waste management policy - bolton nhs ft

DOCUMENT CONTROL PAGE

Title:

Healthcare Waste Management Policy

Version Number: Four

Document type:

Policy

Scope:

All items disposed of by the Trust in hospital and community premises. Also covers waste

produced by staff visiting patients in their home.

Author:

John Horlick – Trust Energy & Sustainability Manager

Groups consulted:

Operational Heads of Service Head of Pharmacy

Risk & Assurance Manager Infection Prevention & Control Team

Hospital Facilities Manager Pathology Manager

Validated by:

Estates & Facilities Divisional Board

Equality Impact Assessment:

Date: 1/10/13

Description of Amendments: (If replacement policy)

Complete overhaul – Merger of original RBH and former PCT policies

Authorising Body:

Trust Executive Board

Date of Authorisation:

27th

November 2013

Master Document Controller

Shirley Ryan

Estates & Facilities Quality Manager

Review Date:

November 2016

Key Words Waste, disposal, cytotoxic, cytostatic,

recycle, recycling, spillages,

confidential waste, sharps, WEEE,

clinical waste

of 31 Healthcare Waste Management Policy

Contents Page No 1. Introduction 4 2. Policy Aim 5 3. Legislative and Regulatory Framework Guidance 5 4. Specific Responsibilities 6 5. Audit and Duty of Care 7 5.1 Premises Registration 8 5.2 Waste Transfer Notes 9 5.3 Carriage 9 5.4 Waste Disposal Checks 9 6. Waste Hierarchy 9 7. Waste Definitions and Classifications 9 7.1 Clinical Waste 9 7.2 Hazardous Waste 10 8. Waste Segregation 11 8.1 Community Staff carrying waste in their vehicles 12 8.2 Self medicating patients and sharps disposal 12 8.3 Pharmaceutical Waste 13 9. Disposal of Confidential Waste 13 10 Disposal of Domestic and Recyclable Waste 14 11. Disposal of Hazardous Waste 14 12. Waste Containerisation 15 13. Local Storage 16 14. Internal Transfer 17 15. Waste Compound 17 16. Off-site Transport and Final Disposal 17 17. Training 18 18. Personal Protection 19 19. Accidents, Incidents & Spillages 19


20. Monitoring and Control 20 Appendices Appendix 1 Specific Guidance for Community Nurses Appendix 2 Personal Protective Equipment Appendix 3 Spills Procedure Appendix 4 Further Guidance Appendix 5 List of Associated Policies and Procedures Appendix 6 Classification of Medicinal Waste Appendix 7 Indicative List Of Cytotoxic and Cytostatic Medicines Appendix 8 Table of Waste Types, Packaging, Tagging, Storage and Consignment Appendix 9 Community Nurses: Table of Waste Types, Packaging, Tagging, Storage and Consignment Appendix 10 Waste Management Chart


1. Introduction

All healthcare staff have a duty to ensure that healthcare waste is disposed of in a safe and appropriate way that ensure the health and safety of themselves, other professionals, service users, contractors, waste carriers and ultimately the environment. This policy has been written in line with Department of Health guidance Health Technical Memorandum

07-01 “Safe Management of Healthcare Waste – 2013 Edition: England and also the

Hazardous Waste Regulations 2005.The Hazardous Waste Regulations superseded the Special Waste Regulations that had been in place since 1980. In England and Wales it is a legal requirement of the Hazardous Waste Regulations to segregate infectious waste (that is subject to special requirements in order to prevent infection) from other wastes. This policy is also written in line with the requirements of the Safety Domain core standard 4e, Waste Management of the Standards for better health (DH2004) and the Health Act (DH2006) Code of Practice for the Prevention and Control of Health Care Associated Infections. The term healthcare will be used throughout this policy. This is defined by the Department

of Health – “Safe Management of Healthcare Waste 2013 Edition: England as waste from

natal care, diagnosis, treatment or prevention of disease in humans/animals. Examples of healthcare waste include infectious waste, medicinal waste, laboratory cultures, anatomical waste, sharps waste, laboratory chemicals and offensive/hygiene waste from healthcare areas. The five original categories of Group A to E clinical waste have been discontinued as they do not equate to the use of the European Waste Catalogue (EWC) codes. These EWC codes are now mandatory and used for all waste transfer documentation.

2. Policy Aim The overriding aim of the policy is to ensure that all healthcare wastes are managed, handled and disposed in accordance with current legislation and best practice. The Trust will take steps to;

comply with current legal requirements

manage waste in accordance with best practice as described in

“Safe Management of Healthcare Waste – 2013.

reduce any risks to health and safety from waste activities

select and work with contractors to ensure adherence to the policy

Monitor and review waste management with an aim of continuous improvement. The scope of the Policy covers healthcare wastes from Bolton NHS Foundation Trust, Royal Bolton Hospital and Bolton Community Premises and activities including the Community directly-managed practices. Independent Contractors are expected to comply with this policy. Adherence to this policy will ensure legal compliance and safe and secure management of waste. To fulfil their obligations under health, safety and environmental legislation, all staff are required to conform to the policy and follow operational instructions. This policy will be reviewed every three years and/or following any relevant changes regarding waste management legislation or guidance.


Target Group

All Bolton NHS Foundation Trust Staff

All external contractors

Shared as best practice with Independent General Practice staff

NHS Property Services Bolton

Cross reference to related Bolton NHS FT policies

See Appendix 5 – List of Associated Policies 3. Legislative and Regulatory Framework Guidance The Trust will ensure that those managers with strategic and operational responsibility for waste management have access to up-to-date legislation, regulations and guidance. In producing this policy the legislation and guidance documents listed below were identified as relevant and/or used as reference material.

i. The Controlled Waste Regulations 1992 ii. The Controlled Waste (Amendment) Regulations 1993 iii. The Hazardous Waste (2005) Regulations iv. Environment Agency Technical Guidance WM2 - Interpretation of the definition and

classification of hazardous waste technical guidance v. The Carriage of Dangerous Goods (Classification, Packaging and Labelling) and

Use of Transportable Pressure Receptacles Regulations 1996 vi. The Carriage of Dangerous Goods (Classification, Packaging and Labelling)

Regulations 1994 vii. Approved Carriage List: Information approved for the carriage of dangerous goods

by road and rail other than explosives and radioactive material viii. Approved requirements and test methods for the classification and packaging of

dangerous goods for carriage

ix. European Union – European Waste Catalogue

x. Ionising Radiations Regulations 1985 xi. The Radioactive Substances Act 1993 xii. The Radioactive Material (Road Transport) Regulations 1999 xiii. Control of Substances Hazardous to Health Regulations 1999 xiv. Management of Health and Safety at Work Regulations 1992 xv. Management of Health and Safety at Work Regulations 1999 xvi. Health and Safety at Work etc. Act 1974 xvii. The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1999 xviii. The Transport of Dangerous Goods (Safety Advisers) Regulations 1999 xix. The Environmental Protection Act 1990 xx. The Environmental Protection (Duty of Care) Regulations 1991

xxi. Waste Management – The Duty of Care – A Code of Practice 1996

xxii. Control of Pollution (Amendment) Act 1989


xxiii. Controlled Waste (Registration of Carriers and Seizure of Vehicles) Regulations 1991

xxiv. Waste Management Licensing Regulations 1994 - HMSO 1994, as amended by the Waste Management Licensing (Amendments, etc.) Regulations 1995 - the Waste Management Licensing (Amendment No 2) Regulations 1995, and the Waste Management Licensing Regulations 1996

xxv. Waste Management Licensing Regulations – A Code of Practice 1994

xxvi. Carriage of Dangerous Goods (Amendment) Regulations 1999 xxvii. Carriage of Dangerous Goods by Road (Driver Training) Regulations 1996 xxviii. Person Protective Equipment at Work Regulations 1992 xxix. NHS Estates Healthcare Waste Management - Segregation of waste Streams in

Clinical Areas - Health Technical Memorandum (HTM) 2065 xxx. Specification for Sharps Containers BS 7320:1990. xxxi. The Carriage of Dangerous Goods by Road Regulations 1996 xxxii. Approved vehicle requirements. Carriage of Dangerous Goods by Road

Regulations 1996 xxxiii. DOH Safe Management of Healthcare waste 2013. xxxiv. Environment Agency Technical Guidance WM2 xxxv. Code of Practice for the Prevention and Control of Health Care Associated Infection xxxvi. 2006.

4. Specific responsibilities

Chief Executive

It is the Chief Executive’s overall responsibility to ensure that the Policy is implemented

comprehensively. They will ensure that personnel are appointed and resources allocated to manage waste in a safe, legal and financially prudent manner. Under the Health and Safety at Work Act (1974) Bolton NHS FT has a statutory duty to ensure safe systems of work and a safe working environment for all its’ employees, visitors, contractors, members of the public and others within its’ premises. Director of Infection Prevention and Control

The designated Director of Infection Prevention and Control and the Infection Control team will provide advice and guidance as required on safe practices and procedures for handling clinical waste materials. It is the responsibility of the Infection Prevention and Control Team to deliver training to Managers on this policy. Waste Management of Clinical Waste is included in the Trust Clinical Induction Programme and staff are directed to read the Waste Management Policy. This needs to be supplemented by on-site departmental induction. Medicines Management Team

The designated Medicines Management Team within the Trust shall provide advice and guidance as required on safe procedures for the handling and disposal of pharmaceutical waste materials regarded as clinical waste.


Estates and Facilities Department

The Trust Estates and Facilities Department is responsible for ensuring that contracts are in place to collect clinical waste from all premises. They are also responsible for monitoring the performance of their staff and waste contractors. All Matrons and Department Managers

All line managers shall ensure that resources are available for the work to be carried out as required in this Policy. They shall also implement monitoring procedures to ensure that operational standards are satisfactorily maintained. They must ensure that all staff has had the appropriate information and training to handle waste properly. They must also ensure that adequate risk assessments have been done and that all staff are provided with risk reductions measures as required. All trust employees have a responsibility to follow procedures and instructions to ensure that waste is handled safely and legally and in accordance with this policy and procedures. Although the householder has no duty to dispose of the waste in the way described in this policy, any trust employee who provides care in a private household does have a legal duty to comply with the regulations and this policy. It is the joint responsibility of the Estates Department and the Infection Prevention Control team to provide training for managers in relation to this policy. It is the responsibility of Matrons and Department Managers to ensure that all staff are aware of this policy and that the policy is complied with in their service. Building Contractors Estates and Facilities have a duty of care to ensure that when any major refurbishment/demolition work is carried out there will be a safe system of work for the removal of any waste associated with the scheme and to reduce the risk of invasive Aspergillosis.

Reference should be made to the “Trust Aspergillus Policy “

5. Audit and Duty Of Care Section 34 of the Environmental Protection Act 1990 imposes a duty of care on persons concerned with controlled waste. Wastes from the Trust will fall into this category, whether classed as Clinical Waste, Hazardous Waste, Domestic Waste or Radioactive Wastes. The duty applies to any person who produces, imports, carries, keeps, treats or disposes of controlled waste, or as a broker has control of such waste. It places a duty on anyone who in any way has a responsibility for control of waste to ensure that it is managed properly and recovered or disposed of safely. Those subject to the duty must try to achieve the following:


To prevent any other person committing the offences of depositing, disposing of or recovering controlled waste without a waste management license, contrary to the conditions of the license, or in a manner likely to cause environmental pollution or harm to health.

To prevent the escape of waste, i.e., to contain it.

To ensure that when the waste is transferred it goes only to an authorized

person or to a person for “authorized transport purposes”.

When waste is transferred to make sure that there is also transferred a written description of the waste, a description good enough to enable each person receiving it to avoid committing any of the aforementioned offences and to comply with the duty to prevent the escape of waste.

As a producer of clinical waste, that is sent for incineration or alternative treatment the Trust has to carry out a pre-acceptance audit. This audit records the details of the process producing the waste, quantity of waste produced, individual constituents of the waste streams and hazards associated with the waste are required for each part of the producer premises. This information has to be made available to any contractor who collects or disposes of Trust waste. This audit must be carried out every year for large producers (> 5tonnes of clinical waste/annum) and every five years for lower risk producers (< 5tonnes/annum) The Trust will ensure that it fulfils this duty by managing waste in its care properly and by appropriate selection and appraisal of waste contractors. The management and filing of transfer notes and diligence checks on waste contractors is described below.

5.1. Premises Registration

All sites producing hazardous waste (if over 200kgs per annum) will register annually with the Environment Agency as a Hazardous Waste Producer. The registration process is co-ordinated through the Estates Department. It is the responsibility of individual site managers to initiate contact with the Estates Department and to inform of any changes in circumstances.

5.2. Waste Transfer Notes

A waste transfer note will cover all controlled waste. This may be an annual note rather than one for each load.

A Hazardous Waste Consignment Note must individually accompany all hazardous waste movements.

As waste producer, the Trust is responsible for ensuring that the details on either of these notes are correct, although others may produce the paperwork such as waste contractors.

Copies of controlled waste transfer notes will be retained for the statutory 3 year period as a minimum requirement. Records will be filed in the Estates and Facilities Department or the producer site


Copies of Hazardous Waste Consignment Notes and quarterly consignee returns will be retained for the statutory 3 year period as a minimum requirement. Records will be filed in a site register at the producer site.

5.3. Carriage

A copy of the waste carriers licence for waste contractors will be retained. Annual checks will be made and recorded to confirm the validity of the licence. Dangerous goods (including infectious waste) must be carried in accordance with the Carriage of Dangerous Goods Regulations. Whilst it is likely that waste contractors will provide a compliant service, as ‘consignor’ the Trust must ensure that dangerous goods presented for carriage are;

Labelled with the Proper Shipping Name

Accompanied by a consignors declaration giving the UN number

Packed according the appropriate packing instruction

5.4. Waste disposal checks

A Duty of Care audit programme will ensure that checks have been made on waste companies and all sites used for disposal of healthcare wastes. This will include copies of all licencing and environmental permitting. Health and safety processes and staff training.

6. Waste Hierarchy

The Trust will focus on the waste hierarchy through:

Sustainable procurement practices

Elimination

Minimisation

Recycling

Recovery of Waste

Safe disposal

and endeavors to incorporate this principle in the Waste Strategy and procedures.

7. Waste Definitions and Classification

The Trust will ensure that there are procedures in place for the correct categorisation and segregation of waste. Waste will be segregated at source and procedures will contribute to ensuring that waste is contained, stored, transported safely, legally and economically.

7.1. Clinical Waste

The definition of clinical waste referred to throughout this document is taken from the Controlled Waste Regulations: Any waste which consists wholly or partly of human or animal tissue, blood, or other body fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, syringes, needles, or other sharp instruments being waste which


unless rendered safe, may prove hazardous to any person coming into contact with it. Or; Any other waste arising from medical nursing, dental, veterinary, pharmaceutical or similar practice, investigation, treatment, care, teaching or research or collection of blood for transfusion being waste which may cause infection to any person coming into contact with it. The European Waste Catalogue itemises clinical waste arising from human healthcare in chapter 18;

7.2. Classification of Hazardous Waste Hazardous wastes under the Regulations means wastes identified as hazardous on the European Waste Catalogue. Hazardous wastes in that catalogue will have a six-

digit code followed by an asterisk (*). Further advice is contained in the Agency’s

technical guidance document WM2. Infectious waste 18.01.03*

Waste defined as clinical waste on the basis of the infection risk, or potential infection risk, posed should be considered hazardous infectious waste as the waste requires

18 WASTES FROM HUMAN OR ANIMAL HEALTH CARE AND/OR RELATED RESEARCH (except kitchen and restaurant wastes not arising from immediate health care) 18 01 wastes from natal care, diagnosis, treatment or prevention of disease in humans 18 01 01 sharps (except 18 01 03) 18 01 02 body parts and organs including blood bags and blood preserves (except 18 01 03) 18 01 03* wastes whose collection and disposal is subject to special requirements in order to prevent infection 18 01 04 wastes whose collection and disposal is not subject to special requirements in order to prevent infection (for example dressings, plaster casts, linen, disposable clothing, diapers) 18 01 06* chemicals consisting of or containing dangerous substances 18 01 07 chemicals other than those mentioned in 18 01 06 18 01 08* cytotoxic and cytostatic medicines 18 01 09 medicines other than those mentioned in 18 01 08 18 01 10* amalgam waste from dental care


specialist treatment/disposal. Within the Trust, any waste arising from a potentially infectious source will be classed as hazardous 18.01.03*. Hazardous Pharmaceutical waste 18.01.08*

Cytotoxic and cytostatic medicines are classed as hazardous 18.01.08. Medicinal waste displaying the hazardous properties the following properties is cytotoxic and/or cytostatic:

H6 (toxic),

H7 (carcinogenic),

H10 (toxic for reproduction) and

H11 (mutagenic) Appendix 7 Cytotoxic and cytostatic medicines gives further information. Other medicinal waste is non-hazardous 18.01.09 under the Hazardous Waste Regulations, but should still be assessed for other properties and should be disposed of by incineration.

8. Clinical Waste Segregation and Handling Waste will be segregated by the user at source to reduce handling risks and enable safest and most appropriate disposal. See Table in Appendix 6 for guidance on this. All staff handling waste must exercise care, so as to avoid injury or risk of infection to themselves or others. Personal protective clothing must be used as described in Appendix two. All bags and containers for clinical waste must be handled in accordance with the following:

Yellow bags to be used for infectious or potentially infectious clinical waste contaminated with chemical or pharmaceutical / medicinal waste – e.g. IV giving sets and bags, medicated dressings, iodine dressings, swabs, wipes, contrast media. (These bags must be incinerated).

Orange bags to be used for infectious or potentially infectious clinical waste contaminated with blood / bodily fluids e.g. dressings swabs, wipes, gloves, gowns, masks aprons and blood.

Securely sealed and labelled with pre-printed tape or identified using a permanent marker at point of use to identify their source (must state organization name and department/ward name)

Bags to be sealed using the Swan-neck method

Checked to ensure the seal is unbroken before moving

Bags to be replaced daily or when 3/4 full and taken to the wheeled bins in the bin store/disposal room.

Handle bags with care – never clasp against the body and never throw, drop from a

height or kick

Handled by the neck only (bags) or the handles provided (sharps containers, sealed units).


The loose contents should not be decanted from one bag/container to another

Clinical waste should be kept separate from domestic waste at all times

Where possible the double handling of clinical waste bags/containers should be avoided

Once a bag/container is sealed it must not be reopened.

Split bags and spillages must be dealt with as instructed in Appendix 3.

All sharps must be handled in accordance with the following;

Syringes, needles, razors, ampoules and other sharps should be placed in a sharps container. (Take the sharps box to point of use

The user must dispose of sharps into the container directly after use.

Sharps items must never be placed in bags

Waste pharmaceuticals must never be placed into clinical waste sacks or sharps boxes

Anatomical waste which includes recognisable body parts, foetal remains and placenta must never be disposed of down a drain.

Sharps containers to be replaced when ¾ full or 3 monthly and taken to the

designated storage point

8.1. For community staff carrying clinical waste in their vehicles

Where clinical waste is brought back to trust premises by community staff, (e.g. District Nurses), they should adhere to the following requirements: “The healthcare worker producing the waste can transport the infectious waste from the home environment back to base where there is a clinical waste collection, providing the quantity is below 333 kg (and therefore below the threshold for displaying orange plates on the vehicle as per the Carriage Regulations). The waste must be transported in a secure, leak-proof rigid container as per packaging instruction P621 and UN-approved. Where healthcare workers are transporting waste in their own vehicles, they must ensure that they have received appropriate training”.

In practice, where healthcare workers are transporting waste in their own vehicles, they must do so in accordance with the following;

Sharps should only be carried by staff where there is no alternative for safe disposal

Sharps should be placed into the container at point of use

Waste must be transported in secure rigid packaging, for example boxes or drums.

The container should be carried in a secure area of the car to prevent tipping whilst driving

The container should be out of sight

8.2. Self-medicating patients and sharps disposal

Where the householder is a self-medicating patient who uses injectables (for example a person with diabetes) with no healthcare worker involved in the administration, the


prescriber should provide the householder a sharps receptacle relevant to the medication being administered and advise them of local disposal options. The householder should be trained in how to use the sharps box before it has been prescribed, to ensure that they understand its use and ensure it is correctly sealed and labelled. If the box is to be left in the patients home, advice should be given about safe storage e.g. away from children and out of sight. Once the sharps bin is three-quarters full, it should be sealed by the householder and taken back to the GP surgery or to the local health centre for disposal. It is not acceptable to advise self-medicating patients to dispose of their sharps and lancets into the household black-bag waste stream.

8.3. Pharmaceutical waste

Pharmaceutical waste includes all part used and out-of-date medicines, creams, ointments and aerosols. It also includes medicines returned by patients to the local pharmacy. Other associated waste e.g. empty blister packs, alcohol wipe containers, and packaging should be disposed of in the domestic waste stream. Cytotoxic and cytostatic medicines - must be segregated at source and placed into purple-lidded rigid UN approved waste container labelled as containing Cytotoxic Waste. Containers must be sealed, labelled to identify source and placed in the designated collection point when ¾ full. See Appendix 5 for classification of these medicines.

All other pharmaceuticals must be placed directly in a blue lidded rigid UN approved waste container labelled as containing Waste Pharmaceuticals. Containers must be sealed, labelled to identify source and placed in the designated collection point when ¾ full.

8.4. Anatomical Waste

Anatomical waste, which includes recognisable body parts and placenta, requires disposal by incineration. The waste should be transferred in yellow containers with red lids and clearly labelled.

9. Disposal of Confidential Waste Confidential Waste includes any material that contains information that could identify a patient, an employee or commercially sensitive material. However it should be noted that any non confidential paper waste can also be disposed of through the procedures outlined below.

9.1. Procedure for the Disposal of Paper Confidential Waste (RBH)

In areas that have a high turnover of confidential waste there are locked consoles. The waste is posted through a letter box aperture into a nylon bag within the console. The Portering staff has a routine schedule for collections in the high use areas, however in between collection times when the console is full the department is required to telephone the Porter Manager and request a collection. (Telephone number; 4562). A porter will visit the department, unlock the console remove the bag, and empty the contents into a secure


wheeled bin. The bag is replaced in the console for further use. The secure wheeled bin is then transported to an onsite secure storage container. In areas of limited confidential waste where a console is deemed inappropriate the department can request from the Porter Manager confidential waste sacks. Once the department waste is ready for collection, they are required to telephone the Portering Manager to request collection. (Telephone number; 4562) the Porter will attend with a secure wheeled bin and put the waste into the bin. The bin is then transported to the secure storage container.

9.2. Destruction of Paper Confidential Waste (RBH)

The approved Company contracted to complete the destruction of the Trust Paper Confidential Waste are required to securely transport the waste to their facility where it is securely stored and shredded within a 24hour period. A waste transfer note is issued to the Trust for each collection made. Certificates of Destruction are issued to the Trust via the Hospital Facilities Manager. There is also an online facility to view the certificates. Access by the contractor to the onsite secure storage container is via the Estates and Facilities Department. 9.3. Disposal of Non-Paper Confidential Waste

In order to dispose of non-Paper Confidential Waste e.g. microfiche, fax rolls, audio, video, and DVD, it should be transported to central stores, where it can be held securely in confidential waste bags. They are then transported across to the onsite secure storage container by the portering staff to wait for collection by the preferred contractor.

9.4. Disposal of Confidential Waste (Community Premises)

Where there are waste consoles sited at a community premise the waste will be collected by the approved confidential waste company. Where there is not this facility available, all confidential waste from Community premises will be shredded before being placed into the domestic waste stream. It should be noted that the purchase, repairs and maintenance of shredding machines is the responsibility of the user of the equipment. Those departments wishing to use the approved company for confidential disposal will need to purchase the appropriate consoles/secure bins. Information regarding this service in the community is available from the Energy and Environment Manager (telephone number 390705).

10. Disposal of Domestic and Recyclable Waste Domestic waste (municipal waste) for the purposes of this document means mixed municipal waste from healthcare and related sources that is the same as or similar to black bag domestic waste from domestic households. The waste should be non-hazardous and suitable for disposal by landfill. The Trust will regularly review opportunities for re-cycling waste. 11. Disposal of Hazardous Wastes The definition is extracted from the List of Waste Regulations 2005:


It is important to recognize that some of the Healthcare Waste streams identified above i.e.

Cytostatic and Cytotoxic wastes, will fall into the “Hazardous Waste” category along with

certain other categories of Infectious Waste . Other wastes listed under Hazardous Waste and may include;

Radiology – Radiological waste

Laboratories – Hazardous chemicals and harmful substances

Dental - Amalgams

Estates and Facilities – Asbestos, waste oils, lead acid batteries, fluorescent tubes,

oil based paints, solvents and glues.

Medical Devices – Mercury containing devices.

Hazardous waste is dealt with on an individual basis dependent upon the specific type of waste. If hazardous waste has been identified, disposal arrangements will be made by the Energy and Environment Manager for a specialist contractor for the collection and disposal of the waste.

11.1. Batteries (Hazardous)

Under the Batteries Directive 2006 all batteries should be recycled and not disposed of into either the domestic or clinical waste streams. Battery types generally include lead/acid, lithium ion, nickel cadmium, nickel metal halide and alkaline cell. Batteries should be sent to Central Stores at Royal Bolton Hospital for collection in a non-public secure area. The batteries are then sent to a licensed contractor for recycling. 11.2. Waste Electrical and Electronic Equipment (WEEE) The Trust will dispose of all electrical equipment as required by the WEEE Directive 11.3. Fluorescent Tubes and other mercury containing waste (Hazardous)

All hazardous fluorescent, sodium tubes shall be stored in secure weather proof containers sited in the coal yard beside the New Boiler House, until collection and disposal by a licensed contractor.

11.4. Waste Oils (Hazardous)

To be kept in appropriate waste oil containers in secure storage and disposed of by a licensed contractor.


12. Waste Containerisation The key to efficient segregation is to provide the right containers in the right place and ensure staff are trained in their use.

Waste containers will be specified to meet the appropriate legal and technical specifications and will conform to standard colour coding i.e. sharps containers that meet BS7320/UN3291 specifications, and clinical sacks of a 225 gauge.

Containers must never be re-used

All clinical waste bags will be fitted into a lidded flip-top bin.

Clinical bins will be cleaned whenever there is visible contamination in addition to a weekly interior/exterior cleaning regime.

Bin labels and posters will be used where necessary to eliminate confusion about waste segregation and containerisation.

Container location will be chosen to assist in correct segregation and to reduce risks, such as those associated with handling of potentially infectious materials or sharps.

Ward/Department bins are cleaned outside as part of the daily domestic clean. An interior steam clean can be arranged by request from ISS Mediclean.

Waste must be double bagged where;

The exterior of the bag is contaminated

The original bag is split, damaged or leaking

Location and storage of sharps boxes will be in accordance with the Trust’s Sharps Policy.

Use appropriately sized sharps boxes to prevent prolonged period of use. Sharps bins must be disposed of after three months use.

Clinical staff shall be responsible for correct assembly, labelling, usage and closure of sharps boxes and for transferring them when closed to the designated waste collection point.

Boxes must be assembled according to the manufacturer’s instructions.

13. Local Storage During design/refurbishment of clinical areas consideration must be given to the provision of suitable waste storage near to the exit of the ward.

Sufficient storage (for bags and boxes awaiting collection) must be provided to prevent hazards arising (tripping, restrictions of access and fire routes) between collections.

Local storage areas must be on an impervious hard standing floor, which is easily cleaned e.g.;

internal vinyl floor

external concrete floor No waste bags should be left in a non-contained condition.


Waste must never be allowed to accumulate in public access areas. Local storage must maintain the segregation of the waste.

The storage area must be kept locked at all times. 14. Internal Transfer (where applicable) Waste will be segregated at the point of use and transported to the waste compound in compliance with local arrangements. Any unlabelled sharps boxes will not be collected for transfer and the person in charge will be informed. Where wheeled trolleys are used for transferring waste, the Trust will ensure that;

The wheeled waste trolleys will not be used for other purposes than the storage and transport of waste.

The waste trolleys shall be designed of a type that: o Are easy to clean and drain o Contain any leakage from damaged receptacles or containers o Are easy to load and unload o Do not offer harbourage for insects or vermin and o Do not allow particles of waste to become trapped on edges or crevices.

15. Waste Compound Clinical waste will be stored within a locked compound. The Trust will endeavor to adhere to the following standards of clinical waste storage;

a dedicated compound for the safe storage of clinical waste only

of adequate size for the quantity of waste and frequency of collection

well lit and ventilated

sited away from general (e.g. food preparation) and public areas

enclosed and secure with restricted access, but accessible to collection vehicles

provided with separate, clearly labelled areas for waste destined for different treatment/disposal options

clearly marked and signed

Hard standing, well-drained to foul sewer, impervious.

subject to a regular clean-down regime

locked when not in use, storage bins to be kept locked

Transport containers must be tagged or labelled sufficiently to ensure safe collection, transfer and treatment in accordance with the Biotrack system.

Other waste storage areas will be located away from public access. All storage areas will be kept clean and free of loose waste. Waste will be suitably containerised in skips or other containers. Areas around the containers must remain clear at all times.


16. Off-site Transport and Final Disposal The Trust will appoint a reputable licensed company to carry out transportation of waste off-site in vehicles conforming to relevant regulations. Disposal will be appropriate to the type of waste and will be at suitably licensed waste facilities. Prior to awarding contracts for waste carriage, treatment and disposal, the Trust will satisfy itself that the contractor has the relevant licences and facilities to manage the waste. There will also be agreement of service levels, reporting requirements and communication channels Clinical waste will be incinerated or treated appropriately and safely in suitably licensed facilities. 17. Training The Trust recognises the importance of training. It shall be the responsibility of line managers to ensure that their staff are appropriately trained and competent. Training and competency records will be maintained, records to be kept in staff files and entered onto the ESR system. Training and re-training needs will be reviewed as part of annual appraisals and risk assessments. All staff involved in waste handling will receive training appropriate to their job requirements. Basic training for all staff will include the following;

the risks to health and safety associated with clinical waste, its segregation, handling, storage and collection

personal hygiene measures

any precautions and procedures regarding waste which apply to their particular type of work;

procedures for dealing with spillages and accidents;

emergency procedures;

and in the appropriate use of protective clothing. For staff that collect, transfer, transport or handle quantities of clinical waste, the training needs to cover:

checking that storage containers are sealed effectively before handling

ensuring that the origin of the waste is marked on the container;

handling sacks correctly (for example, not clasped to the body, thrown, dropped or supported by hand from below);

using handles to move rigid containers;

checking that the seal on any used waste storage container is unbroken when movement is complete;

special problems relating to sharps disposal;

procedures in case of accidental spillage and how to report an incident; and


safe and appropriate cleaning and disinfection procedures. Additional job-specific training will be given according to the individual job descriptions and risk assessments. 18. Personal Protection The Personal Protective Equipment at Work Regulations state that employers must not use personal protection as the first line of defence against health risks, unless all other reasonably practical precautions have been taken. Therefore, waste activities will be

assessed and risks minimised according to the trust’s risk management procedures

However, assessment of the work done by staff who regularly handle, transfer, transport, treat or dispose of infectious waste is likely to show that PPE is required as outlined in Appendix 1 All staff who handle waste will be offered and encouraged to be vaccinated against Hepatitis B and tetanus via the Workforce Health and Well being Department. Emphasis will be given to personal hygiene and washing facilities made accessible. 19. Accidents / Incidents / Spillages

The trust’s policy and procedures for risk management will be applied to waste handling.

Spillages, incidents and near misses will be reported to the Trust Risk and Assurance Department in line with the reporting of other incidents.

20. Monitoring and Control

Standard to be monitored

Process for monitoring

Responsible individual /

group / committee

Frequency of monitoring

Group responsible for

reviewing results /

comments

Group or individual

responsible for development of

action plan

Group / individual

responsible for monitoring action plan

Checks of contractors re: clinical

Audit against terms of contract

Energy & Environment Manager

Annually Estates & Facilities Divisional Board



Checks of contractors re domestic waste

Audit against terms of contract

Energy & Environment Manager and Hospital Facilities Manager




Carry out pre acceptance audits as required by Environment Agency

Hire competent contractor to carry out audit and provide pre-acceptance report.





Correct waste classification segregation and handling

Review information in pre acceptance report.

Energy & Environment Manager Infection Control Team

Annually Divisional Director of Estates & Facilities

Energy & Environment Manager Infection Control Team

Divisional Director of Estates & Facilities

Continuous improvement for sustainable practices

Gather data from various sources including contractors


Monthly Divisional Director of Estates & Facilities



Overall policy is being complied with

Various see above. Provide short annual report to the Board


Annual report Executive Board Energy & Environment Manager and Hospital Facilities Manager


Appendix 1 - Sector Specific Guidance for Community Nurses Where a healthcare worker in the community generates waste, the healthcare worker has a duty of care to ensure that the waste is managed correctly and in accordance with legislation. Specifically any healthcare worker has a legal duty to comply with relevant legislation and with this policy. Assessment of waste Where waste is assessed as posing a risk of infection, a risk assessment must be completed to determine whether there is an increased risk of transmission of infection from the waste using the following guidelines;

Risk of exposure to a third party; for example due to compaction in a collection vehicle of waste containing body fluids causing spread of contaminants

The waste is present in large quantities

Waste is saturated with body fluids such that on slight pressure, free-flowing blood/body fluid would result

The waste originates from a wound, which has been clinically assessed to be infected.

To arrange collection of the waste from the household, the following information must be obtained;

Required frequency of collection

Description of waste e.g. soft waste in bags, sharps in an approved sharps container

Contact details of healthcare worker and collection point This information must be forwarded with a request for household collection to NHS Property Services The patient/carer should be advised to leave waste in a safe area for collection. For waste that is assessed not to pose an increased risk of disease transmission, the following actions must be taken; Mixed domestic waste does contain small numbers of plasters, small dressings and incontinence products. Where the healthcare worker produces the same or similar items, these, with the following considerations – can be double-bagged and place in the domestic waste (with the householder’s permission). The following should considered:

I. Type of healthcare waste – if it looks like a healthcare waste, and is not obviously a normal constituent of domestic waste, then it should not go into the black bag;


II. The quantity produced – where a number of small dressings are produced regularly over a period of time, it may be appropriate to dispose of these as offensive/hygiene waste. If, however, the amount is relatively small and consistent with that likely to be found in the household waste stream(for example that bought from a local pharmacy or supermarket by the householder), it may be discarded in the domestic waste;

III. Packaging – where such waste is placed in the domestic refuse, the waste should be wrapped in plastic. The wrapping should not be in yellow or orange, as the waste is not deemed to be infectious – thin opaque plastic bags such as sandwich bags and bin liners are appropriate.

Stoma and urinary catheter bags flush contents carefully (avoiding splash back) down the toilet The emptied bag should be double-wrapped in plastic bags and placed in the household waste. If not emptiable, assess the contents and if not hazardous can be disposed of as domestic waste Incontinence sheets and pads where the contaminant is solid and can easily and safely be emptied and flushed down the toilet, then do so the sheet should be double wrapped in plastic bags before being placed in household waste Dialysis equipment - When a programme of home dialysis is arranged it should include a collection service of used items. Usually used items will be collected on delivery of new equipment. The person organising the dialysis must arrange this. Cytotoxic and cytostatic medicines - must be segregated at source and placed into purple lidded rigid UN approved waste container labelled as containing Cytotoxic Waste. Containers must be sealed, labelled to identify source and placed in the designated collection point when ¾ full. See Appendix 5 for classification of these medicines. NHS Property Services will arrange for the collection of cytotoxic waste.


Appendix 2 - Personal Protective Equipment

Staff will be provided with personal protective equipment and clothing (PPE) appropriate to the tasks they will be required to perform. It is the employee’s duty to wear any protective clothing supplied to them for their protection. Domestic Services staff; Disposable aprons and latex or vinyl gloves to be worn for routine waste handling. Portering staff; Work wear

• Safety shoes • Heavy duty Kevlar type gloves.

For situations such as cleaning spillages, the risk assessment may indicate a need for protective equipment to prevent skin contact. In these cases, disposable gloves and aprons are best. In some circumstances, face visors may be necessary to protect

employees from splashing. It is the Line Manager’s responsibility to provide all the

necessary PPE and make arrangements for its inspection/replacement as necessary.


Appendix 3 - Spills Procedure All spillages must be dealt with in accordance with the following principles; • Any spillages, torn bags or broken seals must be reported to the line manager. An incident form must be completed. • In all cases the origin of the waste must be determined before dealing with the spill. • A safe system of work must be employed in spillage management i.e. risks must be assessed and minimised • Responsibility for clean-up of the spill must not be delegated. Procedures for spillage of bagged clinical waste • Gloves and apron must be worn. • The spillage must be bagged, labelled and retagged in a new yellow sack. • Dust pan/shovel and brush must be used to minimise contact. • Dust pan/shovel and brush must be washed in hot detergent solution after use. Procedures for spillage of sharps waste • Heavy duty gloves and apron must be worn. • A new container must be used and sealed and labelled on completion

• Never pick up sharps by hand - small quantities may be picked up with

disposable forceps/equipment provided (held by caretaking staff), or by using a dust pan/shovel and brush. • Dust pan/shovel and brush must be washed in hot detergent solution after use. Procedures for spillage of blood and bodily fluids

1.• Wear gloves and apron

2.• Cover spill with paper towels

3.• Pour on solution 10,000 ppm chlorinated disinfectant

4.• Leave at least 10 minutes

5.• Clear and discard as clinical waste

6.• Wipe area with 1000 ppm chlorinated disinfectant as appropriate.

Chlorinated disinfectant can be caustic. It will corrode metals, bleach fabrics and burn skin. Rinse area well after use.


Appendix 4 - Further Guidance In areas of uncertainty advice must be sought to ensure safe and legal waste handling and disposal. Further information or advice on any aspect of waste disposal is available from; Estates & Facilities Department tel: 01204 390705 Infection Prevention and Control tel: 01204 390408 Pharmacy tel: 01204 390559 Risk Management Department tel: 01204 390905 Appendix 5 - List of Associated Policies and Procedures

Medicines Management Policy Infection Control Policies Incident Reporting Policy No1 Aspergillus Policy Appendix 6 - Classification of Medicinal Waste

(Taken from Department of Health “Safe Management of Healthcare waste” 2013 Edition)

All medicinal waste displaying the hazardous properties:

H6 (toxic), H7 (carcinogenic), H10 (toxic for reproduction) and H11 (mutagenic) Above the thresholds described in the Joint Agencies Hazardous Waste guidance (WM2) should be classified as cytotoxic and cytostatic waste.

The following table shows a list of cytotoxic and cytostatic medicines. It should be noted that this list is provided as a guide and is not comprehensive. Further guidance should be sought from the dispensing pharmacist.


Appendix 7 - Indicative list of cytotoxic and cytostatic medicines

N.B: if unsure, please check in the BNF or consult a member of the Trust Medicines Management Team


Appendix 8 - Table of waste types, packaging, tagging, storage and consignment

WASTE TYPE Examples EWC Code

Any Specific requirements

Packaging/Container Tagging/labelling Final storage point

HWCN BioTrack tagging where applicable

Minimum Treatment

Infectious Clinical Waste

Dressings, swabs, contaminated gloves

18.01.03 Orange , UN type approved plastic bag (225 gauge)

Numbered tag Y Orange Infectious waste

Incineration/ autoclave

Sharps Waste Needles, scissors, scalpel bladed, contaminated with non-hazardous medicines

18.01.03/ 18.01.09

Yellow UN approved rigid plastic sharps container (BS7320/UN3291)

Label box on assembly and closure

Y Red Sharps

Incineration

Cyto-sharps waste Needles, scissors, scalpel blades, contaminated with cytotoxic or cytostatic medicines

18.01.08/ 18.01.03

Purple topped approved plastic sharps container


y Purple Hazardous Medicines

Incineration

Hazardous pharmaceutical waste

Cytotoxic and cytostatic medicines and materials contaminated with them

18.01.08 Special Waste Collection

Yellow UN approved purple-topped rigid plastic sharps container or rigid container

Y Purple Hazardous Medicines

Incineration

Non-hazardous pharmaceutical waste

Non hazardous (i.e. non-cytotoxic or cytostatic) medicines

18.01.09 Yellow UN type approved plastic bag or rigid container

N Red Non-hazardous medicines

Incineration

General waste Paper, sandwich wrappers Black plastic bags n Landfill

Glass, aerosols Glass bottles, crockery Cardboard box lined with black plastic bag

n

Confidential waste Patient or staff records, financial information

Certificate of destruction

n Shredding


Appendix 9 - Community Clinicians: Table of waste types, packaging, tagging, storage and consignment

WASTE TYPE Examples EWC Code Any Specific requirements

Packaging/Container Tagging/labelling Final storage point

HWCN BioTrack tagging where applicable

Minimum Treatment

Infectious Clinical Waste

Dressings, swabs, giving sets, contaminated gloves

18.01.03 Collection by local authority

Orange , UN type approved plastic bag (225 gauge)

Incineration/ autoclave

Patient self-administered Sharps Waste

Needles, scissors, scalpel bladed, contaminated with non-hazardous medicines

18.01.03/ 18.01.09


Incineration

Healthcare worker administered Sharps Waste

Needles, scissors, scalpel bladed, contaminated with non-hazardous medicines

18.01.03/ 18.01.09

Return to base in accordance with policy



Y Incineration

Appendix 10 - Waste Management Chart

Healthcare Waste Management Policy of 31

Equality Impact Assessment Initial Screening Tool

12. If the actions in 11 above are completed (answer Yes or No) revisit section 12 when action in 11 complete A

ge

Dis

abili

ty

Gender

Race

Relig

ion/B

elie

f

Language

Sexual

Orie

nta

tio

n

Gypsy/r

om

a

Tra

velle

r

Care

rs

Em

plo

yees

Ne

g

ative

Impa

ct

1. Will the activity present any problems or barriers to any community or group?

X X X X X X X

X X X

1. Directorate Operations

2. Department/Division Estates & Facilities

3. Name of ‘activity’ being assessed Waste Management Policy

4. Person completing this form Shirley Ryan

5. Date 1/10/13

6. Monitoring data/statistics – compare ‘activity’ data with ‘population’ data (see Guidance)

Patients

Staff

Equality Target Groups (ETGs)

(See guidance for detail)

7. Which of the following Equality Target Groups will this ‘activity’

impact on?

8. Could this ‘activity’ have a positive and/or

negative impact?

yes no Positive* Negative*

A. Age

B. Disability

C. Gender

D. Race

E. Religion/Belief

F. Language

G. Sexual Orientation

H. Gypsy/Roma/Traveller

I. Carers

J. Employees

9. Consultation/Involvement – during the development of this activity? (see Guidance)

See policy front cover

10. Details of positive and negative impacts

Safer handling of waste

11. Give details of actions required to remedy any negative impact(s) identified above.

Action to address negative impact Who Target Date

None required

Healthcare Waste Management Policy of 31

2. Will any group of people be excluded as a result of your activity?

X X X X X X X

X X X

3. Does the activity have the potential to worsen existing discrimination and inequality?

X X X X X X X

X X X

4. Will the activity have a negative effect on community relations?

X X X X X X X X X X

Positiv

e im

pact

Could the activity reduce inequalities? Will it… (answer Yes or No) A

ge

Dis

abili

ty

Gender

Race

Relig

ion/

Belie

f

Language

Sexual

Orie

nta

tio

n

Gypsy/r

om

a

Tra

velle

r

Care

rs

Em

plo

yees

5. Promote equality of opportunity?

X X X X X X X

X X X

6. Eliminate discrimination? X X X X X X X X X X

7. Eliminate harassment? X X X X X X X X X X

8. Promote good community relations?

X X X X X X X

X X X

9. Promote positive attitudes towards disabled people?

X X X X X X X

X X X

10. Encourage the participation of disabled people?

X X X X X X X

X X X

11. Consider more favourable treatment of disabled people?

X X X X X X X

X X X

12. Promote and protect human rights?

X X X X X X X

X X X

Thank you for completing this EIA initial screening tool. Please forward an electronic copy of the completed tool to your Divisional E&D Lead for ratification by

your Divisional Board and a copy to: Suzanne Hudson Email: [email protected] Telephone extension: 4017

Decision

Work through the flowchart on page 24 of the Guidance, to determine whether you need to complete a Full EIA or not. Details of any objective justifications or amendments agreed with Divisional E&D Lead: None identified

Full EIA required? Yes No Date approved by Divisional Boards:

Completed by: Shirley Ryan Job Title: E&F Service Development Manager

mailto:[email protected]

waste management policy - bolton nhs ft

Documents