Hygiene | Blenkharn Environmental

Reversal of no liability finding for needlestick injury

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:

it is likely a cleaner using normal skill, diligence and equipment would have detected the needle;
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;
the hotel manager knew or should have known of the risk of injury; and
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.

Hospital hotels?

The press are today full of comment about hospital hotels, a new – at least new to the UK – initiative to use hotels as a half-way house for patients not quiet well enough to go home but good enough to move be moved out of a hospital ward.

It’s an idea predictably popular with Government and with the Department of Health since it frees much-needed hospital beds and todays news reports presumably represent a concerted political manoeuvre to test the waters of public opinion.

Hospital hotel transfers have been used in several countries already, most notably in Scandinavia, though an early trial at UCH London resulted in the unexpected and particularly embarrassing death of a patient while billeted at the local hotel. Continue reading “Hospital hotels?” »

Shooting gallery for Brighton?

Today, the press are getting excited about proposals for a safe injection facility – a shooting gallery – for Brighton.

This would provide a safe environment for IV drug users, where help is at hand and an interface is provided to support and rehabilitate those at the very bottom of society’s ladder.

Some will be aghast at the proposal, which pampers to this vile lifestyle. Others will recognise the considerable advantages, to improve healthcare, to get people away from a chaotic lifestyle and off the streets.

In the US, where such facilities are quite common, the norm is for a clean and secure unit where facilities are available for the use of clean needles, safe injections, and correct disposal of paraphernalia. The moral majority will be pleased to know that there are few home comforts.

Our concern will be for sharps safety. For every person using a shooting gallery there will be not one less needle discarded on the streets, but at least one, every day! And with no needle staying, the public health and safety implications are clear.

It’s a brave move for Brighton, but somewhere has to be first.

Antimicrobial soaps

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” »

Placenta found by London dog walker

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.

Postal restrictions on the carriage of biohazardous materials and sharps

UK postal restrictions forbid the packaging and shipment of small quantities of sharps to some distant disposal centre, even when packages in a sealed ISO-compliant sharps container and suitably impervious outer wrapper.

That creates a problem for many community-based sharps users who must package their used insulin syringes and take these to a co-operating high street pharmacy, to a GP surgery of to the local hospital. Since funding for this additional waste stream is often overlooked and does not flow equitably from the PCT patients are often left to struggle to find someone who will take their sharps waste.

Let’s not fool ourselves into believing that in the US they have it right, since in may States the management of sharps from domestic users is simply appalling. However, some States and cities do operate or permit a sharps by post service. These seem to operate well, with no reported incidents. They must save money, and make life easier for all.

So, why not in the UK? The official answer if to blame Europe, which forbids shipment of bio-hazardous materials by post.

But in the UK, the NHS Bowel Cancer Screening Programme, operates nationally to invite all over-60s to send 3 tiny samples of faeces to a central testing lab. All for the very best of reasons, and repeated through advancing age, the programme seeks to identify those who warrant further and more detailed investigation for the detection of early, and very much treatable, bowel cancer.

How does it work? Just 3 smears of faeces on a set of test cards folded into a paper envelope. With name and dates etc clearly marked, these are placed into a simply unpadded plastic pre-paid envelope and sent 1st class letter post to the lab.

If this is permissible under UK (or European) postal regulations then why not the shipment of suitable sealed and packaged small sharps bins for personal use?

Is there a hygiene risk? A risk of spillage, perhaps of faeces, or of sharps penetration though an ISO-compliant bin? Is the welfare or health & safety of postal workers in jeopardy? Is there some de minimis scale of bio-hazardous materials, and do thousands of faecal smears fall below the line?

It seems, regrettably, that we have looked at Post Office regulations and talked our way out of a perfectly good method for disposal of small numbers of used sharps that might arise from trustworthy and competent patients who might otherwise struggle to dispose of their used sharps.

What a great shame that is.

Blood splashes and blood exposures

Despite all of the effort over many years, it is still not widely recognised that splashes of blood and bloodstained body fluids to the eyes or mouth, occurring directly or perhaps indirectly via contaminated fingers whether gloved or not, risks transmission of bloodborne virus. We have raised the issue many times previously on the Clinical Waste Discussion Forum.

The conjunctiva and mucous membranes are effective routes for virus attachment and penetration, as certain as a deep puncture wound. Where splash exposure is a real risk, then eye or full face protection is appropriate, though when have you seen anyone bother with that? The evidence is there – and for those who still doubt the risk there is experimental evidence for extensive splashing of fluids, including bloodstained fluids, to the torso of those handling clinical waste sacks with an expectation that this is not restricted only to those sample areas.

Sometimes it is easy, as in the case of the Norwegian kindergarten teacher’s who brought a vial of her own blood into the kindergarten, and at ‘sharing time’ took out the vial, poured it on a plate, and let the students pass it around the classroom.

Up to a dozen children may have ingested the teacher’s blood.

The teacher, who has not been identified, reportedly asked the nurse at a recent doctor’s visit if she could have a vial of her blood to take with her to the school where she taught.

http://www.dailymail.co.uk/news/article-2290712/Kindergarten-teacher-fired-bringing-vial-blood-class-letting-children-taste-it.html#ixzz2NEnfs2EC

And in a story from America – where else – the blood facial!

The ‘star’ Kim Kard was trying out the latest beauty technique with a hope to ‘make her look and feel youthful’.

A large needle drew blood from her arm before the sample was spun in a machine to remove the platelets.

The blood was then splattered into Kim’s face using nine tiny little acupuncture-style needles.

But first she had to slap on some numbing cream in a bid to ease the pain.

The results left her looking like she had been in the classic horror flick – or a car crash, with blood spots all over face.

‘It stings a little,’ the medic who administered the treatment warned.

http://www.dailymail.co.uk/tvshowbiz/article-2291391/Kim-Kardashian-vows-I-facelift-gets-vampire-BLOOD-facial-instead.html#ixzz2NEpCoN4T

Only in America!

Recovery of plastics from clinical wastes

Despite all its woes, the recycling industries have a good record – it could be much better – of recovering material resources for reuse.

With correct processing, it matters not that drinks cans end up as a new car body shell, or vice versa, if an old iron bedstead is re-processed to bean cans or manhole covers, if beers bottles become cullet or plastic syringes are reformed to street furniture, picnic cutlery or children’s toys.

Re-processing, especially of plastics recovered from clinical waste streams, requires great care in first ensuring sterility, then cleaning, sorting and re-formulating at high temperature with additional processing to remove pigments and other unwanted additives and contaminants while additional raw materials are added to ensure a good mix.

But does it matter if plastics from clinical wastes are used in this way? We have discussed this several times previously on the Clinical Waste Discussion Forum. Clearly there is some concern, resurfacing again this time in China, the foundation being one of public concern and general sensibility, aesthetic reasons, rather than any concern based upon a sound scientific reasoning.

In the UK, Blenkharn Environmental has dealt with one assessment of this kind, though perhaps somewhat more complex in circumstances where concerns about residual DNA from hospital patients, for example from blood left in a syringe was first sterilised then recovered as plastic waste for recycling into street furniture. And what would happen when some a thug broke off a leg from that plastic park bench to club a passer-by to a violent death, with the police later accusing some innocent person of this mortal crime solely because their DNA was found on the murder weapon?

Implausible? Well, of course it is. Though quite impossible to answer with absolute certainty – the tests necessary would cost an incredible sum – the possibility is so remote that the likelihood is infinitesimally small and should reasonably be discounted.

But in China, Vietnam and elsewhere, the recovery of plastics for re-use may take a faster route to reprocessing. Sterilisation may be omitted; even washing to remove traces of blood, pus, urine whatever might be done away with in the drive for a quick profit. At such times, the sensibilities of others become real and quite understandable. Aesthetic objections come to the fore, and casts a shadow over those who approach plastics recovery in an efficient and properly regulated way. That is a great shame.

Hospital recycles operating room waste into park benches

A Brunswick, Maine, hospital is reported to be successfully recycling operating room waste into park benches.

Mid Coast Hospital has launched a new recycling program that turns plastic waste from its operating rooms into park benches, trash cans and other items. Described by Mid Coast as the first of its kind in Maine, the program targets blue sterile wrap that’s primarily used to protect medical supplies and surgical instruments from contamination. The bulky wrap is clean when it’s tossed into the trash after being removed from surgical tools, but can’t be reused.

This is bulk waste produced in great volume. It can of course be sterilised as waste, but there is no logic in doing so. However, there will be good reasons not to place a black sack in the operating theatre, so what to do is sometimes a rather neutral question – there is only one option, to dispose as clinical waste. This means biting the bullet, to manage many additional bulky waste sacks that must not be compressed, and pay for its disposal at the highest rate.

So disposal as a clean recyclable is an ideal solution. Providing it is segregated reliably from used drapes and gowns that may be contaminate with blood, no further treatment is necessary. It is not, however, a failsafe approach to disposal and there can be few certainties about the elimination of bloodstained drapes from this waste stream.

Molly Gardner, left, Mid Coast Hospital’s linen and waste management aide, and registered nurse Jana Hentz-McDorr dressed up in blue-wrap items recently to educate the Brunswick hospital’s staff about a new recycling program.

Elsewhere, the separation from plastic residues from autoclaved clinical waste is technically possible. Latex gloves and non-woven polypropylene create difficulties but the technology works well enough to give a mixed plastic waste recyclate. It is unfortunate that the bottom has now fallen out of the market.

The use of Brunswick operating theatre plastic wrappings as the material source for bark bench manufacture is laudable. But always, someone will ask a tricky question and indeed I have had to deal with this. “What happens if…?”

Well, what does happen if blood from patient X contaminates the plastic recyclate? What happens if that is remanufactured to create a park bench and at some time in the future an arm is ripped off the bench and used as a weapon to batter a passer-by? Now, if the police seek forensic evidence to trace the criminal, will they discover DNA from patient X, and charge that entirely innocent individual with a crime the did not commit?

If you followed all that, you will realise that DNA will have been heated several times, to 138C and later to ~250C. In between, waste will have been washed thoroughly, and dried. DNA is a tough molecule, but unlikely to survive any one of those multiple treatment steps. Moreover, the DNA, should it survive, would be entrapped into the polymer matrix, not free on the surface, so the proposition that this commendable recycling process might place patients at risk of prosecution owes more to science fiction, and perhaps to CSI Miami, than to science fact.

So, if the process can work effectively, with segregated polypropylene wrappers of with mixed plastics from autoclaved, shredded bulk clinical wastes, even from sharps bins that might deliver a higher grade waste, then crack on. Regrettably, the Environment Agency would prefer such recycling to be dismissed from further consideration as it does not fit with their current ideology. Presently, even landfill deposit is a preferred option for much potentially recyclable clinical and offensive wastes that might feed energy from waste of cement kiln furnaces, plastics or fibre recovery, or methane generation. Instead, the options include landfill disposal and clinical waste incineration without heat recovery while neither should be on the list of acceptable options.

It will change, slowly, but the negative and generally obstructive attitudes of the Environment Agency, and current market conditions, stifle investment and inhibit translational research and commercial development.

Crack on.

http://www.theforecaster.net/news/print/2012/11/23/brunswick-hospital-recycles-operating-room-waste-p/143347

Norovirus appears earlier than in previous years

N Norovirus orovirus infection, a particularly troublesome diarrhoea and vomiting virus infection prevalent in hospitals and homes, and less often in offices and factories, restaurants and catering establishments, schools and colleges etc is on the rise, earlier this year than previously.

It appears that the now predictable winter peak of norovirus gastroenteritis is being seen across Britain at least a month earlier than usual, with thousands of people already suffering. HPA are reporting already that cases are up by around a third.

Transmission of Norovirus is easy – it is highly contagious and less than twenty virus particles can cause infection. The virus can be transmitted by the faecal-oral route and can be aerosolised by a toilet flush or projectile vomiting.

Does this impact on the welfare of waste handlers? Yes, it certainly does. Several cases are on file of norovirus infection in waste handlers with no known risk factor other than handling clinical wastes including in some but not all cases wastes from establishments known to be in the middle of a norovirus outbreak!

Profound, almost explosive watery diarrhoea and projectile vomiting gives few warnings and those sufferers might try to get to a toilet, or call for a bedpan etc, they are often unsuccessful. Though a toilet flush can aerosolise norovirus, as can a badly maintained bedpan macerator/washer/disinfector, the clean-up after “accidents” generates a vast amount of infectious wet waste that generally finds its way to a plastic sack.

Even worse, lack of understanding of infection-related waste hazards and failure to consider waste handlers in a pre-disposal risk assessment puts much of this waste into Tiger bags an sanitary/offensive waste, aided and abetted by the doubtful classifications expected by the Environment Agency who of course take no responsibility for this law of unintended consequence.

Bags leak when filled with wet waste. Worse, their external surfaces can become contaminated and waste handlers can be placed at risk, particularly when hygiene standards slip. Unfortunately, norovirus is not highly susceptible to alcohol hand rubs and these are a poor substitute for soap and water hand hygiene. Take no risks, since norovirus is remarkably stable in the environment and can survive for extended periods outside the body, ready to catch the unwary.

Sometimes, it seems that the odds are stacked against safe waste handling. Norovirus requires great care in waste packaging, possibly with double bagging of wet waste or the use of sealable rigid bins together with great care in managing hand hygiene and PPE.

And if the workwear becomes contaminated, make a resolution to strip off there and then and use a disposable one-piece suite. It’s better that thaking your work home with you!

Hurricane Sandy

The stating effects of Hurricane Sandy will be felt for many months, and right now the great clean-up is no doubt at full speed.

The clean-up requires lots of hard work, rebuilding and/or cleaning that which can be salvaged. But evacuated New York hospitals have to contend also with red bag infectious clinical (medical) waste in their flooded basements!

As the NY Post reported on October 30th, “One official said…at NYU there is medical waste floating in the basement.” Hurricane Sandy has created a potential public health risk at area hospitals that don’t have on-site medical waste treatment equipment. Traffic and low fuel supplies exacerbate the ability for hospitals to truck their medical waste to treatment facilities, which are located hours away from the region.

PR Newswire

Without doubt, we wish them all well in the struggle to regain a degree of safety and normality. And for those having to clean up the additional and hazardous wastes that remain after flood waters have gone, we wish them the very best. It is not a pleasant, or safe, task at all.

And what of the ‘rules’ of managing those wastes? Of course, the rules for management of regulated medical waste (clinical waste) have sailed off and gone down the Swanee, or is it the Hudson, river? Do those rules still apply? Can they? At times like this, it is essential that the clean-up continues as quickly and safely as possible, but there are circumstances where a prompt clean-up necessitates some deviation from those core rules. That was necessitated after Hurricane Catrina and may be necessitated in New York also. For a few days perhaps, for a few specific tasks, with a prompt return to the normal standards of performance as soon as the crisis is reduced.

Embedding flexibility into future legislation, in order to permit the temporary setting aside or suspension of environmental and other policies, may free those responsible for the immediate delivery of disaster relief from the political and legal pitfalls that may occur when established legislation impedes the effective flow of emergency aid. That includes the provision of relief to New York citizens, getting their hospitals back into operation as quickly as possible. That may be dangerous, risking the health and safety of those tasks with this particular clean-up. The environment has been contaminated to a degree never considered when the rules that shape waste management operations were proposed. For the briefest period, some variation may be necessitated, though with an early return to normal standards of operation at the earliest opportunity. In the meantime, let’s hope that a waste regulation jobsworth doesn’t make things ever more difficult.

MRSA in water supply

Bit of a panic, mainly in the press at present, about an interesting paper in Environmental Health Perspectives entitled “Methicillin-Resistant Staphylococcus aureus (MRSA) Detected at Four U.S. Wastewater Treatment Plants“.

As everyone knows, this particular genie got out of the bag several years ago and if now commonplace in hospitals and other healthcare institutions including care homes etc, and circulates freely in the community.

Waste handlers must be exposed, since it is part of the flora of those wastes to which they are regularly exposed. Indeed, Staph aureus, though not particularly the methicillin resistant variant, has been found on the external surfaces of bulk waste carts and of individual waste sacks and their sack holders.

We should welcome this new observation. It is not an indicator of some new hazard, a health and safety risk that requires intervention, and certainly doesn’t need a regulatory kneejerk. Instead, it is proof perhaps that those who come into contact with MRSA and have it on their hands are washing it off properly. It’s fate in wastewater is of no concern to us.

Why so much paper?

Many sacks of clinical waste contain substantial amounts of paper waste. Some of it is secondary wrappings from sterile items and I have not problem with that, since separation is inconvenient and may result in errors that place potentially hazardous clinical wastes into containers for domestic-type waste.

I have no problem with the occasional newspaper either, though would hope that better and more suitable waste disposal arrangements could be made available, perhaps to collect these domestic wastes from patients rather than having them use the clinical waste sacks. This latter is a particular problem since , in most cases, patients will try first to pull up the lid of the sack holder rather than use the foot pedal, contaminating their hands but rarely washing their hands afterwards.

Beware however bed roll waste. This has been disposed routinely to clinical waste sacks for no good reason. Indeed, in some hospitals significant volumes/tonnages of this waste are categorised as clinical waste for no better reason that a patient, perhaps fully dressed lay down on a couch for a brief examination or X-ray or ultrasound examination. This is clearly wrong and there is no need for this. Likewise, the disposal of paper towels at hand wash sinks, even in the clinical areas of a hospital. This too is unnecessary unless for risk management, space or other thoughtfully considered reasons black bags have been removed with ALL wastes going into clinical waste containers. The most likely circumstance, beyond space concerns being able to accommodate only one waste container rather than two, is when potentially hazardous clinical waste items have found their way into the domestic waste stream. Risk management will suggest training to reduce errors, but also of removing choice. In these circumstances, a Tiger bag will suffice, but why not treat and process these wastes for energy or resource recovery? Landfill is simply wasteful and inappropriate. That may comply with prevailing waste regulation but is wasteful and environmentally unsound.

The other common source of paper contamination of clinical wastes is confidential paper waste comprising generally just occasional sheets of paper containing some patient-identifiable information. Of course, it should be disposed in such a way as to acknowledge and preserve confidentiality. Shredders are rarely if every available on the wards, and a separate container for confidential paper waste is uncommon, takes additional space, and is not going to be immediately available when someone has a sheet of paper for confidential disposal – so off it goes into the nearest clinical waste sack!

Is that a problem? Well, probably not and if it preserves patient confidentiality in circumstances where the alternatives are unavailable or inaccessible and errors in disposal likely to occur, then I have no problem. However, the ubiquitous yellow or orange sack is not appropriate when there is a filing cabinet to empty and bulk paper waste must be managed more appropriately.

In the week’s BMJ, a news report notes that the NHS Commissioning Board has predicted that the NHS will be paperless by 2015 with paper records “eradicated” by this time. Some it is rather ambitious, while the Board is pushing hard for developments that will improve efficiency, ensure transferability and access of records at any location, between hospitals and GPs and save the need for the vast amount of correspondence items that move back and forth between different care providers and locations.

It is not clear if this will work, I suspect not, but it is a step in the right direction. Will it reduce clinical wastes being contaminated with confidential and other paper wastes? Certainly not, though the former may one day be reduced in volume. As it does however, the justification for a shredder, or a confidential paper waste box, a porter to collect, and a separate disposal contract, will become economically unviable. So the net result may be, at least during the transition period, a net increase in the amount of confidential paper waste finding its way into clinical waste containers. Live with it.

Bad recycling

Recycling is good. Well, it’s almost always good and we should do all we can to promote it, including the recovery for recycling and reuse of material resources from appropriately treated clinical wastes.

In some regions however, the desire for a quick buck – that on occasions can be the difference between life and death for those at the bottom of the chain – results in attempts at materials recovery from clinical wastes without the inconvenience of any treatment to render those wastes safe.

In Lahore, the Environmental Protection Department has started a programme to educate hospital staff about the proper disposal of waste and the hazards of not doing so. A large amount of plastic waste from hospitals – urine and blood bags, syringes and tubes – is sold to manufacturers of plastic cutlery and furniture, without the benefit of any treatment to render it safe, which is both illegal and dangerous to public health.

“There is a mafia of doctors, nurses and sanitary workers across Punjab who resell used plastic items, spreading disease to our homes,” said EPD Deputy Director (technical) Azmat Naz, who heads the training initiative.

http://tribune.com.pk/story/445450/bad-recycling-epd-hopes-workshops-will-curb-sale-of-medical-waste/

That is so true. Repeatedly, we have spoken of the corruption that results in fresh wastes leaving the hospitals’ back door in exchange for cash, to be reprocessed as new medical supplies or other items, and bought back cheaply to provide “profit” for those who engage in this illicit trade at every stage in the process. Sadly, the fate of patients, who may find themselves treated with non-sterile items of used equipment including used dressings, syringes and needles, is not so rosy.

The public health issues are horrendous, while for recovery of plastics and reprocessing as plastic cutlery the risks are different. Dangerous for those working in this trade, the pre-treatment and heating necessary to remould plastics may well be sufficient to remove any risk to end-users. Some of these plastic cutlery products may enter the UK, so for your picnic or that airline meal, it is the aesthetics that is the greater concern.

Microbiological hazards of clinical waste sacks

There is increasing concern about hygiene precautions in the clinical area, for the protection of patients, but in the occupational arena the message seems hard to get through.

Infections associated with clinical waste disposal are related in the main to infections transmitted by sharps injury and blood and bloodstained body fluid exposure to the face and eyes, though splash inoculation seems to be misunderstood and often overlooked.

More generally, bulk waste carts (Eurocarts) have been demonstrated to carry a range of micro-organisms that may be carried to and from the clinical area, and perhaps between different hospitals. That is a serious risk and may support the spread of pathogens including those more problematic antibiotic-resistant strains.

Now new research from the US, demonstrating the escape of fungal pathogens with air currents generated when the lid of a clinical waste sack holder is opened or closed. The same was not found when tested with bacteria but the authors consider this a technical error in their approach to study and postulate the far easier escape of organisms from dry mixed clinical wastes. That should not surprise us, but it should give cause for concern.

Who is at risk? Clearly, patients are at the top of the list, and also waste handlers who are exposed to the air contaminated from the repeated manual or automated handling of large numbers of waste sacks. Compression of sacks as the pass along the disposal chain must surely exacerbate this problem. In studies performed by Blenkharn Environmental waste handlers were repeatedly exposed to, and their clothing contaminated with, splashes including blood splashes from the wastes. Parallel sampling of air in the vicinity of work moving filled clinical waste sacks showed small numbers of pathogens likely to be associated with releases from wastes, but also larger numbers of harmless organisms typically associated with strenuous human activity and shed from skin and clothing.

This should be a matter of additional concern. More evidence is needed, and research partners are required/

Can YOU help with a study of workwear hygiene?

Reusable sharps containers

We are becoming accustomed to re-usable sharps containers, not least because of the bullish advertising of their sole manufacturer.

But now, there might be a new kid on the block. One that is cheaper – I presume – one that is far more simple and without reliance on a possibly over-engineered mechanism with in-built resilience for many cycles of use.

Rehrig Pacific Co.’s Sharps Tank is an FDA 510(k) cleared, 17-gal. reusable sharps container that may be used in clinical and laboratory environments for the disposal of both small and large sharps.

It has been FDA cleared as a Class II Medical Device and is also DOT approved, PGII rated for bio-hazardous waste collection. Unlike single-use disposable sharps containers, the 100% recyclable and reusable Sharps Tank is both economically and environmentally sustainable with a life cycle of hundreds of uses.

Works in areas with limited space and includes a wide opening, side-hinged main lid and a transparent sub-lid for more restricted access and monitoring fill capacity. Each lid has a two-position latch; one for daily use, the other a full lock position for transport. Optional accessories include a hands-free foot pedal dolly and a molded four-caster rolling dolly designed for the clinical environment.

Tank is designed for automated handling and is nestable for efficient shipping and storing when empty. The high-density polyethylene main lid and container along with the polypropylene sub-lid are made with an antimicrobial additive for additional clinical protection.

It looks like a standard container but one with, one presumes, a removable and re-fixable lid. However it looks, it may be a cheaper option that the present player in the reusable market. Perhaps the difference will be in the reliability of reprocessing processes, and the number of cycles of use possible for each container, and the means of tracking to ensure no container is used excessively.

Importantly, it looks like a standard waste bin, is compact and stackable. Scaled up, perhaps it will be a suitable replacement for the standard sack and sack holder?

The new Clinismart system which is positioned as a shared resource to be moved around a ward or clinic may have significant drawbacks. But this much simpler system, as a direct replacement for each existing waste sack and holder may offer a degree of flexibility and practicality, with cost savings against staff time and the cleaning necessary of fixed sack holders. This may be a model for future development.

The statistics of fatal accident prevention

A recent announcement from HSE records nine deaths involving the UK waste and recycling industry since June 15, 2012. That is an appalling statistic, and HSE are sending “warnings” to the waste sector to improve safety performance.

The fatalities are:

June 15: employee crushed when operating forklift that overturned at a waste site in Towcester
June 19: employee crushed between two vehicles at a scrap metal site in Dudley
June 28: employee struck by a boom while working atop a skip at a skip-hire premises in Wolverhampton
July 25: self-employed person died after falling out of the bucket of an excavator at a skip-hire premises in Arundel
Aug. 7: employee crushed by a skip that fell on him at a skip-hire premises in Kempton Hardwick
Aug. 10: member of the public run over by a backing refuse collection vehicle in Glasgow
Aug. 17: employee run over by a wheeled loading shovel at a waste transfer site in Watford
Aug. 17: employee trapped in a waste compactor/baling machine at a recycling plant in Batley, Leeds
Sept. 5 member of the public found crushed in a refuse collection vehicle’s compacting mechanism in Wirral

Continue reading “The statistics of fatal accident prevention” »

Blood on sharps bins

Blood splashes and smears are common on the external surfaces of sharps bins.

Occurring mostly when sharps attached to a short length of plastic tubing, or an entire infusion set are manouvered into the narrow opening of the sharps bin, blood splashed can be seen on around 40% of sharps bins removed for disposal. Using a forensic technique to aid the visualisation of blood residues this rises to around 65%. Continue reading “Blood on sharps bins” »

Cockroach, rat and feral pigeon troubles

Concerns have been reported of hygiene worries about the Royal Free Hospital after cockroach, rat and feral pigeon sightings.

We should not be particularly surprised as these problems are really not uncommon within hospitals, either old or new build. Much can be done to keep matters under control though eradication is almost impossible. The report implies an annual pest control expenditure of around £30k at the Royal Free.

That is a huge sum, better spent on patient care, but realistically cannot be sufficient if sightings continue with such frequency to prompt reports in the press. For the hospital, its a no-win situation.

Cockroaches are the worst problem at Royal free, and indeed at most other hospitals. Contamination of waste stores is not uncommon, with cockroaches enjoying the warm dark confines of a poorly maintained waste storage block.

Placing bagged wastes into Eurocarts is an essential precaution against pest nuisance, particularly flies, but there are several waste management operations in the southern regions where cockroach and mouse infestation, and nuisance from seagulls, is a constant problem. Since expenditure on control is almost non-existent, the problem continues and it is not uncommon to find a heavy burden or roaches in unwashed Eurocarts used for transfer of smaller waste volumes during collection rounds.

Hospital to contractor, or contractor to hospital? It is not known which way the pests are spread, but without effective control measures and a proper standard of cart and site hygiene, waste management operations will never meet the required pest control standard that is part of the obligation under permitting.

http://www.london24.com/news/health/royal_free_hospital_hygiene_worry_after_cockroach_rat_and_feral_pigeon_sightings_1_1485662#

GPs stripped of trade waste cash

Perhaps surprisingly, GPs have for years received cash supplements for the disposal of trade waste as part of their contracts with PCTs.

Their enjoyment of this welcome uplift in funding, which was always considered discretionary, will come to an end. Pulse reports that GPs now face rising expenses after NHS managers said they would not reimburse practices for expenses incurred for the disposal of trade waste. Continue reading “GPs stripped of trade waste cash” »

Dumpster kids earn 50p per kilo scavenging hospital waste

A few minutes away from the main Peshawar hospitals, children rummage through trash, collecting used syringes, sharp blades and blood bags.

These children are gathering medical waste from garbage dumps outside hospitals to supply to shops in Khyber Bazaar, where the local traders buy them for Rs80, about 50p, per kilogramme.

Of course, none of this has been sterilised or treated in any way, either before sorting or indeed later when some of it is reprocessed or simply repackaged for use in hospitals and clinics. It is truly a deadly trade.

The risks of sharps injury or infection, and infection for those who may be treated using items salvaged from waste and re-used without sterilisation, is immense.

http://tribune.com.pk/story/416114/dumpster-children-hospital-waste-sells-for-rs80-per-kilogramme/

Placenta find prompts police ‘hunt’

Police have launched an investigation after a horrified dog walker found a placenta and medical equipment in woodland.

The grisly discovery was made as the woman walked her dog in South Woodchester near Stroud in Gloucestershire.

She examined the bag – which her dog had disturbed – and found a bowl used by midwives containing the placenta, as well as a towels, tissues and medical wipes.

South coast bin men face needles in black sacks

Two binmen from West Sussex are facing a risk of infection and months of blood tests after being accidentally pricked by hypodermic needles.

The needles had been left incorrectly in black bags by a resident for collection in the Arun district.

Despite wearing protective clothing, both men were pierced in the hands. Continue reading “South coast bin men face needles in black sacks” »

Interim Clinical Waste Manager (NHS)

Location: South West England

Salary: £200 – £300 per day

Type: Temporary

Reference: 423275

An experienced waste manager is required for an NHS organisation for an interim contract. Concentrating on the movement of dangerous goods and clinical waste, the required candidate will be responsible for the following regarding hazardous wastes and the safe management of healthcare waste:

Review the Trust’s current practices
Work closely with Trust staff to understand any constraints that are currently in place preventing best practice being achieved and work out how these can be overcome
Write a clear practical report that outlines the steps that are required to bring current practice in line with best practice
Produce templates of any documentation that should be in use, and make any new systems that are introduced user friendly
Work closely with the Energy and Sustainability Manager to offer guidance
Write a training package that can be put on the intranet
Answer ad hoc queries relating to the carriage of dangerous goods from staff

http://www.badenochandclark.com/jobs/regeneration/other/112197/interim-clinical-waste-manager–nhs-.html

Complains about appalling state of hospital toilets

Toilets at the at the Royal Cornwall Hospital were in an “absolutely disgusting” state, according to a patient. Continue reading “Complains about appalling state of hospital toilets” »

Hiring temporary staff (clinical waste)

The current vacancy for a part-time clinical waste handler/roundsman in west London raises two interesting questions.

The advertisement specifies:

“In order to be considered for this role it is essential you have been inoculated with the Hepatitis vaccination“

and

“Knowledge and adherence to Health and Safety guidelines within this area is paramount” Continue reading “Hiring temporary staff (clinical waste)” »

Managing Norovirus waste

Norovirus outbreaks continue to be a major seasonal problem and cause huge disruption to care services with substantial morbidity and mortality. What to do with Norovirus waste?

Much waste will be destined for the toilet or bedpan washer/macerator and though this creates a substantial risk of further aerosol distribution that is a matter for another day.

Inevitably, there will be large volumes of solid waste for disposal, much of it wet waste, and the ubiquitous plastic sack may be less than adequate. Double-bagging may reduce the risk of leakage but when large volumes of wet waste require disposal a rigid bin should be used as these have tight fitting lids that resist leaks and will not be compressed as they pass along the disposal route.

Some guidance exists. Compiled by HPA together with others, Guidelines for the management of norovirus outbreaks in acute and community health and social care settings offers much practical guidance on the management of Norovirus outbreaks. Sadly, waste management is largely ignored, presumably on the basis that once it leaves the ward the wastes are of no further concern. But that is not so; several cases of Norovirus infection have been recorded among waste handlers and it is likely that the true number is considerable. Regrettably, this latest document confuses healthcare waste and clinical waste and uses the two terms interchangeably. No further detail is provided. Continue reading “Managing Norovirus waste” »

Body parts and medical waste bake in containers

Refrigerating clinical wastes is something that occasionally appears on the UK agenda but is rightly dismissed as an unnecessary energy expenditure (though with global warming perhaps things will change).

However, in many parts of the world ambient temperatures are persistently high and problems due to odour and fly pests are common unless wastes are properly packaged, held in closed bulk containers and refrigerated. Continue reading “Body parts and medical waste bake in containers” »

How do you take you coffee?

Coffee is an increasing popular drink, overtaking tea as the national drink. Coffee shops seem to be everywhere, with outlets in the high street, in book shops and libraries, in rail stations and airports, and in our hospitals.

In those hospitals, the delivery bays that may receive clinical supplies, sterile goods and pharmaceuticals as well as food items are often shared with waste stores to facilitate vehicle movements across the site. However, this creates an often unacceptable mix ‘n match exemplified in these few pictures captured today at a typical district hospital. Continue reading “How do you take you coffee?” »

The Sharps Terminator

The Sharps Terminator is a new(ish) product that is to all intents a reworking of slightly older technologies which aimed to put sharps destruction onto the desktop. We have discussed these previously on the Clinical Waste Discussion Forum and this can be located in the Forum archive files.

This latest incarnation, The Sharps Terminator®, “destroys the needle shaft in a single-handed action leaving the user with only the plastic syringe, has the potential to significantly reduce the number of needlestick injuries reported by healthcare workers every year in the UK“, delegates at the Royal College of Nursing (RCN) Conference in Harrogate heard. Continue reading “The Sharps Terminator” »

Blenkharn Environmental Led by Science Driven by Research

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Blenkharn
Environmental

Led by Science
Driven by Research