MANAGEMENT OF HEALTHCARE WASTE POLICY

MANAGEMENT OF HEALTHCARE WASTE POLICY First Issued by/date BWW& BKW 2001 Issue Version Purpose of Issue/Description of Change 2 Update to meet new regulations Replaces HS20 and ICP18 in line with new guidance Planned Review Date May 2012 Named Responsible Officer:- Approved by Date Capital Projects and Premises Infection Control Committee February 2010 Management Lead Policy File: - Infection Control Impact Assessment Screening Complete- April 2010 Full Impact Assessment Required - No No. 5 Key Performance Indicators 1. Compliance with HTM 07-01 Safe Management of Healthcare Waste 2. Incidence Reporting (non-compliance) 3. Infection Prevention and Control audit 4. Duty of Care Audit and Environment Agency / Intercare pre-acceptance audit UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE PCT WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION Page 1 of 27

Contents Page Introduction 3 Policy Aim 3 Policy Outcome 4 Target Group 4 Cross reference to related NHS Wirral Policies 4 Evidence to support policy 5 Specific responsibilities 5 Background 6 Management of healthcare waste in a clinic setting 7 Management of healthcare waste in a community setting 9 Home collection service 12 Medicinal Sharps Waste 14 Training 16 Audit and Duty of Care 16 Transfer Notes/Consignment Note 17 References 17 List of those consulted in drafting process 17 Appendix 1 Waste description table 19 Appendix 2 Patients with MRSA 20 Appendix 3 Risk assessment of wounds 21 Appendix 4 Request for Home Healthcare Waste / Special Waste Collection 23 Appendix 5 Waste Segregation at NHS sites 26 Appendix 6 Assurance Form 27 Page 2 of 27

Management of Healthcare Waste Policy Introduction All healthcare practitioners have a duty to ensure that healthcare waste is disposed of in a safe and appropriate way that ensures the health and safety of themselves, other professionals, service users, contractors, waste carriers and ultimately the environment. The previous PCT Clinical Waste policy HS20 followed the guidance in the Health and Safety Advisory Committee 1999 Safe Disposal of Clinical Waste, based on: Environmental Protection Act 1990 Controlled Waste Regulations 1992 Special Waste Regulations 1996 This policy has been written in line with the Department of Health, Health Technical Memorandum 07-01 Safe Management of Health Care Waste Guidance and also the Hazardous (England and Wales) Regulations 2005. The Hazardous Waste Regulations superseded the Special Waste Regulations that had been in place since 1980. In England and Wales it is a legal requirement of the Hazardous Waste Regulations to segregate infectious waste (that is subject to special requirements in order to prevent infection) from other wastes. This policy is also written in line with the requirements of the Safety Domain core standard 4e, Waste Management of the Standards for Better Health (DH 2004) and the Health Act (DH 2006) Code of Practice for the Prevention and Control of Health Care Associated Infections. The term healthcare will be used throughout this policy. This is defined by the Department of Health (2006) Safe Management of Healthcare Waste HTM 07-01 as waste from natal care, diagnosis, treatment or prevention of disease in humans/animals. Examples of healthcare waste include infectious waste, laboratory cultures, anatomical waste, sharps waste, medicinal waste, laboratory chemicals and offensive/hygiene waste from healthcare areas. The five original categories of Group A to E clinical waste have been discontinued as they do not equate to the use of the European Waste Catalogue (EWC) Codes. These EWC codes are now mandatory and used for all waste transfer documentation. See appendix 1 Waste Description Table Policy Aim NHS Wirral will ensure that all clinical waste produced as part of the healthcare process is appropriately managed and disposed of in accordance with current legislation and best practice ensuring the safety of all personnel Page 3 of 27

involved in the production, handling, storage, transportation and final disposal of such wastes. This policy applies to all services directly provided by NHS Wirral and all clinical staff should familiarise themselves with the policy. healthcare waste management will be undertaken in a variety of environments, from patients homes, Intermediate Care facilities and specialist clinics. It is the responsibility of each Independent Contractor to reduce Health Care Associated Infections (HCAI) and the transmission of infection during the disposal of health care waste. NHS Wirral recommends that Contractors apply the principles of this policy as minimum standards within their practices to ensure that their professional and contractual obligations are discharged. NHS Wirral will expect Commissioned Services to also apply the principles of this policy as minimum standards within their services. Policy outcome This policy will provide a framework for healthcare waste management, segregation and disposal based upon good practice. As a result, staff should be able to correctly and safely dispose of healthcare waste arising from health care interventions, as well as review the provision and use of the necessary facilities and equipment to ensure that compliance to legislation is possible. Target group NHS Wirral salaried staff. Cheshire & Wirral Partnership Trust External contractors Shared as best practice with Independent General Practice staff, and General Dental Practice staff and where relevant, Independent Pharmacists and Optometrists. Cross reference to related NHS Wirral policies Risk Assessment for the Prevention and Control of Healthcare Associated Infections (HCAI) Guidance Sharps Safety and Management of Contaminated Injuries Policy COSHH Policy Medical Devices Management Policy Hand Decontamination Policy Cleaning and Disinfection Policy Standard Operating Procedure for the Transport of Controlled Drugs Meticillin Resistant Staphylococcus Aureus (MRSA) Policy Procedure for the Transport of Microbiological Specimens by Community Nursing Staff Page 4 of 27

Evidence to support policy Department of Health, Health Technical Memorandum 07-01 Safe Management of Health Care Waste Guidance The Health and Social Care Act (2008), Code of Practice for the Prevention and Control of Healthcare Associated Infections Environmental Protection (1991) Duty of Care Regulations Medical Devices regulations (2002) DEFRA 2005 Guidance for Dentists on Waste Amalgam National Resource for Infection Control. Clinical Practice Waste disposal/management www.nric.org.uk Health and Safety at Work Act 1974 Specific responsibilities Chief Executive The Chief Executive has overall responsibility for ensuring that there are effective arrangements in place for the safe management of healthcare waste. Under the Health and Safety at Work Act (1974) NHS Wirral has a statutory duty to ensure safe systems or work and a safe working environment for all its employees, visitors, contractors, members of the public and others within its premises. Environmental and Energy Project Manager The Environmental and Energy Project Manager will be responsible for operational waste issues within the relevant NHS Wirral buildings and the management of the waste disposal contracts for NHS Wirral and Independent Medical Practices. Service Managers should: Ensure waste is assessed as part of the service risk assessment for HCAI Ensure staff assess waste for specific procedures within clinics and patients home Ensure staff complete risk assessments for individual patient care where no procedure assessments are appropriate Ensure staff attend appropriate training Ensure staff have appropriate supplies of consumables including waste containers, bags, tags etc Staff, external contractors and the Waste Contractor should: Check that waste receptacles are properly sealed and marked, handle waste receptacles in the correct manner, and take appropriate action in the event of a spillage/accident. These members of staff and Page 5 of 27

contractors have the right to refuse to remove the offending articles until rendered safe by the producer. Attend training and obtain advice where classification or risk status is unclear Complete risk assessments for healthcare waste Follow the policy for determining appropriate disposal of waste ensuring compliance to legislation. Background In the United Kingdom the cost of waste disposal is increasing. The NHS produces an average of 250,000 tonnes of waste a year at a cost of over 40 million. Most waste goes to landfill, incineration or to a lesser extent alternative technologies, irrespective of its method of disposal waste has the potential to pollute land, air and water. 75-90% of health care waste is similar to domestic waste, with a smaller proportion of 10-15% posing a risk to human health or the environment. It is essential that health care practitioners risk assess waste, segregate hazardous from non hazardous waste to ensure safe and effective disposal. Waste definition and classification European Waste Catalogue (EWC) Codes: The UK Environmental Regulatory Authorities have produced a joint guidance document on the interpretation, definition and classification of hazardous waste entitled WM2. There are 14 hazard groups identified in the Hazardous Waste Regulations. For the purpose of this policy H9 (infectious) will be the hazard group most focused upon. The Hazardous Waste Regulations define infectious (H9) as substances containing viable micro-organisms or their toxins which are known or reliably believed to cause disease in man or other living organisms. Segregation of different types of waste is critical to safe management of healthcare waste and helps control management costs (appendix 5) Healthcare waste has been traditionally known as clinical waste on the basis of infection risk. Waste is now classified on the basis of its hazardous characteristics and the point of production. Hazardous waste Infectious Waste and potentially infectious waste (H9 infectious*) Body parts or recognisable anatomical waste Waste that poses a known or Non-hazardous waste Offensive/hygiene waste. Waste which is non-infectious and nonhazardous but may cause offence to others coming into contact with it. Page 6 of 27

potential risk of infection (including minor infections) Cytotoxic and cytostatic medicinal waste**(h6 toxic and/or H7 carcinogenic and/or H10 toxic and/or H11 mutagenic) Expired, unused, spilt and contaminated pharmaceutical products, drugs, vaccines. Items contaminated with medicines i.e. bottles, syringes, drug vials Healthcare chemicals and hazardous properties i.e. amalgam, mercury Used incontinence products, used sanitary products, nappies) Non cytotoxic and cytostatic medicines (require specialist treatment or disposal) Expired, unused, spilt and contaminated pharmaceutical products, drugs, vaccines. Items contaminated with medicines i.e. bottles, syringes, drug vials Domestic waste Management of healthcare waste in a clinic setting Healthcare waste generated from healthcare practices e.g. Clinics, General Practices and General Dental Practices or produced by healthcare workers in the community, will be considered to be infectious waste unless an assessment has taken place. The assessment must be included in the risk assessment procedure for the risk assessment for healthcare associated infection for service, procedure and individual patient as appropriate (please refer to nursing polices). When dealing with healthcare waste in health care premises the following should apply:- Labelling Storage All bags should be securely tied using the cable tie supplied to the clinic by the contractor or domestics prior to collection. All cable ties have an identification number that can be traced back to base/department producing the waste. This is the responsibility of the organisation or Practice producing the waste Waste bags should be no more than 75% full as they have to be tied. Clinical waste awaiting collection by the waste contractor must not be stored in clinical areas or offices. Sharps containers used in home treatments and clinics must be closed and labelled as per Sharps policy guidance. Page 7 of 27

All waste and sharps containers must be placed in the designated segregated and secured waste storage area that is well ventilated and prohibits unauthorised access. Segregation Household, offensive and infectious bags should be kept separate Household waste should not be disposed of in orange bags as this increases the cost. Infectious and Offensive waste must not be disposed of in domestic waste bags as this may lead to prosecution. If in doubt, contact the Environmental & Energy Manager or waste contractor. Handling of waste Staff dealing with waste should wash their hands after doing so All staff dealing with waste in any setting should be aware of the correct procedure to follow in case of a spillage. Please refer to Spillage Policy. Non Hazardous Waste Waste contaminated with non-infectious bodily fluids is capable of causing offence and therefore requires appropriate packaging to alert those in the waste management chain of the contents by packaging them as offensive/hygiene waste. Type Domestic refuse Offensive waste Disposal Route Container type and colour Landfill Clear/black bag/domestic waste bin Alternative treatment/incineration Bag - Orange Waste Code 20.03.01 18.01.04 Types of waste in clinic Food waste Clean packaging Paper Uncontaminated paper hand towels Uncontaminated blue paper bed roll Nappies Sanitary waste Incontinence pads Plaster casts Uncontaminated disposable clothing Uncontaminated single use equipment Page 8 of 27

Hazardous Waste Type Disposal Route Container type and colour Infectious/ potentially infectious waste Alternative treatment/incineration Bag Orange Rigid leak proof container yellow/yellow or yellow/orange Waste Code 18.01.03 Hazard group - H9 Types of waste in clinic Bag: Dressings Bandages Single use equipment including non sharp plastic disposable instruments i.e. speculum Rigid leak proof container: Soiled non sharp metal surgical instruments Maggots Extracted teeth Management of healthcare waste in a community setting Community nursing can take many forms and occurs in various environments. It includes healthcare workers who provide care and support to:- Patients in their own homes; Householders who are self-medicating Residents of care homes. As a community practitioner, the following types of waste will be produced: Infectious Sharps Offensive Medicinal Anatomical Domestic Page 9 of 27

Where waste is generated by a healthcare worker in the community, the healthcare worker is responsible for ensuring that the waste is managed correctly; this is part of their duty-of-care. In accordance with HTM 07-01 guidance:- The healthcare worker producing the waste must leave it in the home for collection by the appropriate organisation, depending on the classification of waste, this will be a contractor working on behalf of the NHS, or the local authority through it's domestic waste collection service. The healthcare worker has the responsibility for informing the patient on the safe storage of waste that is awaiting collection, and for arranging that collection. While awaiting collection from the householder s home, the waste should be stored in a suitable place to which children, pets, pests etc do not have access. It is not appropriate to leave the waste unsupervised on the pavement awaiting collection. Waste should be packaged and labelled appropriately and adequate instructions should be given to patient/carer. Please note:- Sanitary towels, nappies and incontinence pads (known collectively as sanpro waste) and enteral feeding syringes and non-infectious gastrostomy tubes which are not considered to be hazardous when they originate from a healthy population can be appropriately bagged and sealed in thin opaque plastic sacks such as sandwich bags and bin liners and disposed of in the nonrecyclable household waste bin. They must not be wrapped in yellow or orange bags as this denotes the waste as being infectious. Offensive/hygiene waste from healthcare Many items classified as healthcare waste produced in the community by a healthcare worker are unlikely to be classified as infectious waste and should be segregated and managed as offensive/hygiene waste. This requires item and patient specific assessment. Examples include:- Non-infectious dressings Non-infectious disposable instruments Non-infectious stoma bags Non-infectious catheter bags Non-infectious incontinence pads. This waste should be segregated at source and packaged and treated as offensive/hygiene waste. If a healthcare worker is involved in the care of a stoma site, the waste from a stoma patient can be disposed of in the patients non-recyclable domestic waste stream. However, if the patient develops any type of gastrointestinal infection or the site becomes infected, the bag must be disposed of as infectious waste into the orange-bag waste stream. Page 10 of 27

Non Hazardous Waste Waste contaminated with non-infectious bodily fluids is capable of causing offence and therefore requires appropriate packaging to alert those in the waste management chain of the contents by packaging them as offensive/hygiene waste. Type Domestic refuse Offensive waste Disposal Route Container type and colour Landfill/pre-treated landfill Clear/black bag/domestic waste bin Alternative treatment/incineration Bag - Orange Waste Code 20.03.01 18.01.04 Types of waste in patients home Healthcare waste that may be placed in general refuse: Non infectious :- Dressings Continence pads/catheter bags (normal daily amount) Stoma waste (normal daily amount) Disposable instruments Please note: non-hazardous recyclable domestic waste should be separated, where recycling facilities have been provided, for example, cardboard and paper. Continence pads/bags over patients normal daily amount Stoma waste over patients normal daily Antimicrobial dressings from non infected wounds Hazardous Waste Type Disposal Route Container type and colour Infectious/ potentially infectious waste Alternative treatment/incineration Bag Orange Page 11 of 27

Rigid leak proof container Yellow body with a yellow lid Waste Code 18.01.03 Hazard group - H9 Types of waste in patients home Bag: Infectious/potentially infectious dressings and/or bandages All dressings if more than normal daily amount Antimicrobial dressings from infected sites Continence pads from patients known or suspected of a gastro-intestinal infection Urine bags from patients with a known/suspected urinary tract infection MRSA infected wounds (appendix 2) Bag: waste from highly infectious cases i.e. Ebola This waste is highly unlikely to be produced in the home setting please seek advice on appropriate disposal protocol. Rigid leak proof container: Wound vacuum drainage Suction fluid where infection is known/suspected. Maggots Home collection service Healthcare waste produced by NHS Wirral staff as a result of treatment in a patient s home is considered to be NHS Wirral waste. Deciding which disposal route to use will be determined by using the Wound Assessment chart (appendix 3). Offensive, infectious or potentially infectious waste produced through healthcare activities which is assessed as being unsuitable for disposal in the domestic waste stream can be collected by the NHS Wirral registered waste carrier. This waste must be disposed of via the infectious waste stream (orange bags). Community staff will need to complete the Request for Home Healthcare Waste/Special Waste collections referral form (appendix 4) for patients with any quantity of offensive, infectious or potentially infectious waste. Page 12 of 27

Staff must ensure the patient and/or relatives are aware and consent to the storage of healthcare waste on their premises. Waste must be stored in an area inaccessible to pets and children. Waste must never be left by or on a public highway awaiting collection, but must remain in a secure place. If the waste is offensive in smell or very wet it may be appropriate to double bag the waste to reduce odour or risk of leakage or consider using a rigid clinical waste container. Only two types of waste arising from Healthcare activity are considered to be both clinical waste and hazardous waste and therefore unsuitable to be placed in the normal household/domestic waste stream. These are: Sharps and other clinical infectious waste (EWC codes: 18 01 01 and 18 01 03 Cytotoxic and cytostatic medicines (EWC codes:18 01 08 and 20 01 31) Where the householder produces non-offensive and non infectious waste such as continence/sanpro waste, staff should advise patients to bag and seal their waste and mix it with their normal household residual rubbish, regardless of quantity. Provision of additional green bin storage will be provided free of charge by Wirral Council. Green bins will be collected on alternate weeks in line with the Council s waste collection system. Patients living in multi-occupancy accommodation using bulk containers have the option of being provided with their own green wheeled bin (supplied free of charge by the Council) that will be emptied fortnightly. Residents may need to seek permission from the site owners to store the bin in a communal area. Patients preferring to have their non-infectious waste emptied more frequently from their green bins can choose to opt for a weekly green bin collection service. However, staff should note that patients will be charged for any collections that are requested above and beyond that of the standard fortnightly green bin service. Patients can contact the Council's Streescene department (0151 606 2004) to organise collections and find out current collection charges. Residents will not be charged for the disposal element of this service. Sharps waste Staff may only transport sharps containers that have been used by PCT community staff. Staff must always transport sharps containers with the lid in the temporary closed position in a secure position in the boot of the car. Staff should assess the size and type of container required based on appropriateness/need and ensure the container is signed and dated. Please refer to the Sharps Policy for further guidance. Page 13 of 27

Patients own sharps waste Where the householder is a self-caring patient who uses injectables (for example a person with diabetes) the GP or healthcare worker should prescribe the householder the appropriate container (for example a sharps box) and advise them of local disposal options. Under no circumstances should residents place sharps waste or sharps containers in any bins provided by the local authority for general household waste. Once the sharps box is three-quarters full, it should be sealed by the householder and taken back to the GP surgery or to the local pharmacy. Disposal of disposable instruments Disposable instruments can take the form of either plastic or metal instruments. Contaminated plastic disposable instruments where there is no risk of sharps can be safely disposed of into the orange-bag waste stream. Metal disposable instruments where there is no risk of sharps and they are deemed to be infectious should be put into a rigid yellow container marked for incineration only. For further guidance contact the Environmental & Energy Project Manager. Where the instruments are deemed to be non-infectious, they should be sent for disposal as offensive/hygiene waste and in the case of metal instruments, metal reclamation and recovery where available. Disposable instruments cannot legally be disposed of in the domestic refuse. Medicinal Sharps Waste Type Disposal Route Container colour Fully discharged sharps used for medicinal products other than cytostatic and cytotoxic products Partially discharged sharps not contaminated with cytostatic or cytotoxic products Partially discharged or fully discharges sharps used with cytotoxic or cytostatic products Incineration Incineration Incineration Rigid sharps container - Yellow body with orange lid Rigid leakproof sharps container - Yellow body with yellow lid Rigid leakproof sharps container - Yellow body with purple lid Sharps Sharps Sharps Page 14 of 27

Waste Code Types of waste in clinic and patients home 18.01.01 18.01.03 18 01 08 Fully discharged sharps which have not been used for cytotoxic/cytostatic products Includes sharps from phlebotomy Partially discharged sharps containing medicinal products which are not cytotoxic/cytostatic products Includes self care prescribed by Primary Care i.e. Diabetic patients Partially or fully discharged sharps which have been used to give cytotoxic/cytostatic products. Includes self care prescribed by Primary Care i.e. Hormone injections Please note that sharp boxes should be collected when three-quarters full and must never exceed the permissible marked mass. If the sharp box is seldom used, it should be collected after a maximum of three months regardless of the filled capacity. Medicinal Waste Type Disposal Route Container colour Medicinal waste not in original packaging Incineration Rigid pharmacy container - Yellow body with yellow lid Cytotoxic/Cytostatic Medicinal waste in original package Incineration Rigid pharmacy container - Yellow body with purple lid liquid solid Waste Code Comments 18.01.09 18.01.08 Medicines not in their original packaging should be segregated to minimise the potential harmful effects of intermixing. Page 15 of 27

Specialist Healthcare Waste Type Disposal Route Container colour Dental Amalgam Specialist recovery White leak proof rigid container White container Waste Code 18.01.10 Types of waste Amalgam fillings Extracted teeth with amalgam fillings Training All clinical staff should attend the Healthcare Waste training sessions. The delivery model for these sessions will be face to face, information bulletins and eventually E Learning. Training sessions will be delivered through a variety of ways which will include team meetings, information on the Intranet and staff bulletin. Heads of Service and line managers will be responsible for cascading information to all relevant staff and ensuring a record is kept of any training undertaken (appendix 6 assurance form) Audit and Duty of Care Under environmental legislation, waste producers have a cradle to grave responsibility for the control, management and disposal of their waste. To be sure that waste is being segregated and disposed of correctly, Infection Prevention and Control will carry out an audit as part of their regular audits in clinics, dentists and General Practices (ICNA2005). Everyone who manages waste and/or has responsibility for the management of waste is required to fully comply with his or her own duty of care. A duty of care visit will be carried out each year by NHS Wirral in order to ensure the appointed Waste Contractor adheres to all relevant legislation. For contractor details please refer to the Home Request Referral form (appendix 4). The Environment Agency in England and Wales has recently produced new guidance for the healthcare waste sector. From July 2010 there will be a requirement for producers of healthcare waste to complete a pre-acceptance audit of all premises on a regular basis. The purpose of the audit is to Page 16 of 27

determine how compliant the producer is with the segregation guidance within HTM 07-01 Safe Management of Healthcare Waste. Transfer Notes/Consignment Note NHS Wirral, its employees and service partners have a duty of care to ensure all waste is disposed of legally. A duty of care is imposed on all who import, produce, carry, keep, treat and dispose of controlled waste or have control of such waste. All those to who the Duty applies must: Prevent waste from escaping Ensure that waste is transferred only to an authorised person or to a person for authorised transport purposes Transfer a written description with the inclusion of the relevant EWC code along with the waste, sufficient to enable others to avoid committing an offence (transfer note). This is required for each collection of waste. A consignment note is required that accurately describes the type of waste produced. If the waste does not change in description only one a year is required. Waste transfer notes must be kept for a minimum of two years. If the waste does not change in description it will be valid for a 12-month period. However, if any changes to the waste stream occur, such as a new waste type, then a new consignment note must be provided. Consignment notes are not required for waste that is disposed of via the local authority, as this is considered to be household waste. References Department of Health (2006) Health Technical Memorandum 07-01: Safe management of healthcare waste, London: The Stationary Office. Statutory Instrument (2002) The Landfill (England and Wales) Regulations, London: The Stationary Office. Statutory Instrument (2005) The Hazardous Waste (England and Wales) regulations, London: The Stationary Office. List of those consulted in drafting process Capital Projects team Cheshire & Wirral Partnership Trust Community Staff Finance Directorate Governance Page 17 of 27

Health & Safety Advisors Health, Safety & Welfare Committee Infection Control Committee Intercare Service Heads Wirral Metropolitan Borough Council Page 18 of 27

Appendix 1 Waste Description Table The table below denotes the EWC codes most commonly used in healthcare. However there are other codes that will also be used to describe other wastes, for example household waste (contained in chapter 20 of the catalogue). The household (or municipal) waste stream is only included in the context of providing healthcare. It is beyond the scope of this policy to include issues such as recycling of paper etc. A separate waste policy will be produced in the future. EWC Code Description of Waste 18 01 XX Waste from natal care, diagnosis, treatment or prevention of disease in humans 18 01 01 Sharps except 18 01 03* 18 01 02 Body parts and organs including blood bags and blood preserves (except 18 01 03*) 18 01 03* Waste whose disposal is not subject to special requirements in order to prevent infection 18 01 04 Waste whose collection and disposal is not subject to special requirements in order to prevent infection e.g dressings, plaster, casts, linen, disposable clothing 18 01 06* Chemicals consisting of dangerous substances 18 01 07 Chemicals other than those listed in 18 01 06* 18 01 08* Cytotoxic and Cytostatic medicines 18 01 09 Medicines other than those mentioned in 18 01 08* 18 01 10* Amalgam waste from dental care *Denotes Hazardous Waste list entries. Page 19 of 27

Appendix 2 Patients with MRSA Where a patient in the community has been diagnosed with MRSA and is being cared for by a healthcare worker, the healthcare waste generated is not necessarily infectious. In assessing the risk from waste produced by a patient with MRSA, the following should be considered: Is the patient colonised with MRSA but not receiving specific treatment for MRSA? If the answer is yes, the MRSA status of the patient does not effect the assessment of waste. The healthcare worker should refer to the wound and dressing assessment (appendix 4). Is the patient colonised with MRSA and receiving specific treatment for MRSA? If the answer is yes, an assessment of waste is required. Is the patient infected with MRSA and receiving treatment, and is the infection present in the waste generated? If the answer is yes, the waste produced should be classified as infectious waste. Page 20 of 27

Appendix 3 Risk assessment of wounds Contaminated dressings or disposable instruments from sites assessed as infectious or potentially infectious must be disposed of as hazardous waste using an orange bag or containers as appropriate. The Delphi process of identifying wound infection can be used in the assessment. (European Wound Management Association 2005). Signs and symptoms of infection Probability of wound being infected Disposal route Presence of erythema/cellulitis High Orange bag/infectious waste stream Presence of pus/abscess High Orange bag/infectious waste stream The wound is not healing as it should or has healing been delayed The wound is inflamed and has changed appearance Medium Medium Orange bag/infectious waste stream Orange bag/infectious waste stream The wound produces a pungent smell High Orange bag/infectious waste stream The wound produces an increased purulent exudate Medium/High Orange bag/infectious waste stream Pain has increased in the wound High Orange bag/infectious waste stream There is an increase in skin temperature Medium Orange bag/infectious waste stream The patient is on antibiotics for an infection present in the wound High Orange bag/infectious waste stream You are thinking of swabbing for infection Medium Orange bag/infectious waste stream Note: this is not an exhaustive list of signs and symptoms of wound infection and that different types of wounds will present differently. This tool is to assist in the basic assessment of all wounds in order to correctly categorise whether the waste produced contains an infectious fraction and therefore infectious Page 21 of 27

waste. For further information contact Ian Mansell Specialist Nursing Team Tissue Viability at Port Causeway. Page 22 of 27

Appendix 4 Request for Home Healthcare Waste/ Special Waste Collections CLIENT DETAILS Name Full address MUST include postcode Telephone Number Request service start (date ) Cancellation from (date) Please tick the relevant boxes concerning this request Healthcare Waste New Collection Required One-Off Collection Required Cytotoxic Waste Cancel UTFN Please give details of the approximate amount to be collected, e.g. 1 orange bag or sharps box, etc. Frequency of Collections required. Please tick the relevant box concerning this request Weekly Twice Weekly Monthly Please give details of any special instructions, e.g. knock at neighbours or do not call in the mornings/beware of the dog or any other risk Collection Requested By- (Please complete all sections) Name Base of clinic/locality Date Position Telephone Number Signature Name of NHS Trust Page 23 of 27

Please fax this form to both of the following: 1. Intercare /Polkacrest (Waste Contractor) 01270 583298 The above will arrange the collection for your client 2. Tasmin Harvey, NHS Wirral on 0151 643 5445 (Safe Haven fax) This will ensure the trust has a copy of your request and for verification of enquiries and invoices, etc. For problems with collections please telephone Intercare: 01270 539860 Healthcare Waste Collections from Clients Homes INFORMATION NHS Wirral currently manages a contract with an independent Waste Registered Company for the disposal of healthcare waste. Polkacrest/Intercare was appointed for a three year period running from October 2008 to October 2011. The contract covers GP surgeries, clinics, pharmacies and home collection patients. The contract includes the collection and disposal of waste and the provision of consumables such as sharps and bags. For Staff Requesting a Service Please use this guide when requesting collections of healthcare waste from clients homes within NHS Wirral s boundaries. Request Form As from 1 st October 2008 the waste contractor will be Polkacrest/Intercare. The new version of the form must be used. The form must be completed with all the relevant details to commence/amend or cease collections in the community. It is important that you include full postcode details for patients as well as stating clearly what locality or clinic base you operate from. The form must not be used for the collection of any other forms of waste other than that it is intended for. Collection Frequencies As a guide collections of waste are only made once or twice per week and you should follow the instructions below to ensure your request is processed by the contractor and scheduled with the relevant run/driver. 1. Complete NHS Wirral Home Healthcare Waste collection form. 2. Fax the form to Intercare /Polkacrest (Waste Contractor) 01270 583298 who will arrange the collection for your client and to Page 24 of 27

3. Tasmin Harvey, NHS Wirral on 0151 643 5445 (Safe Haven fax), This will ensure the trust has a copy of your request and for verification of enquiries and invoices, etc. 4. Complete above process to cancel a collection 5. If you have problems with clinical waste collection please contact Intercare: 01270 539860 Page 25 of 27

Appendix 5 Waste Segregation at NHS Wirral sites Domestic Waste Infectious/ potentially infectious/ offensive waste Pharmaceutical Waste Sharps waste Clear/black domestic waste bin disposal route landfill & alternative treatment* e.g. Food waste Clean packaging Paper Uncontaminate d paper towels Uncontaminate d blue paper bed roll *Please use the recycle facilities based at each site Orange bags must be labelled or secured with an Identity tag disposal route incineration or alternative treatment e.g. Nappies Sanitary waste Incontinence pads Plaster casts Cytotoxic and cytostatic waste medicines are also classed as Hazardous waste and must be incinerated. Purple lidded Bin Sharps should be placed directly into an approved UN sharps container in orange or yellow lidded bins. Staff must follow the instructions below:- Label container with area/date etc Seal correctly Store in secure area prior to collection. Sharps can be treated by alternative methods and by incineration. Page 26 of 27

Appendix 6 Assurance Form Health Care Waste Policy Department:... I have read and understood the above document and agree to abide by its content. Name Signature Date Page 27 of 27