Download the Chartered Institution of Wastes Management (CIWM) publication “An Introductory Guide to Healthcare Waste Management in England & Wales”

 

http://www.ciwm-journal.co.uk/documents

 

 

 

 

tablets and capsulesThe evidence is now sufficiently strong as to be almost incontrovertible, save for a spirited rear-guard action by the vested interests of the big pharmaceutical companies who have a record of non-disclosure, that Tamiflu and other antivirals have limited protective benefit in the event of epidemic influenza, swine flu etc, and for treatment of affected persons are little better than a couple of paracetamol.

Many hundreds of millions of pounds of taxpayers have been wasted on Tamiflu stockpiles. Yet more money will now be spent on disposal.

 

 

 

The news media today are headlining the dramatic rise of drug abuse and needle sharing in gyms and sports clubs across the UK, and proposals by NICE to install needle exchange programs within the gym to prevent spread of bloodborne virus disease.

NICE have updated their draft guidelines and slowly, PHE staff will be including high street gyms in their scope of operation while existing needle exchange schemes, often voluntary or charity-funded, will expand to include some gyms in their sphere of operation.

Steroid abuse is rife in gyms. Needle finds in the toilets of even the shiny brand-name gyms has been a problem for cleaners and maintenance staff but has been hushed up to avoid sullying the healthy reputation of the gymnasium. Any help will be invaluable, though ultimately if these pumped up idiots stopped taking illegal and unregulated steroid products their health would be better still. However, , it happens and this new publicity can help if it followed rapidly be those needle exchange schemes and not suppressed by the gym owners, keen to maintain their clean image.

Though there are crime issues involved in the illegal manufacture, distribution and supply of these anabolic steroids and other injectables used as tanning enhancers, safety and protection of public health is ever more important.

Nonetheless, the abuse of injectable drugs is now rife and initiatives such as needle exchange schemes are essential in order to stop the spread of bloodborne virus disease.

This suggests that sharps bins and subsequent disposal should be appropriate for pharmaceutical waste disposal, though colour coding of sharps bins, with the exception of purple-lidded bins for cytotoxics, seems to have fallen largely into disarray.

 

see also http://www.ianblenkharn.com/?p=6438
see also Further drug abuse in sports and gymnasia
see also Muscle bound sharps users

…and so on!

Indeed, if you search this site for the word GYM you will find much more. Looking back through the archive files you will find much more, going way back to late 2006 when the Clinical Waste Discussion Forum first raised this observation which has subsequently grown massively, to become something of a global health issue.

 

 

 

In an interesting approach to regulation and more generally the US move away from high temperature incineration of clinical and related wastes, Utah has given final approval to a measure blocking facilities burning infectious medical waste from being built within two miles of existing neighbourhoods.

The Environment Agency, as least its healthcare waste ‘specialist advisers’, have for some years seemed enamoured with US regulation and standards, and have been generally happy to follow suit. They have also demonstrated an unhealthy and scientifically unsubstantiated preference to high temperature incineration which left a suspicious cloud of smoke over their entire operation.

This is a plausible approach for the largely unpopulated wilds of Utah. To adopt this latest US bill would be entirely unworkable on the small island that is the UK.

Let’s prove that the we in the UK can think for ourselves, and lead in the EU with a mixed approach to management of this multi-fraction waste stream, to protect the environment and encourage development in energy and resource recovery through heat capture and materials recovery from all waste treatments. And let’s stop the deposit of sanitary/offensive wastes into sanitary landfill when far better alternatives exist.

 

 

Sales Consultant – Clinical Waste

An establJobsished name in the Clinical Waste market are looking to grow their business in the forthcoming years, they have a settled team that manage specific geographic locations. One area that they require a Field Sales Consultant is the Derby, Nottingham and  Stafford area

About the Client:

A multi-service business with a strong name in the Clinical Waste market, our client has their own transfer station which is a major selling point or their client base. The business is looking to invest heavily in their sales function over the coming years  and one of the most important things for them to do is to source an experienced sales person to join their settled team in the Midlands

About the Role:

* Selling Clinical Waste solutions to clients across the Midlands
* Potential clients would include – Hospitals, Doctors Surgeries, Dentists & Nursing Homes
* The role is heavily road-based, covering a large patch across the West Midlands
* You will have telesales support however this role will require focus on sourcing new business opportunities

About the Candidate:

* Prior experience in the Clinical Waste industry would be hugely beneficial
* If you have experience of selling products or services into the Healthcare Sector that would be ideal
* It is essential that you have B2B sales experience
* This role comes with a large patch, it is essential that you have excellent organisational skills

Points of Appeal:

* £25,000 – £30,000 Basic Salary
* £40k year one OTE, increasing over time
* Telesales support & clients to manage
* Large Patch to manage

Details of job reference 24674111 at http://www.reed.co.uk/jobs/sales-consultant-clinical-waste/24674111

 

Good luck

 

 

 

There are a great many needlestick prevention devices now on the market, broadly categorised as ‘active’ devices incorporating a shield or cover that is placed by the user, and ‘passive’ devices based upon retractable needles.

Some are undoubtedly better that others. And few are better that the user who can defeat even the best passive devices which may not activate unless used precisely as intended.

That alone creates confusion and an obvious training need for healthcare staff and others; ideally a national standard safety device would be a great step forward since sharps injuries are slightly more common in ‘new’ staff including those moving to a new Trust where they will use a new and unfamiliar range of sharps safety devices. Continue reading “Cochrane review of needlestick prevention devices” »

Addenbrooke’s and all other NHS England hospitals have been instructed not to incinerate aborted foetuses as waste.

Sir Bruce Keogh, NHS England medical director has written to all trusts, including Cambridge University Hospitals (CUH), ordering them to cremate or bury aborted foetuses rather than incinerate them. In his letter, Sir Bruce wrote: “I share the view that incineration of foetal remains is inappropriate practice and that other methods offer more dignity in these sensitive situations.”

A freedom of information request found 10 trusts disposed of more than 1,000 foetuses as clinical waste, while CUH was one of two which used a furnace that generates energy to power wards.

Human Tissue Association (HTA) rules currently allow remains under 24 weeks – the point at which the average weight is 1lb 2oz – to be incinerated and anything over must be buried or cremated, but health ministers are now calling for a ban on incineration, which was stopped in Scotland in 2012.

Addenbrooke’s and others may have been compliant with the prevailing regulation, which nonetheless did not meet the expectations of those loosing an early pregnancy, and others, who have not considered that a blob of tissue may not really justify the formality, cost and upset of a ‘funeral’. The reality is now that increased costs will be borne by Trusts, and perhaps by Local Authorities also, while distressed mums and dads walk away to manage their grief in their own way.

see Disposal of aborted foetuses

 

 

The State of Massachusetts has fined a hospital over its clinical / medical waste disposal.

Imposing a fine of USD 6,000 on Cooley Dickinson Hospital in Northampton, the Department of Environmental Protection acted on concerns over failing to comply with state regulations regarding the proper disposal of hazardous waste.

The UK equivalent seems hardly, if ever, to see the light of regulatory days. Instead, failures  are addressed by penalising the politically easier and obviously practical target of the waste disposal contractor. Penalties, either direct or expressed as a general lack of cooperation that can impose on contractors a need to jump through a variety of hoops, not all of which legal, in order to maintain the status quo and avoid jeopardising future permitting renewals.

That cannot be right. It characterises the fine line taken by EA in their approach to regulation, at least of clinical waste operations. A dictatorial, sometimes possibly illegal, approach to bullying and veiled threats is simply not acceptable, but continues to operate as if imposed from some individual fiefdom.

As EA staff move on, things have the change of getting better. However, the focus of regulatory attention on waste contractors who then take the hit for the failures of their customers increases prices for everyone. However, it would be politically unacceptable to impose heavy fines and other restrictions on NHS hospitals. Is that the reason EA act as they do? If it, like FFI and the HSE, simply the approach to regulation focussed more on targeted money-raising than it is on improving waste management?

 

 

 

The beginning of an interesting debate can be found on Debate.org.

Are the current protocols on medical waste disposal sufficient to protect public health? Yes, or No?

Presently, the answer is a Yes, with a 4 to 1 majority but with only 5 contributors the answer is far from resounding.

Why not have your say?

 

A couple of years ago, an increasing number of community nurses got a bee in their collective bonnet about the carriage of clinical wastes in their NHS-funded cars.

The issue was that wastes produced during care delivered by community nurses visiting a patient in their own home was considered by Local Authorities to be tin the ownership of the nurse, and thus of the primary care trust. That had a small, probably insignificant, cost impact on the LA who might have approached this by agreeing a notional cross-charge to the PCT. Continue reading “Whose waste is it anyway?” »

With an aim to ensure quick and better management of clinical/medical waste, the Ministry of Health on Oman has appointed 28 health safety and environment officers.

Dr Issa Said al Shuaili, head of occupational health section in the department of environmental and occupational health, MoH, said, “This is a new concept. We have appointed qualified professionals who will ensure proper disposal of medical waste.”

The officers will be posted at the Khoula Hospital, Al Nadah, The Royal Hospital and other hospitals across various governorates.

“They will supervise the medical waste management programme and conduct risk assessment. They will also check infection rate in the hospitals,” added Dr Shuaili.

These professionals will be given a comprehensive training by experts from April 6 to 17 on infection control and health safety. They will also be told about the guidelines set up by the World Health Organization (WHO).

http://www.muscatdaily.com/Archive/Oman/MoH-appoints-28-health-safety-officers-to-manage-medical-waste-30ge

What a great idea. Twenty eight inspectors will really make a difference. Can we have some too?

 

 

 

 

Ozone treatment of clinical wastes has been and gone over the years, several times over.

Never quite sparking great excitement, and always under a cloud of suspicion by regulators ozone treatment plant in their various formats have always struggled.

Now, Colorado is adopting what it describes as a “Greener Method” of Medical Waste Processing. Perhaps the “Green” soubriquet will help its future acceptance

 

 

The news services have picked up a story to be aired in Channel 4 based on the claims of a mother who lost her pregnancy between 6 and 13 weeks.

Regrettable as that is – and we cannot fail to recognise the distress to the lady involved and others in her situation – there will be a disposal issue that must be addressed.

What to do with a blob of tissue? A formal burial with religious service or secular equivalent? Take it home and bury it in the garden? A simple woodland burial perhaps? And what about a memorial? Costly in a cemetery, and all too often decorated in the various momentous, so may say ‘tat’ that often decorated the graves of the newborn, or a DIY equivalent in a garden or parkland? And what about rules and regulations, that might restrict or forbid such approaches, causing further upset when rules are applied?

The reality is that, for late pregnancy losses, staff are trained to discuss, sympathetically, the options for disposal. Where possible, parents can be given a little time to consider their options and choice, but storage is an issue and storage facilities are costly so a hospital may push for an early decision or expect that a foetus is transferred to an undertaker.

For early pregnancy losses, those blobs of tissue that require disposal, there is still the same need for sympathy and compassion. However, it becomes more a matter of disposal and, within the relevant legal framework, disposal as clinical waste is the generally appropriate option. This necessitates disposal by incineration.

But one mum has complained, though she is not the first to do so. Aghast at the reality that an alleged 15,000 aborted foetuses are incinerated as clinical wastes the press has picked up the story, and a ‘celebrity mum’ has jumped on the bandwagon.

There are rules, and those rules are complex and convoluted. However, they refer really to the disposal of a rather more mature foetus and not the blob of tissue arising from loss of a pregnancy at just 6 weeks. However, the Human Tissue Act complicates matters and their is often no discretion.

The costs to NHS service providers will escalate dramatically if formal cremation if demanded for all aborted foetuses. Cremator capacity will be stretched and inevitably multiple foetuses will be cremated together. That too will then generate complain, indignancy and uproar.

This is, potentially, a no-win situation. Further discussion and debate will become heated, and is so doing will increase the distress of many would-be parents. Compassion is essential, but perhaps that might best be directed at a more pragmatic, less emotional, approach to management of these tissue remnants. Midwives and hospital/community Trusts will bear the brunt, emotionally and in cost. In the meantime, the disposal contractors will be painted as villain of the piece in a truly no-win situation.

Perhaps inevitably, the Addenbrooke’s incinerator is in the headlines, and has immediately take on that role as villain. “Aborted babies used to heat hospitals” scream the headlines., prompting the Department of Health to act and prohibit the practice. The problem now moves to local authorities, who will want neither the responsibility nor the cost, or to the parents most of whom will want to mourn in the own way but otherwise move on, without the cost of an undertaker.

What a mess.

 

 

Yesterday, and for the second time recently, I became aware of a research laboratory using ethidium bromide (EtBr) to stain electrophoresis gels.

Nothing unusual in that, except that each lab admitted discarding its EtBr waste comprising the gels, all consumables and towels used to wipe down equipment and workspace surfaces, and gloves, into a clinical waste sack for disposal. The expectation was that since “these wastes are incinerated”, all would be well.

One of the labs was about to changing from yellow to orange sacks as their previously large stock was running low and they had found that orange sacks could be ordered internally, saving money compared with a one-off external purchase.

EtBr fluoresces nicely but in neither case were checks made of the outgoing waste sacks to ensure that they were free from external contamination. That alone was a significant error, and sat uncomfortably against the diligent checks of all workplace surfaces to ensure that the lab was free from contamination. Perhaps others don’t matter quite so much, and their health and safety is optional?

Ethidium bromide is a nasty chemical. It is a potent mutagen intercalates double stranded DNA, that is it inserts itself between the double strands of DNA, deforming that DNA. It is assumed that it is the subsequent metabolites of ethidium bromide that actually cause the damage. It is readily absorded through skin and becomes fixed in the underlying tissues where it can induce tumour formation.

In most jurisdictions, EtBr can be poured down the sink for disposal, and low level solid wastes can be discarded without specific restriction. However, most reputable laboratories and many local policies dictate that even low level EtBr waste is managed as hazardous chemical waste. There is unlikely ever to be any risk of infection, so disposal as or with clinical wastes in entirely inappropriate, no matter how convenient this may be.

Chemical waste disposal may be expensive, but is necessary and appropriate for EtBr wastes. The Environment Agency would do well to issue a specific guidance note or reminder about this, to ensure correct classification and ensure proper packaging and handling of these wastes, and subsequent disposal in an appropriate facility. This will ensure that all those coming into contact with the wastes as they pass along the [presently and inappropriate] disposal chain are not exposed to EtBr residues.

 

 

All credit to those involved in the delivery of healthcare waste training in Lahore. Addressing a two-day training workshop on hospital waste management for health managers, nurses and sanitary inspectors of government hospitals, Adviser to the CM on Health Khawaja Salman Rafique said that hospital waste was causing dangerous diseases. He said all stakeholders should adopt a consolidated strategy for tackling with the problem.

The photo shows source segregation Lahore-style. With critical shortages of funds and a greater importance on recovery of material resources, this is about as good as it gets. The latex gloves are a great leap forward as previously not gloves would have been used, or expected to be used. They simply would not have been available, and would cost far too much.

Soap and water will be in short supply, or non-existent. Training is just beginning, though training, supervision and support of those working further along the disposal change is unlikely to exist.

But its a start, and an important start, to introduce training like this even where the circumstances are so poor and the challenge faced by trainers so great.

Good luck to them all, their work is invaluable.

 

 

 

Two yellow clinical waste sacks have been found on a north London street, by the look of it conveniently (?) left next to an already overflowing waste bin.

Clinical waste sack, north London

Noting that it has happened before, A resident has spotted them, and quite responsibly reported the find to the appropriate Council contractor. I wonder how long ’till they get removed, and whether any attempt will be made to address the issues involved in this waste being inappropriately dumped?

That’s not such an easy task – identify the producer, explain how the wastes should be categorised and packaged (is yellow really appropriate), make arrangements for appropriate container supply and uplift at an agreed frequency, interim storage arrangements, costs, talking with GP and hospital teams, and community nurses, to make sure their advice is up to scratch,  etc, etc, etc. That’s much more than throwing into the back of a truck in the hope it doesn’t happen again, or worse to threaten some penalty to a householder struggling with home treatment, without dealing adequately with the underlying issues.

A 16 month old toddler has died after overdosing on iron tablets he thought were ‘Mummy’s sweets’ after his sister climbed onto the bathroom sink to reach them.

When children are in the house, ALL tablets and capsules etc are dangerous and should be kept under lock and key to prevent accidental poisoning.

For adults, the additional risks of stockpiling old and unwanted medicinal products, whether prescription drugs or not, include unwanted adverse effects from deteriorating and out-of-date medicines, and in a few of intentional self-harm.

Though limits on prescriptions should alleviate the latter, GPs and others have repeatedly blamed patients for asking for a prescription, and then for repeat prescriptions, without a hint of irony since it is their own responsibility, not the patient’s, to assess each request and prescribe accordingly. Regrettably, that takes just a little too much time and effort.

And our concern, of disposal of these unwanted products that accumulate in a kitchen or bathroom cupboard, is to ensure environmentally sound disposal. That cannot happen if unwanted pharmaceuticals are thrown into a black sack or poured down the toilet.

Until the Environment Agency awake from their slumbers and address this issue, instead of fussing about an occasional blister pack that the might observe in an orange sack, the better and safer this will be. Lower NHS costs, fewer accidental overdoses, less intentional self-harm, and far lower environmental impact from inappropriate disposal.

There is a GP surgery or clinic, or a family pharmacy in every High Street and shopping precinct, and in every large supermarket. The opportunities to operate a properly funded and effective take-back scheme are there, but need purpose and negotiation, and a willingness to make an effort at least to initiate those negotiations and drive them forward in a positive and encouraging way. Regrettably, that isn’t the way of the Environment Agency, but why not?

see also Prescription drug residues in natural water sources

and Cutting medicines waste through prescription control

and Wales urges patients to avoid prescription waste

and Presciption numbers rocket to new high

and Drug residues from wastes – the impact on the environment?

and http://www.ianblenkharn.com/?s=prescription

 

 

 

 

We at the Clinical Waste Discussion Forum and at Blenkharn Environmental have always promoted the use of cable ties to fasten clinical and other healthcare waste sacks.

Toothed or serrated tags make certain that a the gathered neck of a waste sack or bag is held firmly without damage, though most people will find that the smooth tags of ties work equally well and do not slip provided the sack is not overfilled.

This is always preferable to tying the neck in a ‘bunny ears’ knot which requires some compression by – hopefully – gloved hands and too often by unprotected forearms also.

Since waste tracking is important, to provide feedback in the event of any problems, and for the increasingly popular unit charging, an effective identification system per sack can be invaluable. This allows unit or ward-by-ward charging, and effective measurement of waste outputs by location and/or type, providing information that can be invaluable in resource planning.

RFID devices can be attached to bulk containers but in many locations these may be shared between users and this approach lacks detail and specificity and can fail to provide the required information.

Step in the cable tie. We have been promoting it – without any commercial link or undertaking as this is the Clinical Waste Discussion Forum – for a long time. It’s just a good idea.

One company is now marketing numbered cable or sack ties specifically for use with clinical wastes. In an array of colour codes and overprinted with the producer (Trust) name and a unique sequential numeric codes, and complimented by a software suite to permit allocation and tracking of numbered tags, the system seems [almost] ideal.

Better still is the use of tags with an additional machine readable barcode print which may appear along the loose end of the tag or on a flattened extension. Electrical suppliers and asset management service providers use them. So why not for clinical wastes?

Such a system provides a better closure suitable also for tracking of sharps containers, with a simple and straightforward tracking system that can be enhanced with machine readability using a simple handheld barcode reader. This might be used to trace wastes across a single site, or by roundsmen collecting smalls from multiple sites, where uplift and recording can be made far more efficient and speedy.

 

 

 

A local Stoke newspaper is reporting that plans to use a warehouse for the storage of clinical waste have been submitted, a move that will without doubt lead to much concern and criticism.

Energy Plant UK Ltd has lodged a planning application to change the use of the former HW Plastics distribution centre in Sir Stanley Matthews Way, Trentham Lakes.

According to the plans, a quarter of the building would be turned into a waste storage and handling area. The remaining three-quarters would be used as a waste processing area, which will be the subject of a future planning application.

Stoke-based Energy Plant UK eventually hopes to use the site to produce energy from waste materials, with 10 full-time workers employed on the site.

Good idea, and presumably based upon some sound estimate of need. But why claim warehouse storage?  Isn’t that misleading?

Planners at Stoke-on-Trent City Council are due to make a decision on the proposals by May 19.

 

 

 

The Philippines Manual on Healthcare Waste Management, 3rd edition, published in 2011 contains a wealth of practical and regulatory information. It is a great credit to its authors.

Obviously applicable to waste generation, segregation, collection and disposal activities in the Philippines, it additionally provides a counterpoint to other guides and policy documents including the excellent ICRC manual, and our own HTM 07-01.

see also ICRC Clinical waste management guide

 

It is reported in today’s BMJ that there is a further increase in drug abuse found among some sportsmen and women, and those using gyms and bodybuilding facilities.

Steroid abuse is now rife in certain sections, to build muscle and promote what is seen as a ‘perfect’ body shape, and to enhance sexual ability (allegedly!).

Now the breast cancer drug Tamoxifen is being used to reduce breast overgrowth in those artificially pumped up and muscle-bound devotees.

Tamoxifen is a prescription-only medicine but it’s active substance is found in a specific ‘artificial supplement’ and a high purity product is now flooding the UK market. As popular as so many other legal highs, and as yet unregulated, this is causing all sorts of health problems in users. But it will also add to the troubles for those managing waste disposal from gyms and sports clubs. Sharps use is at an all time high and many gym operators now have sharps bins mounted in their toilets. These will inevitably contain much drug residue, be it a POM or an illegally imported and unregistered POM-equivalent. And now yet more of these pharmacologically active herbal supplements.

Tamoxifen, a selective oestrogen receptor modulator, is not quite a cytotoxic drug substance though it has many similar properties and should be handled, and disposed, with great care.

 

 

SEPA have updated and expanded their guidance surrounding the management of clinical waste.

On this page, they aim to provide access to guidance and best practice for those involved in the management of clinical wastes.

 

 

 

A green box marked ‘Property of NHS suppliers’, dumped by fly-tippers on some Radcliffe wasteland close to residential properties, sparked concerns of clinical wastes when spotted by residents.

Flytipping NHS box

The box appears typical of those used extensively by individual hospitals and Trusts, and by NHS supplies.

A Cross Lane resident said the site is frequently blighted by discarded rubbish but he had never before seen anything identified as belonging to the NHS left there.

Bury Council sent workers to attend the patch of land, close to Cross Lane, who confirmed the green crate was empty and the rubbish was mainly domestic waste.

A spokesman for the local Pennine Acute Hospitals NHS Trust said green storage crates, identical to the one pictured, have not been used by the NHS for a decade.

Though that might be an explanation based less on accuracy and more of defence since it is common to find these boxes used throughout all hospitals where they serve a useful purpose, for storage and goods movement. However, it is equally likely that these bins find their way out of the hospital to find a new life in lofts and cupboards, and in the garden shed!

It’s a similar problem with waste sacks. Black sacks disappear regularly. Of more concern is the pilfering of orange, yellow and Tiger bags for domestic use. Placed out for collection as domestic waste overflow, or simply by those too tight fisted to buy their own, this creates huge problems for community waste collection teams.

Regrettably, it’s invariably an inside job. GP clinic employees and hospital staff regularly pilfer these waste sacks intended for clinical and for sanitary/offensive wastes, and as we have noted many times previously their appearance outside houses owes more to pilfering that to domiciliary clinical waste production.

 

 

 

The Chartered Institution of Wastes Management (CIWM) has published new guidance on healthcare waste audits intended for use with large healthcare waste producers in England.

New guidance on waste auditing for large healthcare producers has been published today by the Chartered Institution of Wastes Management (CIWM). Prepared by the Institution’s Healthcare Waste Special Interest Group, the document is designed to provide simple and concise guidance on pre-acceptance waste audits, as required by the Environmental Permitting (England & Wales) Regulations.

Pre-acceptance waste audits are required to ensure that healthcare wastes are sent for the correct treatment and disposal, and robust auditing and reporting practices are essential to ensure compliance. Good auditing, however, also brings other benefits, including potentially significant cost savings and carbon footprint reductions that can be realised by efficient and appropriate segregation of higher and lower risk healthcare waste streams. The Royal College of Nursing has estimated that there is the potential for annual savings of approximately £5.5 million for the NHS if just 20% of incorrectly classified infectious waste were to be reclassified as offensive waste with lower associated waste management costs.

The new guidance has had input from a range of healthcare waste experts including practitioners, academics, and consultants.

Mat Crocker, Head of Illegals & Waste for the Environment Agency, says: “It is essential that producers of waste correctly segregate and describe their waste to ensure that it is managed correctly and gets to the right place. This guidance for producers of healthcare waste sets out how waste audits can help producers both to fulfil their requirements and to enable their waste management contractor to comply with their legal obligations. The Environment Agency welcomes this publication and the work that CIWM has put into its production.”

The guidance has also been endorsed by the Cambridge University Hospitals NHS Foundation Trust. Victoria Sawford, Environmental Services Manager for the Trust, says: “I believe this will be a very useful tool, especially for those who are new to the waste management sector. It not only highlights the legal requirements but also provides a step-by-step approach to the audit methodology, as well as enabling the user to make an informed decision with regards to the packaging, collection, storage, transportation and disposal routes for the various waste types produced within the healthcare environment.”

Pre-acceptance waste audits: a guidance document for large healthcare waste producers in England is available as a downloadable PDF from the CIWM website and can be found here.

 

 

 

The Environment Agency is consulting on “Small clinical waste treatment units: standard rules and risk assessment”

We, the Environment Agency, have developed a new standard rules permit for small clinical waste treatment units. We are asking for your views on these rules and our identification of the risks associated with this activity.

This is the ninth consultation on sets of standard rules and associated risk assessments.

It is obviously important that all of those who might be affected by these proposals, either directly or indirectly, review the documentation and submit their responses, whether positive or negative.

Who knows, they might actually take heed of those comments. Just don’t bank on it!

https://www.gov.uk/government/consultations/small-clinical-waste-treatment-units-standard-rules-and-risk-assessment

https://consult.environment-agency.gov.uk/portal/ho/ep/src/clinicalwaste/standardrules9

The consultation period runs from 17/01/14 10:00 to 11/04/14 10:00

 

 

 

The West Middlesex Hospital infection control standards are not up to scratch, say CQC inspectors.

Inspectors from the health watchdog the Care Quality Commission visited the hospital, in Twickenham Road, Isleworth, unannounced in November last year.

Among other problems, they found bins overflowing with healthcare waste, staff failing to wear the necessary protective gear and shoddy record-keeping of how and when wards had been cleaned.

Problems with clinical waste management, at ward level and beyond, always seem to trip up those organisation where standards of hygiene and infection prevention practise slip, and are almost always instantly visible.

A slightly black mark for the West Middlesex University Hospital. Unsurprisingly, they are not alone.

 

 

There are several teaching aids and guides applicable to the management of healthcare wastes, mostly focussed on source segregation.

beyond poster s and labels, these training aids are actually few and far between. They can assist in teaching activities – of waste producers, waste handlers etc – and in raising performance, improving standards of safety, and compliance with regulatory requirements. Several companies place their teaching aids into the public domain, in part as a generous gift to others and, inevitably, as part of their marketing activity.

Users must be aware of the sometimes significant differences in regulation that may affect the suitability of training aids that might not translate from one location to another. However, there is always something to learn.

A particularly impressive training package can be found at http://quizlet.com/33679033/info

Teach, learn, improve, comply

 

 

 

 

 

 

“St. Elizabeth Hospital in Belleville, Illinois is to pay a $10,000 state fine for allegedly failing to properly store hazardous waste and for other violations.

“The fine stems from an inspection of the Belleville hospital in Sept. 2011 by the Illinois Environmental Protection Agency. The violations allegedly occurred in 2009, 2010 and 2011.

“The inspectors allegedly found 178 one-gallon plastic bottles containing spent solvents used to “de-water” human tissue were not labelled within the hospital’s hazardous waste cage.

“The hospital also allegedly did not have a plan in case a fire or other disaster unexpectedly released hazardous waste.

“Other alleged violations include failing to:

  • Maintain aisle space in the hazardous waste cage in the hospital’s basement
  • Conduct weekly inspections
  • File necessary waste reports to state officials
  • Ensure all employees complete training in hazardous waste management
  • Maintain spill control equipment

 

http://www.bnd.com/2013/12/13/2958325/st-elizabeths-hospital-to-pay.html#storylink=cpy

This is one of a small number of fines issued to hospitals for failure to manage their wastes properly – fewer still in the UK, where the Environment Agency prefer to chase waste management companies while ignoring that many, perhaps most, of the infringements that arise, or errors in waste segregation, classification, packaging, storage etc are the responsibility of the producer and not the carrier.

The standards of clinical waste management and storage in UK hospitals has been a matter of repeated audit, in 2005/6 and in 2006/7 with little improvement noted between those dates. I sometimes doubt if anybody really cares.

 

Standards of clinical waste management in UK hospitalsJournal of Hospital Infection 2006; 62: 300-303

Standards of clinical waste management in hospitals – a second look. Public Health 2007; 121: 540-545

 

“More than a dozen cleaners at Cheltenham General Hospital say they have been left severely traumatised after they were stabbed by hypodermic needles in the last 12 months.

“At least 13 members of staff at the hospital have reported being pierced by used syringes in the last year due to “improper disposal” by medical teams.

“The “domestic assistants” have condemned “poor practices” by the hospital’s doctors and nurses which they say are putting the health of the cleaning teams at risk.

“Cheltenham General Hospital has admitted liability for seven cases of piercing by hypodermic needles and one case of contributory negligence.

Regrettably, there is no mention of intervention by any of the various regulators that might step up to the plate here, either HSE or CQC, perhaps even the Environment Agency.

One can only hope that the costs of a private compensation claim has been sufficient to drive a sustained improvement in disposal practise.

Although sharps injury rates are highest among frontline healthcare professionals, we should remind ourselves that a US study comparing injury rates with employment statistics revealed an overall rate of injury among support staff 10x greater than that for nurses, and 30–40x  greater than for clinicians (Leigh et al. Characteristics of persons and jobs with needlestick injuries in a national data set. Am J Infect Contr 2008; 36(6): 414–20).

I guess that the cleaners at Cheltenham General Hospital found that out the hard way.

 

 

This sounds exciting. What is being done to reduce the production of clinical wastes? What is being done differently, or not being done at all?

There are perhaps many ways to reduce clinical waste outputs. Some are promoted in schemes such as this one, others presented as more scientific study. One common theme is reclassification, rendering claims for real reduction little more than smoke and mirrors. Continue reading “US Hospital takes steps to reduce medical waste” »