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”?

http://www.turkstat.gov.tr/PreHaberBultenleri.do?id=16117

 

 

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 

https://consult.defra.gov.uk/waste/red-tape-challenge-alternatives-to-waste-transfers

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.

http://www.therepublic.com/view/story/e83614381bda4c39aa2068a8959243ba/UT–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 insidetheenvironmentagency.co.uk.

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.

http://www.mhra.gov.uk/home/groups/is-md/documents/drugalert/con329308.pdf

 

 

 

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.

 

 

 

A burning Detroit warehouse filled with medical (clinical) waste has been linked to medical problems in those living nearby.

With dramatic footage of the fire, reports that the warehouse held [some] clinical wastes might seem rather strange. Stranger still when listening to the few reports of alleged ill-health that seem most unlikely to be associated with the presence of clinical wastes and more likely associated with a smart claims agent and others seeking a quick payoff.

Not surprisingly, some of those living nearby are suffering some asthma symptoms. It’s hardly likely to be associated with the presence of [some] clinical wastes – Look at the fire, and the smoke!

 

 

Ever more strange is the details revealed in the news report, of a guy receiving clinical wastes and shipping it is a regular hire box van – keep your eyes left of the screen and see the unsuitability of the vehicle – then storing it in a garage and in successive buildings including this warehouse.

Regrettably, none of this is unknown, and Blenkharn Environmental has dealt with each of those situations, though back in the days of LWRA. No longer does that happen here, thanks perhaps to better regulation and regulatory oversight, but also – perhaps more so – to a higher professionalism and pressure from the larger, and better equipped operators managing their services to the highest standards.

There is no longer any room for the small guy with a van, prepared to cut corners and ignore standards, and rightly so.

But that aside, how good are your fire precautions?

 

Read more: http://www.wxyz.com/dpp/news/region/detroit/people-who-work-by-fire-at-detroit-warehouse-filled-with-medical-waste-report-medical-problems#ixzz2iAKfbWeE

 

And by the way – to the lady with cellulitis on the tip of her nose, who is presumably looking forward to a claim for compo and trying to link this to burning clinical wastes, as one of many items that would have been engulfed in the warehouse fire. We would suggest simply that she stops picking!

 

 

It is reported that the US medical/clinical waste management market is worth $10,327.0 million by 2018

Forecast in a recent MarketsandMarkets report, “Medical Waste Management Market by Sector (Hospital & Pharmaceutical), Service (Collection, Transportation & Storage, Treatment, Disposal & Recycling), Treatment Technology (Mechanical, Thermal, Chemical, Microwave Irradiation) & Geography – Global Trends & Forecast to 2018” by MarketsandMarkets, defines and segments the Medical Waste Management Market with analysis and forecasting of the global revenue.

This market sector is predicted to grow reasonably in the upcoming years. With the growth of western markets, the medical waste management industry is projected to achieve a slower, yet stable growth. The growing environmental concerns with regards to the dumping of medical waste and rapid expansion in the pharmaceutical industry over the years, have led to an overall increase in the Medical Waste Management Market. The Americas and Europe are the major regional markets growing at a steady pace.

 

Medical Waste Management Market

Waste Treatment Technology: Market Revenue, By Categories, 2013 ($Million)

 

The medical waste management market revenue, in terms of geography, is expected to reach $10,327.0 million, growing at a CAGR of 4.9% from 2013 to 2018. The Americas dominates the market with $3,100.0 million in 2013, and is expected to reach $4,040.0 million by 2018, at a CAGR of 5.4%. This is followed by Europe, which is expected to reach $2,710.0 million by 2018, at a CAGR of 4.8% from 2013 to 2018.

Healthcare is a massive cost to nations, and continues to grow almost without limit. Restraint is unpopular and soon becomes a vote loser so few politicians are able or prepared to deal with this effectively.

Yet with increasing demand, increasing complexity, and increasing environmental concern, disposal costs for clinical wastes will continue to grow. Some useful savings in healthcare cost se patients discharged early to community care, and for some long-term domiciliary treatment. The associated waste outputs are often reduced, but with a price premium for collection of smalls this is a growing market subsector that needs to be serviced.

 

 

Clinical waste from domestic sources has been a particular concern on the Clinical Waste Discussion Forum. Too often, these wastes are managed badly, to the great inconvenience of the patient (resident) and the concern of others who might be worried about exposure to these potentially hazardous wastes including sharps, left in accessible locations for extended periods to await collection.

I notice this week a note from Enfield Council who have placed information on their web pages to inform service users that collection days for clinical wastes are changing.

Though the core arrangements will stay the same, the day of week is to change, so let’s hope they contact each service user directly rather than rely only on a web page that might be rather troublesome for the elderly. However, Enfield note that:

The collection procedure will still remain the same.  Please ensure your sharps bin/clinical waste sack(s) are sealed and placed out for collection on your doorstep by 7am on the day of collection.  With each collection we will provide you with replacement sharps bin/clinical sacks.

Please note - If you live in flats, please present your sealed sharps bin/clinical waste sack(s), outside your communal entrance front door.

 

 

 

 

 

So wastes will be left without supervision, in communal locations at the entrance to a tower block. And later, perhaps some considerable time later, new sacks and sharps bins will be left in the same spot.

I sympathise with Enfield and others organising these services. It cannot be easy, and any more personal – dare we say helpful and considerate – service will cost vast sums of money.

But for the elderly and infirm this really is a challenge that many could well do without. Perhaps there is support from a home help, a relative or a neighbour, but if the resident is to manage this single-handedly it is no surprise that problems arise. Missed collection with wastes sitting in totally unsuitable locations give rise to complaints, or incidents of spilled wastes. It gets worse, and ever more costly.

It would be, in some quarters, an unwelcome suggestion but perhaps this is a service that might be transferred in its entirety to social services, to operate vans collecting wastes, and where necessary soiled linen, with drivers able to visit the householder and provide assistance with bagging wastes. carrying bins and sacks, and distributing new supplies? If outsourced, but under that same umbrella, then there are many companies providing the support services to social servicers, delivering supplies to the infirm and those others receiving care in their own home. When those medical supplies are delivered packaging waste and some drug waste containers (mainly dialysis bags) are removed. Why then, not extend this service to manage clinical waste collections also?

If that creates waste carriers of clinical support companies, or extends the role of the existing waste management companies it really doesn’t matter. Either way, or a collaboration between the two specialties, would be ideal, to provide a better yet more effective and user-friendly service to the growing numbers of domiciliary patients.

 

Sharps disposal for home-based users is far from satisfactory.

Some may be provided with sharps bins, while others buy their own or simply muddle along without due to lack of a properly joined-up service.

And when the bin is full, a trip to the GP surgery, back to hospital or to the local high street pharmacy may be the appropriate step in disposal. But too often, petty squabbles concerning funding for disposal will result in refusal to accept a filled bin. So where does it go?

Local Authorities may collect, and may provide a new bin too, but once again funding can be an issue. Whether it is appropriate to leave the filled bin at the garden gate is debatable, especially when home is a tenement or a tower block.

On the Clinical Waste Discussion Forum, we have discussed many times the potential advantage of sharps disposal by post. It would tick all of the boxes. It works in US and Canada, so can it work here? Continue reading “Sharps by mail” »

Temporary workers hired by Ohio State University to separate plastics and cardboard came across medical waste and various medical files, the workers told 10 TV News in Columbus.

The workers were separating items as part of the university’s zero waste program. Several workers described various medical waste in the items they were separating, including needles, catheters and IVs. Those workers also told the television station that they saw patient records in the paper as well.

Officials from the university declined to go on camera for an interview, but provided the station with a list of procedures on how it would be impossible for medical waste to end up in the stream that workers were sorting.

As we noted recently, green initiatives can and do go badly wrong and perhaps this is just another example.

Details of the Ohio incident are limited. Medical files should be managed securely, particularly in the US where patients and next of kin will file a lawsuit for any breach in confidentiality at the very drop of a hat.

As for the medical (clinical) wastes, clearly something has gone badly wrong in segregation and management of separate waste streams.

What is most obvious is the matter of temporary workers.  They are called in from an agency and put to work within minutes. Any induction is, at best, notional in content and in all probability of limited value. Essential PPE items will be recycled from a previous user – no problem there if they are in good condition. But what about supervision. At the very bottom of the pile, those agency staff that make a substantial contribution to the workforce of most UK waste management companies, including those handling clinical wastes, receive inadequate training to do their job safely. That is huge problem, since training an agency worker for 1/2 day of more, when they may only stay for a short time is not money well spent.

Supervision is the key, but that is rather limited in scope, even in the best of companies. Once more, supervision of costly, and that hits the bottom line.

But these agency workers need some reasonable standard of protection for injury and infection. First among this must be a mandatory selection of appropriate PPE items, and a list of do’s and don’ts.

That list should be in the worker’s own language, since there is no value in a brief spoken introduction to a worker who cannot or does not understand because of their nationality and limited English language skills.

And then they’re gone back to the agency. But responsibility does not finish then and there, though many would like to think otherwise.

Perhaps the ideal solution to this tricky problem is a written list of those do’s and don’ts, in a range of languages  - check first that they can read – supplemented with some take-home information about hygiene and the need to report any exposures, with necessarily some reasoned explanation of how those exposures may arise ie, sharps injury, contamination of broken skin, splashes to the mouth or eyes.

The purpose if to inform, not frighten, so great detail is not required. Inevitably, information should be supplemented with some basic hygiene information. On arrival, this written sheet would supplement, not replace, a basic induction delivered orally. And none of this is an excuse for inadequate supervision!

Is this value for money?

Yes it is, if it prevents a claim and even more so if it prevents an avoidable incident that now would be likely to incur additional costs when HSE come knocking. And those agency workers, who disappear back into a transient pool, might just be  back again, better and more efficient or effective than before. Of better still, future employees, setting off from day one on the right foot.

 

 

The RCN report compiled and published in 2011 from a raft of Freedom of Information (FoI) requests concerning waste management in the NHS has recently come to the fore.

The report is available here.

Helpfully, the report quantifies, albeit from an incomplete and thus somewhat unreliable data set, quantities of waste produced, stratified by municipal, offensive and “infectious”. Though this last categorisation is somewhat flexible and open to a particularly wide interpretation, it is clear that few have accepted the most recent attempt by the Environment Agency to manipulate the figures of healthcare waste outputs by further down-regulation of the bulk of orange-bag waste to sanitary/offensive.

Yet more interesting is the table of costs for disposal. Though massive ranges of cost can be seen, this report does not consider the premium charges or smalls, and for minor but high-cost fractions such as cytotoxic wastes, tissue wastes, some related chemical wastes, and dental amalgam).

The report considers England, Wales, Scotland and Northern Ireland, and within those countries Foundation/acute trusts, Primary care trusts, Care trusts and Mental health trusts and should therefore include data representing a particularly wide diversity of producers, outputs, waste types and locations that perhaps explains yet further the apparent variation in costs. That the average costs for sanitary/offensive and for “infectious” wastes vary so little gives support to the idea that additional to producers’ views of waste classification and regulation, there is no real financial motivator to down-regulate wastes, especially if that means the cost impact of managing an additional waste stream.

The RCN report is a superficially valuable report that would benefit from further and more detailed study to investigate those issues raised above, and others, and to permit comparison of current data from that of 2010/11.

Despite that reservation, the RCN report represents a vast amount of effort, including effort by those hit with FoI requests. It is an important document and one those should be dusted off for review every now and again.

 

 

Green initiatives in hospital practice can make valuable contributions, to the environment and to environmental protection, and to cost containment. But it can also increase costs and we, as a community, must decide to what extent we value the environment and how much we can afford to pay to keep up the good work.

Nonetheless, hospitals in North America and in Germany, Scandinavia and some parts of Holland/Belgium are ‘doing their bit’ with generally nurse-led green initiatives. There is even a hint of this in the UK, where several groups have tried to make their mark, though generally unsuccessfully. Continue reading “Saskatoon green initiative fades” »

It’s easy to ignore Albania. After its freedom from the tyranny of hard line communist rule and the totalitarian regime of Enver Hoxha, there isn’t much more to say.

But Albania is a county with a population of around 3 million, with a need for healthcare that is perhaps greater than our own. When they do get care, the clinical and other waste that are generated must then be managed but in all probability we neither know nor care what happens to it.

But we should. There is a market to exploit, albeit a rather small one. There are concerns regarding public health and environmental protection, but before that we should be concerned regarding safety of those who might be exposed to those wastes by virtue of their job, or otherwise. We have so little information about Albania, and in particular its healthcare systems and waste management operations that we must glean information in piecemeal manner. Continue reading “Albania trying hard to manage its clinical waste” »

The BBC is today reporting concerns regarding disease transmission – Hepatitis C, Hepatitis B and HIV – associated with hygiene failures during high-street piercing outlets.

To offer a piercing service, outlets must register with the local environmental hygiene office and comply with various hygiene standards that extend to the layout of premises, training of staff in hygiene and other matters, and arrangements for disposal of used sharps. But inspections are few and far between and one might imagine that standards can sometimes be woefully inadequate.

The National Institute for Health and Care Excellence says growing numbers of people are injecting tanning agents, dermal fillers and Botox at home and in salons, and some are lax about hygiene. These beauty treatments go beyond piercing, and tattooing, which are, or should be, licenced activities, and sitting at the edge of regulation frequently include rather backstreet and thus unlicensed outfits where there is a risk from untrained providers, poor hygiene standards and thus of infection from the use of dirty needles.

Sharing needles can spread blood-borne diseases like HIV and hepatitis C, and NICE is updating its advice for England and Wales accordingly. The guidelines, which are out for public consultation, aim to encourage people to use sterile needle and syringe programmes to stem the spread of infections. Fair enough, but we should make our voice heard regarding disposal of used sharps and drug residues.

As of today, the consultation documents should be available on the NICE web site. However, at the time of writing these are not yet available but please do check there later and make your voice heard to ensure the highest standard of sharps safety in a manner that is both safe and practicable.

 

 

Neil Spooner has been fined for allowing waste to be dumped on his farm. A court heard how hospital waste was among the items found when environmental health inspectors visited Spooner’s property near Margaretting.

The man’s farm became a dump when he allowed waste, including medical items, to be tipped and stored there without an environmental permit.

It would be of great interest to see evidence of quite how much of these “medical items” were identified and what if any evidence existed to identify these as being of hospital origin. Continue reading “Neil John Spooner fine for enviro-crime” »

On the Clinical Waste Discussion Forum we frequently report regarding issues – let’s be ‘honest’, and call them failures - in the standard of clinical and related wastes management on wards and in the various departments, and further as these wastes pass sometimes precariously along the disposal chain to await uplift for final disposal.

Now it seems, the tables have been reversed and an NHS hospital has been the victim of fly-tipping.

Around 3.5 tonnes of building waste has been fly-tipped in the grounds of Stanmore’s Royal National Orthopaedic Hospital.

Somewhat regrettably, a householder has been fined more than £2,800 after inadvertently paying criminals to get rid of his building waste from home renovation works that was instead fly-tipped in the grounds of Stanmore’s Royal National Orthopaedic Hospital. Continue reading “Hospital is fly-tip victim” »

The world is rightly concerned about the presence of prescription drugs in natural water sources. Everywhere you look, in wastewater discharges from hospitals, in lakes and rivers, and in drinking water, drug residues can be found.

Some address patient requests for unnecessary prescriptions in order to reduce the impact on disposal, and save money too, though a focus on issuing the prescription and greater care by GPs would be far more appropriate. Still others prefer to place controls of wastewater discharges from hospitals, sometimes with a heavy hand of regulation and threats of penalty if anyone is caught disposing pharmaceutical wastes into a drain. Rightly so, but as we have discussed previously on the Clinical Waste Discussion Forum the problem is entirely different, with the bulk of pollutants leaving the body in urine. And, of course, patients in the community consume and subsequently excrete prescription medicines. Continue reading “Prescription drug residues in natural water sources” »

The Isle of Man is a popular and busy island with a large and well-equipped central hospital and many other small sites of arising for clinical and related wastes. Where does it all go?

Some small fraction is shipped off the Island for specialist incineration, this being mainly pharma and cytotoxic wastes. The remainder was being incinerated in a small incinerator located on the site of a large and efficient W2E facility receiving municipal and selected agricultural wastes.

The clinical waste incinerator can’t cope. It is inefficient to operate it continuously so there are considerable commercial, practical and environmental factors to consider, and difficulties caused by repeated start-up and cool-down cycles. When it is operating it meets emission control limits but the diversity and lack of feedstock creates problems from discontinuous use. Overall, the facility is unduly costly, difficult to operate effectively, and inefficient.

Proposals to move low-risk clinical (healthcare and/or offensive/sanitary) wastes to be fast-tracked to the W2E facility are coming to fruition.

Operators of the W2E plant have applied for a temporary licence to burn clinical waste in the main incinerator. There are questions that the plant’s second incinerator – which is currently used for burning clinical waste – is working and helping to generate electricity. But plant operators SITA Isle of Man says it needs to be shut down for maintenance and they’ve applied to use the main incinerator instead for burning hospital waste.

The secondary incinerator was designed to process up to 5,000 tonnes of clinical, animal and oil waste. It struggles.

We cannot give too much detail of the existing arrangements or plans for future configurations of waste management of the island since Blenkharn Environmental had a central role in resource identification and planning, and in the identification of future disposal options.

The plans make best use of the most efficient and environmentally sound waste treatment resources, to provide an effective solution to the Island’s needs and self-sufficiency.

 

 

There are many studies estimating the amount of clinical waste produced per bed per day. That figure varies by day of week and season, by type of hospital and by ward type (paediatrics, geriatrics, maternity, surgery, medicine etc). There are also differences dictated by location, with some countries generating more or less clinical waste, dictated by approaches to care and the use of disposables, and by the regulatory framework that sets definitions of what is and what isn’t clinical waste.

An informal and as yet unpublished study of waste outputs in the Kingdom of Saudi Arabia show that their hospitals generate 127 tons of biomedical waste every year. This equates to 1.13-kg biomedical waste per bed per day, and an average of 0.08 kg produced per visit to a medical centre (GP, minor treatment centre or private health provider).

These data, though not yet in an academic journal, add to the body of existing data on clinical (or medical or healthcare or biomedical) waste outputs in various countries. The data are invaluable for resource planning, and when compared against similar data from other countries can provide useful pointers toward approaches to improved waste minimisation, waste segregation, packaging and transport, treatment and disposal.

 

 

We cannot forget the many failings in satisfactory clinical waste management reported on the Clinical Waste Discussion Forum with reports from the UK, from north and south America, Europe and Asia, the ISC, Middle East, Australia and New Zealand.

However, to date northern and Eastern Europe has been excluded though we might find it hard to believe that an absence of reports equates to uniformly good practice.

Not all failures are critical in nature, though of course some are. Many point to a general and more diffuse decline in hygiene and safety standards, or poor management performance. Others are, we hope, one-offs.

But some are truly awful. As in the case of reports coming to us from Siberia, of vast quantities of yellow sack clinical waste from several Omsk hospitals dumped on the surface of a landfill site and part-burned in situ. To make matters worse, the bag were left to stand for days or longer and contained tissue wastes including aborted foetuses. This provided carrion for wild dogs and for birds, who fed openly on the remains.

It is claimed that the bags were wrongly dumped by a company called “Institute of Ecological Problems” – and you just couldn’t make that up, could you?  Just what sort of problems were they contracted to create?

 

Placenta disposal is a huge problem. Bulky, rather messy with a predictable habit of dripping blood unless packaged properly, and rapidly decaying into a rather unpleasant mush, there seems no end in the inexorable rise in birth rate and thus of placentae needing disposal.

In resource poor counties this can be far more of a problem than here in the UK, though there are always more interesting ways to manage placenta disposal.

If cooking your placenta doesn’t appeal, take it home and bury it under a bush with a touch of some new age.

At one time, the pharmaceutical industries would pay for a chest freezer and periodically collect placentae for processing of hormones that are now produced biosynthetically at the cutting edge of molecular biology. So now there are few real answers that can deal with the vast numbers of placentae to be disposed daily. Resomation is a viable option but has never really caught on.

In the Philippines, innovation has resulted in a busy metropolitan hospital in the Philippines is using a biodigester to generate methane from placentae and food wastes. Novel, practical, and environmentally sound, it may look a bit Heath-Robinson but is none the worse for that.

The biodigester has been constructed at the Perpetual Succor Hospital, in the centre of Cebu City in the Philippines. It generates methane gas from the waste produced by the hospital, including garden and food waste and placentae. The gas produced is then measured, collected, and used to power the hospital in a sustainable and efficient way. Since February, the hospital has been harvesting the methane for cooking, and there are plans to start using it to power the laundry rooms.

Fantastic work, and a great credit to all of those involved, though regrettably if we tried to do the same back here I fear some functionary from the Environment Agency would work diligently to find reasons to prohibit such developments simply because it doesn’t fit the tick box mentality that pervades the regulatory framework dictating clinical and related waste disposal practices.