Many sacks of clinical waste contain substantial amounts of paper waste. Some of it is secondary wrappings from sterile items and I have not problem with that, since separation is inconvenient and may result in errors that place potentially hazardous clinical wastes into containers for domestic-type waste.

I have no problem with the occasional newspaper either, though would hope that better and more suitable waste disposal arrangements could be made available, perhaps to collect these domestic wastes from patients rather than having them use the clinical waste sacks. This latter is a particular problem since , in most cases, patients will try first to pull up the lid of the sack holder rather than use the foot pedal, contaminating their hands but rarely washing their hands afterwards.

Beware however bed roll waste. This has been disposed routinely to clinical waste sacks for no good reason. Indeed, in some hospitals significant volumes/tonnages of this waste are categorised as clinical waste for no better reason that a patient, perhaps fully dressed lay down on a couch for a brief examination or X-ray or ultrasound examination. This is clearly wrong and there is no need for this. Likewise, the disposal of paper towels at hand wash sinks, even in the clinical areas of a hospital. This too is unnecessary unless for risk management, space or other thoughtfully considered reasons black bags have been removed with ALL wastes going into clinical waste containers. The most likely circumstance, beyond space concerns being able to accommodate only one waste container rather than two, is when potentially hazardous clinical waste items have found their way into the domestic waste stream. Risk management will suggest training to reduce errors, but also of removing choice. In these circumstances, a Tiger bag will suffice, but why not treat and process these wastes for energy or resource recovery?  Landfill is simply wasteful and inappropriate. That may comply with prevailing waste regulation but is wasteful and environmentally unsound.

The other common source of paper contamination of clinical wastes is confidential paper waste comprising generally just occasional sheets of paper containing some patient-identifiable information. Of course, it should be disposed in such a way as to acknowledge and preserve confidentiality. Shredders are rarely if every available on the wards, and a separate container for confidential paper waste is uncommon, takes additional space, and is not going to be immediately available when someone has a sheet of paper for confidential disposal – so off it goes into the nearest clinical waste sack!

Is that a problem? Well, probably not and if it preserves patient confidentiality in circumstances where the alternatives are unavailable or inaccessible and errors in disposal likely to occur, then I have no problem. However, the ubiquitous yellow or orange sack is not appropriate when there is a filing cabinet to empty and bulk paper waste must be managed more appropriately.

In the week’s BMJ, a news report notes that the NHS Commissioning Board has predicted that the NHS will be paperless by 2015 with paper records “eradicated” by this time. Some it is rather ambitious, while the Board is pushing hard for developments that will improve efficiency, ensure transferability and access of records at any location, between hospitals and GPs and save the need for the vast amount of correspondence items that move back and forth between different care providers and locations.

It is not clear if this will work, I suspect not, but it is a step in the right direction. Will it reduce clinical wastes being contaminated with confidential and other paper wastes?  Certainly not, though the former may one day be reduced in volume. As it does however, the justification for a shredder, or a confidential paper waste box, a porter to collect, and a separate disposal contract, will become economically unviable. So the net result may be, at least during the transition period, a net increase in the amount of confidential paper waste finding its way into clinical waste containers. Live with it.