Guidance signposts improved methods of managing healthcare waste disposal

The handling, treatment and disposal of clinical or healthcare waste has been cause for concern in recent years as hospital managements and the waste industry waited for new guidance to emerge from the Government and the regulators, following a long period of slow progress in dealing with problems in that sector. Last year saw the publication of new guidance on Safe Disposal of Clinical Waste from the HSE and the Environment Agency and this has now been supplemented by guidance from the IWM on Healthcare Waste Management and Minimisation.

The latest guidance on dealing with healthcare waste, published in July, has been produced by the Healthcare Waste Management and Minimisation Working Group, part of the Scientific and Technical Committee of the Institute of Wastes Management.

The new guidance has been prompted by a range of factors including fundamental changes within the health service, including the removal of Crown Immunity, the increasing management of hospital sites by NHS Trusts, the need to incorporate healthcare waste into the Packaging Regulations and health and safety considerations when dealing with healthcare waste.

The report by the Audit Commission, Getting Sorted, highlighted its concerns regarding failure to separate clinical and non-clinical waste streams, as well as providing some ideas as to how to tackle the healthcare stream.

The new IWM publication builds on this and is intended to guide those responsible for waste through a maze of issues surrounding healthcare waste management. IWM says it does not seek to replicate existing guidance, but to provide a “sign-posting” document to identify more detailed sources for further investigation and guidance.

Waste generation

Beginning with definitions and regulations, the main focus of the publication is on waste generation and management in hospitals. There are also chapters on healthcare waste within the community, recognising the growing need to raise awareness of the significance of this sector, as well as transportation, waste treatments and Best Practical Environmental Option (BPEO), implications for training and quality assurance. The final chapter provides an international perspective, considering the global implications of waste.

The scale of the problem could be growing: figures in the IWM guidance indicate that there is a total of 155,500 tonnes of clinical waste being produced by health authority premises in the UK, while the HSC has stated that 200,000 tonnes are produced annually from NHS Trusts in the UK.

On the waste minimisation front the new publication refers to a report, Compendium of Good Practice, published by NHS Estates in 1999, which contains case studies of examples of waste minimisation initiatives in several hospitals.

Transportation & treatment

The IWM guidance points out that the five-year derogation which the UK secured to allow the use of UN type approved yellow plastic sacks for transportation of clinical waste on the road, rather than using enclosed containers, will expire in December 2001. Rigid containers will then have to be used after that date. Yellow sacks can still be used to contain waste but they will have to be placed in secondary rigid containers for transport to a transfer station or treatment and disposal facility.

Dealing with disposal and treatment technologies, the IWM document notes that the majority of incinerators handling clinical waste are commercially operated by specialist clinical waste collection and treatment companies.

The guidance also states that the Hazardous Waste Incineration Directive, which came into force in July 2000, requires all incinerators which burn certain special wastes such as certain grades of clinical, pharmaceutical or cytotoxic wastes, classified as “hazardous wastes” under the directive, to meet more stringent emission standards. They will also probably be registered under the IPPC Regulations when they come into force. Many existing plants will require substantial investment in equipment to meet these standards.

The IWM guidance describes alternative technologies such as heat treatment disinfection units, including dry heat, microwave radiation and steam sterilisation.

The publication states: “Chemical treatment of clinical waste does not seem to have many practitioners in the UK although it is practised in the USA. Chemical sanitisation is practised in the collection of ‘Sanpro Waste’ by a number of companies in the UK.”

The potential of recycling healthcare waste is being increasingly recognised, according to the IWM document, both at the point of arising and also after treatment.

Radioactive waste

The need to deal with radioactive waste from hospitals has also been the subject of a report by RWMAC, the Radioactive Waste Management Committee which advises Government. Dealing with “Small Users”, which covers organisations outside the civil nuclear industry and defence sectors, but which does include most, if not all, of the UK’s larger universities and hospital trusts, the committee points out that some radioactive materials held by Small Users, notably spent sealed radioactive sources (SSRSc), can, if not managed safely, cause very serious harm to health.

RWMAC warns: “The lack of funding in current hospital and university budgets allocated for dealing with SSRSc is a matter of serious concern.”

Despite some serious problems RWMAC believes that the Government and the regulators should continue to take positive action in managing radioactive materials and wastes.

The committee recommends that the Government, when defining the principles for UK radioactive waste management, should consider, in conjunction with the regulators:

  • whether the practice of driving down discharge limits without regard to a threshold for optimism will create an imbalance of actual health risk versus benefit, and may prejudice access to some forms of treatment in hospitals.
  • A second recommendation hit the headlines in the national press recently.

    The Government is asked to consider the case for encouraging the use of “controlled burial” in landfill sites for suitable low level radioactive wastes produced by Small Users.

    Increasing the scope for controlled burial could provide direct benefits for Small Users, both in waste management and cost terms, and also nationally – by protecting the valuable national asset of LLW capacity at Drigg.

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