Refrigerating clinical wastes is something that occasionally appears on the UK agenda but is rightly dismissed as an unnecessary energy expenditure (though with global warming perhaps things will change).

However, in many parts of the world ambient temperatures are persistently high and problems due to odour and fly pests are common unless wastes are properly packaged, held in closed bulk containers and refrigerated.

Bermuda’s Royal Gazette reported medical (clinical) waste, including human parts and bloodied hospital gowns, was left “baking” inside shipping containers off the hospital grounds, according to sources close to King Edward VII Memorial Hospital.

The biomedical waste was kept at the special waste facility at Sally Port at Dockyard, sources told The Royal Gazette, after KEMH’s specialised incinerator broke down several weeks ago.

Contingency arrangements should always be considered, and for many sites one or more trailer hook-ups can provide power to refrigerated vehicles as and when required. Smaller locations without back-up disposal facilities may not find this so attractive as the duration of storage may be considerable and there simply isn’t another treatment facility available down the road.

And when vehicles are to be used – the default option for contingency planning in UK permitting, the choice of vehicles is particularly important. Since few if any UK clinical waste fleet vehicles are refrigerated it would be necessary to hire in additional vehicles.

This creates a quandary – what are those vehicles to be used for next? Food distribution would be the obvious concern, and this has happened on at least one previous occasion when a vehicle from the Ryder fleet was used first for clinical wastes and then for food distribution. The particular difficulty is that a hire vehicle is unlikely to comply with the design and build characteristics required for the carriage of clinical wastes with smooth impervious surfaces to the walls and flood of the load compartment suitable for effective cleansing.

If global warming is a real threat then perhaps we in the UK should be planning now for some basic approach to refrigeration of clinical wastes in hospitals, during transit and at treatment facilities to be used when immediate terminal treatment is not possible.

Guidance is available on planning for loss of treatment capacity and the arrangements necessary for the temporary storage or diversion of wastes. This is, however, somewhat different from that required for more routine application in persistently hot weather. Guidance should extend to the speed to treatment of incoming wastes (turn-round times) and the use of cooling systems for what, at present are little more than open factory units with little possibility for effective air cooling or other atmospheric control, for effective odour management or control of fly pests. The management of ATT treatment residues should also be considered since there will become secondarily contaminated – with microorganisms of environmental origin, and create a powerful odour nuisance unless management with care.