The Hospital Infection Society is presently reviewing the penultimate draft of its guidance document “Guidelines for the Management of Norovirus Outbreaks in Acute and Community Health and Social Care Settings”.

The focus of this guidance is on the control and prevention of infection, part of which requires consideration of waste disposal procedures. In fact, little is said about waste except that it should be bagged and disposed as healthcare or clinical wastes (the terms are used interchangeably).

Norovirus infection in waste handlers have been recorded following contact with waste sacks containing Norvirus-infected waste. In a large outbreak, the wastes are likely to comprise a high proportion of wet wastes and leakage or seepage of sack contents, or contamination of their outer surfaces, is quite likely.

Gloves become contaminated and without exemplary hand hygiene waste handlers are at risk. Alcohol hand rubs are completely ineffective as Norovirus is not susceptible to alcohol; careful and thorough handwashing with soap and water is the only solution but facilities are so often lacking.

The high risk of infection might require classification of these wastes as hazardous by risk of infection. Despite this, it is likely that most waste producers will categorise their outgoing wastes as non-hazardous and continue to use orange sacks. Does that matter?

The ATT processing of these wastes will be perfectly adequate, despite that high risk of infection. The important issue is the care required in hygiene management – correct packaging and containment of wastes, care with wet wastes, prevention and management of any leakage, exemplary personal and hand hygiene possibly requiring an additional disposable protective apron to protect general workwear.

This is a good example of the unsuitability of current waste regulation that seeks to create arbitrary divisions between waste categories based on some notional understanting of infection risk. Sadly, that division promotes a dual standard of care and the health and safety of ancillary workers and waste handlers receives less attention when handling “non-hazardous” or “non-infectious” wastes in the believe that they are somehow less hazardous to the individual. That assumption may be entirely wrong.

Further concern must apply to the processing of wastes that may, or may not, be classified as “infectious” when contaminated with Norovirus. As so many pathogens, Norovirus is heat sensitive and will be inactivated by ATT processing. Incineration is not required to ensure sterility of processed wastes, while of course the hygiene risks of all pre-treatment waste handling are comparable whatever final treatment process is applied.