How do we improve clinical waste disposal practice?

The answer to this question is not so easy. There is the hugely bloated HTM 07-01 that seeks to instruct but not inform, and which is flawed by a palpable misunderstanding of microbiology and the risks associated with pathogens, perhaps because someone wanted to blunderbuss his way through the compilation to ensure that it was constructed in line with his own rather unscientific concept.

Perhaps it is the cost and practicalities of training, with a vast healthcare workforce for which training is yet another time-consuming diversion from the task in hand? Perhaps it is the cost of training; perhaps the quality of training, that so often is given by a local manager unaware of the realities of healthcare delivery, or an infection control nurse with no idea about the waste management process?

Some teaching aids have been developed, and we have discussed these previously on the Clinical Waste Discussion Forum. Interactive (visual) web pages funded by waste management companies, from which trainees can practice source segregation, are an invaluable resource. Elsewhere, we might be lucky to get a few home made pictographs stuck onto the wall behind, or on the top of, waste containers to guide and support better segregation but left there until they are stained and curling at the corners like a British Rail sandwich.

And there are also psychosocial factors, the sometimes highly complex set of factors that make so many feel unaware and unenthusiastic about their own responsibility to proper waste management. Some are simply too arrogant, too self-important, to take part in any training, while at the other end of the scale others are training in their university years with complete disregard for waste management and bio-safety that is simply not included in the curriculum.

Stericycle, among other, are now making a contribution to waste training through their  Steri-Safe training program. How much this overlaps with the training offered by consultancies, including Blenkharn Environmental, is somewhat irrelevant. Good quality comprehensive and properly tailored training and support is an important service that should not come before commercial concerns though we and others are well aware of how often individuals and groups will, without asking, take our training resources and re-badge them as their own.

Perhaps waste management companies can and should do more. More posters and labels available – better quality wipe-down labels for waste containers – that can guide correct segregation and safe waste management. Syringe and needle manufacturers are starting to produce these – for their sharps products only – but these focus on safe sharps use and omit detailed disposal advice. Labels and charts cost little, and can carry a company logo. Training might be subcontracted by waste management companies, badged in their own name as a profit-making but primarily marketing-based service to existing customer groups. This can be, and Blenkharn Environmental had previously held service-level agreements with some waste management companies to provide this add-on training service for customers’ own staff. Sometimes it might be a series of open sessions for nurses, or more usefully training sessions for waste managers and infection control nurses, and infection link nurses who are able and expected to act as ambassadors for waste management, hygiene and infection prevention to every ward and department.

In the meantime, the Clinical Waste Discussion Forum will continue to identify and promote best practice. If you want to add a note of your own training materials and support services, please do – but no overt advertising please.

This is all well and good, and should get better, but there are whole groups of workers who have largely been forgotten. Hospital ancillary and support staff, including especially those who are subcontracted by service management and facilities companies are often excluded from training as they are not the responsibility of the NHS Trust. In private care homes and hospices, largely untrained and unqualified carers receive similarly little training. And in the waste management sector, training and supervision is often lacking.

For each of these groups, so reliant on agency and casual staff safety induction and training is almost non-existent. There just isn’t time, and often no will to put effective training and supervision into place. H&S law can be a potent driver but if you are lucky enough to avoid an incident the chance of an unannounced inspection is small enough not to bother. That is not good, and training of these groups must likewise become a priority, requiring on behalf of trainers a completely different skill set with a comprehensive understanding of the waste management process, of occupational health and hygiene, and of healthcare wastes and their microbiology.

From its almost unique position, Blenkharn Environmental can offer those training services while identifying safer working practices to reduce risk. Others might do likewise, in part or in full. Either way, it needs to be done.