HCWH Releases New Global Inventory of Healthcare Waste Management Technology Suppliers

To aid in the procurement of appropriate technologies, Health Care Without Harm first published an inventory of non-incineration healthcare waste treatment technologies in 2007. The new version has been fully updated and provides listings of suppliers from one hundred and six countries, from Albania to Zimbabwe. Many of the suppliers also ship globally. As well as the most widely applied technologies, such as autoclaves, the listing covers several different steam and heat based technologies, such as microwaves and frictional heating, and chemical based technologies like ozone disinfection, and alkaline hydrolysis, which can safely destroy pathological wastes and laboratory cultures. For the first time, it also includes new categories such as needle or syringe destroyers, which can prevent many of the needle stick injuries which happen during the disposal of syringes.

Ruth Stringer, International Science and Policy Coordinator for Health Care Without Harm said “Procuring the right technology can be a very time consuming task, and not everyone who is tasked with purchasing is aware of the variety of alternative technologies available. We have worked hard to include as many suppliers as possible to make this task easier for those looking for alternative medical waste treatment technologies.”

New companies enter this dynamic market all the time, and existing ones updating their products periodically. To make sure that the inventory is as up to date as possible, Health Care Without Harm is also working on an online database, which will be released later this year.

  • The Global Inventory of Alternative Healthcare Waste Treatment Technologies can be downloaded from here.
  • Suppliers wishing to provide new information to be incorporated into the forthcoming online database can write to: medwastealternatives@hcwh.org


HCWH, clinical waste, Blenkharn Environmental, autoclave, incinerator, ozone treatment, pyrolysis, clinical waste discussion forum, clinical waste disposal, development, healthcare waste, medical waste, needle disposal, pharmaceutical waste, sharps disposal, syringe disposal, waste management, waste regulation, waste treatment



ApplauseIn a generous act of compassion Hampshire based technology developer, PyroPure, is to donate one of its on-site medical waste pyrolysis systems to West Africa in a bid to help stop the spread of the Ebola – particularly amongst health professionals treating victims of the deadly virus.

The company’s latest move follows a World Health Organisation (WHO) report that found that the devastation is much worse that initially feared.

In a recent statement the WHO said that “the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak” and that “the outbreak is expected to continue for some time”.

PyroPure’s system features a 100 litre chamber, which is enough for around two regular bin bags of waste. To treat the waste it uses both pyrolysis, in which the waste is heated in the absence of oxygen and gasification where the waste is processed in the presence of very little oxygen.

According to Andrew Hamilton, chief executive of PyroPure, the chamber up to around 500°C – 600°C and all the organic waste vaporises, primarily into CO. That gas is then put through a catalytic converter, which at around 400°C converts the CO and other tars and polluting gases into clean CO2.

The system is said to be capable of transforming 6kg to 12kg of any type of organic waste into a handful of residue, while recovering energy in form of heat and safely sterilising the waste.

The move to send one of its machines to West Africa follows the recent call from Peter Selkirk, the company’s executive chairman, for UK hospitals to rethink their approach to hazardous waste disposal in the wake of the outbreak. (See WMW Story)

“Whilst our gesture only represents a small part of a huge operation we hope that the contribution goes some way to halt the outbreak,” Selkirk.

PyroPure said that it is currently assembling an in-house team who will travel out to West Africa to install the system and train health practitioners responsible for handling hazardous and potentially infectious medical waste.

Well done, Pyropure






WyboneAt best, hospitals are rather soulless places. With stark design, neutral – or is that bland? – colour schemes, and limited furnishings further justified now to aid infection prevention, even a few brief days in hospital can be soul destroying for adults.

For children, this is ever more so and must surely contribute to, in some cases, a significant additional psychological burden adding to that caused by separation from Mum, Dad and friends, and the distress of all those horrible smells, sights and sounds, the medicines and other treatments.

Improved visiting arrangements for children’s wards may matters a little easier, and in the newer build hospitals designers and planners have recognised the need for a more friendly environment and do brighten up the environment. Regrettably, others seem to rely solely upon the same tired adhesive prints of Disney carton characters stuck to walls and doors. It may distract a 3 year old, at least for a few minutes, but older children derive no comfort from this.

And then, whatever the approach to environment design and furnishings, it becomes necessary to plonk one or more healthcare waste sack holders in that environment. Can there appearance be improved?

Wybone have a solution to this with their zoo animal bin stickers. Nice idea, assuming that the stickers are sufficiently robust to survive daily cleaning without deterioration and peeling at the corners.

The stickers look attractive, and would work equally well on any existing sack holders without the additional cost of buying an entire set of new bins. Its a clever idea, and do note that the main image colour reflects the sack designation of green, orange, yellow or black in order not to detract from the visual prompt for source segregation. Continue reading “New designs for hospital waste bins” »

The problem of bio-medical waste management has been felt globally with the rise in deadly infections. The main hindrance to sound health care waste management programme is lack of training and suitable skills, lack of resource allocation and lack of proper equipment.


This course has been developed to create basic awareness about health care waste management practices and prepare the learners with required skills for efficiently managing health care waste and safe guard themselves and the community against adverse health impact of health care waste.


After the completion of the course, jobs can be found in Hospitals, Waste Management Recycling Organizations and Government Agencies. Students could work as Hospital Administrator, Environment Regulator, Manager, Superintendent etc.


Please check very carefully and consider the academic accreditation of any course before enrolment.






The U.S. Court of Appeals for the Ninth Circuit will hear the Pharmaceutical Research and Manufacturers Association of America (PhRMA), Generic Pharmaceutical Association (GPhA), and Biotechnology Industry Organization (BIO) appeal of the district court ruling in favor of Alameda County’s Safe Drug Disposal ordinance, which requires pharmaceutical companies to design, fund, and operate a medicine collection program.

This hearing will be the fifth of five cases on the docket (http://1.usa.gov/1jgZYR8) starting at 9am tomorrow, Friday, July 11th and can be viewed here: http://1.usa.gov/1zrUrvO>.

The hearing will be recorded and can be downloaded after noon, Saturday, July 12th at: http://www.ca9.uscourts.gov/media/view_video.php?pk_vid=0000006491 Search for the case number: 13-16833.

Check the links above for live streaming and later a recording of the hearing.


The NHS has unveiled plans to cut up to £300m worth of medicines waste from its budgets.


Overprescribing is the problem. Too quick with the pen to write a script, sometimes for the wrong drug or incorrect dose, and then too often the prescription is repeated, over and over.

Each time the NHS gets sight of its drug budget and estimates wastage, every time the adverse effects of prescribed drugs reaches the top of the agenda, every time  disposal costs become an issue the realisation dawns. The NHS is prescribing too many and too much drugs.

Almost inevitably, it is described as the patients’ fault, having the temerity to demand a prescription for some minor symptom, or daring to ask for a repeat prescription.

But wait. Who controls the issue of a prescription? Blaming the patient for the consequences of bad prescribing by GPs and hospital doctors is simply absurd, though may be a good headline maker and demonstrate some action toward remedying the problem.

This latest NHS approach can be found here:

Medicines Optimisation Prototype Dashboard

It seeks to do the same as previously, though using more words and a bit of IT support. But it is still patient focussed. The patient is the problem in the eyes of those who have constructed this latest approach, but barely a word about insisting that the prescriber smartens up their act.

As we have noted previously on the Clinical Waste Discussion Forum, it seems bound to fail as all previous attempts have failed to make a dent. And at what additional cost?

see also Reducing antibiotic resistance – better prescribing for less waste

see also High cost of island healthcare waste disposal

see also Cutting medicines waste through prescription control

see also NHS Isle of Wight drug waste reduction

and more generally http://www.ianblenkharn.com/?s=prescribing




A courier delivery van disguised as a meals on wheels vehicle has been exposed as cover for Chinese traditional medicine peddlers, who used it to collect human placentas from hospitals whilst pretending to deliver meals to patients.

The placentas were taken from hospital by crooked medics who sold them to the traditional medicine men when they turned up in the food delivery service van.

The valuable medical waste, which was packaged up in meals on wheels styrofoam boxes, was seized at a highway toll station near in the city of Ji’an in eastern China.

According to officials, the driver of the mini van where the placentas were loaded said that he was delivering a special seafood service for hospital patients.

But a routine search soon turned up the bloodied bags containing the remnants of human birthing procedures.

“It was disgusting,” said one officer. “They buy this stuff illegally from people working in hospitals. They then send it off to remote workshops where it is dried and ground down into all sorts of medicines designed to make one strong, potent, wealthy – you name it.”

The Chinese Ministry of Health declared years ago that human placentas must be designated as medical waste and destroyed. It is forbidden for any organisation or individual person to trade in human placentas including transporting them.

But such is the hunger for traditional medicine that the laws are flouted across the country and it is estimated thousands of placentas are illegally sold and processed every week.

The minibus driver was fined for carrying his illegal cargo and is currently co-operating with police attempting to track down the gang.





The Sion police probing into the case of medical waste seized on Thursday will be questioning the owners and staff of SMS Logistics that have been given the contract to dispose the hazardous refuge by the BMC. The cops will also write to the civic body, asking it to take action against contractors flouting rules.

Traffic police blew the lid off an organized racket concerning hospital medical waste, sparking health concerns. During a nakabandi [road block] at Sion, the traffic police intercepted a tempo containing medical waste that the driver planned to resell instead of disposing. The driver, Mujahid Shaikh, 40, and his cleaner, Inayat Khan, 27, have been arrested. Both are Mankhurd residents.

Officials from the Matunga traffic division had conducted a nakabandi at BA Road in Sion on Thursday. “We came across a tempo smelling off antibiotics and stopped it on suspicion. The tempo was carrying a board which said that it was an ‘on-duty BMC’ vehicle, which it wasn’t. The tempo was carrying discarded gloves, syringes, bags, bottles etc. The driver admitted that he had purchased the medical waste, at the rate of Rs 15 per kg, from a company contacted by a south Mumbai-based hospital for disposal,” said senior inspector Sujata Patil, Matunga traffic division.

Around 5pm, the two accused and the tempo were handed over to the Sion police. “We will investigate if the hospital was aware of the racket,” said an official from Sion police.

Sion police have registered a case under sections 171 (wearing garb or carrying token used by public servant with fraudulent intent), 275 (sale of adulterated drugs), 336 (act endangering life or personal safety of others), 420 (cheating), of IPC. They will be produced before a magistrate court on Friday.



A doctor accused of dumping confidential information about his patients in his neighbour’s bin in Tunbridge Wells is waiting for his fate to be decided by a jury.

The doctor, who runs the Wells Medical Centre in London Road, is accused of throwing away of sheets of personal data, containing details of medical treatment and phone numbers, as well as medical waste such as syringes boxes and latex gloves, in his neighbour’s bin on two occasions.

He pleaded not guilty to failing in his duty to transfer commercial waste to an authorised waste carrier and to create and retain a waste transfer note on March 1 and June 14 last year, as well as failing to provide waste documents on March 17 following notice served by the waste regulation authority.

Read more: http://www.courier.co.uk/Jury-Tunbridge-Wells-doctor-dumped-patients-info/story-21193109-detail/story.html#ixzz33sZD4zxU

Using sharps containers to dispose sharp waste is emerging as a standard practice in various healthcare institutions. These containers are used for disposing off the sharp wastes, like needles etc immediately after their use in order to prevent injuries. According to a new report by RNCOS, “Indian Medical Sharp Container Market Assessment and Forecast 2018″, with the growing number of healthcare establishments in India, coupled with increasing awareness regarding disposing the sharp waste in the right manner, the demand for medical sharp containers is increasing in the country.

According to our report, sharp wastes are generated from hospitals, diagnostics centres, nursing homes, and other healthcare institutions. These wastes pose risk of causing health hazards to humans and spread infectious diseases such as HIV and Hepatitis B. Over the past few years, the awareness related to risks involved with sharp waste is increasing in India; hence, providing the required boost to the growth of sharp container market. Further, the government of India has made it mandatory to follow the ‘Bio-Medical Waste (Management and Handling) Rules’, in which all the healthcare institutions are legally bound to use the bio-medical waste containers for waste disposals. Thus, the medical sharp containers market in India is witnessing growth.

Our recent market research report on Indian Medical Sharp Container covers the current and future market forecast of sharp container, their demand in application areas (hospitals and pathology labs), along with their regional demand analysis. It further depicts the macro & demographic indicators, industry drivers and trends to provide a clear picture about the growth prospects of the market. Besides, the report also covers the tax structure and government regulation levied on sharp containers. The challenges hampering the growth of the market have also been highlighted in the report. Further, the market strategies that should be adopted have also been outlined. A brief overview of the market from the point of view of manufacturer, covering details of supply chain management, pricing and fast moving containers have also been covered in the report. Additionally, it includes business overview and a snapshot of capacity-wise price range of major manufacturers’ sharp containers in India.


This is good news, but does not tell the entire story.

What happens to filled sharps bins? Are they being treated/destroyed and put safely beyond use, or quietly disappearing to find their way back into re-use?

News of increasing sharps bin use is heart warming but without certain destruction to put used sharps safely beyond re-use the task is incomplete and lives remain at great risk.

Blenkharn Environmental has worked hard for many years, to identify and improve the safe handling and storage of clinical wastes, in the community, in hospitals, and by waste contractors.

Few others seem to bother, as this was always an issue far from the oversight of regulators and far too expensive to do properly. But in recent years, CQC has identified though its inspections many failures in clinical waste handling and storage in healthcare premises. This includes unsafe handling and storage of wastes, and poor hygiene standards that results in blood splashes on waste containers – all issues previously identified in our research and available from our Publications page.

These issues have become an easy target, perhaps rightly so as they are indicative of systemic hygiene failures and unsafe practises.

The latest to fall foul of these inspections is Lewisham Hospital. There will soon be many more as this provides an easy target for regulators. Many failures overlap with the requirements of the Environment Agency and HSE, both of whom have conscientiously sat on their hands for years and instead chosen the easy pickings of the clinical waste management companies.

Unfortunately, the consequences of those failures must now be overturned, and it will take time. It is some years since the second and most recent clinical waste survey. Perhaps it is time to do it all again? If we do, the results will appear here on the Clinical Waste Discussion Forum.

see also Clinical waste errors at West Middlesex Hospital

see also Clinical waste errors at West Middlesex Hospital

see also Plastic surgery clinic falls foul of regulator




An Oregon waste-to-energy facility has cuts ties with “aborted-baby hauler” Stericycle.  The US waste-to-energy facility has been forced by the county in which it operates to cut ties with a Canadian provider of biomedical waste after the story broke globally last month that some of that waste allegedly includes the remains of babies destroyed by abortion in B.C. facilities.

The Marion County Board of Commissioners moved to cancel the county’s contract with biomedical waste-hauler Stericycle, despite the company that owns and operates the waste‐to‐energy facility claiming that aborted babies are not being burned for electricity. Continue reading “Pressure mounts on Stericycle” »

International Expert on Healthcare Waste Management Issues

This vacancy will based in Kazakhstan. The individual must have a mid-level experience in healthcare waste treatment. Excellent writing English skills are essential. Knowledge of Russian would be an asset. The successful candidate will prepare recommendations on analysis of current situation on healthcare wastes prepared by the national expert, and recommendations on its improvement. S/he will review of international experience in healthcare waste management and monitoring. The incumbent will prepare recommendations on adapting best available technology for use in Kazakhstan.

more at https://www.devex.com/en/jobs/international-expert-on-healthcare-waste-management-issues-44516/secure?mem=ua&src=job







Not for the first time, inspectors have found evidence of poor hygiene and safety practice at Ninewells hospital.

In its entirety that need not concern us, but one section of the Healthcare Environment Inspectorate (HEI) report, abstracted by a local newspaper report, reveals:

Inspectors found there was “poor compliance” with procedures for managing sharp objects such as needles, with bins for them contaminated with blood on the outside. Two were overfilled and the HEI said NHS Tayside must address the problem to cut the risk of injury and infection to patients, staff and visitors.

In all, inspectors found 4 sharps bins in use having blood splashed on their external surfaces. But that ins not surprising. Blood on the outside of sharps bins, and in the vicinity where they stand is to be anticipated. It requires care in use, and effective cleaning of the area around, underneath and behind the sharps bins, but not of the bins themselves.

To do any more would itself be hazardous and should be avoided. But to change a large sharps bin after one use, when a splash of blood appears around its neck or on some other surface, is equally wrong. How to prevent, avoid, or reduce this soiling is the important question. Likewise inspectors, and cleaners too, must look around the sharps bin, as splashes appearing on the bin itself inevitably point to contamination of the wider area, with blood and with pharmaceutical residues.

We at Blenkharn Environmental and at the Clinical Waste Discussion Forum have been banging on about this for several years, including this issue in our research and teaching, in our audits and inspections, and in publication (below). It is a common and widespread problem to which their is no immediate and easy resolution.


Blenkharn JI. Blood splashes around sharps bins: hygiene failures in the clinical environment? International Journal of Hospital Environment and Hygiene Management 2012;1:1-9











An RCN guidance document entitled “The management of waste from health, social and personal care” is now available for download from https://www.rcn.org.uk/__data/assets/pdf_file/0008/571427/004187.pdf





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







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).


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.