HTM 07-01 recommends extensive segregation of waste and in their turn the Environment Agency expects that it will happen and penalises waste management operators if it doesn’t.

That regulatory stance has an inherent flaw, seeking to place restrictions on waste treatment facilities without any meaningful attempt to address thsi problem at source. This creates rather than resolves potential conflict.

But the real issues, that we have discussed on the Clinical Waste Discussion Forum many times previously, are the practicalities of space and time. Time in the busy workload of healthcare professionals to separate waste items into yet more waste stream, and the space to accommodate the various additional waste containers that will be required.

Leaving aside the health & safety implications that can make the additional source segregation more hazardous – taking each waste container to the bedside just isn’t practicable – few hospitals have space for many more waste containers. Already there are waste pharmaceuticals, cytotoxics, sharps in various flavours, soft wastes that may be infectious, non-infections or sanitary/offensive, laundry and soiled laundry, paper, glass, aerosols, batteries……

Demands for additional segregation are generally ‘excused’ with an explanation that an average or typical classification of wastes can be assumed with one ward producing only non-infectious wastes. But is it per ward? Or per patient? Or a hospital-wide classification? It may all go in the same vehicle so should it be per cart load or per truck?

Forget, though it happens frequently, the concatenation of wastes previously segregated at source, and consider for now just the space issue for all those containers.

Nearly a fifth of NHS hospital buildings fail to meet the national standards for patients. Cramped wards, limited storage and poor washing facilities are among the key issues. Bristol Royal Infirmary has ward blocks dating back to 1735 while one in five hospital building was put up before the NHS was founded in 1948. Many are poorly maintained.

Though upgrade and refitting seems to be an almost constant activity in most NHS hospitals facilities are often less than perfect. More space might be devoted to utility services, for example to accommodate an array of waste containers on every ward, but if more are required then space demands become critical.

If it comes to loosing one bed space or doing without and reducing the extent of source segregation of wastes by eliminating additional waste containers then the answer is obvious. In that case, the wastes may not be segregated to the extend expected – actually reflecting the reality of current circumstances – and policy documents and regulatory action should be modified accordingly.