Waste Management Policy and Procedure

Transcription

1 This document has been redacted to remove personal information (e.g. staff names/contact information) that, under the Data Protection Act and hence Section 40 of the Freedom of Information Act 2000, should Waste Management Policy and Procedure Document Information Version: 2.0 (KD) Date: June 2014 Ratified by: King s Executive Date ratified: 24 November, 2014 Author(s): Responsible Director: Responsible committee: Date when policy comes into effect: Roland Sinker- Chief Operations Officer Environmental Committee 16/12/2014 Review date: January 2016 Target Audience: External standards addressed by this policy: Location of document: Trustwide CQC 10b &10d The Environmental Protection Act 1990 (as amended) Controlled Waste Regulations 2012 The Hazardous Waste Regulations 2005 COSHH Regulations 2004 (as amended) The Health & Safety at Work Act 1974 (as amended) The Carriage of Dangerous Goods and Use of Transportable Pressure Equipment 2013 Landfill Regulations 2002 Water Authority Regulations (1991) List of Waste Regulations 2005 Waste Management Licensing Regulations 1999 Waste Electrical and Electronic Equipment 2005 The Data Protection Act The Human Tissue Act 2004 Environmental permitting regulations 2013 Waste Management Regulations 2011 Health Technical Memorandum (HTM 07-01) Water Guidance Thames Water Pre-acceptance Waste audit KCH Trust-wide Policies Version: 2.0 (KD) Waste Management Policy & Procedure 2014

2 This document has been redacted to remove personal information (e.g. staff names/contact information) that, under the Data Protection Act and hence Section 40 of the Freedom of Information Act 2000, should Document History Document replaces: Waste Management Policy and Procedure v3.0 Published on January 2012 Replaced document archive location: KCH Trust-wide Policies Consultation distribution (before ratification) Sent to Version Date Actions taken as a result Environmental Committee 3 21/10/11 Met with infection control to revise guidance for waste contaminated with CJD. OSC 3 07/12/11 Minor amendments Reviews and updates Date New version no. Summary of Changes Previous version 3, now archived available at request from the Kingsdocs via ICT if required 05/10/ (KD) Version amended to reflect migration to Kingsdocs on 5 th October 2012 by Stephanie Goddard Major change/s (must go to KE) or minor change/s Minor Author of change/s June KD Version amended to Include (KCH - All sites) Major Dissemination schedule (after ratification) Target Method audience(s) Trustwide Publicise via King s News, Environmental Committee, Waste project group and Environmental Champions. Person responsible Update on Trustwide Policies. Version: 2.0 (KD) Waste Management Policy & Procedure

3 This document has been redacted to remove personal information (e.g. staff names/contact information) that, under the Data Protection Act and hence Section 40 of the Freedom of Information Act 2000, should 1. INTRODUCTION Policy Objectives 5 2. DEFINITIONS 6 3. PURPOSE AND SCOPE 6 4. DUTIES Chief Executive Chief Operations Officer Environmental Committee (EC) PFI Partners and Appointed Contractors Kings College Hospital Foundation Trust Domestic and Departmental Ancillary Staff Portering Staff All Staff Contractors WASTE STREAM MANAGEMENT Recycling, Re-Use And Reduction Co-mingled Recycling (Green Bag) Ink Cartridges Batteries X Rays and Film Slides Cardboard General /Domestic waste Food waste Clinical Waste Clinical waste orange-stream Clinical waste yellow stream Clinical waste purple stream (cytotoxic/cytostatic) Offensive Waste Tiger Stripe bag yellow with black stripe Sharps Waste Laboratory Waste to be autoclaved prior to leaving site Viral Haemorrhagic Fevers (Category A contaminated clinical waste) Creutzfeldt-Jacob Disease (CJD) Hazardous Chemical Waste 26 2

4 This document has been redacted to remove personal information (e.g. staff names/contact information) that, under the Data Protection Act and hence Section 40 of the Freedom of Information Act 2000, should Waste Chemical labelling Waste Chemical Disposal COSHH Chemical Waste Effluent Broken Glass Dental Institute / Community Dental Amalgam Waste X-ray fixer and developer Plaster casts, moulds or models Mercury Wastes Pharmaceutical Waste Empty Containers - Used Equipment Medicinal Products no longer required or expired Controlled Drugs Cytotoxic / Cytostatic Products Undischarged Aerosols and Gas Cylinders Blood Gas Analyser gas cylinders - ABL800 or ABL700 series and ABL90 FLEX Radioactive Waste Building and Engineering Waste General Contractor and Sub-Contractors Asbestos Fluorescent lamp tubes Broken/Obsolete furniture and Equipment Labelling and decontamination Electrical Equipment IT Equipment Leased Equipment Medical Devices Refrigerated Items Confidential Waste WASTE STORAGE ARRANGEMENT Local Storage Arrangements Central Storage Arrangements Main waste Compound WASTE COLLECTION AND TRANSPORTATION Ward and Departmental level Removal of waste bags from sack holders/bins. 43 Version: 2.0 (KD) Waste Management Policy & Procedure

5 This document has been redacted to remove personal information (e.g. staff names/contact information) that, under the Data Protection Act and hence Section 40 of the Freedom of Information Act 2000, should Removal of Condemned / contaminated Mattresses from Clinical Areas Removal of waste from disposal rooms Collection and Movement Arrangements CORRECT ASSEMBLY AND USE OF SHARPS BINS Sharps Injuries CLINICAL WASTE PRODUCED IN THE COMMUNITY SPILLAGE ARRANGEMENTS Clinical Waste Spillage Chemical Waste Spillage ASSOCIATED DOCUMENTS MONITORING COMPLIANCE REFERENCES 50 APPENDIX 1: CHECKLIST FOR THE REVIEW AND APPROVAL OF TRUST-WIDE POLICIES 51 APPENDIX 2: EQUALITY IMPACT ASSESSMENT 54 APPENDICES: LINK S FOR SOPS, GUIDANCE AND FORMS: 55 4

6 Waste Management Policy and Procedure 1. Introduction Kings College Hospital NHS Foundation Trust recognises that by its activities waste is created. Waste is stored and transported through the hospital before its ultimate disposal. Some of the Trusts waste streams are not only harmful to the environment but can present a risk to human health. The Trust has a variety of chemical and infectious waste streams. The Trust endeavours to manage its waste prudently in compliance with legislation, recognizing that waste of any kind is not only a drain on its own resources but that waste can only be the end product derived from natural resources with limited finite life spans. It is also recognised that waste whether in the initial packaging or at the end of the products life cycle ultimately has an adverse effect on the environment. For this reason sustainable waste management solutions form a key part of the Trust objectives. The Trust aims to improve and introduce new waste management procedures resulting in waste minimisation, reuse and recycling. Thus contributing towards sustainability. All staff in the Trust has a responsibility to ensure that waste is managed in line with the procedures outlined in this document. This will minimize any risk to themselves, other staff and those who transport the waste. Where there is evidence of poor or inappropriate waste management practices, further action may be considered Policy Objectives The Board of Kings College Hospital NHS Foundation Trust is committed to safe, efficient and effective management of all waste types produced by the Trust s activities. The Board is further committed to comply with all relevant legislation. The Trust intends to: Comply with legislative requirements associated with waste management. Maximise the recycling systems available to the Trust. Work together with suppliers in an effort to minimise the waste handled by the Trust. Promote a culture that recognizes the importance of safe, effective and efficient waste management. Provide a place of work free from danger of risk of injury caused by waste management. Operate in a manner, which minimizes risks to employees, patients, the environment and the community at large. Version: 2.0 (KD) Waste Management Policy & Procedure

7 Continually strive to improve its performance with regard to waste management through participation, commitment and support of all its employees. Liaise closely with other organizations to ensure continued good practice in its premises. 2. Definitions Hazardous waste Clinical waste yellow stream: Clinical waste orange-stream Recycling: PPE: Waste EWC WEEE Offensive Waste (Tiger Stripe) Any waste stream that is deemed to be hazardous as classified under the Hazardous waste Regulations Hazardous infectious wastes for incineration only Hazardous infectious wastes for alternative treatment NOT contaminated with pharmaceuticals/chemicals. Any item that is no longer required by the Trust and is being sent for reprocessing. Equipment that is in working order that is being sent to charity is not deemed as waste Personnel Protective Equipment Any item that is no longer required by the Trust and is being discarded European Waste Code Waste electronic and electrical equipment Yellow bag with black stripe Non-infectious Offensive Waste for deep burial at landfill 3. Purpose and Scope The policy and procedures within this document encompass the activities and responsibilities of all Trust staff as well as all contractors and temporary workers who are engaged to work on Trust premises. Duty of care requires that the Trust manages the impact of its waste both on site and to final treatment and disposal sites, including road safety responsibilities of the Trust as a consignor and carrier under the Carriage of Dangerous Goods and use of Transportable Pressure Equipment Regulations This policy is intended as the main Policy Statement of the Trust Waste Management. It is further supported by the following Trust policies and also to a number of policies from external organisations that work within the Trust. Health & Safety Policy COSSH Policy / Safe Device Policy / BBV Policy Controls Assurance Clinical Governance Infection Control Policy Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Policy Estates Environmental Procedure 20 Disposal of Human Tissue Collected prior to 1 September 2006 Radiation Safety Management Policy King s Environmental Strategy 6

8 Chemical Spills and Respirator Policy CJD Policy VHF ( viral haemorrhagic fevers ) The main organisations with which there are policy links for similar activities are: King s Health Partners HpC Medirest Sodexo Norland The Health Protection Agency Building contractors on the approved list ISS Vinci 4. Duties 4.1. Chief Executive The Chief Executive has overall responsibility on behalf of the Trust Board for ensuring compliance with statutory law. The Chief Executive will ensure that the requirements specified within this policy are resourced and implemented within the Trust. This will be achieved by: Ensuring receipt of bi-annual reports on KPI s, audited compliance, incidents. Taking all reasonable action on recommendations of Chief Financial Officer and the Environment Committee. Ensuring referral of waste policy issues in governance forums to Chief Financial Officer and/or the Environmental Committee Chief Operations Officer The Chief Operations Officer has been given delegated responsibility for the duties of Executive Director Responsible for Waste Management. The responsible duties are: Be responsible for the day-to-day compliance of the Trust with all relevant legislation and requirements specified within the policy. Version: 2.0 (KD) Waste Management Policy & Procedure

9 Ensure that there is an appropriate Waste Management Policy adopted by the Trust Board and contracted providers of services. To ensure that facilities / funding are available or are purchased for the disposal of all wastes generated by the Trust, which comply with the relevant legislation. To ensure that there is a regular review of the Waste Management Policy and an ongoing program of work for monitoring and policing. Updates to be included in the bi-annual report Environmental Committee (EC) The EC is responsible for developing the Trust waste management strategy and revision of internal policies to ensure compliance of legislation. To set KPI s in relation to waste management and set best waste management practises. From the EC a working Waste Project Group will be responsible for implementing revised Processes, procedures and policies for the prevention, safe segregation, handling, transport and disposal of waste to minimise risks to the health and safety of staff, contractors, patients, the public and the environment in accordance with all relevant Legislation. The EC is also responsible for: The day-to-day compliance with the requirements of the Policy and protocols. Ensuring that pro-active arrangements exist for the monitoring and implementation of the policy and strategy and will notify the Chief Financial Officer of areas of concern. The Chief Financial Officer will receive reports on the monitoring and implementation of the policy and other environmental initiatives on bi-annual basis for presentation to the Executive PFI Partners and Appointed Contractors The above groups of staff have responsibility to: Ensure that all staff under their direct control is adequately trained to deal with all types of waste produced by the Trust. Investigate and report all incidents. Ensure all staff has access to the Trust waste policy. To ensure that waste minimisation and facilities are taken in consideration when procuring new services or expanding the existing. Provide information to all staff working in their areas of responsibility information regarding waste procedures, disposal points, etc. Complete and maintain waste audit risk assessments and procedures for their own activities. Provide PPE to all staff involved in the handling and disposal of wastes. Identify and act on new waste management minimisation and requirements in existing, new or expanded processes / supply items. Ensure that all waste contractors are audited accordingly. (appendix 15) Ensure that all necessary and up to date licences and compliance information are kept on file. Ensure that all waste operations are provided and carried out in line with all relevant legislation. 8

10 Ensure that all staff are immunised. The nominated Facilities Officer responsible for each site waste will be responsible for the site s waste management audit requirements as detailed in Appendix Kings College Hospital Foundation Trust Divisional Managers, Heads of Services, Ward Managers, Head of Departments and Supervisory Staff at Denmark Hill, the PRUH, Orpington Hospital, Beckenham Beacon Hospital and Satellite Units. The above groups of staff have responsibility to: Ensure that all staff under their direct control are adequately trained to deal with the types of waste produced within their service. Investigate and report all incidents. Ensure all staff has access to the Trust waste policy. To ensure that waste minimisation and facilities are taken in consideration when procuring new services or expanding the existing. Ensure that adequate waste storage Facilities are included in the design or refurbishment of areas. Provide information to all staff working in their areas of responsibility information regarding waste procedures, disposal points, etc. Identify training needs of their staff. Provide PPE to all staff involved in the handling and disposal of wastes. Complete COSHH assessments for hazardous waste streams. Identify and act on new waste management minimisation and requirements in new or expanded processes / supply items. Ensure that the necessary local resources are available to ensure that all aspects of the protocols can be met. Ensure all bin receptacles are clearly labelled with the appropriate waste stream sticker. Contact the relevant helpdesk to order new stickers when required. Line management must resolve problems in the first instance. Any recurring or substantial problems should also be drawn to the attention of the relevant Facilities Officer. To ascertain the relevant Facilities officer for your site contact the FM Operations Manager Domestic and Departmental Ancillary Staff They are responsible for bagging; sealing and handling the majority of waste produced by the Trust in accordance with the procedures outlined in this policy. Domestic and departmental ancillary staff also have the following responsibilities: Bring to the attention of their line manager or the ward/department manager any waste that has been disposed of incorrectly. Ensure waste is bagged and sealed properly, appropriately marked / labelled and taken to the nearest designated storage area to await collection. Waste bags must be placed within the appropriate container and NEVER placed on the floor. Version: 2.0 (KD) Waste Management Policy & Procedure

11 Ensure that all large waste bins are kept locked and secure at all times and staff have access to bin keys at all times. Should the staff find that there is not sufficient capacity within their waste disposal area they should immediately notify the relevant helpdesk and arrange for portering staff to replace bins. Ensuring that a helpdesk reference number is obtained. Site Denmark Hill Orpington Porters Princess Royal University Hospital Beckenham Beacon front desk Contact Telephone Number Ensure that waste holdall areas are kept locked and secure at all times. Ensure that hazardous and domestic bags or containers are not mixed or handled together at any stage. Attend training sessions when indicated by their manager Portering Staff Portering staff have the following responsibilities: Ensure that waste receptacle capacity is available at all time for all waste disposal areas. Collecting waste from the designated storage areas around the Trust and transporting this waste to the central storage area for collection, or compaction prior to collection. Ensure that all waste storage wheelie bins are fully washed and disinfected after being emptied prior to returning it to the wards/departments. Ensure that bins are wiped over in wet weather to ensure that water is not spilt onto flooring whilst being transported. Ensure any spillages that occur during transportation are reported immediately via extension redacted option 1 to be cleaned and area cordenned off immediately to avoid slips and falls. And the leakadge will need to be stopped before carrying on with the transportation to avoid long trails of spillages on public areas. Ensure that all bins are locked on delivery, and also during transportation. Ensure that no bin bags are protruding outsides of the containers whilst transporting bins Store all wastes waiting collection appropriately in line with the requirements of the Trust Waste Management Matrix and the contractual requirements. Ensure that appropriate documentation is completed and exchanged when wastes are collected for disposal as required by the Waste Regulations. When requested, collect and transport large, non-compactable or WEEE items of waste for disposal, as detailed in the waste charts. All requests must go through the appropriate helpdesk for each site. Site Denmark Hill Contact Telephone Number 10

12 Orpington Porters Princess Royal University Hospital Beckenham Beacon front desk Bring to the attention of their line manager any waste that has been disposed of incorrectly Ensure that all hazardous waste is correctly described on the consignment note. Denmark Hill will record accurate weights, the PRUH, Orpington, and Beckenham Beacon will use weights taken from the hazardous waste quarterly returns. Ensure that quarterly returns are received for all hazardous waste that is consigned. Ensure that the appropriate PPE worn at all times when handling waste. Attend training sessions when indicated by their manager. Ensure that the correct cages / Receptacles are used when transporting or storing waste. 4.8 All Staff For the purposes of this document bank/agency staff and students/trainees are considered to be Trust staff All members of staff generate waste as a by-product of their employment within Kings College Hospital NHS Trust. They are responsible, as the producer of this waste to ensure it is minimised, handled, transported and disposed of in accordance with the policy and procedures laid down in this document. All staff has a further responsibility to ensure that no member of staff, member of the public, patient or external contract staff contravenes the policy and procedures laid down in this document. Failure to do so may result in disciplinary action being taken. This responsibility cannot be delegated to any other person. Staff should note that non-compliance with regulations made under the Environmental Protection Regulation (EPR) 2010 Regulation (EPR) 2010 could in certain circumstances result in individual prosecution Contractors All contractors employed by, or working on behalf of the Trust will make the necessary arrangements to comply with this policy. It is the responsibility of the Divisional Managers to ensure that contractors are aware of the policy. Capital, Estates and Facilities contractors should also refer to Estates Environmental procedure 20 and the KCH 10 point environmental guide. For further information on roles and responsibilities and contact details see appendix 10. Version: 2.0 (KD) Waste Management Policy & Procedure

13 5. Waste Stream Management The Trust has adopted a colour coded system outlined in the Department of Health Safe Management of healthcare waste HTM07-01., to identify all the waste streams produced by Kings College Hospital NHS Foundation Trust. All waste types are identified throughout the process of production, storage, transportation and disposal. See the Waste Management Matrix (Appendix 4). In the Waste Management Matrix all types of waste will be identified with the EWC code and the colour code assigned Recycling, Re-Use And Reduction Under The Waste Regulations 2011 it is a legal requirement for the Trust to apply the waste management hierarchy prior to waste being disposed of. The waste hierarchy sets out in order the way in which waste should be dealt with prior to waste being disposed of. The waste Hierarchy is as follows; 1. Prevention 2. Preparing for reuse 3. Recycling 4. Recovery, e.g. energy recovery 5. Disposal The Trust has chosen to implement and adopt suitable recycling practices in line with government recommendations and to achieve sustainable development within the NHS. These practices will involve a reduction in the amount of waste sent to landfill and incineration, and the amount of packaging accepted by the Trust from suppliers. For further information on prevention and re-use see the King s Environmental Strategy. A recycling waste stream is included in the Trust Waste Management Matrix (Appendix 4). The Trust intends to recycle waste where practicable and various schemes are being developed to maximise this potential. Items that will be recycled include: Paper (all types) Cardboard Plastic bottles Ink cartridges Batteries Newspapers and Magazines Cans Furniture Fluorescent tubes Scrap Metal Waste Electronic and Electrical Equipment 12

14 X-Rays films / slides Co-mingled Recycling (Green Bag) Recycling stations are available in all wards, departments and public access areas to maximise its potential for waste minimisation. All staff are expected to support the system and make the effort to ensure all items that can be recycled are disposed in the appropriate green bags/bins. Should you require an additional recycling capacity or collection contact the relevant helpdesk. Site Denmark Hill Orpington Porters Princess Royal University Hospital Beckenham Beacon front desk Contact Telephone Number The following are included in the recycling scheme at Denmark Hill; Paper (all types except that containing confidential material Empty Plastic bottles Newspapers and Magazines Empty Drinks cans Empty Food tins Tetrapaks The following are included at PRUH, Orpington, Beckenham Beacon and All Satellite Units Paper (except that containing confidential material) White, coloured, newspaper, magazines, books and clean hand towels. Cardboard Empty aluminium and steel cans Empty plastic and drink and food bottles Empty drink cartons Empty plastic and cardboard cups Empty plastic water bottles, Couch roll (Clean and dry) Ink Cartridges Place empty cartridge into original packaging. Contact the relevant helpdesk for ink cartridge collection and recycling. Version: 2.0 (KD) Waste Management Policy & Procedure

15 A central drop off point is also available in the Post Room at Denmark Hill. A central drop off point is available in the procurement stores at PRUH A central drop off point is available at Orpington Porters Lodge. A central drop off point is available at Beckenham Beacon Behind the front Information Desk Site Denmark Hill Orpington Porters Princess Royal University Hospital Beckenham Beacon front desk Contact Telephone Number Toner cartridges for Konica multi-function devices. Remove used consumable from Konica Minolta Business Machine. Pack into the plastic bag that the new consumable came in. Collect packed items and place in a box to form a parcel (up to 10kg) or bag that can be provided free of charge from Konica s recycling partner. Securely seal box/bag. Contact Procurement (Denmark Hill) on extension to arrange collection. Contact extension for PRUH and extension for Orpington to arrange collection Batteries Denmark Hill All household batteries are to be placed in the Battery Bags provided and placed in the internal post. Follow the directions on the Battery Bags. Battery Bags are available by contacting the Medirest helpdesk on options All lead acid batteries are to be notified to Medirest on ext. option for disposal, as these are classified as Hazardous Waste and will be handled via the hazardous chemical waste stream ref 5.5. Keep these in a secure location until they are collected by the hit team. PRUH Battery bins are located within: Theatres Clinical Measurements Switchboard Staff with access to these areas can use these disposal points. Lead acid batteries should be notified to on ext. 14

16 Orpington 5 Litre Battery bins are located strategically within the hospital site for household batteries (contact ISS helpdesk on if unsure of location of battery bins). There is a central collection point at the post room near the porters lodge where a 60 Litre container is located for battery storage. Notify ISS helpdesk on when the 5 Litre battery bins are full and also to arrange collections. Lead acid batteries should be notified to on ext. Beckenham Battery bin is located within the front information desk area. Staff with access to these areas can use these disposal points or request collection from the departments by contacting the porters via the front information desk on X Rays and Film Slides PRUH, Orpington, Beckenham Beacon and Satellite Units All X- Rays: remove the cardboard sleeve and place into the confidential waste stream, as these may contain patient details. The outer areas of the confidential bags must be marked / labelled clearly with a marker as X-Rays / Film Slides All X-Rays are to be notified to the relevant helpdesk to arrange collection. Site Denmark Hill Orpington Porters Princess Royal University Hospital Beckenham Beacon front desk Contact Telephone Number Cardboard Cardboard boxes must be broken down and flat packed before disposal. All wards and departments are responsible to ensure that all boxes are flattened before placing into disposal rooms or relevant cardboard cages or stores. The PFI Company responsible for Waste is responsible to managing and reviewing the recycling systems to ensure they are fully maximised General /Domestic waste This category includes all types of normal dry household waste. It must not include any waste that falls under the heading of Recycling, clinical waste as defined in Section 5.4, offensive waste as defined in section nor must it include any waste that is otherwise radioactively, biologically or chemically contaminated. Version: 2.0 (KD) Waste Management Policy & Procedure

17 The following are included in this waste stream: Non-recyclable packaging Flowers Small amounts of food left over where composting is not available Paper hand towels (Denmark Hill only these can be recycled at PRUH and Orpington) Disposable coffee cups - ensure that these are empty prior to placing in the waste bin. (Denmark Hill only these can be recycled at PRUH and Orpington) Household domestic and office waste falling under this category must be placed in clear plastic bags and adequately sealed and tagged. Bags of General / Domestic waste are to be stored inside the black wheelie bins awaiting collection by the porters Food waste All food waste is to be disposed of either by maceration or via the composting waste system (if available). No solid food items should be disposed of via domestic waste stream. All food entering the composting system must be in the appropriate composting bags 5.4. Clinical Waste Clinical waste should be segregated from other types of waste and be treated/disposed of appropriately in suitably licensed facilities on the basis of the hazard it poses. The Hazardous Waste (England and Wales) Regulations 2005 and the List of Wastes (England) 2005 Regulations, require producers to adequately describe their waste using both a written description and the use of the appropriate European Waste (EWC) Code(s). At Kings College Hospital NHS Foundation Trust, clinical wastes are segregated into a number of waste streams, identified by a designated colour as per the Waste Management Matrix (Appendix 4). Each type of waste is described with the appropriate EWC and required disposal method i.e. incineration or alternative treatment. Hazardous wastes are those marked with an asterisk. A consignment note must be completed for the disposal of all Hazardous wastes. A waste transfer note must accompany all other controlled wastes. Staff must consult the Waste Classification Chart (Appendix 4) when identifying types of waste and its disposal requirements. If any further clarification is required, contact the site s relevant Facilities Officer. All clinical waste packaging is to be UN approved and ISO 2014 approved sharps containers. All waste bins and bags must be approved by the Trust Dangerous Goods Advisor and be designed to comply with the Dangerous Goods Regulations Clinical waste orange-stream Hazardous infectious wastes that can be treated in a suitable licensed or permitted facility via alternative technology i.e. autoclave and microwave. This waste MUST NOT be contaminated with pharmaceuticals/chemicals. Orange plastic bags -These bags are located at various locations throughout the wards and clinical areas and must only be used for the disposal of Orange-stream Clinical wastes in 16

18 accordance to the Waste Management Matrix (Appendix 4). It is an offence under the Hazardous Waste Regulations (2005) to place domestic waste, offensive waste or recycling in this waste stream. Yellow sharps bins with orange lids Sharps waste for suitably licensed alternative technology treatment plant only. These bins must be used for the disposal of sharps, NOT contaminated with pharmaceuticals/chemicals. see Appendix Clinical waste yellow stream Hazardous infectious wastes for incineration only. Yellow plastic bags These bags are located in laboratories in accordance with the Waste Management Matrix (Appendix 4). This is due to a high risk of waste being contaminated with chemical re-agents. Should infection control deem that in an outbreak situation clinical waste need to go for incineration, departments are to be provided with yellow bags via the appropriate helpdesk. Site Denmark Hill Orpington Porters Princess Royal University Hospital Beckenham Beacon front desk Contact Telephone Number Yellow sharps bins with yellow lids Sharps waste for incineration only. These bins are stored in various locations in wards, laboratories and outpatient s areas and must be used for the disposal of sharps, including sharps and items contaminated with chemicals and pharmaceuticals, which are NOT cytotoxic and/or cytostatic materials. These include syringes, vials, ampoules, glass medicine bottles, infusion bags and administration sets. DENMARK HILL An access plus Sharpsmart bin should be available in sluice areas for administration sets. PRUH, ORPINGTON, BECKENHAM BEACON AND SATELLITE UNITS A Daniels bin with large aperture, XA (extra access) range, should be available in sluice areas for administration sets. This includes all generated sharps which ooperates within the boundaries of the Safer / BBV Policy. 2.5 litre containers must be available on the wards/ departments to use in conjunction with the sharps trays.sharps bins that are used at floor level, must be placed on stands, provided by the suppliers, to prevent floor contact. All staff users of sharps must operate temporary closures on all sharp bins. Version: 2.0 (KD) Waste Management Policy & Procedure

19 WIVA BINS Yellow rigid plastic bin for incineration only. Should be used for anatomical waste (recognisable anatomical waste i.e. body parts, organs, body tissue). Chest drains canister, suction liners/canister and any other clinical item that may contain a liquid content. These bins should also be used to dispose of pharmaceutical waste from pharmacy and samples from laboratories. These bins can be used for Catergory A waste. Ensure when ¾ full, all WIVA bin lids are securely sealed, appropriately labelled and removed to waste room for disposal prior to collection.(refer to Category A waste SOP for appropriate disposal of Category A waste) These bins are to be transferred by the porters from the areas of production to the appropriate point of disposal. To arrange a collection contact the following helpdesks: Site Denmark Hill Orpington Porters Princess Royal University Hospital Beckenham Beacon front desk Contact Telephone Number An identification label must be fixed to the bin prior to being sent for disposal. All labels are available from the helpdesks above if required. Blue Pharmaceutical Purple Cytotoxic/Cytostatic Yellow Infectious Light Pink Laboratory samples with reagents Red Anatomical specimens preserved in formalin or other chemicals Red Anatomical including placenta All anatomical waste including laboratory specimens and research tissue must also be disposed of in line with the Trust policy Policy for the disposal of human tissue collected prior to 1 September here Yellow bins with red lids All anatomical waste for incineration only. These bins are found in various locations in the Trust such as (Theatres, Labour ward and Midwifery Centres) and must only be used for anatomical including placenta waste. An identification label must be completed prior to sending for disposal Clinical waste purple stream (cytotoxic/cytostatic) Cytotoxic/cytostatic waste for high temperature incineration only. Purple plastic bags are located at various locations throughout the wards, clinical and laboratory areas and must only be used for the disposal of Purple-stream Clinical wastes in accordance to the Waste Management Matrix (Appendix 4). A full list of cytotoxic/cytostatic 18

20 drugs used within the Trust is available (Appendix 15). These bags are to be used for Cytotoxic and/or Cytostatic soft wastes i.e. items such as gloves and gauze which have been used during preparation or administration of cytotoxic/cytostatic drugs. These bags must remain segregated from other bags at all times. The waste porters will collect the bags from the area and transfer it to the designated storage. If you do not have space in your waste room to segregate purple waste from orange or yellow arrange a collection directly by contacting the relevant helpdesk detailed below; Site Denmark Hill Orpington Porters Princess Royal University Hospital Beckenham Beacon front desk Contact Telephone Number Yellow sharps bins with purple lids Sharps waste contaminated with Cytotoxic and/or cytostatic drugs for high temperature incineration only. These bins are stored in various locations within the Trust and must only be used for sharps, syringes, infusion bags and administration sets contaminated with cytotoxic and/or cytostatic drugs Offensive Waste Tiger Stripe bag yellow with black stripe Non-infectious Offensive Waste for deep burial at landfill or Energy from waste These bags are to be used for waste which is non infectious and which does not require specialist treatment or disposal or need to be classified for transport, but which may cause offence to those coming into contact with it. Offensive waste is classified as waste that does not present a risk of infection or contain any contamination from pharmaceutical or chemical agents. Examples of offensive/hygiene waste include: Non- Infectious incontinence and other waste produced from human hygiene; Non Infectious nappies; catheter and stoma bags Nasal secretions; sputum; vomit and soiled human bedding from a non-infectious source Non-clinical PPE i.e. food hygiene PPE - gloves and aprons from food service (ward & clinical areas) This waste is therefore deemed not to require any further treatment when leaving site i.e. autoclave or incineration. However, this waste will be produced as a by-product of clinical care. Clinical practitioners are expected to apply an assessment to each patients waste as depicted in the diagram and table below. This will ascertain whether the waste should be disposed of into the offensive (tiger stripped) or clinical waste stream. Version: 2.0 (KD) Waste Management Policy & Procedure

21 Under the Hazardous Waste Regulations 2005 it is an offense to mix hazardous waste with nonhazardous waste. This means that offensive waste and domestic waste must be segregated from the clinical waste stream. All offensive waste must be placed in the Tiger stripe -stream wastes in accordance to the waste classification process detailed below. In view of the Trust s Waste strategy, It is the intention to ease segregation of the appropriate waste stream by positioning waste receptacles strategically in designated areas to effect the appropriate waste stream effectively.( i.e. orange bags in infectious rooms or areas, the rest of the ward is tiger stripe stream and domestic stream) Assessment and classification of offensive waste Start (i) Is the waste a culture or enrichment of a microorganism or toxin known or reliably believed to cause disease in man or other living organisms? No OR Is the waste a sample from an animal or human known or clinical assessed to have a disease caused by a microorganism or its toxin? No (ii) Does the waste arise from a patient who is known or suspected to have a disease caused by a microorganism or its toxin? Yes Yes This element of the waste possesses the hazardous property H9 infectious and should be placed into the clinical waste stream H9 - Infectious : substances and preparations containing viable micro-organisms or their toxins which are known or reliably believed to cause disease in man or other living organisms. 20

22 No (iii) Might the waste cause infection to any person or living organism coming into contact with it? (Please see table below for guidance on this assessment) Yes No (iv) Has the individual waste item and source patient been clinically assessed for H9 infectious? The outcome confirming that the patient is non infectious. (Please see table below. NB waste products contaminated with blood, pus and wound exudates require confirmation from laboratory results to confirm clinical assessment) Yes No Place into offensive waste stream The table below depicts how waste may present a risk of infection, as required in step (iii) of the assessment diagram above. Might the waste cause infection to any person or other living organism coming into contact with it? YES NO Version: 2.0 (KD) Waste Management Policy & Procedure

23 Any healthcare waste contaminated with blood, pus, wound exudates and similar substances is regarded as presenting a risk of infection. This would not apply if both the following were true: It was known that the individual source patient does not (e.g. as a result of pathology tests or clinical assessment) have an infection that might result in pathogens contaminating the waste; And No other risk of infection was identified (such that the material is not considered a clinical waste). This will include urine, sputum, vomit and faecal contaminated materials (including urine bags, incontinence pads, single use bowls, nappies, PPE) where the answer to question (ii) was no after appropriate item and patient specific assessment. Sufficient information (e.g. from pathology tests or clinical assessment) is known about a specific item contaminated with blood from a particular patient to classify an individual item as non-infectious. Examples of this might include: Blood transfusion items Maternity, sanitary and placental waste where pathology tests have confirmed or clinical assessment has assessed that no infection is present and no other risk of infection exists. Dressings contaminated with blood where there is sufficient knowledge of the patient for the assessment to conclude not infectious (e.g. it is known that no blood-bourne viruses or other infectious agents are present) Faecal-contaminated pads, nappies or similar items where pathology tests or clinical assessment indicate no gastro intestinal infection. For further guidance contact the Infection Prevention Team Sharps Waste It is possible that a patient s status may change whilst being treated. I.e. a patient may be suspected to have contracted noro virus. It is the clinical practitioner s responsibility to assess and classify the waste accordingly if a risk of infection is felt to be present. Sharps waste should be segregated in accordance to the colour guide in appendix 4. Sharp bins should be used at point of injection. When ¾ full, must be sealed, appropriately labelled and removed to designated waste room for disposal 22

24 Sharps should be placed into the designated disposal room for collection at Denmark Hill on the floor next to the clinical waste bin. / The disposal room must remain locked at all times. If using the sharps smart re-usable system, at Denmark Hill, upon collection a new bin will be delivered. If stocks of re-usable sharps bins are running low contact the Medirest help desk on extension option. Disposable sharps bins may need to be used in some areas at Denmark Hill and across PRUH, Beckenham Beacon and Orpington sites as well as Satellite Units. At PRUH full bins labelled and sealed are to be left in the sluice area and these are collected daily by Portering staff. Disposable sharps bins should be ordered via your materials management clerk. Should you have any queries regarding these contact procurement via the following extension numbers; Site Denmark Hill Princess Royal University Hospital Orpington Porters Beckenham Beacon front desk Extension Sharps bins should NEVER be placed within clinical waste sacks for disposal Laboratory Waste to be autoclaved prior to leaving site Designated clinical waste and category A waste generated from certain laboratories, e.g. Microbiology, must be treated as infectious, and must be autoclaved on site. This waste must be stored in clinicla waste bag prior to autoclave. Once the waste has been treated it may go into the offensive waste stream, as long as the autoclave validation process has been approved, as dictated by the Microbiology SOP. On occasions when the autoclave is not working the waste must be placed in rigid yellow 60 litre WIVA bins, and disposed as Hazardous Waste for incineration only. The Relevant Facilities Officer must be informed at every occasion when this happens, as waste will need to be incinerated and consigned differently under the Transportation of Dangerous Goods Viral Haemorrhagic Fevers (Category A contaminated clinical waste) Version: 2.0 (KD) Waste Management Policy & Procedure

25 Clinical waste generated from the treatment of patients who are known, or suspected, to be infected with a Category A listed micro-organism must be segregated at point of production from other clinical waste. A list of Category A microorganisms is listed in appendix 5. This is because the clinical waste must be: packed in two layers consisting of a plastic clinical waste bag and a rigid outer package both of which comply with United Nations (UN) packaging standards for clinical waste; stored in the patient s room before been moved by porters to store in a dedicated, secure area away from other clinical waste; (Refer to SOP for Category A waste Appendix 6) sent for disposal by incineration only at a special site under strict security controls. All disposable waste generated from a patient with any confirmed or suspected Viral Haemorrhagic Fevers must be treated as infectious waste and Category A waste for transportation purposes. See Standard Operating Procedure in Appendix 6 for packaging the waste and how to manage it. This includes all linen, the mop heads and uniform scrubs. Contact the Clinical Site Manager and the Environmental / waste Manager to notify them that this waste is being generated. They will ensure that the necessary waste management plan is implemented to deal with this waste stream(refer to Category A waste Security Plan). This waste must be kept segregated and must not enter any other clinical waste stream. Failure to meet requirements risks the safety of the Trust s clinical staff, waste portering staff, waste contractor drivers and personnel working at disposal sites. Fines and prohibition notices can be issued to the Trust by the enforcement agencies including the Health & Safety Executive (HSE), Environment Agency and Police Force Creutzfeldt-Jacob Disease (CJD) All tissue from a patient with confirmed and suspected CJD must be treated as waste for incineration. All linen, medical instruments and cleaning materials e.g. mop heads from theatres based procedures must also be disposed of via incineration and/or those that have come into contact high risk tissue or bodily fluid as per the table below. All disposable waste must be placed in a yellow WIVA bin, sealed and ready for disposal by incineration and sharps into a disposable sharps box. Label with the yellow infectious waste label and mark lid with CJD contaminated. For patients with confirmed and suspected CJD receiving treatment at ward level producing waste such as sharps and general clinical waste. These can be placed into the yellow sharps waste stream and orange bags for autoclave. These waste streams are contaminated with blood, urine & saliva only. Table 1 Disposal of Clinical Waste from patients with or at increased risk of CJD 24

26 Taken from: Annex A1 TSE Agents: Safe working and the prevention of infection - see section 6 for link to full document Key: +ve = tested positive -ve = tested negative NT = not tested P = infectivity proven in experimental transmission studies Tissue Presence of abnormal prion protein and level of infectivity TSE other than vcjd vcjd Brain +ve High P +ve High P Spinal cord +ve High P +ve High P Cranial nerves, specifically the entire optic nerve and only the intracranial components of the other cranial nerves +ve High +ve High Cranial nerve ganglia +ve High +ve High P Posterior eye, specifically the posterior hyaloid face, retina, retinal pigment epithelium, choroid, subretinal fluid, optic nerve +ve High P +ve High Pituitary gland +ve High (?) +ve High (?) Spinal ganglia +ve Medium +ve Medium P Olfactory epithelium +ve Medium NT Medium Dura mater -ve Low +ve Low Tonsil -ve Low +ve Medium P Lymph nodes and other organised lymphoid tissues containing follicular structures Gut-associated lymphoid tissue -ve Low P +ve Medium P -ve Low +ve Medium Appendix -ve Low +ve Medium Version: 2.0 (KD) Waste Management Policy & Procedure

27 Spleen +ve Low P +ve Medium P Thymus -ve Low +ve Medium Anterior eye and cornea Contd. Tissue -ve Low -ve Low Presence of abnormal prion protein and level of infectivity TSE other than vcjd Peripheral nerve +ve Low +ve Low Skeletal muscle +ve Low +ve Low Dental Pulp -ve Low -ve Low Peripheral nerve +ve Low +ve Low Skeletal muscle +ve Low +ve Low Gingival Tissue NT Low -ve Low Blood and bone marrow vcjd NT Low -ve Low CSF -ve Low P -ve Low Placenta -ve Low -ve Low Urine -ve Low -ve Low Other tissues -ve Low P +ve Low If in any doubt about the procedure, contact the Infection Prevention Team or see CJD policy Hazardous Chemical Waste Chemical wastes vary in their flammability, toxicity, ecological damage potential and reactivity. It is the responsibility of each user of chemicals to make themselves aware of the handling hazards associated with chemicals used and to inform waste handlers of any special disposal hazards. Chemical waste can be categorised into; Hazardous property Symbols Hazardous property name, category of danger and description H1: Explosive Explosive, E Explosive : substances and preparations which may explode under the effect of flame or which are more sensitive to shocks or friction than dinitrobenzene 26

28 H2: Oxidizing Oxidising, O Oxidizing : substances and preparations which exhibit highly exothermic reactions when in contact with other substances, particularly flammable substances. H3-A and H3-B: Flammable H4/H8: Irritant and Corrosive Extremely Flammable, F+ Highly Flammable, F Highly flammable - liquid substances and preparations having a flash point below 21 C (including extremely flammable liquids); or - substances and preparations which may become hot and finally catch fire in contact with air at ambient temperature without any application of energy; or - solid substances and preparations which may readily catch fire after brief contact with a source of ignition and which continue to burn or be consumed after removal of the source of ignition; or - gaseous substances and preparations which are flammable in air at normal pressure; or - substances and preparations which, in contact with water or damp air, evolve highly flammable gases in dangerous quantities. Flammable, F Flammable : liquid substances and preparations having a flash point equal to or greater than 21 C and less than or equal to 55 C. Irritant, Xi Irritant : non-corrosive substances and preparations which, through immediate, prolonged or repeated contact with the skin or mucous membrane, can cause inflammation. H5/H6: Harmful and Toxic Harmful, Xn Harmful : substances and preparations which, if they are inhaled or ingested or if they penetrate the skin, may involve limited health risks. H6: Toxic (see H5/H6) H7: Carcinogenic Toxic, T Very toxic, T+ Toxic : substances and preparations (including very toxic substances and preparations) which, if they are inhaled or ingested or if they penetrate the skin, may involve serious, acute or chronic health risks and even death. Carcinogenic, Carc.Cat. 1, 2 & 3 Carcinogenic : substances and preparations which, if they are inhaled or ingested or if they penetrate the skin, may induce cancer or increase its incidence. Version: 2.0 (KD) Waste Management Policy & Procedure

29 H8: Corrosive (see H4/H8) Corrosive, C Corrosive : substances and preparations which may destroy living tissue on contact. H9: Infectious Not subject to labelling requiremen ts of chemical legislation H10: Toxic for Reproduction Not allocated a category of danger by chemical classification legislation. Infectious : substances and preparations containing viable micro-organisms or their toxins which are known or reliably believed to cause disease in man or other living organisms. Toxic for reproduction, Repr. Cat. 1, 2 and 3 Toxic for reproduction : substances and preparations which, if they are inhaled or ingested or if they penetrate the skin, may induce non-hereditary congenital malformations or increase their incidence. H11: Mutagenic Mutagenic, Muta.Cat. 1, 2 and 3 Mutagenic : substances and preparations which, if they are inhaled or ingested or if they penetrate the skin, may induce hereditary genetic defects or increase their incidence. H12: Produces toxic gases in contact with water, air or acid. Waste which releases toxic or very toxic gases in contact with water, air or an acid. H13: Sensitizing Sensitising, Xn, Xi Sensitizing : substances and preparations which, if they are inhaled or if they penetrate the skin, are capable of eliciting a reaction of hypersensitization such that on further exposure to the substance or preparation, characteristic adverse effects are produced. H14: Ecotoxic Dangerous for the Environment, N Ecotoxic : waste which presents or may present immediate or delayed risks for one or more sectors of the environment. 28