THE DISPOSAL OF HEALTHCARE WASTE BY NHS GRAMPIAN FROM ACUTE HOSPITAL WARDS

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1 THE DISPOSAL OF HEALTHCARE WASTE BY NHS GRAMPIAN FROM ACUTE HOSPITAL WARDS Arrangements for the Collection and Disposal of Healthcare Waste NHS Grampian provides a range of healthcare waste disposal services for the collection and disposal of the various clinical and special wastes that may arise from providing healthcare within the premises. This is based on the legal and licensing requirements of the Environmental Protection Act: 1990 etc. The wastes require to be source segregated in accordance with NHS Grampian waste segregation policy, to ensure that they can be safely treated or disposed at facilities particular to the type of waste. (for clarity see the segregation chart and the NHS Grampian Waste Management Procedures guide) NHS Grampian provides a range of specific containers for the wastes. (see NHS Grampian healthcare waste containers list for selection) Containers must remain secure at all times and when full, must be stored in a delineated manner in the distinct waste stream, in accordance with the NHS Grampian waste segregation policy. To clarify, the arrangements are subject to the following summary duties and procedures and these should be reflected in the local Health and Safety Policy for the premises: The Waste for Disposal may involve: a Human Hygiene Offensive Wastes (such as Urine and Faeces from patients) where there is no degree of clinical suspicion of infectiousness or contamination should be discharged to drain in the normal manner. a Household/Domestic Waste (Black Stream) take simple steps to avoid it becoming contaminated and having to be disposed as Clinical Waste it should be recycled in the GREEN Stream, whenever possible. a Low Risk Clinical Waste (such as dressings, swabs and disposables, including gloves, aprons, masks, contaminated wipes and soiled incontinence pads, nappies, bed pans etc) from providing healthcare within the premises place carefully but directly into the Orange Stream waste bag selected. a Low Risk Clinical Waste (such as Used Sharps, Used Drug Vials, Blood and Contaminated Liquids, including needles/syringes, spent vials, broken glass, Unrecognisable Tissue, Haemodialysis waste and Only water, saline, glucose based Medicinal Products etc) from providing healthcare within the premises place carefully but directly into the 2.5, or 5.0 or, 11.5 litre Orange Stream Waste bin selected, as appropriate. Be mindful to avoid sharp or broken parts and do not force into the container. Ensure any liquids are leakproofed. Clipped needles from Diabetic patients should be placed in the Used Sharps Orange Stream Waste bin. For empty intravenous giving sets only from water, saline, glucose based Medicinal Products, or empty blood, plasma or contaminated liquid bags, tubes etc these may be placed into Orange stream waste bag, where no sharps are involved and there are no other risks of bag rupture; For Blood, Albumen and contaminated liquids, including tubes, plasma bags and transfusion waste, especially where these are in bulk or in volume, present a

2 moderate risk of spillage or incident between the workplace and the waste treatment facility. There are a number of required options using acceptable UN Type Approved packaging for disposing through the Orange stream. In the event of small or ad hoc arisings: 1. Place the liquid substance carefully but directly into an appropriate 2.5, or 5.0 litre Orange stream waste bin and render safe by use of self setting compounds or gel; or 2. Place the liquid substance in a bag or bottle container or similar primary package carefully but directly into a 11.5 litre Orange stream waste bin and render safe by use of self setting compounds or gel; In the event of large or recurring arisings: 3. Place liquid substances carefully but directly into bags, suction units or bottle containers or other similar primary packages. Then place such multiple containers or suction units into a 35.0 litre size Waste bin container (ref FZS712) or a 60.0 litre size Waste bin container (ref FZS713) and render the multiple containers safe by use of a self setting compound or gel. When three quarters full close the Waste bin container and tape a small Orange Stream waste bag over the label and indelibly mark Blood or Contaminated Liquid as appropriate for disposing through the Orange Stream. (this is an interim measure until a preprinted label is made available); or 4. Render the liquid substance or the suction unit safe by use of a self setting compound or gel, then place into a Baxter Box. Place the Baxter Box with multiple blood bags, bottle containers or suction units into a 35.0 litre size Waste bin container (ref FZS712) or a 60.0 litre size Waste bin container (ref FZS713) When full, tape a small Orange Stream bag over the label and indelibly mark Blood as appropriate for disposing through the Orange Stream. (this is an interim measure until a pre-printed label is made available); Note: 5. For removal from the site, 35.0 and 60.0 litre Waste bin containers and Baxter Boxes must then next be placed into a dedicated Orange Stream Eurobin suitably marked as containing Blood or Contaminated Liquids. On no account should 35.0 and 60.0 litre Waste bin containers, or Baxter Box wastes, containing Blood or Contaminated Liquids be mixed with Orange stream or other wastes. a High Risk Clinical Waste (in the event of recognisable body parts, including organs and limbs, where appropriate etc) place carefully but directly into the 11.5 litre Yellow Stream Contaminated Metal Parts, Implants and from Minor Procedures Waste Bin container. Ensure any liquids are leakproofed. Store in a secure delineated temperature controlled environment (at room temperature for no more than 12 hours, between +2 o C to + 8 o C for no more than 3 days and thereafter at 18 o C for up to 6 months). a High Risk Clinical Waste (Pharmaceuticals Medicinal Products) water, saline, glucose based Medicinal Products such infusion fluids and dialysis solutions, etc can be placed for disposal in the Low Risk Orange Stream as detailed above;

3 small quantities of residual Medicinal Products from partially discharged sharps syringes or drug vials may be discharged to drain (where under Scottish Water Consent). BUT ON NO ACCOUNT should Antibiotics, Vaccines, Hormones, Steroids, Cytotoxics, Cytostatics or other dangerous Medicinal Products (such as poisons etc) be discharged to drain. Mutation and damage to the watercourses and wider environment are well recorded. Otherwise - undischarged, surplus, dangerous, or Medicinal Products removed from patients - place carefully but directly into the 5.0 litre Yellow Stream dangerous medicinal products waste bin container. This bin should not be used for Cytotoxic or Cytostatic medicine wastes. For Vaccines please also refer to the NHS Grampian Pharmacy Medicines Unit Vaccine Handling Procedures. Within the acute sector, waste uplift arrangements by Facilities staff will take this directly to the Waste Transfer point for onward bulk disposal by incineration. Cytotoxic and Cytostatic Medicinal Products - place carefully but directly into the 11.5 litre Yellow Stream cytotoxic and cytostatic waste bin container, and return as appropriate. This bin should be used solely for Cytotoxic or Cytostatic medicine wastes. Please also refer to the NHS Grampian Pharmacy Guidelines for the Safe Use of Cytotoxic Chemotherapy. Within the acute sector, waste uplift arrangements by Facilities staff can take this directly to the Waste Transfer point or return to Pharmacy Department as required, for onward bulk disposal by incineration. a High Risk Clinical Waste (where there is a degree of clinical suspicion that this is from vcjd and TSE cases for quarantine of any associated surgical instruments) advise the Consultant in charge and case specific instructions for quarantine of any surgical instruments will be provided. All other waste from vcjd and TSE cases shall be placed carefully but directly into Yellow Stream waste bags as normal and where possible placed into the 11.5 litre Yellow Stream waste bin for disposing through the Yellow Stream. a High Risk Clinical Waste (where there is a degree of clinical suspicion that this is from COSHH Hazard Category 4 cases and quarantine etc) advise the Head of Medical Microbiology at Foresterhill Laboratories immediately and case specific instructions will be provided. a Any Waste where the healthcare has involved Low Level Radioactive Waste (LLRA) is managed by the NHS Grampian Radiation Protection Advisor the waste bag or bin shall be over-marked and the uplift and disposal will be in accordance with the conditions in the Certificate of Authorisation for the disposal and accumulation of radioactive waste and the national contract method statement. a Mercury (such as spillages from thermometers, sphygmomanometers or from specialist batteries) - should be returned to Central Stores, using the standard mercury spillage kit and specified instructions, which are available from Central stores or Pharmacy Department. a Particular Special Wastes (such as amalgam, lead, or other heavy metal compounds [including x-ray and other photochemicals and fixers with silver, cadmium, lithium etc] which cannot be disposed

4 by incineration, or requires to be safely recovered) place as described below into the appropriate Red Stream Waste Bin container provided. Ensure any liquids are leakproofed: From Endoscopy, X-Ray or involving other Photochemicals or Fixer substances place specific individual substance carefully into the 20 litre Red Stream Waste Bin container provided. When full, complete the label with the name of the specific fluid / chemical (see COSHH DATA SHEET if this is not clear) and EWC as appropriate. r These arrangements do not include for the disposal of any other Special Waste (such as pesticides, chemicals or other CHIP 3 substances etc). NHS Grampian can provide this service, if required, under separate arrangements. r The arrangements do not include for the disposal of Sanitary Products or other Offensive Human Hygiene Wastes (such as sanitary towels or nappies arising from staff or the public). NHS Grampian can provide this service, if required, again under separate arrangements. However such waste, if not arising from healthcare, can (and is recommended to) be disposed in the normal Household Black Bag route. Your Duties as the Waste Producer a Use the correct waste containers (bags and bins supplied by NHS Grampian); a Keep waste containers secure at all times; a Bags should be held by ringholder, labelled for the intended waste stream, at appropriate locations will avoid confusion when bags are being replaced; a Change bags when three quarters full, handle with care, twist neck and apply the sealing clip supplied, close and lock in position ready for uplift; a If small waste bags are used, these should then be placed into a large waste bag to reduce implications on handling and storage; a When full, properly seal bins ready for uplift. Complete the bin label giving the premises location, the name of the person disposing and date of disposal, before storing and presenting for collection; a Safely store the waste, at a designated secure point, exclusively for the type of waste, in a manner suitable for collection. i.e. keep the Orange Stream distinctly separate from the Yellow Stream and same from the Red Stream and within each stream - keep bags separate from bins; r NEVER overfill waste containers bursts and spillages can be avoided; r NEVER place bin containers into bags; r NEVER use bags as sleeves in pedal-bins or similar domestic containers; r Incorrectly packaged or inadequately sealed waste containers presented for collection will not be uplifted; a Ensure the Producer Sections of any Transfer/Consignment Notes are completed and signed by the Authorised Person for the premises. Producer Records require to be maintained for three years. (where required, paperwork will be provided for signature at uplift, based on the contract specification for retention). Waste Producer s should be aware that SEPA frequently inspect premises and records on wastes. If found lacking in undertaking the duty of care (by mis-segregation, mishandling/storage or mis-consignment), SEPA will take action directly with the Waste Producer concerned.

5 Points of Contact If there any concerns regarding Operational Services, please contact Gary Mortimer, NHS Grampian - Estates Manager on If there any concerns regarding infection control, or advice and training, please contact NHS Grampian Infection Control - on If there any concerns regarding the Waste Management System or if further advice required, please contact Ken Walker, NHS Grampian - Property and Environment Manager on AcuteWards_ April 2006