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.



The Environment Agency has issued its Regulatory Position Statement 160, “The sterilisation and cleaning of waste medical instruments containing metal for recovery”

Further useful information is available on the website, though since this concatenation of separate websites under a common banner it seems near impossible to find what you need.


Choice framework for local policy and procedures (CFPP) 01-01: guidance about the management and decontamination of reusable medical devices








Tissue waste disposal is a perennial problem. Incineration is the obvious though not only solution, but it is the problem of prior packaging, segregation and waste handling that creates some, perhaps most, of the problems.

Now a Dutch man has found a solution, at least for him. He had an above knee amputation decided not only to retain his amputated leg, but to make it into a lamp.

Presumably he was unsatisfied with the outcome, or perhaps in it just for the money.  Whatever the circumstances, he has decided now to offer the leg lamp for sale.

Will it cost an arm and a leg?



Needle with drop of bloodOn the Clinical Waste Discussion Forum we have often reported on needle finds in a diversity of locations. Parks and gardens, playgrounds, car parks, alleyways and beaches etc are commonly affected locations. Though we will continue to report those which we believe carry some particular interest or learning point there are so many of these, occurring daily, that it no longer becomes newsworthy unless these happen to involve your own locality.

So now, it becomes not where, but how many?

And to kick things off, how about the Birmingham park from where volunteers picked up no less than 700 needles!

More than 700 needles have been found during a community clean-up of a Birmingham park.

Empty bottles of methadone were also found among the narcotics gear at Highgate Park by volunteers who spent ten weeks clearing the grounds to “restore some pride” to the neighbourhood.

The abundance of dangerous drugs paraphernalia prompted one exasperated visitor, called ‘Neil’, to leave a note to addicts pleading with them to stop.”

Read the rest of this entry »

Health Technical Memorandum (HTM) 07-01 is a guide for those involved in the management and disposal of healthcare waste.

Several emails have been received from people struggling to find this document on any of the original web sites that were carrying it – Department of Health, Environment Agency etc, since the UK government completed the brining together of its various department websites under a single brand.

Further confusion arises from the different versions form England, Wales Northern Ireland and Scotland, each coming to you with its own ‘bloat’ so make sure you have a fast and reliable network connection!

For the record, download the English version here,

…the Welsh version here,

…the Northern Ireland version here,

…and Scotland here


All absolutely free!




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:


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. Read the rest of this entry »

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 ( starting at 9am tomorrow, Friday, July 11th and can be viewed here:>.

The hearing will be recorded and can be downloaded after noon, Saturday, July 12th at: 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




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.