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unwanted medicinal products, whether prescription drugs or not, include unwanted adverse effects from deteriorating and out-of-date medicines, and in a few of intentional self-harm.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?






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!

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

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

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” »

Clinical wastes and indeed just about all other waste streams are managed poorly right across the Indian sub-continent.

A good friend living and working in Goa tells tales of almost daily waste mismanagement, waste-related crime and, more often than not, relatively simple problems that can have far reaching consequences solely due to lack of joined-up waste management systems.

A report from Kerela, of clinical wastes dumped at the roadside, is typical. Wastes have been bagged but dumped, or perhaps dropped accidentally, at the roadside, creating a problem for those using the road, and those tasked with the clean-up. But the TV news report shows much of the wastes smoke stained but essentially unburned.  Has someone tried to do the right thing, but been thwarted by a fundamental lack of resources?



Alongside the revelation of radioactive wastes of hospital origin having been deposited in N Ireland landfill, and the many incidents and irregularities in clinical waste disposal South of the border, there are reports of landfill problems elsewhere.

In Greece, the department of the Attica Regional Authority responsible for managing the Fylis landfill northwest of Athens suggested on Wednesday that more than 20 tons of hazardous medical waste has made its way to the dump since late November.

The announcement came after the fourth discovery in just 10 days of hospital waste at the capital’s biggest landfill. The waste, which included used gauze, tubes and IV drips, was brought to the landfill in dump trucks doing their regular rounds, suggesting that hospitals around Athens are using municipal bins to dispose of hazardous waste. Continue reading “More landfill discoveries” »


Recent history tells of many ‘surprises’ hidden in the landfill sites of N Ireland, and indeed elsewhere in Ireland.

In some circumstances, perhaps healthcare wastes have been the least of the problems, but it has become clear that many thousands of tonnes of healthcare wastes have been deposited illegally, both north and south of the border.

The latest revelation is of possibly substantial quantities of radioactive wastes, from hospitals and universities, deposited in sites at Duncrue Street in north Belfast and at Culmore Point outside Londonderry.

Previously confidential British government files from 1983 released in Belfast confirm the secret dumping of radioactive waste in the early 1980s.

A memo in the file revealed that solid radioactive waste had been buried at two local authority disposal sites during the period 1977-82. These were at Duncrue Street in north Belfast and at Culmore Point outside Londonderry. At Duncrue Street, the memo noted, “a number of controlled burials of hospital/university waste of short half-life together with small amounts of industrial waste were arranged”.

The total activity disposed of was approximately 180 millicuries, of which the bulk comprised radioactive iodine with a half-life of less than two months. At Culmore Point, two consignments of hospital waste had been disposed of by controlled burial.

With such modest quantities of short half-life materials the residual risk is negligible. However, it is clear that this should not have happened, nor should it have been followed by an official silence – dare we say, a ‘cover-up’? –



It seems most unlikely. A fake clinical waste operating plant? What was it? What did it pretend to be?

Amusing perhaps, but the reality seems far more sinister. In fact, the story relates to an unlicensed clinical (biomedical) waste plant operating at Samurou Makha Leikai in Imphal West which is in Manipur state in northeastern India. There, local officials from the Manipur Pollution Control Board (MPCB) unearthed a scam operation that was purporting to be a regular clinical waste disposal facility. In reality, there was no treatment facility at all, but instead a recovery and recycling operation that processed unsterilized syringes and other items for reuse.

The MPCB staff should be praised for identifying and putting a halt to this operation, for which the owner has been summoned. No doubt many lives have been saved by the elimination of unsafe injection equipment and other healthcare items. The regulation of clinical or biomedical (medical or healthcare) waste facilities has an importance that far outweighs the immediate box-ticking approach, extending as in this case to significant and wide ranging public health protection and crime prevention.



Sixty-nine thousand tonnes of medical waste were collected in Turkey in 2012, according to Waste Statistics Of Health Institutions of the Turkish Statistics Institute (TurkStat).

In the report, posted on TurkStat’s website on Friday, the Waste Statistics of Health covered 1,449 health institutions, which were in operation by the end of 2012.

All of them indicated that the medical waste was collected separately within their institutions.

According to the data, the medical waste collected separately, 46% was disposed of in controlled landfill sites after sterilization and 28% without sterilization; 16% was disposed of in municipal dumping sites after sterilization and 1% without sterilization, and 8% was incinerated.

TurkStats data shows that 41% of total medical waste was collected in three metropolitan cities.

Out of the total medical waste, 22% was collected from health institutions in Istanbul, 11% in Ankara, and 8% in Izmir.

The Table footnote is particularly interesting, showing a huge reduction in the amount of healthcare waste burned in open pits of buried (hopefully in sanitary landfill, but there is no evidence for this). That is a commendable improvement, but one must wonder how much waste is simply not recorded here, arising in centres outside the three main metropolitan cities and thus officially “off the radar”?



Is it possible? Can the Environment Agency really do the job with less Red Tape, or will it be an exercise in smoke and mirrors?

The Government’s Red Tape Challenge claimed that it is burdensome for some small businesses to fill in Waste Transfer Notes. In consequence, the Government is proposing greater flexibility around Waste Transfer Notes as well as making two minor amendments to legislation relating to waste carrier registration and enforcement

This should be a step in the right direction, but it would be hugely out of character despite plans to streamline services and slash budgets with the lass of 1,400 jobs.

How long before inspectors are charged with the task of direct income generation through a model of FFI similar to that recently implemented by HSE?

Any bets?




So, an interesting product development, ‘The Flip’, from Wybone had recently caught my eye.

Intended to extend the value of waste sack holders, these flexible and wipe-able magnetic covers sit neatly onto the upper and outer surface of a sack holder lid to identify the intended waste stream, be it intended for orange or yellow sacks, or tiger stripe etc.

This is a clever idea that can save money and supports improvement in source segregation, though it would be better still if it was over-printed with some indication, as text or pictograms, of the wastes intended for disposal within. Continue reading ““Flip your clinical waste stream”” »

Dealing with waste pharmaceuticals is currently something of a hot issue, for wards and clinics, for patients in their own home, for manufacturers and pharmacists, and others, and for all of those others working at the farthest end of the disposal chain.

When pharmaceutical wastes enter the disposal chain, waste processing is expected to satisfactorily destroy or otherwise minimise any likely adverse environmental impact. Dispersal and dilution and a disposal option simply will not do. Instead, the environment agency continues with its policy – something of a one-man policy – to demand ever more complex assessments of waste treatment technologies.

Regrettably, the scientific integrity that underpins those Environment Agency demands is paper thin. This has been adequately discussed on the Clinical Waste Discussion Forum on previous occasions. In summary, there is little understanding of the impact of native drug or of its perhaps many and varied thermal degradation products, nor of the other thermal degradation products of each and every compound present in waste, including the very bag or box into which it has been placed. Continue reading “Dealing with pharmaceutical residues” »

Clinical Waste Discussion Forum tops 1,000

Some of our visitors may have noticed already, but just a few days ago we topped 1,000 posted since restructuring of the Clinical Waste Discussion Forum in September 2010.

Some funny; some deadly serious. Most posts have been informative, inquiring, instructive, questioning and challenging, reporting on issues central to the safe management of clinical wastes. Some have concerned regulatory of business issues, others more practical matters, to share best practice, news, views and opinions.

There have even been a few posts to pass the time over coffee or use as a training aid.

In addition to this, as some of our regular and long-standing visitors will be aware, the Archive section containing and additional 1,500+ posts. This goes way back to September 2006. Though it contains much in the way of news information contemporaneous to the date of posting, this remains a valuable archive of information that might provide the answer you are looking for.

Regrettably, the Archive section of the Clinical Waste Discussion Forum is not included in the site search system, and now probably never will be. But as just 3 subsections, it is quite easy to search using the Ctrl+F word search function of Internet Explorer or one of the other web browsers.

We have a small number of registered users on the Clinical Waste Discussion Forum, and a modest number of others who choose to leave a comment (only registered users can start their own thread, but anyone can post a comment). Feel free to add your thoughts, comments, suggestions, criticisms etc.

There is always a healthy stream of emails coming to us, referring to issues that have appeared in the Forum or informing us of things that might be helpful or interesting to others. If you want, that’s fine and we will do the rest. But do feel free to engage fully with the Clinical Waste Discussion Forum. It’s here for everyone interested in, concerned about or affected by any aspect of clinical waste generation, packaging, handling, transport and storage, treatment and beyond, covering the entire disposal chain from [before] the point of production to [beyond] final destruction.



A group of Utah doctors have urged boycott of Stericycle Inc in the on-going battle against the company and its incinerator operations in the Salt Lake City region.

Calling for a boycott of a clinical (medical) waste incinerator in an effort to shut it down as the company fights emissions violations and faces a special investigation ordered by the governor.

The Utah Physicians for a Healthy Environment stepped up its campaign against Stericycle Inc. by asking customers to stop doing business with the company’s burn plant in North Salt Lake. The investigation by state health authorities is doing little but delaying action against the company, the group added.–Medical-Waste-Incinerator


see also Stericycle clients wavering as Utah woes continue

and Campaign ramped up against Stericycle incinerator

and Stericycle clinical waste incinerator violates air quality standards; allegations of cheating

and Stericycle – vitriol and threats continue

and US “Stop Stericycle” campaign spreads to Stericycle suppliers


and more !



An interesting discussion on LinkedIn concerning allegations of time consuming ‘snooping’ by Environment Agency staff, actions that are considered to be of little apparent value and without justification.

The discussion goes on to consider staffing numbers and budget compared with other EU countries with links to data from

Good reading, and certainly not complimentary to the Environment Agency, to their staff or to their managers.




In a development that would hopefully be promulgated on rather better reasons than simply kicking back at the seemingly universally unpopular Stericycle Utah incinerator proposals, it is reported that a Utah hospital has decide to install a “clean-air hybrid technology that converts medical waste into ordinary trash using a biodegradable, disinfectant-based process”.

Hyped by the press as an alternative solution for managing clinical wastes, the development at Blue Mountain Hospital in Blanding, Utah, seems too good to be true, but that doesn’t have to get in the way of a popular news report.

“A small hospital in Blanding has announced it will dispose of its own medical waste and no longer be among those facilities that ship medical waste to Stericycle in south Davis County for incineration. Medical facilities from eight Western states ship their waste to Utah for disposal. Continue reading “Utah hospital invests in ATT processing” »

Glaxo has been required to issue a recall of pre-filled syringe/needle sets of Imigran Subject, a preparation of sumatriptan used for the acute treatment of severe migrane. 

Apparently, a small number of syringes may have needles protruding from the needle shield.

According to the recall notice issued by the Medicines and Healthcare Products Regulatory Agency (MHRA), “the risk to the patient of finding an affected syringe is extremely low; the implication of patient exposure to a syringe with a protruding needle is the potential risk of infection”.

So too for those involved in disposal through once used the combined needle device should be placed into a suitable sharps bin or back into its container since this is quite robust, and if closed securely can then be disposed into a more general clinical waste container.

The used drug vial and syringe may contain a detectable, though ultimately trivial residue of drug substance and in the mind of officialdom it may be necessary to manage this waste as for other pharmaceutical or pharmaceutical-contaminated sharps and ensure this is disposed only by incineration. However, for wastes that might comprise at most a single pack of two injectors, and two empty drug vials inside a secure pack, pragmatism might suggest that since the wastes will arise in the community – the product is intended for patient self-administration – a less formal approach to segregation and disposal would be more than adequate.




It seems that every few months we hear on the Clinical Waste Discussion Forum of yet another problem in the collection of clinical wastes from domiciliary waste producers.

This time, its Birmingham (again) receiving criticism for difficulties caused to Bartley Green householders who waited for three weeks for the Council or its contractors to collect clinical wastes generated in the treatment of their disabled son.

They claim they were fobbed off by the local authority after complaining about the mound of orange bags, containing syringes, bottles and bandages – items used in the care of their five-year-old son.

By the beginning of this week, four bags sat on the driveway of the Bartley Green property.

“We’ve just been fobbed-off. All they seem to be interested in is the ‘job number’.

“We’ve been given no reasons. What’s worse is my wife’s a diabetic and she couldn’t dispose of her sharp bins because it’s too dangerous to leave them outside for days.”

It all sounds predictably poor. There is an issue of administration and financing and that cannot be circumvented, but it can be made far more efficient, with error avoided and customer care placed high on the list of performance standards.

But one can sympathise, both with the householders and, albeit less so, with the local authority for whom this can be a particularly costly service that becomes even more complex when liaising with PCTs , now CCGs, to ensure funding and then arranging a one-off or occasional collection.

That is, however, no excuse for poor service, for which Birmingham seems now to have earned a particularly unwanted and wholly negative accolade.

see also Clinical waste left on Northampton street for weeks

see also Kirklees Council 0/10 for clinical waste services

see also Clinical waste collection failures in Birmingham

see also Birmingham clinical waste collection problems

see also York City Council clinical waste failures




Perhaps not surprisingly, another Ireland hospital has been found in breach of hygiene standards, and clinical waste mismanagement features in the list of failures.

Presently, Ireland is in the middle of a purge as health regulators get their act together to drive up deficiencies in hygiene standards in hospitals. There is always something to find, and few hospitals might be expected to gIMG_1633aet it right every time, but it is widely reported that for some considerable time standards have been inadequate, as indeed was until recently the case in the NHS also.

In the most recent case, Nenagh Hospital in Co Tipperary, has been ordered to clean up its act within weeks after inspectors found dirty sinks, soiled toilets and unclean floors posing a risk to patients. Among the list of failings was:

  • a lack of doors, or locked doors, to clinic room thus allowing unfettered access to hazardous waste, as well as needles and syringes, and to oral medications.
  • stained bedsteads
  • soiled areas in patient toilets and showers
  • sticky residue on bedside lockers
  • crumbling wall surfaces and dusty surfaces
  • faulty electrical fittings
  • a medical device for monitoring patient temperatures was unclean
  • stained floors
  • black mould on sinks in shower rooms and toilets
  • unclean surfaces
  • severed electrical wiring hanging free in a utility area


State health watchdog Health Information and Quality Authority (Hiqa) said there was “much evidence” of the hospital breaching national hygiene standards.Hospital chiefs have been given six weeks to produce a report on improvement plans.

Our concern, above making sure that we might not be admitted until the place is properly cleaned, repaired and perhaps re-staffed since those presently responsible for the service are clearly not performing, is the matter of clinical waste management.

And it is the lack of a door to close and secure an internal waste store that catches the eye.image_00026

Clinical waste sacks are, by definition, insecure, so perhaps we need not concern ourselves with those same sacks when they are stored in bulk.

But if we do, must we be concerned about carts full of waste sacks, the inevitable side wastes and the bits and pieces protruding from beneath gaping lids? Do we concern ourselves that these can be found in the corridor of just about every hospital?

And when the waste carts are moved to a waste store to await collection, is it secure? Unlikely.

Access might be required at all times so a gated compound, if it exists, will be unlocked and probably have the gates wide open 24/7 .

Carts without locked lids, and lids without locks.

Carts in the hospital grounds, blocking or at best restricting egress from fire escapes, obstructing walkways.  Used as general waste receptacles, sometimes as ashtrays or worse and visitors fail to recognise the colour coding and labels, if present, but who might try their best to place their waste into some sort of container.

But never mind. The Regulators will not since few health regulators would step beyond the immediate clinical area. And regulators of the Environment Agency, more talk than action and happy to let issues fall through the gaps of what should be joined up regulation.

For all its fault, HTM 07-01 contains much useful information and outlines not a standard, since it has no status in law, but a useful framework for performance in clinical waste management. Once this is teased out from what has become a ludicrously bloated document that in other jurisdictions can be just as effective but little more than a 5 or 10 page document, there should be no reasonable excuse for poor performance.

Improvement can save money, by identifying waste reduction strategies, and reconsidering waste categorisation/classification in order perhaps to reduce costs in disposal. Integrated with improvement in hygiene management, health & safety standards for staff, patients and visitors, and environmental, fire and general management including the not insubstantial staff costs that might be reduced through waste management improvements, there is so much to gain.