The safer system of sharps segregation

SMS Guide new designed to protect TM TM The New Sharpsafe SMS guide to HTM 07-01: Safe Management of Healthcare The safer system of sharps segregation

Your guide to HTM 07-01 This booklet accompanies a PowerPoint presentation and is designed to assist Managers, Infection Control Teams and other NHS Professionals in choosing a sharps segregation system which identifies and satisfies the specific needs of individual Trusts whilst meeting their obligations in accordance HTM 07-01: Safe Management of Healthcare. Contents What is HTM 07-01 and how will it affect current practice? classification, segregation and colour coding segregation and disposal routes Sharps segregation stream Your choice 4 alternative colour coded segregation routes. Need some guidance? An application chart the Sharpsafe range. HTM 07-01 Frequently asked questions and answers. What happens next? Sharpsafe SMS Support and educational material Sharpsafe SMS toolkit. 1 2-3 4 5 6-7 8 9-11 12 13

designed to protect What is HTM 07-01 and how will it affect current practice? Health Technical Memorandum 07-01: Safe Management of Healthcare Replaces Health Services Advisory Committee s (1999) guidance document Safe Disposal of Clinical. Guidance produced to provide a framework st practice management to help healthcare providers and other producers to meet legislative requirements. Guidance focuses on the management of medicinal and infectious. Key recommendations of HTM 07-01 Guidance recommends adopting: A new methodology identifying and classifying infectious and medicinal that complies health and safety, transport and regulations (the new methodology is descrid as the Unified Approach). HTM 07-01 divides medicines into three broad groups Cytotoxic and Cytostatic Pharmaceutically active but not or Not pharmaceutically active and possessing no hazardous properties e.g. saline on glucose A separate Sharpsafe SMS brochure provides inmation on Sharpsafe products and services and how to migrate from current practice through to adoption of HTM 07-01: Safe Management of Healthcare. This booklet can obtained from Frontier Medical Customer Services (Telephone 01495 235800) or by visiting www.sharpsafe.co.uk Sharpsafe SMS brochure A revised colour-coded st practice segregation and system. An offensive/hygiene stream to descri that is non-infectious (human hygiene and sanpro ). Definition of infectious and medicinal Infectious Infectious is essentially a that poses a known or potential risk of infection, regardless of the level of infection posed. Medicinal Medicinal includes expired, unused, spilt and pharmaceutical products, drugs, vaccines and sera that are no longer and need to disposed of properly. 1

classification, segregation and colour coding segregation Segregation of at the point of production into suitable colour-coded is vital to good management. The charts shown low and on the following pages identify both the type of and colour each stream. segregation chart type Radioactive (use infectious/medicinal EWC codes as appropriate) Cytotoxic/ medicinal s in EWC = 18 01 08* EWC = 18 01 09 Medicinal (non-cyto) in Medicinal NOT in eg loose tablets EWC = 18 01 09 Medicines not in their original should segregated in order to minimise the risks of combustion, explosion or noxious fumes that occur through intermixing If cyto container should have purple markings and EWC = 18 01 08* Medicinal in original EWC = 18 01 09 Sharps / medicinal products EWC = 18 01 08* & 18 01 03* Sharps medicinal s other than and medicines EWC = 18 01 03* (or 18 01 01), & 18 01 09 Anatomical & other potentially infectious which requires disposal by EWC = 18 01 02 & 18 01 03* Sharps or sharps (fully discharged) medicinal s other than and medicines EWC = 18 01 03* (or 18 01 01), & 18 01 09 Potentially infectious and known infectious EWC = 18 01 03* Laboratory cultures (see paragraphs 28 and 29 in the Research and laboratories facilities sector guide) EWC = 18 01 03* Offensive/hygiene s EWC = 18 01 04 or 20 01 99 Domestic EWC = 20 03 01 Dental amalgam EWC = 18 01 10* Photographic and X-ray EWC = (from) 09 01 Seek guidance from contractor Large equipment eg mattresses Seek guidance from contractor Implanted devices Figure 6 segregation chart 33 Management of in-house Packaging Treatment & disposal SUBJECT TO RSA 1993 Medicinal container Return to pharmacy Liquid Solid INCINERATION Orange stream also suitable HTM 07-01: Safe Management of Healthcare Liquid Solid Leak-proof rigid container Pre-treat on site (eg autoclave) Leak-proof rigid container compacted on-site Leak-proof rigid container Hg suppressant Leak-proof rigid container TREATMENT LANDFILL RECOVERY Seek guidance from contractor 7 segregation and national colour-coding approach 2

Figure 4 coding key to segregation system Environment and sustainability Health Technical Memorandum 07-01: Safe management of healthcare Figure 4 coding key to segregation system Description Figure 4 coding key to segregation system Figure 4 coding key to segregation system Figure 4 coding key to segregation system Description Figure 4 coding keyrequires to segregation Description which disposal bysystem codingdescription key to segregation system is in a suitably or Description which requires disposal by Description is in a suitably or Description which requires disposal by which requires disposal by is in a suitably or which requires disposal by is in a suitably or which treated which requires disposal by is in a suitably or which requires disposal by is to rendered safe a suitably is in a in suitably oror is in a suitably or which treated facility, usually alternative plants (ATPs)). However this is to rendered safe in a suitably or ofby treated also which disposed. facility, usually alternative (ATPs)). this or which treated is to plants rendered safe However in a suitably which by treated which treated also disposed of. is to rendered safe in a suitably facility, usually alternative plants (ATPs)). However this or is toisto rendered safe safe in a suitably or rendered in this a suitable facility, usually alternative plants (ATPs)). However also which disposed ofby treated. facility, usually alternative plants (ATPs)). However this Cytotoxic and is to rendered in a suitably or this or facility, alternative safe plants (ATP s). However also disposed of byusually. also disposed of by. is in a suitably or facility, usually alternative plants (ATPs)). However this Cytotoxic andalso of disposed by. also disposed of by. is in a suitably or Cytotoxic and Cytotoxic and Cytotoxic and and is in a suitably or Cytotoxic is in a suitably or is in a suitably or Offensive/hygiene * is in a suitably or Cytotoxic and is landfill in a suitably or Offensive/hygiene * is in a suitably or This should not compacted in un/ Offensive/hygiene * Offensive/hygiene is landfill in a suitably or facilities. This should not iscompacted un/ Offensive/hygiene * landfill in in a suitably or is landfill in a suitably or Offensive/hygiene * facilities. is landfill in in a suitably or This should not compacted un/ This should not compacted in un/ facilities. is landfill in a suitably or Offensive/hygiene * This should not compacted in un/ facilities. Domestic (municipal) This should not is compacted un/ landfill in in a suitably or facilities. Minimum is landfill in a suitably or facilities. Domestic (municipal) This should not compacted in un/ Domestic (municipal) Recyclable components should removed through segregation. Minimum is landfill a suitably facilities. Minimum (municipal) is landfill in ain suitably or or Domestic Clear/opaque receptacles also used domestic. Recyclable components should removed through segregation. Recyclable components removed through segregation. Domestic (municipal) Minimum should is landfill in a suitably or Domestic (municipal) Clear/opaque receptacles used domestic. or Clear/opaque receptacles alsoalso should used domestic. Minimum is landfill in a suitably Recyclable components removed through segregation. Minimum (municipal) is landfill in a suitably or Domestic Recyclable components should removed. through segregation. Clear/opaque receptacles also should used Amalgam Recyclable components domestic removed through segregation. Amalgam Minimum landfill in a suitably or Clear/opaque receptacles also is used domestic. white Clear/opaque receptaclescomponents also should used domestic. For recovery Recyclable removed through segregation. For recovery Amalgam white Clear/opaque receptacles also used domestic. For recovery Amalgam white Amalgam For recovery * The use of yellow/black offensive/hygiene was chosen as these colours have historically en HTM 07-01: Safe Management of Healthcare Amalgam white For recovery white universally used the sanitary/offensive/hygiene stream For recovery * The use of yellow/black offensive/hygiene was chosen as these colours have historically en Amalgam white Example: segregation colour code and definition chart (Non Sharps Stream) universally used the sanitary/offensive/hygiene stream as these For recovery * The use yellow/black offensive/hygiene was chosen colours have historically en Figure 5 of and colour-coding * The use of yellow/black offensive/hygiene was chosen universally used the sanitary/offensive/hygiene stream as these colours have historically en * The use yellow/black offensive/hygiene was chosen as Example these colours have historically en Figure 5 of and colour-coding receptacle types contents / Description universally used the sanitary/offensive/hygiene stream universally used the sanitary/offensive/hygiene stream * The use of yellow/black offensive/hygiene was chosen as these colours have historically en disposal Figure 5 and colour-coding receptacle types Example contents / universally used the sanitary/offensive/hygiene Figure 5 and colour-coding stream Healthcare Disinfection Dressings, tubing etc from Appropriately disposal Infectious Clinical Figure 5 and colour-coding receptacle types Example contents / involving low level facility All clinical produced bytypes infectious patients and all items by blood or blood receptacle Example contents / Healthcare Dressings, tubing etc from Appropriately disposal Figure 5 and colour-coding receptacle Example contents / material types isotopes products. All items by semen, vaginal secretions or fluids that are; cerebro spinal, disposal Dressings, involving level Appropriately facility Healthcare tubing etclow from disposal receptacle types contents / synovial, pleural, peritoneal, pericardial and amniotic.example material involving isotopes Healthcare Dressings, tubing etc from Appropriately Dressings, level Appropriately facility disposal Healthcare tubing etclow from involving low level facility Hygiene Landfill material isotopes Over-stickers the Dressings, involving low level Appropriately facility Healthcare tubing etc from material isotopes and other produced from human hygiene (urine, faeces, sputum, tears, nasal Continence symbol pads material isotopes involving low level facility Over-stickers the secretions, vomit). Disposed equipment that does not pose a risk of infection (inhalers, gowns, gloves, used on yellow material isotopes symbol casts). and plaster Over-stickers the Infectious Dressings/tubing from Incineration used on yellow Over-stickers the symbol Over-stickers the Cyto Incineration and/or and/or symbol Infectious Dressings/tubing from Incineration used on yellow symbol & All the medicinal clinical produced by infectious patients and all items products Over-stickers used on yellow and/or and/or Infectious Dressings/tubing from Incineration by blood or blood products. All items by semen, vaginal secretions or fluids that are; used on yellowsymbol medicinal products pericardial and Infectious and/or Dressings/tubing from Incineration and/or spinal,infectious synovial, pleural, peritoneal, amniotic. used on yellowcerebro Dressings/tubing from Incineration and/orproducts and/or medicinal and/or Infectious and/or from Incineration Suitable Recycling medicinal products Dressings/tubing medicinal products and/or and/or Hand towels/tissues, newspapers/magazines, /plastics, cans/bottles, crisp packets, 30 sandwich/chocolate wrappers, aerosol cans, toiletries medicinal products such as shower gel bottles, soap, 30 30 30 30 30 shampoo bottles etc. Domestic Landfill Flowers, food s (biscuits, apples, banana skins, orange peel, tomatoes, salads, potato skins, sweets and chewing gum) floor sweepings and j-cloths. 3

segregation and disposal routes Based on the recommendations of HTM 07-01, Frontier Medical have identified four possible segregation routes. The segregation route chosen will depend on local policy but Frontier Medical can help identify the right solution your particular circumstance. It is understood that current Environment Agency advice discourages aggregation of sharps into one single colour coded stream. Permutations other than those shown are possible and Frontier Medical can provide advice on other options. The chart shown low indicates the 4 segregation routes available. Route A Route B Route C Route D 4

Sharps segregation stream stream colour coding Whilst the guidance identifies a numr of colour coding options this document will focus on the Orange, Yellow and Purple sharps streams, together a Blue Stream pharmaceutical. segregation colour code and definition chart (Sharps Stream) Description Orange Stream infectious treated to render it safe prior to final disposal including landfill. Orange - lidded sharps containers should contain sharps not medicinal products and/or fully discharged sharps. Yellow Stream infectious requires disposal by in a suitably licenced or Yellow - lidded sharps containers should contain partially discharged sharps medicinal products other than and medicines. Purple Stream requires ultra high temperature in a suitably licenced or Purple - lidded sharps containers should used sharps that are and / or medicinal products. Blue Stream Sharpsafe Pharma containers are available lals designating Solid Pharmaceutical. These containers comply UN 3249 and the in-mould lals reflect this fact. Blue lidded is medicinal in original and medicinal not in original (e.g. loose tablets) and requires in a suitably licenced or 5

Your choice - 4 alternative colour coded segregation routes The following charts are a simplified interpretation of HTM 07-01 and provide 4 alternative colour coded segregation routes. Segregation Route A Orange, Yellow & Purple MEDICINAL FULLY DISCHARGED OR NON-MEDICINAL MEDICINAL NON-CYTO CYTOTOXIC/STATIC FULLY DISCHARGED MEDICINAL CYTO Dispose of into ORANGE Lidded Container Dispose of into YELLOW Lidded Container Dispose of into PURPLE Lidded Container Segregation Route B Yellow & Purple EXCLUDING CONTAMINATED WITH CYTO WASTE NON-MEDICINAL MEDICINAL NON-CYTO CYTOTOXIC/STATIC MEDICINAL CYTO 6 Dispose of into YELLOW Lidded Container Dispose of into PURPLE Lidded Container

Segregation Route C Orange & Purple MEDICINAL FULLY DISCHARGED OR NON-MEDICINAL MEDICINAL NON-CYTO CYTOTOXIC/STATIC FULLY DISCHARGED CYTO Dispose of into ORANGE Lidded Container Dispose of into PURPLE Lidded Container Segregation Route D Purple NON-MEDICINAL MEDICINAL NON-CYTO CYTOTOXIC/STATIC CYTO Dispose of into PURPLE Lidded Container It is understood that current Environment Agency advice discourages aggregation of sharps into one single colour coded stream. Permutations other than those shown are possible and Frontier Medical can provide advice on other options. 7

Need some guidance? Each Hospital or Trust will choose a combination of the following coloured lids; 1. Orange (Fully discharged) 2. Yellow (Medicinal) 3. Purple (Cytotoxic/Cytostatic) 4. Blue (Pharmaceutical) NHS Trusts have a choice of one of 4 segregation routes to choose from. Current Environment Agency advice discourages aggregation of sharps into one single colour coded stream. Frontier lieve that a minimum of 2 separate coloured lid sharps container streams should utilised. Frontier Medical can assist Trusts in selecting the most appropriate sharps segregation streams. Once a stream segregation route is chosen Frontier Medical can provide an HTM 07-01 Toolkit comprising a series of posters and other training material to assist in educating staff on the new guidelines and reincing the individual segregation route chosen by each Trust, namely route A, B, C or D as shown on pages 6-7. The chart low provides a guide as to the likely application each container in most clinical settings. Where Orange and Yellow are shown together, that represents a choice of one or the other. Safe management of healthcare product placement guide Community Sharpsafe Clinisafe Leakproof 0.6L 1L 2L 3L 4L 7L 7.5L 9L 13L 24L 30L 9L 10L Community Bag STB1 GP s / Clinics Cyto Non-cyto General Wards Cyto Non-cyto Oncology Cyto Maternity Cyto Non-cyto Theatres Non-cyto Outpatients Cyto Non-cyto Phlebotomy Non-cyto INSERT INSERT INSERT Pharmacy Solids Liquids UN3249 UN3249 Laboratories 8 Key: INSERT INSERT UN3249 UN3249 Sharpsafe container Protected Access feature Solid pharmaceutical container complies UN 3249, MEDICINE, SOLID, TOXIC, N.O.S INSERT INSERT UN3249 UN3249 Liquid Pharmaceutical complies UN 1851, MEDICINE, LIQUID, TOXIC, N.O.S UN 3291, CLINICAL WASTE, UNSPECIFIED, N.O.S Sharpsafe standard container combined a Protected Access Insert.

designed to protect Safe Management of Healthcare HTM 07-01: Frequently asked questions What does each colour represent? Sharpsafe sharps container lids are available in four colours: Orange Sharps or alternative. Marked Fully Discharged Sharps use fully discharged sharps not prescription only medicines or POM s. Yellow Sharps including infectious sharps only. Marked Medicinal Sharps For use sharps including those medicines other than those which are /. Purple sharps which are and medicines. Marked Cyto sharps. Blue Lid - Sharpsafe Pharma containers are available lals designating Solid Pharmaceutical. These containers comply UN 3249 and the in-mould lals reflect this fact. Are these colours going to the same England/ Wales/Scotland/Northern Ireland? The Safe Management of Healthcare (HTM-07-01) document has en adopted by the health services of England, Scotland and Wales. However, it is likely that further guidance issued relating to Scotland. This guidance has not en adopted by Northern Ireland. Which size containers will this affect? This guidance covers all clinical containers, including all sizes of sharps containers. Will these containers comply the new regulation? Yes the Sharpsafe colour-coded range will continue to comply all relevant regulations. Can I order through NHS Logistics? NHS Logistics is now known as NHS Supply Chain since the organisation was outsourced to DHL. A full range of Sharpsafe containers in each of the three colours is stocked by NHS Supply Chain. Will the containers still comply BS? Yes BS7320:1990 is still the applicable standard sharps containers and, whilst Safe Management of Healthcare does not make reference to the standard, Frontier will ensure that all Sharpsafe products continue to comply. Why do we need a message printed on the lid? Frontier has decided to keep a standard, generic lal on the base of the container and to print a message on the lid two reasons: Whilst lids and bases are packed in the same carton they occasionally get mixed up e they are assembled at point of use. Consequently, if both the lals on the bases and the lid are specific, there is a significant danger that they mismatched e.g., the lal says one thing about the contents and the colour of the lid implies another; The message on the lid is designed to give users of the container a clearly visible indication of what should placed in it whilst lals are useful reference, they are less immediately obvious users in a busy healthcare environment. The denotes it is acceptable to place specific into that colour container e.g. Cyto Sharps indicates it is ok to place or sharps into this container. In addition, the retention of the generic lal allows customers an easy migration path in that the standard yellow-lidded products continue to used all sharps until the organisation is ready to adopt the new guidance. 9

10 In short, Frontier has tried to keep the colour-coding system as simple and failsafe as possible, given its unavoidable complexities. Which colour should I use? The guidance offers organisations a degree of flexibility and the colour or combination of colours adopted is likely to vary due to differing circumstances including capability to segregate at point of use, type of healthcare facility and disposal arrangements. Separate guidance has en produced to advise Sharpsafe users as to the most appropriate colour combinations their particular circumstances. Do I need super-absornt sachets in the container? Not in the normal circumstances. So long as there are not significant quantities of free liquid in the container and the container is correctly assembled and closed, no leakage should occur. Sharpsafe containers are specifically designed to retain liquids in normal use as a sharps container and whilst not ing leakproof in the technical sense, they do offer greater levels of fluid retention than other products available in the UK. How much liquid can I dispose of in these containers? Sharpsafe containers comply BS7320:1990 which require them to retain liquids up to 5% of their nominal capacity. In practice, it is considered that residual contents of syringes can continue to disposed of in Sharpsafe sharps containers. Can I still order super-absornt sachets? These sachets can still ordered directly from Frontier should they particular circumstances. Are they more expensive? As would expected, the colour-coded products are more expensive to manufacture. However, Frontier have chosen to absorb this additional cost and to sell the new colour-coded products at the same price as the old range. Can I still order black containers? Black-lidded containers were previously used by many customers to designate the presence of sharps. These containers have en superseded by the purple-lidded containers in the new colour-coded range. However, black-lidded containers will continue to available by special arrangement direct from the factory. Do you manufacture a leakproof container? Leakproof is both a common-usage adjective ( so constructed or contrived as to prevent leaks or leakage ; designed to prevent leaking ; not subject to leaks, according to various dictionaries) and a technical term. Standard Sharpsafe products are designed primarily as sharps containers and permance tested in accordance : BS7320:1990 which, in this context, requires the container to retain liquids of 5% of nominal volume; and UN3291 solids, which has no specific requirement relating to fluid retention as it is not anticipated that large quantities of liquids will present. Consequently, so long as substantial quantities of free liquid are not present, it considered that Sharpsafe containers are functionally leakproof. However, where substantial quantities of free liquids need to contained, it is appropriate a product designed this specific purpose to used. In this context, it would appropriate the container to comply UN specifications liquid containers which require pressure testing, implying a far greater level of fluid retention. Frontier aim to add such containers to the Sharpsafe range to enable large quantities of liquids to appropriately contained during the route to disposal.

Are these stock items? Yes, these products are stocked by NHS Supply Chain, Welsh Health Supplies and National Procurement NHS Scotland. The products will also available as stock items through independent distributors. A factory stock is maintained, available immediate despatch. Will these colour changes apply to the 30 & 60 Litre clinical containers? Yes the guidance covers all clinical containers. However, in practice, it is likely that the majority of these containers will continue to have yellow lids. Will the in-mould lal change? The in-mould lals on the Sharpsafe range of sharps containers are unchanged and include: Clear written and pictorial instructions on the use of the products Why do Sharpsafe lals not include EWC codes? European Catalogue (EWC) codes are mandatory all documentation i.e., it is necessary the documentation which accompanies the consignment of containers to state what the is including its classification per the EWC. Contaminated sharps could fit into any one of approximately 10 EWC codes dependent on particular circumstances. If the container lal includes the EWC code, then there is a likelihood either that the code will wrong or that a substantially greater numr of containers will. Frontier have taken the view that by not including EWC codes on the lal provides far greater flexibility users whilst the accompanying documentation provides the necessary regulatory compliance. All necessary regulatory inmation British Standard inmation and kitemark UN classification (UN 3291) and code Disposal instructions This main nefit of one standard lal is its simplicity and lack of opportunity mismatch different coloured lids. 11

What happens next? Once you have chosen a segregation route Frontier Medical can offer you all the support you need in order to implement the change effectively and efficiently. call 01495 235800 or visit www.sharpsafe.co.uk Simply contact your local Area Sales Manager, details of whom are enclosed. Alternatively, you can contact our Customer Services Department on 01495 235800. Rememr we are here to help, so if there is anything we can assist you in order to make the transition as smooth as possible then please do not hesitate to contact us. Sharpsafe SMS Safe Management of Sharps A system of safe management of sharps and other healthcare, which results in a reduction in needlestick injuries and produces cash releasing savings. Adoption of this guidance will assist NHS Trusts demonstrate conmity their duties under the Management of Health and Safety at Work Regulations 1992. Sharpsafe SMS adopts the key recommendations of HTM 07-01: Safe Management of Healthcare and incorporates Near Patient Sharps Disposal (NPSD ) in accordance chapter 9.6 of The Blue Book, The management of health, safety and welfare issues NHS staff, 2005. 12

Version 1.0 Support and educational material TM New Sharpsafe SMS toolkit A helping hand from Frontier Medical Whichever segregation route you take, assured of support from Frontier Medical. As well as a fully compliant product range we also offer a helping hand in the m of a comprehensive range of posters, ordering guides and educational support materials and training services. Sharpsafe SMS toolkit and CD-ROM Sharpsafe SMS brochure Sharpsafe product range literature www.sharpsafe.co.uk Sharpsafe SMS Toolkit Safe management PowerPoint presentation 13

SMS Guide Frontier Medical Products Ltd Newbridge Road Industrial Estate Blackwood, South Wales NP12 2YN Sharpsafe is a registered trademark of Frontier Medical Products Limited Septemr 2007 Frontier Medical Products Limited. All rights reserved. The inmation and advice contained in this document was correct at the time of printing, but subject to subsequent changes. GP0059_A22_01 Tel: +44(0)1495 235800 Fax: +44(0)1495 235808 Email: enquiries@sharpsafe.co.uk www.sharpsafe.co.uk