid expansion of W2E plants across the UK, many of which are planned without clear evidence of sufficient feedstock available to operate them successfully, this seems to be the ideal option for autoclave, microwave and other treatment residues for clinical and sanitary/offensive wastes.

This will be environmentally sound, and will undoubtedly be preferable to landfill disposal. The regulatory stance must change, to acknowledge the errors that place barriers in place for this disposal option, opening the way to materials or resource recovery from treated wastes via materials recovery or at W3E plants

Remember, you heard it first on the Clinical Waste Discussion Forum.

 

 

With at least one hospital waste incinerator, perhaps the only one, out of action, it is reported that clinical waste is filling the streets النفايات الطبية تملأ شوارع القليوبية.. ومحارق المستشفيات خارج الخدمةof Cairo.

In such a troubled and generally under-resourced country, this comes perhaps as no surprise.

It shows, firstly, a lack of suitable equipment and either the ability to maintain it adequately, or access to components and technical expertise.

It also speaks of a lack of planning and regulation that fails to ensure wastes are stored appropriately. In a country with high daytime temperatures refrigeration may be considered but except for bulk wet sanitary wastes and nappies containing faeces the value of refrigeration is perhaps minimal and the lack of suitable cold plant should be no great problem. However, at any time, secure storage of wastes is an obvious necessity.

In the absence of better containers, open metal skips are better than nothing as they will contain leakage, prevent access by vermin and allow easy removal when suitable treatment options are found. A tarpaulin of netting cover will keep birds away, while a light spray with insecticide will prevent nuisance from flies. Dosing with strong disinfectants is almost certainly unhelpful and unnecessary. In this way, the health and safety of those close to the wastes will be properly managed, as will the wider public health impact of wastes piled in the streets. Waste regulators and public health specialists should be working hard to prevent this.

And what is unnecessary if the siting of a skip sitting haphazardly in an open ditch, with waste sacks spilling from it and scattered around at its base.  When its full, in fact before its full, get another skip. Surely it ain’t that difficult?

 

Landfill sites of all kinds had been alleged to be linked to a diversity of health hazards and nuisance and operators often face an on-going battle with nearby residents, pressure groups and others opposed to their operation. In the US, matters are no different. But perhaps somewhat predictable, they are more extreme.

Ontario resident Jim Stenton is suing Clean Harbors’ industrial hazardous waste site in Ontario for $25,000 because of the facility’s terrible odor.

Stenton claims the odor made him nauseous, gave him headaches, made it hard to breathe, caused him to lose sleep, his eyes to water, made him suffer the discomfort of swollen testicles and even drove him from his home three times last year.

At least he has the balls to stand up in Court and talk about it!

http://www.theobserver.ca/2013/02/28/lawsuit-begins-against-clean-harbors