News items
July 2008 NEW	Scirus Topic page - Clinical Waste Scirus Topic Pages is a free, wiki-like service for the scientific community, where scientific experts summarize specific scientific topics, and where links to the latest, most relevant journal literature and web sources are presented on one page. Having been invited to produce a Scirus Topic Page on the subject of Clinical Wastes I am pleased to report that this is now live. Though the Scrius description of Topic Pages makes reference to similarities to Wikipedia, the on-line encyclopedia, Scirus Topic Pages are not intended to be a vade mecum but rather to present an automated portal for scientific reference location* and themes relating to matters of current concern. http://topics.scirus.com/Clinical_waste.html?navbar=off * Automated reference retrieval is managed by Scirus.com and the Scopus service
July 2008 NEW	Are you looking forward to your holidays? Airport dermatophytoses As summer approaches we must all be thinking of our vacation. Despite escalating costs due to currency fluctuations, fuel surcharges and and bags that seem to fly off in a direction different from our own, arriving at the airport marks the start of two weeks or rest and relaxation. Check in. Seat allocation. Say goodbye to your luggage (perhaps for ever) and head off to Passport and Security Control on the way to Duty Free where you might pick up a bargain. But while waiting patiently in the security hall, ponder this.  With anything from 15% to 100% of passengers required to remove their shoes as they pass through the scanner you may pick up something quite unexpected. The floor surfaces in the airport security hall, either vinyl or carpeted, will accommodate up to 3,000 pairs of feet in the narrow pinch point either side of the scanner. Thanks to a security requirement to remove shoes for X-ray examination, many pass through in bare or stocking feet. The dermatophyte fungi that cause athletes foot infection (tinea pedis) are readily deposited by affected individuals walking over hard surfaces or carpets. Socks or nylons neither prevent deposition, not protect against picking up those fungi and the development of infection in others. Standard cleaning regimens for airports will have almost no impact on fungal contamination of airport floors and as the season peaks the floor becomes a rick reservoir of fungi each looking for a new foot to infect. The current security situation that dictates enhanced screening of passengers is likely to increase the spread of athletes foot fungus. Sadly, this may be the unavoidable price we must pay for improved air safety. It will certainly be an unexpected, and unwelcome, holiday souvenir for many travellers. Happy holiday. A paper on this subject is to appear soon in the journal Public Health and a reprint will become available soon. Please contact Ian Blenkharn for further information.
June 2008 NEW	Clinical wastes in the community: Local Authority management of discarded drug litter Despite comprehensive multi-agency management of complex social, criminal, and health issues surrounding illicit drug use, substance abuse continues to escalate. Previously limited to deprived inner city areas, most communities now record rising numbers of intravenous drug users with increases of drug litter carelessly discarded in the environment, particularly in parks and gardens, and public toilets. Bloodborne virus transmission with Hepatitis B (HBV) and Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV), is the primary hazard. Needlestick injuries continue to occur, often involving children. Seroconversion and life-threatening infection is uncommon, though post-exposure prophylaxis and extensive follow-up is necessary and this may precipitate prolonged and debilitating stress for the victim and family group. How well do Local Authorities perform in dealing with discarded drug litter? The approach of many Authorities fails to safeguard public safety and does little to encourage public support or provide reassurance to communities. Incomplete or misleading and often frankly dangerous advice to those finding drug litter in the Community is common, and response times far below the required standard. The results of a comprehensive audit of Local Authority approached to dealing with drug litter in the Community highlight the poor standard of information provided by Authorities, the confused and confusing instructions to finders, that sometimes are frankly unsafe and risk injury of the finder. Clinical wastes in the community: Local Authority management of  discarded drug litter. Public Health 2008; 122: 725-728   Please contact Ian Blenkharn for a reprint.
June 2008 NEW!	Sharps injuries to waste handlers Sharps injury rates among waste handlers suggest continuing failures in disposal by healthcare staff. Are your staff at risk? Despite considerable effort in reducing sharps injuries among users, in the design and construction of sharps containers, and of PPE for waste handlers and others dealing with clinical wastes including hospital ancillary staff, sharps injuries continue to occur at a rate of approximately 1:29,000 man hours. Blenkharn JI, Odd C. Sharps injuries in healthcare waste handlers. Ann Occup Hyg 2008; 52:281-6 Please contact Ian Blenkharn for a reprint.
May 2008 NEW!	Testing for latent blood contamination We can now offer a proven and highly sensitive assay for the detection of latent blood contamination. Useful as part of an assessment of workplace or healthcare hygiene and bio-safety, the approach to testing is rapid and discrete, non-disruptive and can be accommodated within established work patterns. New and unique to Blenkharn Environmental The assay is highly sensitive, and is able to detect old and fresh blood including dried blood residues, and will detect trace blood contamination invisible to the naked eye. With low light conditions, testing can in many cases be complete in situ, or sampled for later testing with almost no loss of sensitivity of the assay. Testing can be extended to include the use of safe and non-toxic marker products that can be used in simulation studies to provide a more comprehensive assessment of actual and potential contamination and dispersal, and of the extent of secondary or cross-contamination. This provides invaluable additional information, and is useful as an adjunct to staff training in personal and workplace hygiene and safety. [more] Please contact Ian Blenkharn for further information.
April 2008 NEW!	Needlestick injuries in primary care In response to a paper from Wales that examined the risks to community healthcare staff including GPs and practice nurses, it is apparent that the risks to waste handlers are significantly greater and that the incidence of sharps injuries may in fact be higher. This brings to the attention of community medical groups the risks to waste handlers, identifying the need for prompt specialist care that is rarely if ever available in the Community, and of course the need for greater care from sharps users. The paper is appear soon in the Journal of Public Health and a reprint will become available soon. Please contact Ian Blenkharn for further information.
April 2008 NEW!	The 9th edition of the Clinical Waste Discussion Forum Newsletter has been sent to subscribers, and is available for download
April 2008 NEW!	Clinical wastes in the community: Local Authority management of clinical wastes from domestic premises The increasing numbers of patients receiving often complex home-based healthcare, and the growing number of insulin-dependent diabetic and home haemodialysis or continuous ambulatory peritoneal dialysis patients, contributes to the substantial volumes of clinical wastes generated from domestic premises. Sadly, though perhaps predictably, the arrangements for the collection and safe disposal of these potentially hazardous wastes, generally managed by Local Authorities, may be inadequate and in part unsafe. To assess the quality and availability of services, an audit of the web pages of the 526 Local Authorities in England, Wales, Scotland and Northern Ireland. Web pages were scrutinised for information concerning clinical waste collections from domestic premises, the limits and constraints on this service, service accessibility, the practical arrangements for collection of wastes, and the health and safety issues of clinical waste management for patients who manage their own care in the community. 262 of 526 (50%) Local Authorities provided information on their web sites concerning the collection of clinical wastes from domestic premises. Others referred patients onward to a District or County Council, to another agency, or to private contractors (n=72), while the remainder provided an in-house collection service. Weekly collections were most common, though several Local Authorities offered addition flexibility depending on need. By contrast, limits on the minimum or maximum volumes of waste to be collected, or of the types of clinical wastes accepted for disposal, do not support domiciliary healthcare and create an additional burden for patients and their carers. Of particular concern was the health and safety implication of instructions to place potentially hazardous clinical wastes in a freely accessible location outside the home, at the doorstep or on the footpath, as early as 4am on the day of collection or the night before collection! It is clear that the arrangements for Local Authority clinical waste collections from domestic premises are in part inadequate and may be unsafe, and do not properly support domicillary patients or their carers.   Clinical wastes in the community: Local Authority management of clinical wastes from domestic premises. Public Health 2008; 122: 526-31 Please contact Ian Blenkharn for further information.
April 2008 NEW!	Forensic detection of latent blood; an approach to rapid wide-area screening combined with simulant studies A novel techniques has been developed to detect and map the distribution of blood splashes with concomitant simulant studies to identify high risk procedures,  equipment failures etc.  with assess the eDespite considerable effort in reducing sharps injuries among users, in the design and construction of sharps containers, and of PPE for waste handlers and others dealing with clinical wastes including hospital ancillary staff, sharps injuries continue to occur at a rate of approximately 1:29,000 man hours. The note is accepted for publication in the Journal of Hospital Infection and a reprint will become available soon. Please contact Ian Blenkharn for further information.
February 2008 NEW!	The International Federation of Infection Control has listed the Clinical Waste Discussion Forum as key resource for Infection Control professionals
December 2007	The 8th edition of the Clinical Waste Discussion Forum Newsletter has been sent to subscribers, and is available for download
December 2007	Change to methodology enhances Geobacillus stearothermophilus and Bacillus atrophaeus sterility control of industrial steam, ethylene oxide and dry heat sterilisation processes - reporting times reduced to 24 hours To provide a more rapid and responsive sterility control testing service for industrial steam, ethylene oxide and dry heat sterilisation processes changes to core methodologies will soon be implemented. Releasat® is an SGM Biotech Inc biological indicator culturing kit optimised for SGMStrip® paper strip biological indicators (tested using FDA approved methods). Comprising tubes of specially formulated soybean casein digest culture medium containing a colour indicator that turns a dramatic yellow when spores grow, these highly optimised broths provide visual results within 24 hours (steam) or 72 hours (EO) as opposed to the standard 5 – 7 days. Each lot of Releasat culture tubes are quality control tested with appropriate SGMStrip spore strips and relevant positive controls are included with every batch. To date, spore strips have been processed in tryptic soy broth with bromocresol purple indicator (TSB + bromocresol purple broth, Raven Biological Laboratories Inc) and incubated at 56ºC for 5 days. The new Releasat® system will make results available within 24 hours, or 72 hours for ethylene oxide sterilisation systems, to provide a much improved and more responsive sterility control service. Please contact Ian Blenkharn for further information.
September 2007	The 7th edition of the Clinical Waste Discussion Forum Newsletter has been sent to subscribers, and is available for download
July 2007	Hygiene and waste management in UK hospitals: are self-reported compliance scores always valid? Evidence from audits of healthcare (clinical) waste management in UK hospitals performed in 2005 and 2006 had revealed generally poor standards of performance. In many hospitals, unlocked clinical waste carts were common, with many carts overflowing, with gaping lids and spilled items lying free at their base. Individual clinical waste sacks and sharps containers were frequently left on the floor, both within hospital buildings and in the hospital grounds, apparently due to a lack of sufficient waste carts and an inadequate frequency of collections for transfer of wastes to a secure central storage compound. The current annual health check report published by the Healthcare Commission reports that 93% of NHS Trusts (n=368) declared compliance for Core Standard C4e that specifies standards for the safe handling and disposal of waste. Overall, these data sit uncomfortably with the evidence of widespread deficiencies in clinical waste segregation, storage and security noted during successive audits. The evolving legislative framework and operational standards demand rigorous segregation of wastes, the correct use of an unambiguous segregation scheme and containment of potentially hazardous clinical wastes, and secure storage of those wastes pending onward disposal. Notwithstanding, the fundamental requirement for safe, effective and secure management of potentially hazardous clinical wastes has remained unchanged. With evidence of multiple waste management deficiencies at hospitals that report full compliance with Core Standard C4e, the results of the annual health check process can falsely enhance the record of compliance in some UK hospitals, suggesting that self-reported compliance scores may not always be valid. Hygiene and waste management in UK hospitals: are self-reported compliance scores always valid? Journal of Public Health 2007 (in the press) Please contact Ian Blenkharn for further information.
June 2007	Standards of clinical waste management in hospitals - a second look In a follow-up audit of 16 UK hospitals, the standard of performance in clinical waste management remains poor, with evidence of neglect of basic hygiene, housekeeping and safety standards. Though there were some notable improvements, overall the results showed little change from previously published audit data, with evidence of a general decline in maintenance and operating standards. However, codes of practice exist, and despite implementation of the Hazardous Waste Regulations 2006 that provide further control on all wastes management issues, the reality of clinical waste management in some National Health Service (NHS) hospitals continues to be largely inadequate. A reprint is available in PDF format but cannot be made available for direct download due o copyright limitations. Please contact Ian Blenkharn to receive a free copy.
June 2007	The disposal of pathology wastes - a confidential questionnaire So just what does happen?  It goes into yellow bags, or bins, or.....and then someone takes it away! Some gets autoclaved, but not always. There just isn't enough autoclave space, or it's broken, or so-and-so needs it to prepare some culture media, or....  When it leaves the lab, how is it identified? Where does it go? How is it treated? All important questions, of course, but the answers are often vague and uncertain, and the reality is that the disposal of Pathology wastes may be less than perfect. A confidential questionnaire is now available, and it is hoped that the results will assist in clarification of the current status of Pathology waste disposal, the interface between Pathology departments and clinical waste management from other hospital areas, and further down the disposal chain the impact to the disposal companies who are required to treat these potentially hazardous wastes.
May 2007	The best and the worst of waste management? These are the questions asked in a short note in CIWM Journal (May 2007, p12). A simple question perhaps, but the answers will be many and varied. So, what gets your vote as the best, and the worst, modern developments across the waste industries? A development in policy or legislation, a technological development or a few simple words that have managed to change public perception and practice?
May 2007	Extending current research studies that examine glove use and hand hygiene for all of those required to handle clinical wastes, a short questionnaire have been prepared to gather additional information. If you are handling wastes in a healthcare establishment, or for a waste management company, or are a manager responsible for those who handle wastes, your input will be extremely helpful. All data will be treated in STRICT CONFIDENCE. Your identity and other details will NEVER be divulged Click for access to Questionnaires.
April 2007	The 6th edition of the Clinical Waste Discussion Forum Newsletter has been sent to subscribers, and is available for download
February 2007	Weird & Wacky - A clinical waste photo competition! What is the strangest use for a clinical waste container, or the most inappropriate place that a clinical waste container has been seen? Waste containers turn up in the most amazing places - being used for domestic refuse, in gardens and on allotments; rolling around the luggage belt at Heathrow Terminal 1; a sharps bin in a GP reception area used as an impromptu flower vase; clinical waste sacks on a London bus. And no doubt many more! If you have a photo of any clinical waste container turning up in an inappropriate location, or perhaps used for some odd purpose other than that for which it was intended, do let us know. A prize for the best entry! Click here for more details
February 2007	Domestic of kitchen recycling - an additional health hazard for households? The domestic kitchen is a dangerous place. Deficiencies in kitchen hygiene conspire with potential pathogens on raw foodstuffs to contaminate working surfaces, utensils and prepared foods, increasing the risk of foodborne infection. Although epidemiological relationships are difficult to demonstrate, 10% of respondents report sporadic cases of foodborne infection, with an apparent increase in frequency following the introduction of food waste recycling. Public health professionals must be aware of the potential impact of domestic food waste recycling, and deficiencies in kitchen hygiene, that may be associated with increases in foodborne intestinal infection. Education is a key step in prevention. High standards in kitchen hygiene are essential, and local authorities wishing to promote the recovery and composting of kitchen wastes should include simple hygiene instructions in their accompanying literature. Please contact Ian Blenkharn for further information.
February 2007	Clinical wastes in the Community Research findings focusing on the approach of Local Authorities to the collection of clinical wastes from the community have been analysed and a manuscript submitted for publication. A reprint in PDF format will be available for download after publication. Please contact Ian Blenkharn for further information.
February 2007	The 5th edition of the Clinical Waste Discussion Forum Newsletter has been sent to subscribers, and is available for download
December 2006	Avian influenza: a need for forward planning? Are we ready for avian influenza? In the event of a pandemic, could we manage the unprecedented increases in demand for acute healthcare, and in the corresponding increases in infectious waste. Is there sufficient disposal capacity? Enough waste containers?  Will we cope with disposal of the dead? Please contact Ian Blenkharn for further information. CIWM Journal December 2006 p12
December 2006	New site search facility added
December 2006	The 4th edition of the Clinical Waste Discussion Forum Newsletter has been sent to subscribers, and is available for download
December 2006	Standards of clinical waste management in UK hospitals - a second look The results of the second annual audit of standards of waste management in UK hospitals is scheduled for publication in Public Health. Once more, storage of carts in areas freely accessible to members of the public and failure to lock individual waste carts was common. Though in a few hospitals there was some limited evidence of improvement in waste handling, the overall standards were still far below an acceptable minimum. In some hospitals, waste management standards appeared likely to breach environmental and Health & Safety legislation. Failures in maintenance standards, segregation and waste security seen in the 2005 audit showed no improvement, and in some cases the extent of neglect had increased with clear signs to suggest no maintenance of cleaning between the two audits performed almost exactly 12 months apart. A reprint will be available in PDF format after publication. Please contact Ian Blenkharn for further information.   Public Health 2006; in the press
November 2006	Health & Safety implications in clinical waste management - audit and training services Recently successful litigation opens the door to prosecutions under COSHH regulations for infections caused by MRSA and other multiple-antibiotic resistant bacteria acquired while in hospital or indeed while receiving treatment in the community. Exemplary hygiene standards in healthcare premises, together with standard infection control precautions, should suffice but are these standards as good as they should be?  There is much evidence that standards of ancillary staff support and higher level waste management policies are lacking in many healthcare establishments. The impact of these deficiencies on exposure to claims for healthcare associated infections acquired by patients, and for claims by support staff suffering from injury or exposure to potentially harmful items in wastes, may be considerable. In the waste disposal sector,  the health and safety impact of waste handling may be underestimated. Hygiene standards and the use of PPE, though well described in many guides and Codes, are often less than adequate; education and awareness is at best limited in scope and content.  A comprehensive range of audit services is available, intended to identify risks and liability associated with healthcare waste management activities from bedside to final disposal, and to identify and deliver the required improvements in training and supervision intended to reduce exposure and ensure the highest standards of safety management, for both the healthcare and waste management sectors. Please contact Ian Blenkharn for further information.
November 2006	Quo vadis? Science and regulation as uneasy bedfellows Published scientific research is the bedrock underpinning environmental legislation, shaping its construction, interpretation and implementation.  It is the currency of investment in waste management, and of environmental protection. However, there is a substantial and increasingly apparent trend toward the construction and application of our regulatory framework predicated largely on a limited or incomplete knowledge base, heavily influenced by prejudice and personal opinion. The bedrock of science is increasingly set aside in favour of ideology and assumption, to be replaced with dogma and ex-Cathedra statement that cannot easily be questioned or formally challenged. These issues conspire to undermine public and professional confidence. There is a particularly unhealthy tendency for matters defined upon flimsy evidence or assumption to acquire a veneer of respectability and be presented as fact. Sadly, this may be defensively ring-fenced against further critical review. Many would concur that extensive root and branch review and reform is essential now in order to rectify these deficiencies. To reassure and support stakeholders, scientists and the public alike, Government and the Commissioners of its regulatory agencies must declare their policy and approach to regulation, and affirm the standards by which those policies will be managed at every level. This should ensure that the need for an effective scientific foundation is properly met at all times, is managed effectively, and applied objectively and with uniformity. Anything less would be unacceptable. A review of these complex and important issues will soon be published and will then be made available for download. Please contact Ian Blenkharn for further information.
October 2006	Managing hazardous wastes in the community Many 'Hazardous Wastes' arise in the community, while other non-Hazardous Wastes may be hazardous and present a risk to collection staff and householders when handled inappropriately. Clinical waste collections from domestic premises, the retrieval of discarded sharps, food waste recycling, and other safety issues were discussed at a recent National Hazardous Household Waste Forum Autumn conference in Nottingham. Download and view the PowerPoint presentation. Please contact Ian Blenkharn for further information.
October 2006	Be careful in the kitchen Most Local Authorities in the UK now insist on the separation of kitchen (food) wastes from domestic premises, with separate collections of these wastes that are now elimination from landfill deposit or municipal incineration in favour of commercial composting.  All good stuff, except that many households face problems with the arrangements pout in place for collections. Reports of fly-blown containers, insect infestations, increases in rodent sightings and nuisance from smell have been common and widespread, particularly during the hot summer months.  If press reports are to be believed, most Local Authorities have resisted the overwhelming clamor of complaints and battle on regardless. Foodborne infection associated with kitchen waste recycling creates a particular problem for householders.  In a survey of households required by Local Authorities to separate kitchen wastes, most kept the food waste container that had been provided in or close to the kitchen, rather than in a more remote location as for a dustbin. Critically, it appears that this proximity does not promote handwashing that might have been considered after depositing more general wastes in a dustbin.  Since many food products are contaminated with food poisoning organisms at the time of supply, and these multiply in wastes at ambient storage temperatures, the food waste bin becomes a potent source for widespread contamination of the kitchen environment.  in the absence of heightened standards of environmental and personal hygiene, an increase in the incidence of foodborne infection can be expected. Collection staff may be at similar risk.  Lids and handles of food waste containers will be heavily contaminated; splash contamination is inevitable during emptying of bins.  The correct use of PPE and provision of vehicle mounted handwashing facilities is essential to protect collection staff.  Smoking, eating and drinking must be prohibited prior to removal of PPE and hand sanitation in order o protect staff from acquired infection. A reprint is available in PDF format. Please contact Ian Blenkharn for further information.
October 2006	The cost of kerbside recycling? Most Local Authorities now undertake extensive kerbside recycling of glass bottles and jars, paper, food wastes, and a range of other recyclable materials. Observation of two collection crews leaning far into their vehicles' glass bins, smashing bottles and jars with a hammer top to secure greater capacity, and reduce the frequency of return to base for unloading makes it apparent that, for those involved, the high cost of kerbside recycling may include the loss of their sight! A reprint is available in PDF format. Please contact Ian Blenkharn for further information.
October 2006	The third edition of the Clinical Waste Discussion Forum Newsletter has been sent to subscribers, and is available for download
September 2006	Classification and management of clinical wastes Most containers of clinical wastes contain items that, at least initially, are not contaminated and present no risk of infection. Eliminate them at source and segregate this non-hazardous component and money can be saved but errors in segregation can be particularly dangerous. Competent risk management suggests that segregation of wastes at the point of disposal is unsafe and inappropriate. But this is not a universally held opinion.  Some use the mixed composition of clinical wastes as evidence to support a general down-regulation - "if most items were safe at the time of disposal, then the entire load will be safe(ish)".  This is however, unsafe and inappropriate as cross-contamination is inevitable and though there might be some initial saving in expenditure the implications are severe. A short note to document these issues will soon appear in the Journal of Hospital Infection. Please contact Ian Blenkharn for further information.
July 2006	The recent UK Department of Health consultation on the "Safe Management of Healthcare Waste" has moved another step forward, with release of a pre-final draft for final peer review. A response to this release has been prepared and submitted, and is available here for review or download.
July 2006	Potential compromise of hospital hygiene by clinical waste carts Bulk waste storage carts are common in hospitals, and undoubtedly assist in the day-to-day management of clinical wastes.  Intended for the transport and interim storage of primary clinical waste containers, carts are often located close to or within hospital buildings to receive wastes from wards and clinical departments. Examination of a random selection of bulk clinical waste carts at 9 acute hospitals across Greater London revealed external soiling in all of 23 carts.  Eight carts were soiled also on the inner surfaces, with some evidence of bloodstains, and free fluids in the base of 5 carts.  Staphylococcus aureus and enterococci were recovered, in low numbers, from the lids (n=7) and wheels (n=10) of carts, with Escherichia coli, Enterobacter species and Pseudomonas aeruginosa from the wheels only of a further 5 carts.  Two carts were heavily contaminated with Aspergillus species. Pathogens originating from clinical wastes may be transferred from contaminated bulk waste carts to the wider hospital environment.  It may thus be prudent to require that bulk carts be kept outside clinical areas, and preferably outside all hospital buildings. This becomes particularly important in circumstances where carts supplied by contractors are not dedicated to a single hospital or NHS Trust. A reprint is available in PDF format. Please contact Ian Blenkharn for further information. Journal of Hospital Infection 2006; 63: 423-427
June 2006	The second edition of the Clinical Waste Discussion Forum Newsletter has been sent to subscribers, and is available for download
May 2006	The recent UK Department of Health consultation on the Safe Management of Healthcare Waste has moved a step forward, with completion of stage 1 of the review process of responses to Consultation. A summary of those responses has been prepared by the DoH and is available here. Alternatively, the summary can be downloaded from the DoH web pages. It is particularly pleasing that  many of the issues identified in the responses received have taken on board. In particular, it is reassuring that the key issues of the universal classification of clinical wastes as hazardous under the terms of the European Waste Catalogue (EWC 18 01 03), of how and when clinical wastes are to be classified as hazardous or non-hazardous, and by whom, have been noted and will be incorporated into future revisions. This will help ensure the safe handling of clinical wastes, in accord with established CDC Universal and Standard Precautions for the Prevention of Infection, that have been the mainstay of objections, and which form the basis of a recent publication.  This is a hugely rewarding outcome to many months of work.
April 2006 updated for 2007 HONCode approval	The Health On the Net Foundation Code of Conduct (HONcode) for medical and health web sites addresses one of Internet's main healthcare issues: the reliability and credibility of information. Health On the Net Foundation is the leading organization promoting and guiding the deployment of useful and reliable online medical and health information, and its appropriate and efficient use. Created in 1995, HON is a non-profit, non-governmental organization, accredited to the Economic and Social Council of the United Nations. This site and the Clinical Waste Discussion Forum have been approved by the Health On the Net Foundation. They comply fully with the 8 principles of the HON Code of Conduct that provide an indicator of quality: Authority Complementarity Confidentiality Attribution Justifiability Transparency of authorship Transparency of sponsorship Honesty in advertising & editorial policy
March 2006	Safe working with clinical wastes - an investigation of incidents, accidents and near-misses I have created a web-based questionnaire to gain some insight into the type of incidents (including near-misses) that occur when handling clinical wastes.  It will be an interesting and hopefully useful research project, that may identify common patterns etc.  The questionnaire is now live.   Though I invite some personal and demographic data, to identify as far as possible duplicate reporting, all data will of course be held securely and any report or publication will be fully anonymised. A detailed report will be prepared and made freely available for consultation; if the data permit this will be prepared also for peer-review publication in a suitable professional journal.   I hope the data obtained will prove to be of value.  It may identify risky procedures, and risky practices, might identify areas where there is room for improvement and better control, and those areas considered empirically as hazardous where the reality may suggest otherwise.  The questionnaire will be live for at least 6 months   I hope that site managers, safety officers and front-line staff will contribute to the questionnaire.  The promotion of such initiatives, intended to define more accurately the real hazards associated with the handling of clinical wastes, moves forward from the risk assessment sponsored by the Environment Agency (Risk Assessment for Handling and Disposal of Clinical Wastes 2002 RD Report P4-073/TR).  As I member of the EA panel undertaking that risk assessment it was clear that that, while the report provided useful indicative data about a range of infectious hazards, many of the conclusions drawn were based on rather flimsy and incomplete data that had to be supplemented with professional opinion rather than fact.    I hope that there will be wide support for this research initiative.  As well as individual contributions, it will be additionally very helpful to receive input from managers and safety supervisors, based upon Accident Book records, RIDDOR notifications and general professional awareness, in order to maximise the extent of the database, and ensure that firm conclusions can be drawn. Please contact Ian Blenkharn for further information.
March 2006	Lowering standards of clinical waste management - Do the Hazardous Waste Regulations conflict with CDC Universal Precautions? Driven by the adoption in the UK of European Hazardous Waste Directive 91/689/EC, the Hazardous Waste Regulations 2005 seek to improve the management of wastes, and particularly of hazardous wastes, in the UK. With classification of wastes as "hazardous" or "non-hazardous" based upon fixed analytical criteria or, for clinical wastes, on risk assessment, the regulations have much to commend them. Supporting guidelines for the classification of clinical wastes may, however, be less than satisfactory. These guidelines conflict with the universally recognised Standard Precautions for the Prevention of Infection that are intended to ensure the safety of healthcare staff and of patients, reduce the incidence of hospital acquired infection, and to support effective hygiene standards in hospitals. But will this be undone by the additional waste classifications available through the Hazardous Waste Regulations and the supporting guidelines that promote down-regulation of some clinical wastes? A reprint is available in PDF format. Please contact Ian Blenkharn for further information. Journal of Hospital Infection 2006; 62: 467-472
March 2006	Glove use by ancillary and support staff - a paradox of prevention? Correct glove use provides a cornerstone to the prevention of hospital acquired infections. However, the incorrect use of gloves and corresponding failures in hand hygiene may be widespread and counterproductive. Together, these create a paradox of prevention. In a new publication to appear in The Journal of Hospital Infection, Ian discusses the use and mis-use of protective gloves by hospital ancillary and support staff, and the possible implications to hospital hygiene and infection control. A reprint is available in PDF format. Please contact Ian Blenkharn for further information. Journal of Hospital Infection 2006; 62: 519-520
February 2006	Clinical Waste Discussion Forum launched A new Clinical Waste Discussion Forum, accessible at this web site, offers a focal point for the dissemination of information concerning every aspect of clinical waste management, a soapbox from which to share news, views and opinion, and an exchange for practical knowledge in the hope of promoting best practice. Primary themes for discussion include: Health & Safety issues News & Information Ask a Question Waste Policy & Regulations Disposal technologies An addition "Miscellaneous" theme can accommodate any other topic; other themes will be added as necessary.   The Discussion Forum is intended to provide a unique interface between producers of clinical wastes, scientific, nursing and other special interest groups, equipment manufacturers, waste management companies, representatives of government and government agencies, and all others with an interest in this field. It is an open book - presently with blank pages! - and is there to receive your input.   This forum is free, independent, non-commercial, and non-political.  It is open to anyone interested in, involved with, or affected by the management of clinical wastes or other healthcare wastes, from their generation to final disposal.  No prior registration is required, and although we accept anonymous posts we do ask that you leave your name and email address.  Email addresses will NOT be used for any other purpose.
February 2006	Standards of clinical waste management in UK hospitals The arrangements for bulk clinical waste handling were studied in 26 UK hospitals. Storage of carts in areas freely accessible to members of the public and failure to lock individual waste carts was common. Many clinical waste carts and the areas dedicated to their storage were in a poor state of repair. To eliminate the possibility for acquired infection through unauthorised and inappropriate access to clinical wastes and to minimise adverse local or systemic effects resulting from contact with waste pharmaceuticals, to comply with the Duty of Care imposed by UK Health & Safety legislation, and to satisfy concerns regarding the general standard of hospital hygiene, substantial improvement is required in the management of clinical wastes in hospitals. A reprint is available in PDF format. Please contact Ian Blenkharn for further information.   Journal of Hospital Infection 2006; 62: 300-303
January 2006	New waste audit services for healthcare establishments and other clinical waste producers Using a team of highly experienced biological scientists with a proven track record in audit at Oakland Calvert Consultants Limited, and supported by a research-driven programme specialising in clinical waste management, a new service is being rolled out within Q1 2006, to provide a comprehensive waste audit service for healthcare establishments and other clinical waste producers. This will encompass a detailed quantitative and qualitative review of multiple waste streams, including but not restricted to clinical, domestic, catering and confidential paper wastes. Waste disposal/packaging, segregation, identification and security, local (internal) transport and storage, and arrangements for off-site transport will be included. An exhaustive review of training needs and standards, and of waste marking/signage, together with an evaluation of the needs of key staff groups working in clinical, administrative, support & service areas, will address issues of hospital hygiene to compliment existing arrangements for the control of hospital-acquired infection. The review services will additionally address the interface between PCTs/Trusts and their contractors, including cleaning, catering and other support service providers, to ensure a uniform approach to waste management and safety.   Click here for further details, or contact Ian Blenkharn for additional information
January 2006	A backward step - Landfill disposal of clinical wastes? Detailed scientific debate is the key to the advancement and exchange of knowledge and opinion. It is therefore most welcome that comments made in a recent publication, "Safe disposal and effective destruction of clinical wastes" have been questioned by other. But is that challenge appropriate? Others propose that, in the absence of detailed epidemiological evidence to support the view that clinical waste is indeed hazardous to health, the greater proportion of that waste should be sent to landfill. Few would agree with that proposal, which was considered on the basis of infection risk alone, which conflicts with consensus opinion, and which is contrary to a worldwide drive to reduce the landfill disposal of wastes. The complex issues involved in healthcare waste disposal require a rounded approach that addresses a complex range of hazards, as well as practical, environmental and legal constraints, and the global cost of disposal. Suggesting that clinical wastes are unlikely to cause infection, and can therefore be landfilled, is a truly backward step.  It deals only with the superficial issues of waste disposal, without regard to the underlying complexities, and is the antithesis of good infection control practice. Please contact Ian Blenkharn for further information. Journal of Hospital Infection 2006; 63: 105-106
January 2006	Natural disasters: a view from afar Responding to the challenges presented by the devastating Hurricane Katrina, of other natural disasters occurring around the world, of armed conflict and terrorist action, Ian discusses the implications to hazardous waste management in the specialist international journal Waste Management. Download a reprint, or contact Ian Blenkharn for further information. Waste Management 2006: 26: 318
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