Hundreds of thousands of pounds are wasted in north Norfolk due to medicine wastage.

Said to be due to patients’ stockpiling medicines this could not be further from the truth.

Holt Medical Practice said unused medicines from its patients alone cost about £15,000 a month, or £180,000 a year. Nationally, more than £300m of the £13.8bn spent on prescribed medicines each year is wasted. The lost money could fund an extra 11,700 community nurses across the UK.

So, the Holt Medical Practice has issued an urgent plea to patients to only order what they need, and has called on people to let their doctor know if they stop taking their medication.  And made fools of themselves in the process!

Where do the drugs come from?  Not from the supermarket or local corner shop, but from prescriptions issues by the GPs of Holt Medical Practice and others who fail in their duty to prescribe carefully and conscientiously.

That is a palpable breach of duty, and the root cause of medicines waste accumulation.




The Ministry of Health of Kuwait has established a special department for medical waste treatment encompassing two divisions, one that deals with incinerators’ issues and the other with follow up and training, said a ministry official.

The remarks by the Head of the department of medical waste contracts, Ghanim Al-Sabeeh, were made during a seminar on evaluating the quality of terminating medical waste, hosted by the Audit Bureau.
The follow up division is specialized in training Kuwaitis via local and abroad workshops on maintenance, he noted. The ministry is planning to close ten old incinerators nearby hospitals, except the one near the psychiatric hospital and opening two in the north and three in the south instead, the official said.
Meanwhile, he noted that the ministry is facing some difficulties in the process of terminating medical waste, including the lack of spacious areas to establish new incinerators and the delay in receiving waste from the source itself, that is hospitals and health clinics.
The seminar is part of the eighth meeting of the Arab Organization of Supreme Audit Institutions (ARABOSAI), hosted by the Audit Bureau.
Good luck to all. This seems like the start of a well thought out approach to healthcare waste management.
Blenkharn Environmental, clinical waste, clinical waste discussion forum, clinical waste disposal, development, incineration, medical waste, regulation, waste management, waste regulation, waste treatment, training

Tissue waste disposal will generally necessitate high temperature incineration, or perhaps Resomation.

Highly regulated more for aesthetic reasons than for concerns regarding infection – though even the most amorphous blob of tissue may has come from an HIV or Hepatitis B or C positive patient.

Particularly troublesome are placentae simply because of the matter of scale – the Office of National Statistics records 698,512 live births in England and Wales in 2013 though this had decreased by 4.3% from 729,674 in 2012.  But that is still a hell of a lot of placentae for disposal.

Presenting other practical problems because of size and weight are the amputations of a limb. Finding the right container can be tricky but fortunately this is not a frequently occurring waste disposal challenge.  But when it does happen, waste packaging and disposal, and everything in-between must be done properly.

A Miami, south Florida, man is suing a hospital for emotional distress, saying his leg was amputated and thrown in the garbage with his name tag still on it.  The 56 year old had his right leg amputated below the knee in October at Doctors Hospital in Coral Gables.

“Rather than properly disposing of the plaintiff’s limb as expected and as required by Florida law, Doctors Hospital threw the Plaintiff’s amputated limb into the garbage, with tags indicating it belonged to the Plaintiff,” according to the lawsuit filed on Wednesday in Miami-Dade County Circuit Court.

A month later the patient’s family was contacted by homicide detectives investigating if he had been the victim of foul play! Read the rest of this entry »

South Tyneside council is to scrap domiciliary clinical waste collections.

Announced on their website, the move is no doubt predicated on concerns regarding cost.

As an alternative, households producing sharps wastes are advised to “contact the District Nurse or other healthcare professional who will be able to advise on their correct disposal”.

“Any other medical waste such as dressings, bandages nappies etc. may be placed in your normal refuse bin, but please bag securely beforehand”.

This move will undoubtedly save money, and that is no bad thing. But I wonder what might be the cost of incorrectly disposed wastes, spilling from black bags or slipped into household recyclables that cause health and safety concerns and/or bring picking lines at the recycling hall to a standstill as a sharps bin bobs along the conveyor?

Time will tell if this change in approach will really save money, when viewed as a bigger picture, or just push costs from one budget holder to another?  And in the middle of this there is firstly, that patient who must struggle that little bit harder to manage their wastes – not a problem for many but a likely challenge for the housebound and chronically ill. Can social services – also funded by the local authority – cope with this additional burden?

Secondly, I foresee problems for waste handlers and others working for the local authority refuse services who no longer have the protection of a clear colour-coded warning of the possible hazards associated with these wastes.  The line of reasoning may follow the naïve ideas of the Environment Agency who in its earlier guidance could not foresee ‘any risk of infection associated with clinical wastes from an orthopaedic ward as these patients have a generally low incidence of infection’, ignoring of course the inevitability that individuals with Hepatitis B or C or HIV infection break bones too.  Astounding incompetence from their technical adviser and others who draft this nonsense, that was  quietly withdrawn and redrafted after this was drawn to their attention.

Time will indeed tell if this policy change by South Tyneside will work safely, since that must be the key determinant.  Other local authorities may well follow suit, while the Environment Agency sit quietly and do nothing at this possible risk and potential ‘violation’ of their guidance.

Let us hope there are no serious accidents.




In a news report describing plans for a recycling plant to be established on the site of a former Dundee school there is but one interesting claim, that the site will accept clinical waste?

Of course, few if any community recycling sites will touch clinical wastes – I know of one only, and they will take offensive/sanitary waste in extremis, for those who have not yet got proper arrangements for doorstep collections.

But why is this so rare, that community recycling sites accept at least some fractions of clinical waste. The obvious solution would be for sharps, presented face to face in a sealed approved ISO standard sharps bin.  This would allow staff to check that the sharps are packaged correctly, and perhaps issue replacement sharps containers as required, while ensuring sharps are not ‘dumped’ inappropriately.

This would reduce the burden to Local Authorities in occasional domiciliary clinical waste (sharps) collections, and may ease disposal for regular sharps users such as insulin-dependent diabetics.

Everyone wins. So, what’s the problem?




A workshop/interaction program on Hospital Waste Management was organized by Butwal Sub Metropolitan city with the technical support of Friends Service Council Nepal (FSCN) on 14th February 2015.

The main objective to organize this interaction was, to disseminate the information, knowledge and its hazardous counterpart impact delivered to the entire community and ultimately to the whole nation by medical waste. The targeted strata of this workshop was health professionals, health institution, person involved in hospital waste.

It seems that Nepal has a very active and properly structured training and regulatory framework intended to ease the country toward maintenance of an effective clinical/healthcare waste management infrastructure.

The Clinical Waste Discussion Forum has previously reported the approach to training in waste management in Nepal.

Congratulations and good luck to them all.





“A man who authorities think dumped vials of blood and used syringes into the Arkansas River was charged Friday in connection with the theft of medical waste from a Tulsa hospital.

“Garrett Gibson, 27, of Ralston was charged in Tulsa County District Court with unlawful possession of controlled drugs with intent to distribute, larceny of controlled drugs and larceny from a structure, court records show.


It remains quite obvious why sharps bins are stolen from hospital premises. The search for syringes and needles is easily satiated, while every now and again they might hit pay dirt and come across a prefilled but only part used syringe containing a narcotic analgesic or other controlled drug.

Clearly, it happens in US, and it still happens in the UK. We make it easy, with clinical waste carts unlocked, left overnight in unsupervised and accessible locations.


Do we store waste with the required security provision? It really is time to repeat the clinical waste survey!









Most clinical waste will be placed into an orange sack, with some in yellow or perhaps a Tiger bag.

But surely not black?

Well, no, except in Arun District where the local authority says of clinical waste collections:

Clinical waste collections

“Medical dressings and incontinence waste are classed as clinical waste and should not be disposed of with the normal rubbish. We offer a free domestic collection service for these items. Please contact us on 01903 737754 to discuss your requirements and set up the service. The collections will be weekly, and you will be told your collection day upon booking. For the first week, you will be asked to put the waste into a black sack and label it clearly as clinical waste. You should leave it on the door step (or in the bin store for flats) by 07.00 on the correct day, when it will be collected and replaced with a new yellow bag. If the bag is not out when the collector arrives we will not return until the next week. If you will not need a collection for a few weeks, please contact us to tell us otherwise your collection may be cancelled. Please do not put needles in the yellow bag, if you have a need to dispose of sharps, please request a sharps collection.

Sharps collections

“Needles and other sharps should not be placed in with the normal rubbish or clinical waste. Instead, they should be contained in a special box. To set up a free domestic sharps box collection please contact us on 01903 737754 and we will arrange for one to be delivered to your property. Once this is nearly full, please contact us on the number above. Seal the box by pressing the access flaps into a fixed position and leave it on your doorstep before 07.00 on the specified day. If you are in a block of flats, it should be left in the bin store. The box will be collected and a replacement will be left.


So for a new sharps collection, Arun can get out and deliver a sharps bin before the first collection, but not for soft wastes. That those soft clinical wastes will, under instruction from the Council, be placed in a black sack, seems to be a recipe for trouble.

And why is Arun District Council issuing yellow sacks at all? What happened to orange, or is all of the clinical waste in Arun of a higher risk category? I wonder if they would be so understanding if a resident mixed up their household refuse and recyclables?

But anyway, perhaps black is the new orange, or yellow, or whatever?


Clinical waste sack, yellow, tied




Landowner’s anger as council refuses to remove drugs waste

Christopher Davies found used needles and drug taking equipment on his land in Rhydfelin. He has found used needles and other drug taking material on his land has hit out at the authorities for not helping him.

Christopher Davies, who lives on Heol-Y- Bryn at the top of Rhydfelin, only noticed the “dangerous waste” on his land last weekend.

When he saw there were used needles among the rubbish, he contacted Rhondda Cynon Taf Council to ask them to get rid of the waste, but he said they refused as they said the waste was on private land.

Christopher, 46, said: “I live on the side of Eglwysilan mountain. In the winter, I hardly go on the land but in the summer I usually take my grandchildren up there.

“Last Sunday, my grandchildren noticed there were children playing on the land and as it’s my land, I went up to shoo them off, which is when I noticed a tent and lots of rubbish.

“I’ve since found out from a local farmer that the tent has been there since Christmas.

“When I looked closer at the rubbish, I noticed there were used needles and tin foil and things used to take drugs.

“I didn’t want to touch any of this as it’s contaminated, dangerous waste. So I contacted the council but they won’t help me remove it.

“I pay more than £2,000 a year in council tax and they’re saying there’s nothing they can do. I don’t know what to do with it as I don’t want to touch it because it’s so dangerous.”


In fairness to the Council, they make it abundantly clear that they, as all other Councils, do not accept liability for the removal of drug waste and needles etc from private property.

They may take action against the property owner when it is believed that the public will be at risk, and really should take a rather more pragmatic approach toward needle finds on private residential property where some idiot has tossed a used needle over a garden wall.

However, for private land owners the responsibility for and cost of clearance cannot be passed to the Council or anyone else, at least unless a culprit has been found and a civil claim is successful. Some chance.




In the US and Canada, it is apparently illegal to stand still and protest. Instead, we witness the rather ridiculous snake of people walking almost aimlessly in a loop while they protest.

At least is shows commitment and effort.


The interviewee in this link is clear that this clinical (medical or healthcare) waste is a danger to their community. Perhaps they expect blood running down the road and giblets on the floor?

What is not recognised, quite obviously, is that the waste they are so concerned about is that same waste that sits in a red, orange or yellow waste sack in the corner of their hospital room or at locations throughout their ward, the clinic or GP surgery. In these location, they give it not a second thought. Nothing jumps out to attack them. With some straightforward common sense precautions, there is no risk.

And so it is at a waste processing site, whether incineration of ATT. A properly managed site creates no risk for residents ort he environment, though we would come down hard of any site not working safely, as is the purpose of a mandatory licensing process and regulatory oversight.

With a rational explanation, this protest and other protests at planning and licensing application can be pacified, and neutralised. This requires knowledge and understanding, and goes beyond the skill set of the waste industries.

But perhaps with a microbiologist, that’s where we come in ……




A dozen NHS Grampian workers have successfully sued their employers after being injured by needles at work.

Staff faced months not knowing whether they had been hit with infections such as HIV and Hepatitis C following their injury.

NHS Grampian confirmed that payments were paid to the 12 staff after legal claims were lodged on grounds of stress suffered during the “agonising” wait.

While all of the workers received the all-clear following testing, undisclosed sums were agreed given their ordeal.

Exclusive figures show needlestick injuries were one of the most common personal injury claims made against the health board by staff over the last three years.

Litigation expert Julie Clark-Spence, a partner at Balfour and Manson in Aberdeen, said clients often faced months of uncertainty following such injuries.

She said: “We act for a number of individuals who have suffered needle stick injuries.

“Clients are often faced with an agonising wait for test results following injury because of potential exposure to blood-borne viruses. Many are under a great deal of stress and anxiety whilst tests are being carried out.

“Clients are subject to regular blood tests and immunisation which can take many months to conclude.”

Martin McKay, health spokesman at Unison in Aberdeen, said much work had been done to reduce the number of needlestick injuries.

However, he added that staffing shortages at the board may have contributed to the claims.

He said: “There have been vast improvements made in the past decade to reduce these injuries but incidents still occur.

“We believe the protocols put in place have vastly improved the safety of staff.”

“We have had a difficult few years at NHS Grampian and there have been well documented staffing and recruitment issues.

“Sometimes these issues may be factors in some cases.”

Strict rules govern the safe disposal of needles but the kit can become misplaced, with cleaners and laundry workers amongst those at risk.

A spokesman for the board said, if a needled had already been used on a patient, the patient would be traced and blood tests carried out on them.

The injured worker would then be offered appropriate immunisations with their blood stored for future testing, depending on the outcome of the patient’s screening.

The spokeswoman added: “We take the safety of our staff very seriously. Staff are encouraged to report all incidents and we use this information to improve safety all the time.

“We are by no means complacent and we continue to study accident reports in order to learn lessons.”


The mandatory introduction of engineered sharps safety devices was intended to reduce the rate of sharps injury.

Indeed, that has occurred but as we predicted several years ago safety sharps introduction has introduced a degree of complacency among users, particularly at the point of disposal. Data are not available to ascertain whether or not this has resulted in a consequential increase in the number of sharps injuries among ancillary staff and waste handlers. However, that increase does seem quite likely.

There are many situations during blood taking and injections where sharps injury might occur despite safety engineered devices. When a patient jumps or recoils suddenly, with agitated patients, and perhaps just being unlucky can lead to a sharps injury despite good practice.

There is evidence that a few trusts have reduced sharps training for some groups of staff presumably due to time and cost constraints, maybe through the arrogance of senior staff who will not attend training sessions, and in the expectation that safety devices have reduced the need. There may be issues also with the quality of this training, that properly focusses as much on disposal as use of sharps, this being an aspect of least concern for busy healthcare staff.

There remains an issue of staff being unfamiliar with a different type of safety sharps device when moving between employers resulting in a transient increase in sharps injury rate.

Even worse, some trusts are reported still to implement safety sharps use, apparently for reasons of costs.

Despite pressure for safety sharps starting among users, healthcare professionals and their professional bodies and later by the learned bodies and trades union groups, and through specific legislation, universal protection has not been achieved. The impetus is beginning to wane, perhaps only slightly, but that downward trend does not help.

Mandatory reporting of sharps injury incidents and near misses under RIDDOR has not been accepted by HSE, presumably because it would simply be too much work. Thus, HSE sits on its hands and the UK sharps injury legislation remains more or less on the shelf.

Perhaps the reality of costly legal action, or simply the threat of legal action, will reinvigorate sharps injury prevention among healthcare professionals, ancillary staff and waste handlers, and all of those others who might come into contact with sharps. We can but hope.


see also Sharps in the Clinical Waste Discussion Forum



The information given by suppliers, in their catalogues or on-line, can guide users or lead them far up the garden path.

So it is with this medical equipment and supplies provider advertising orange, located on the web today, Saturday 21 February 2015.



The small print associated with this offering assures the purchaser that the sack is:

  • Unique colour indicates that contents can be recycled, autoclaved or sent to landfill
  • Clearly printed with UN markings to signify clinical waste
  • Available in medium and heavy duty gauges and in a number of sizes
  • Supplied on rolls for convenient dispensing
  • Ideal for use with clinical waste bins MSC0270, MSC0271 and MSC0272.
  • Ideal for use in a first aid rooms – helps comply with HSE guidance document L74


Of course, if one of these filled sacks appeared at a recycling facility or a landfill site alarm bells would ring, klaxons sound, and lights flash as everything grinds to a standstill for clean-up and investigation. Someone, somewhere, would be for the high jump.

Going further, the supplier claims that it’s use would be ideal for use in a first aid room, where a Tiger bag could be more appropriate, and to help comply with the HSE guidance document L74.

L47 First Aid at Work. The Health and Safety (First Aid) Regulations 1981: Guidance on Regulations 2013. ISBM 9780717665600 is an important document though in the case of a recommendation for orange waste sacks, it is a yellow sack specified in L74. Perhaps both suggestions are incorrect, certainly for the average first aid room dealing with otherwise healthy adults and children with sprains, cuts and grazes etc.  As we know, it is essentially a risk assessment that is necessary, with in most cases will conclude that a Tiger stripe bag is most often the appropriate choice.

Oh dear. Oh dear. Oh dear!




IMG_1633There has been much publicity concerning the enforced closure by the CQC of the Merok Park nursing home in Surrey.

It is reported that conditions were little short of appalling, but high up on the list of problems, as so often, are issues with clinical waste.

The report states:

Staff (including the cleaner) had not had infection control training and there were no cleaning checklists. Staff had left soiled clinical waste in open bags in a bathroom and the outside clinical waste bin was unlocked which was a serious infection control risk.”

Clearly it is inappropriate to read too much into an individual CQC report since we did not see what the observers saw on the day of inspection. [The image is for illustrative purposes only and not linked to this CQC report or nursing home]

However, an open clinical waste bin – it should have been a tiger bag – in a patient bathroom is not unusual or inappropriate. It should be in a clean holder, secure yet in a location that is not likely to obstruct or trip users, and replaced periodically. If waste accumulated slowly, use a fresh but smaller waste sack and aim to replace daily. If that is still too much, I would support less frequent replacement as long as it not odiferous or otherwise offensive; every 2 or 3 days might suffice.

What concerns me most is the “outside clinical waste bin … unlocked which was a serious infection control risk”. Well, if you jumped inside and rolled around in the waste, perhaps it would be an infection risk. But that undermines the obvious, the cart or bin should have been locked. There is no excuse.

Now, go around any NHS establishment and there is a high probability that carts are stored outside, and in an unsecure area. If there is a lockable compound it probably will not be locked. Carts inside may have locked that are engaged, but in at least 1/3 of premised these locks will not be engaged. So too for those carts used for satellite storage. Worse, depending on the contractor and/or region, some carts will have defective locks or no lock at all.

Contractors will blame their users who deliberately break locks, but the responsibility for repair rests with the contractor. Ideally, users and contractors finding a defective lock should mark this to indicate a repair is needed, and the cart should be taken out of use until that has been completed. If extra keys are required by users, provide them, and if defective carts are delivered, reject them.


Sounds good, doesn’t it? We will all keep our eyes open for this particular problem, and bring things up to a satisfactory standard. But will it happen?

Don’t hold your breath.



With uncertainty and, by the sound of it, a bit of a rumpus about who should fund about domestic clinical waste collections and thus who is responsible for pulling the plug on the service, patients are complaining bitterly as they are left in the lurch.

The decision to stop the contract, taken on the orders of London-based NHS England, shocked medical supervisors, local councils and MPs. NHS England has now promised to investigate , after some prompting from local reporters, but don’t hold your breath or expect a straightforward answer.

The mainly kidney dialysis patients were unaware of the decision until by-products of their therapy were not picked up in the New Year. The move has outraged doctors and patients often unable to dispose of the waste which is banned from domestic rubbish collection. And as so often is the case, patients receiving long-term care in their own home try so hard to comply with safety rules and regulatory requirements and have every right to be concerned, having been left out of the loop.

The service users pictured here, from a report in the Lancashire Telegraph, are obviously struggling with a garage full of yellow sacks. But what about others, who do not have space in a garage, no garage or other free space, perhaps living in an apartment or tower block?  What idiot failed to plan before making this change?

MPs Graham Jones, Gordon Birtwistle and Jack Straw have written to Health Secretary Jeremy Hunt demanding he sort out the mess, branded a health risk by Lancashire Telegraph doctor Tom Smith. Let’s hope someone pulls out the Ministerial finger very soon indeed.

  • Have you been affected by funding changes such as this?
  • Are you told to put waste that was previous collected as clinical waste into a black sack for disposal?
  • Are you a Local Authority or other collection service provider/contractor feeling this cut in funding?
  • What are you doing with sharps waste?

Please do let us know, so that we can help keep everyone concerned properly informed and add pressure to the push to speedy and satisfactory resolution.










Water UK has updated and republished its “guidance” regarding healthcare waste water discharges that might apply to healthcare premises and might no doubt be extrapolated to healthcare waste treatment facilities also.

The document has no legal status, despite a clear attempt to present it as such. It is the work of a 100% commercially funded trade representative body.

There is nothing inherently wrong with that. It might be considered at least to hint toward best practice but is badly flawed, letting itself down by a palpable lack of knowledge regarding hospital practice, drugs and drug administration. Those who are responsible for the next version of this document, hopefully to be produced without delay, should seek a suitably experienced healthcare Read the rest of this entry »

In a long-overdue move, the depth and extent of which has yet properly to be seen, HSE is to carry on with – or is that pick up the threads of? – its programme of local authority waste management services inspections after a report found that 14% of councils were ‘non-compliant’.

There is much to be done as standards of safety, including hygiene and biological safety matters, have slipped noticeably as margins are sliced ever thiner.

Regrettably, it is those important and not insubstantial but diffuse hygiene and waste management activities of litter picking, clinical and hygiene waste services areas and cleaning in public lavatories, Local Authority care homes, hostels etc that are unlikely to be considered for inspection. Perhaps HSE is simply unaware that these activities exist, or unaware of their impact. Most likely, it is simply the intention to aim for the low hanging fruit and concentrate of routing kerbside collections, recycling services etc, since this might deliver a bigger impact on limited funding.

But accidents and near misses continue to happen, and these cannot be overlooked, intentionally or otherwise, by HSE, by the Environment Agency and Environmental Health Officers. These are dangerous jobs, and the health & safety of employees should be paramount. If the regulators don’t make an effort, its hard to see how the employers might be encouraged to do so.




A new compact energy solution has been launched that will enable hospitals to turn contaminated syringes and other medical devices into heat.

DPS Global has unveiled its ST Series, which offers health trusts an alternative to sending clinical waste to landfill.

The technology involves staged and separated pyrolysis and gasification of healthcare waste to produce small amounts of ash and heat. This enables hospitals to utilise their waste as a substitute for fossil fuels, thereby reducing CO2 emissions and heating bills by as much as £100,000 a year. Read the rest of this entry »

It has been in the news a lot recently, and we have discussed this previously on the Clinical Waste Discussion Forum – to ponder upon when a blob of tissue becomes a foetus and at what stage it is reasonable to expect some formal religious or other service?

It is a hugely complex matter? How many weeks gestation before any formal arrangements for disposal as a [potential] human being? Who should make those arrangements, and who should pay? When to ask Mum? Too soon and it may cause unnecessary distress, and likewise if left too late. What about those untold millions of foetuses discarded from terminations of pregnancy? And does a clinical waste incinerator differ that much from a cremator?

It seems remarkable that some women seek to claim months if not years after loosing a pregnancy, though that is not to say that the grief might be any less. Others choose simply block out all memories and feel worse when thing are raked up at some later stage.

It can be a no win situation, and one that is leaving hospitals with another and very considerable expense.

To remove at least some of the doubt about where any line might be drawn, the keynote case of Maric v Croatia concerning a hospital’s disposal of a stillborn child as clinical waste has been heard by the the European Court of Human Rights which held, unanimously, that there had been a violation of Article 8 (right to private and family life) of the European Convention on Human Rights.

The case concerned the disposal of a stillborn child as clinical waste by a publicly-owned hospital and, in this case, the father’s complaint that he was then unable to obtain information about the resting place of his child.

After appeal, the Court concluded that the disposal of the body of the stillborn child together with clinical waste, leaving no trace of the remains or their whereabouts, was not in accordance with the law, and constituted a violation of Article 8. Thereby, the Court held that Croatia was to pay Mr Marić 12,300 euros in respect of non-pecuniary damage.

Read the Press Release here

This helps clarify the current situation, though leaves many uncertainties as listed above.  All-in-all, is it any more clear as to the expectation under this ruling of the ‘rules’ disposal of foetal remains after stillbirth or abortion?

Realistically, nobody is likely to seek those clarifications since the cost to do this would be prohibitive. Therefore, it is likely that hospitals will have to continue with their evolving practice of arranging the disposal of all aborted foetuses via a Local Authority cremator and scattering the ashes in a suitable place, keeping records indefinitely, and bearing the cost.

But first, Mum will have to be asked. That will cause upset and perhaps unnecessary distress. Decisions made may later be regretted, and some cooling off period must be matched by storage of the remains before disposal in case there is a change of mind. And for those who choose to make their own arrangements, suitable mortuary storage until arrangements have been made and the remains are transferred to the care of an undertaker.  And when Mum finds out how much the undertaker plans to charge, she may well change her mind!




Rich countries should help poorer countries deal with the risk posed by pharmaceutical contamination of the environment, says an Australian expert.

Dr Rai Kookana, an environmental chemist with the CSIRO, made the comments following the release of a study published in a recent issue of Philosophical Transactions of the Royal Society B.

The study is the first to compare the risk of pollution from drugs, including antibiotics, anti-inflammatories and antidepressants, in high-income and lower-income countries around the world.







EU rules for waste medicines should be harmonised and strengthened, Health Care Without Harm (HCWH) has claimed, after a survey of six member states revealed a wide discrepancy in collection practices.

Under the 2004 medicinal products directive, member states must implement appropriate collection schemes for unused pharmaceutical products. But the directive gives no guidelines on how to implement such schemes.

European guidelines and an EU-level reporting mechanism are needed, the pressure group HCWH said on Monday. How they propose that should be funded is not mentioned, and probably not even though of. Almost certainly, the cost of harmonisation would be massive and unsupportable in most EU countries without a hefty subsidy from other members who at present are themselves feeling the pinch. Read the rest of this entry »

The Care Quality Commission (CQC) has branded Cerne Abbas Care Home in Dorset as inadequate in all areas in a report published 2 December 2014.

The watchdog visited the facility in July 2014 and has now published its findings. The CQC says since its inspection the home has now closed.

It said the home was poorly maintained and put people at risk of harm. A total of 38 people were living there at the time of the inspection.

The CQC looks at five key areas, safety, effectiveness and if the service is caring, responsive and well-led. All were deemed inadequate.

Among other observations, the inspection report noted that:

“Armchairs, wheelchairs and walking frames were not clean some were covered in general dirt and grime. Some parts of the home, especially atrium, smelt of urine.

“We saw that the clinical waste bins outside of the home were unlocked and there was an accumulation of used continence aids and used plastic gloves. This demonstrated that the home was not being effectively cleaned which meant that people were at risk of healthcare acquired infections through cross contamination.”

It is this latter point that attracts our attention. Go to any NHS hospital and somewhere you might find an unlocked and accessible healthcare waste cart; in a substantial number of hospitals, most or all carts will be unlocked and accessible, 24 hours a day, for anyone who cares to delve within.

Clearly, the regulation of healthcare premises, and in this case of private sector operators, is not the correct place for supervision and enforcement of healthcare waste management standards or of infection prevention and control performance. It is in some respects a last resort, in circumstances where the Environment Agency and Department of health, Local Authorities and HSE must work collaboratively to ensure that these basic standards of waste management performance are adopted and maintained.

Clearly, since the 2006 Clinical Waste Management Forum/Blenkharn Environmental healthcare waste management audit, it standards of performance are getting no better

see Standards of clinical waste management in UK hospitals




A new and updated version of the PHE publication Eye of the Needle: United Kingdom Surveillance of Significant Occupational Exposures to Bloodborne Viruses in Healthcare Workers is published this month.

Available for download here.

The Royal College of Nursing has commented in the way of all other Trades Unions, to highlight the continued risk of exposure of nursing staff to bloodborne viruses from sharps injuries, with figures [from Eye of the Needle] showing a rise in staff reporting these incidents.

This is despite the availability of safety-engineered devices and new rules promoting their use, noted Public Health England in its Eye of the Needle report.

It found the number of staff exposed to bloodborne viruses via sharps injuries increased by a third from 373 in 2004 to 496 in 2013. Around 80% of the 4,830 incidents reported over the period involved doctors, nurses and healthcare assistants.

Of course, the RCN make the strong case for their members but do not make comparisons on an entirely direct level field since, as they allude to albeit obliquely, reporting rates are now considerably increased such that the reported rise rate of injury may be more apparent than real.

It is important to highlight that many NHS Trusts are still dragging their heels in the implementation of safety-engineered sharps safety devices.

If that legally required but now overdue roll-out of safety sharps were to be completed, the incidence of sharps injuries might be reduced considerably. It might also help ancillary and support staff, and waste handlers, all of whom are unrepresented in the PHE report, who suffer sharps injury from carelessly discarded sharps that find their way to waste sacks.

As we have noted previously on the Clinical Waste Discussion Forum, sharps injury to ancillary and support staff, when estimated against number of persons employed, is around 10x greater than for nurses and up to 30x greater than for physicians.

Take care, take great care!



Clinical waste – including human tissue, organs and limbs, contaminated surgery room implements and laboratory waste – are ending up in the South Hedland landfill, according to WA Country Health Service and the Town of Port Hedland.

The North West Telegraph understands all general and clinical waste from the hospital and associated health services at the Hedland Health Campus are disposed of at the local tip, rather than being incinerated.

But despite being a dumping ground for body parts, among other things, WACHS regional director Ron Wynn said he had never received reports of human tissue being unearthed at the site.

He said the disposal of such waste at the landfill was carried out in accordance with the Town’s environmental health regulations.

“General waste from the hospital and associated health services at the Hedland Health Campus poses no greater risk than general household waste sent for disposal at the Town of Port Hedland landfill,” he said.

“Clinical waste is disposed at a separate area of the Town of Port Hedland landfill in accordance with the Town of Port Hedland environmental health regulations.

“The hospital and health services at the Hedland Health Campus’ general and clinical waste disposal methods comply with the requirements of the Environmental Protection Act 1986 and the Environmental Protection (Controlled Waste) Regulations 2004 and the Town of Port Hedland environmental health regulations.”

Mr Wynn said there were strict conditions for incinerators and there was no licence for burning clinical waste in the Pilbara.

Town chief executive Mal Osborne said the class 2 licence for landfill allowed it to accept clinical and biomedical waste.

“We have separate disposal points for household, industrial and special waste. Special waste includes asbestos and medical waste,” he said.

“Only authorised personnel are allowed in this area. Stringent requirements are in place around the management of this pit, including appropriate coverage, compaction and registration of waste products.

“The hospital is also required to provide advanced notice to the landfill of incoming waste.

“If we think a certain type of waste can’t be disposed of at the landfill, we refer to a technical consultant for the correct disposal method.”


It is easy to forget, despite remote parts of the UK from Cornwall to the Scottish Islands managing their clinical and other hazardous wastes, that in Australia and indeed on other continents many communities are so incredibly isolated. With costs for effective ATT and incinerator waste treatment facilities so high, landfill disposal of untreated wastes has to continue despite our move away from such practices elsewhere.



GE Healthcare says a study examining the environmental impact of its +PlusPak polymer bottle has superior environmental benefits compared to its glass counterparts.

Healthcare clinicians traditionally use glass bottles for storage, handling, and disposal of contrast imaging agents for X-ray and MRI procedures. Traditional glass bottles have challenges, as clinicians risk breakage and possible injuries, loss of product, cleanup needed upon breakage, as well as the cost of proper disposal after use.

GE’s life cycle assessment study compared the polymer bottle to traditional glass bottles, and showed that polymer bottles can provide the following advantages including: Read the rest of this entry »

An excellent Guidance Note on the packaging and transport of waste from suspect and confirmed cases of the Ebola Virus is published by The Health Protection Surveillance Centre (HPSC), Ireland’s specialist agency for the surveillance of communicable diseases.,14932,en.pdf





The Environment Agency (England) have launched their consultation on the hazardous waste guidance document WM2. The deadline for responses is 3rd February 2015 and the consultation is now open.

The consultation can be found by following this link:

Remember, that WM2 guidance has been in part hopelessly flawed and correcting even the worst of these errors is an uphill task, in circumstances where the might of the Environment Agency turns to prevent any admission of fault on their part.  Do have a look at the WM2 revision and respond accordingly, in the hope that your views will be taken into consideration.

Of course, Environment Agency ideology will be much in evidence and changing that will be an even greater struggle. So, don’t hold your breath for any change based on this consultation!


On September 30, a US administrative law judge upheld seven citations and $186,000 in fines for a uniform laundry service that exposed workers to hazards from bloodborne pathogens and lead. Read the article to learn where the company went wrong and how you can avoid making the same mistakes.

The initial inspection took place in 2011 in response to a complaint. OSHA inspectors found that workers at the facility picked up and sorted dirty lab coats and other laundry from customers who regularly drew and/or tested blood. The workers were exposed to lab coats and laundry potentially contaminated with blood or improperly disposed contaminated needles or syringes mixed in with the laundry. In spite of this exposure, the company failed to train its employees in OSHA’s bloodborne pathogens standard and to provide Hepatitis B vaccinations to drivers and loading-dock workers.

In the September 2014 ruling, the judge determined that the majority of the company’s employees neither received the Hepatitis B vaccine nor signed the form declining the vaccine. In some cases, employees were not given the option to receive the vaccine for months or years after beginning work at the facility.

The judge also determined that the company did not comply with OSHA standards requiring the use of biohazard bags.

more at:


Regrettably, this case is unlikely to set any state or national legal precedent. Nor is it likely to prompt for similar proceedings in the UK and Europe where specific bloodborne pathogens legislation does not exist but where existing health and safety legislation would suffice.

The analogy between laundry workers and waste handlers is obvious, and we know only too well that improperly packaged clinical wastes are responsible for blood exposure of ancillary and support staff and of waste handlers. Does the law, guided by regulators from HSE and EA, really care?



Ebola waste is a huge problem, but fortunately the heat resistance of Ebola virus is not particularly great. Autoclave treatment would suffice, and of course incineration. Added to this is the newer small-scale Pyropure pyrolysis system that can be used close to the point of production thus limiting any potential for inadvertent spread of infection.

It seems that the US is making a bit of a meal of planning for Ebola waste management, but with so many government agencies and individual states setting their own standards, its perhaps not unexpected. Despite this, no doubt all will work well, and those managing Ebola waste will remain safe.

Of course, public opinion can sway matters.

“US states refuse to take incinerated Ebola waste with fear – not science – blamed for leaving ashes in limbo a month after items belonging to Thomas Duncan were burned.

“It took a crew 38 hours to clear out the Dallas apartment where a Liberian man was staying before he was diagnosed with Ebola in September. Workers in protective suits piled shoes, carpets, mattresses, bed sheets and clothes into 140 55-gallon drums. Only a few items were salvaged: a computer hard drive, legal documents, family photos, an old Bible belonging to Thomas Duncan’s grandmother.

“The drums were packed, decontaminated and then carted away by Cleaning Guys environmental services employees.
The contents were incinerated. But nearly a month later, the ashes sit in limbo at a facility in Port Arthur, Texas, according to Veolia North America, the company that owns the facility, as Louisiana officials fight to keep it out of a landfill there.

“While the federal Centres for Disease Control and Prevention says incinerated Ebola waste poses no danger, Louisiana officials have asked a judge to block the waste of Mr Duncan from entering the state, saying they wanted to determine for themselves that it was not dangerous. A hearing is scheduled for November 5.

“The unresolved fate of the ashes highlights the problem American hospitals and communities could face in disposing of their own Ebola waste.Hospitals routinely deal with hazardous medical waste, sealing, transporting and disposing of vials of HIV-infected blood or boxes of used syringes.

“But Ebola waste is more problematic because of the intense fear of the virus and the sheer amount of the waste, which could include patients’ clothes, their mattresses and scores of protective outfits worn and discarded by medical workers.

Read more at:




Nobody would disagree with the sentiment that UK doctors have and ‘ethical duty’ to prevent waste. All that is missing is the reality of lean practice and waste minimisation.

“Doctors have an ethical duty to prevent waste in the NHS, argues a report by the Academy of Medical Royal Colleges.

Its authors point to potential savings of nearly £2bn. Examples include better use of medication, tests, hospital beds and operating theatres.

The British Medical Association said doctors were ideally placed to identify savings, but patients must come first.

The health secretary said he was determined to tackle avoidable waste in healthcare.

The report is based on the premise that one doctor’s waste is another patient’s delay, and may even mean treatment is withheld.

The authors argue it is better to develop a culture of finding the best way to do something, and then do it right across the health service.

There are 16 examples of changes to clinical practice which have saved money and benefited patients.

They include medication reviews to prevent adverse drug reactions, which account for 6% of all hospital admissions. The report says eradicating this problem would save £466m.

It also suggests more than £200m could be saved by stopping unnecessary scans.

Other recommendations include:

  • Prescribing lower-cost statins, which could save £85m
  • Reducing unnecessary face-to-face contact between patients and healthcare professionals by using technology such as e-mail and Skype
  • Cutting the number of X-rays for lumbar spine or knee problems, which could save £221m
  • More frequent consultant ward visits to ensure patients can be discharged promptly

The report does not provide a definitive total of potential savings, but indicates what a change in culture – where doctors resolve to eradicate waste – could potentially deliver.


All well and good, and nobody would argue against what has been a particularly hot topic in America for the last 2 – 3 years. The UK report simply echoes the US situation.

And there is no reason whatsoever why this waste reduction should not extend to a reduction in material waste, and while we are at it an improvement in waste segregation at source and so on. But that is perhaps not quite so newsworthy.

What is particularly surprising about this report is the number of column inches it has gained in just a few days. BBC and other TV news services, radio, and national newspapers have all carried the report. But for those working hard to achieve some improvement in the far less ‘sexy’ healthcare waste reduction, source segregation, sharps and waste safety etc, support is so hard to find.

Perhaps we just don’t have the PR support of The Academy of Medical Royal Colleges?

Whatever the answer, this most recent publicity can do nothing but help overall. Quite how much remains to be seen.




Hospitals worldwide are be unprepared to safely dispose of the infectious waste generated by any Ebola virus disease patient to arrive unannounced in the country, potentially putting the wider community at risk, biosafety experts said.

In the US, waste management companies are refusing to haul away the soiled sheets and virus-spattered protective gear associated with treating the disease, citing federal guidelines that require Ebola-related waste to be handled in special packaging by people with hazardous materials training, infectious disease and biosafety experts told Reuters.

Many US hospitals are unaware of the regulatory snafu, which experts say could threaten their ability to treat any person who develops Ebola in the US after coming from an infected region. It can take as long as 21 days to develop Ebola symptoms after exposure.

The issue created problems for Emory University Hospital in Atlanta, the first institution to care for Ebola patients here. As Emory was treating two US missionaries who were evacuated from West Africa in August, their waste hauler, Stericycle , initially refused to handle it. Stericycle declined comment.

Ebola symptoms can include copious amounts of vomiting and diarrhoea, and nurses and doctors at Emory donned full hazmat suits to protect themselves. Bags of waste quickly began to pile up.

Ebola has become a global problem. Clinical waste from Ebola cases, of which there will be many more, and from those secondary and suspect cases arising worldwide, will generate massive amounts of high risk waste.

That waste must be treated. But by whom, and where?

Individual hospitals will have no capacity for suitable on-site treatment, apart perhaps from taking the waste to the local hospital laboratory and autoclaving it there. However, those autoclaves would not necessarily be suitable for waste processing, not performance tested to the same degree as required by the Environment Agency, and not licensed for waste processing.

A red bag for these wastes will not offer any additional protection!

Local treatment undertaken as close as possible to the patient facility will reduce risk of any incident.

Bags are convenient since they do not provide a complete seal. This cannot reliably be addressed by double bagging which merely offers two incomplete seals. The outside surfaces must be treated with disinfectant making handling more difficult. Run-off should be contained as this may be contaminated, irrespective of concerns regarding chemical residues.

Rigid waste containers might offer leakproof seals but not all such ‘leakproof’ waste bins can actually deliver this, though at least they are easier to handle and would generally remain upright, reducing the risk of spillage.

Undeniably, local treatment will reduce the risk of exposure. Those handling wastes must be properly protected by suitable PPE which in this case necessitates far more than a pair of gloves and a high viz tabard.

Few local waste treatment units exist. The Pyropure pyrolysis device looks promising, and small freestanding autoclaves might be installed but if patient numbers increase and waste outputs grow, capacity may be limited. An approved treatment option is required and overall the Pyropure device looks like a winner, if approval for this purpose is confirmed and the company can ramp up manufacture, installation and testing to met expected demand.

Treatment residues must be separated from untreated waste to avoid unintended release of untreated wastes, and for this the Pyropure device would win hands down. But whichever process is applied there will be some residues. These should be completely safe, but I might anticipate some hesitation to accept these residues for onward disposal – similar concerns arose during the foot and mouth outbreaks though with the sight of all those carcasses burned in open pits put this into context and soon resolved the matter.

CDC and others are close to issuing guidelines for safe disposal of Ebola waste and it would not be surprising if these were adopted worldwide. That’s fine, but there will be significant compromise and therefore lesser standards of safety if the necessary resources are not available locally.