The National Clinical Guideline Centre has released its latest and probably last draft of its document “Infection: prevention and control of healthcare-associated infections in primary and community care” for pre-publication check of factual errors.

The guide includes a long-winded section on waste disposal. It says little that is new. In fact, it says very little indeed since it refers to, but does not go as far summarising the guidance of HTM 07-01.

New in this 2012 guidance is the comment that healthcare staff should “Educate patients and carers about the correct handling, storage and disposal of healthcare waste“.

In some part, that is correct. Patients and carers must indeed be guided toward the very basics of source segregation, for example of re-usable and disposable items and of sharps versus soft waste. For some, there might also be a need to recognise and segregate cytotoxic wastes, but further and more detailed segregation is probably unreasonable.

Already, some local authorities expect, without a hint of irony, that patients receiving car in their own home should be “to be trained in safe disposal and instructed in the identification of hazardous waste properties”, skills not normally expected of patients receiving care in their own home. The current NICE guidelines are likely to promote such expectations. The possibility that standards might improve are negligible, though there is every possibility that blame will shift to fall upon those who receive care in their own homes.

The guide is conspicuously silent on more important issues such as how domestic clinical waste collections might be managed. Who collects the waste, how often and from where? Who manages the service, and who funds this? What about the storage of wastes in premises too small to stack more that one or two waste sacks? High rise blocks and other ‘difficult premises’ where leaving wastes outside to await collection simply does not work. And what about all of those diabetics and others who generate sometimes substantial amounts of sharps waste – is this collected from home, taken to a GP surgery or pharmacy, or to a local hospital? While patients and their waste are treated like a game of pass the parcel with no standard approach to waste management errors will continue to occur.

http://guidance.nice.org.uk/CG/WaveR/85/PrepublicationCheck