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CET CONTINUING EDUCATION & TRAINING

1 CET POINT

This article provides a broad understanding of the regulations around clinical waste management and gives a solid outline of what constitutes clinical waste and how to appropriately segregate and dispose of it. Practical advice covering the basic principles of infection control within the practice is also detailed.

Clinical waste management and infection controlRebecca Allen BSc (Hons)

About the authorRebecca Allen has worked in the healthcare sector for the past 13 years and was a research chemist with Bayer CropScience prior to joining Rentokil Initial in 2003. She is an active member of the Chartered Institute of Waste Management and the Sanitary Medical Disposal Services Association and is currently the category manager for Initial Medical.

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Learning objectives To be able to understand the need to undertake infection control measures and dispose of clinical waste effectively (Group 1.1.11)

Course code: C-37865 | Deadline: October 31, 2014Learning objectivesTo be able to understand the need to undertake infection control measures and dispose of clinical waste effectively (Group 2.1.1)

Learning objectives To be able to understand the need to undertake infection control measures and dispose of clinical waste effectively (Group 2.1.1)

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Learning objectives To be able to understand the need to undertake infection control measures and dispose of clinical waste effectively (Group 2.1.1)

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For the latest CET visit www.optometry.co.uk/cet

Introduction How to handle your clinical waste may not

seem like the most exciting procedure to have

to research and implement, but even as a

relatively small producer of clinical waste you

still need to ensure your business organises

correct disposal procedures and adheres to

current legislation.

Due to the potential risks associated with

the improper handling of clinical waste, its

proper management and disposal is vital and

there are strict regulations in place to prevent

harm being caused to both the environment

and to human health. Furthermore, checking

that all the waste you produce is segregated

properly at source, rather than allowing

general waste to fill-up your clinical waste

bags and containers, can deliver substantial

cost savings.

Defining different types of wasteClinical waste is defined as ‘any waste which

consists wholly or partly of human or animal

tissue, blood or other body fluids, excretions,

drugs or other pharmaceutical products,

swabs or dressings, syringes, needles or

other sharp instruments, and any other

waste arising from medical, nursing, dental,

veterinary, pharmaceutical or similar practice,

investigation, treatment, care, teaching

or research, or the collection of blood for

transfusion.’1 This type of waste may prove

hazardous to any person coming into contact

with it unless it is rendered safe. Waste is

defined as ‘hazardous’ when the waste itself

or the material or substances it contains are

harmful to humans or the environment. The

other main waste stream is known as offensive

waste, which primarily contains waste that is

considered unpleasant due to its appearance

and smell, for instance incontinence waste.

Clinical waste regulationsThe controls that are in place to ensure that

clinical waste is managed and disposed

of safely are listed under the Environment

Protection Act 1990, where it states that it is

‘unlawful to deposit, recover or dispose of

controlled (including clinical) waste without

a waste management licence, or in a way that

causes pollution of the environment or harm

to human health’.2

As a general rule all clinical waste

handling and disposal procedures must

comply with the following regulations:

• The Environmental Protection Act 1990

(including the Duty of Care Regulations)2

• The Controlled Waste Regulations

20123

•The Hazardous Waste Directive 20114

• The Carriage of Dangerous Goods

Regulations.5

The statutory Duty of Care Regulations

state that it is the responsibility of

the producer of any controlled waste

to properly manage the controlled

waste their business produces. The

main principles of Duty of Care cover

documenting the transfer of waste and

ensuring that carriers handle waste

correctly. This means that businesses

producing clinical waste are required to

use a registered carrier, which takes it

to suitably licensed/permitted sites. It is

worth remembering that failure to comply

with Duty of Care regulations could leave

the business subject to fines or even the

closing down of premises.

Waste transfer paperworkFor all transfers of waste, appropriate

documentation must be provided. For non-

hazardous waste this is usually in the form of a

waste transfer note. The carrier will provide an

annual waste transfer note covering all transfers

of non-hazardous waste for a 12-month period;

this documentation must be checked for

accuracy purposes and the return slip sent back

to the waste contractor for full traceability.

All consignments of hazardous (special)

waste must be accompanied by a hazardous

or special waste consignment note, which will

include:

• All site addresses and personnel involved with

the waste transfer

• A full description of waste type, including

required shipping terms

• Correct European waste catalogue (EWC) code

for each waste stream

• A copy to store on the premises.

Segregating clinical wasteIt is imperative that clinical waste is separated

out at the point of production, following

the Safe Management of Healthcare Waste

Figure 1 Proper segregation of different types of waste using the national colour coding system is critical to its safe management

Yellow – Infectious waste for disposal by incineration

Orange – Infectious waste for disposal by treatment or incineration

Yellow/Black (Tiger) – Offensive/hygiene waste for disposal by deep landfill

Blue – Medicinal waste for disposal by incineration

Purple – Containing cytotoxic or cytostatic waste for disposal by incineration

Red – Anatomical waste for disposal by incineration

CET CONTINUING EDUCATION & TRAINING

1 CET POINT

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guidance

issued by the

Department

of Health.6

The mixing of

waste streams

is prohibited by

law in England

and Wales, and

separation is

best practise

in Scotland

and Northern

Ireland. This approach helps to support waste

disposal efficiency and reduces the risk of

exposure and injury to employees.

All containers used for the disposal of

clinical waste must be labelled in accordance

with details of the legal requirements for

transporting and packaging waste

(see Figure 1). Container labels should also

clearly identify the waste types present within,

and should be signed by the producer ready

for onward disposal.

Optometric practices will typically produce

a variety of waste. This will include standard

waste similar to that produced by an office

or retail business such as general packaging,

paperwork and kitchen waste as well as

sector-specific waste, which may include

time-expired drugs and used medical

solutions along with devices such as contact

lenses and contact lens solution.

For the optometry industry tiger colour

coding will typically apply for waste bags,

which is for offensive/hygiene waste for

disposal by deep landfill and would include

sector-specific non-hazardous healthcare

waste such as used disposable tonometer

probes and time-expired contact lenses.

Domestic type waste such as paper,

cardboard, used tissues and paper towels can

be disposed of in the normal ‘black bag’ waste

stream, or recycled where appropriate.

Disposing of needles (sharps) It is essential that sharps are also segregated

and disposed of on the basis of their medicinal

contamination. The lid colour of the receptacle

relates to how the waste should be treated

and disposed of. Some optometrists may

use sharps for procedures such as removing

corneal foreign bodies and these should be

disposed of in a sharps box, colour coded

accordingly – typically for optometrists this

will be an orange lidded container

(see Figure 2).

Disposing of medicines Non-hazardous pharmaceutical waste,

including all non-hazardous medicines

whether pharmacy or prescription only

used or time-expired minims, need to be

incinerated and should be discarded in a

medicine disposal box (see Figure 3).

Medicines that are not pharmaceutically

active, for example, saline solution, can

be disposed of in the non-hazardous

pharmaceutical waste stream or emptied into

the foul sewer and the container placed in the

appropriate healthcare waste stream.

Hazardous wasteThere are special requirements regarding

the disposal of hazardous waste, which may

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derive from the non-healthcare side of

the business such as old fridges, batteries,

computer equipment and even some

cleaning products, which is beyond the scope

of this article.

Important information for domiciliary visitsFrom January 2014, it is necessary to register

as a waste carrier if you regularly transport

waste as part of your business. If you only

transport waste that is generated by your

own business, such as sharps and clinical

waste, you will need to register as a low tier

carrier. You can be fined up to £5,000 if you

do not register.

Registration is quick and easy and, most

importantly, free if you are just transporting

your own waste. Once registered, you do not

have to renew your registration; however, it is

advisable to keep a record of your registration

number and any other related information.

Registration can be undertaken at:

www.wastecarriersregistration.service.gov.uk

Selecting the right waste carrier for your businessThe first and most important thing to check is

that you are using a registered waste carrier,

which you can do by asking to see copies of

Tips for reducing waste disposal costs• Only put used needles in your sharps container –

the wrapping can go in general waste• Train your staff correctly on waste procedures so they know which waste goes where

• Display a poster/notice of the National Colour Coding system as a reminder• Check with your waste carrier if they will supply containers free of charge • Ensure your clinical waste disposal service has been tailored to your specific

requirements• Check if your supplier also sells consumables (for example, latex gloves or hand

sanitisers) that you may be able to purchase at a competitive price and have delivered to your premises as part of your servicing contract.

Figure 2 Orange lidded box for sharps that are not contaminated with medicines for disposal by treatment or incineration

Reflective learning Having completed this CET exam, consider whether

you feel more confident in your clinical skills – how will you change the way you practice? How will you use this information to improve your work for patient benefit?

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their licences.

Most waste

management

companies will

offer a flexible

service to suit

the needs

of different

customers

including

daily, weekly,

fortnightly or monthly servicing visits. It is

important that your business has a waste

collection and disposal service that meets

your bespoke requirements and level of

waste production. Overflowing waste bins

and uncollected containers are hazardous if

they are not addressed. It is worth noting that

three months is the maximum time period

that clinical waste can remain uncollected on

your site. Prior to contracting the services of

the waste carrier it is important to consider the

following points:

• Is the waste carrier licensed to take away the

types of waste you are producing?

• Are the service technicians that will be

collecting your waste ADR licensed? This is

essential when transporting Dangerous Goods

such as clinical waste

• Will you receive all the compulsory waste

documentation to cover your waste transfers?

• Will your waste be fully traceable from point of

production through to end disposal?

• Do all the products supplied to you meet legal

requirements, such as UN approval for your

sharps containers?

• Will your waste be fully segregated on site and

during transportation, to meet the current

regulations?

• Can the clinical waste management company

guarantee your service delivery will happen

on time?

References

Visit www.optometry.co.uk/

clinical, click on the article title

and then on ‘references’

to download.

Exam questions

Under the enhanced CET rules of the GOC, MCQs for this exam appear online

at www.optometry.co.uk/cet/exams. Please complete online by midnight on

October 31, 2014. You will be unable to submit exams after this date. Answers

will be published on www.optometry.co.uk/cet/exam-archive and CET points

will be uploaded to the GOC every two weeks. You will then need to log into

your CET portfolio by clicking on ‘MyGOC’ on the GOC website (www.optical.

org) to confirm your points.

Infection control guidelinesManaging your clinical waste effectively

is part of ensuring good infection control.

Another important issue to consider is

that winter will soon be approaching, and

with this time of year once again comes

the increased threat of Norovirus, which

is one of the most common causes of

gastroenteritis. Last year, the number of

people affected by the winter vomiting

bug surpassed one million.7 As it can be

transmitted through direct contact with

people who have the bug, or by contact

with contaminated surfaces and objects, the

virus can wreak havoc on any business with

a regular footfall of clients. The infectious

dose is very low (just a few viral particles

can cause illness) and the virus can survive

in ambient indoor environments for long

periods, and so Norovirus can spread quickly

in places where there people moving in

and out.

According to NHS Choices, symptoms of

the virus include feeling nauseous, followed

by forceful vomiting and watery diarrhoea.8

Some people may also experience a raised

temperature, headaches, painful stomach

cramps and/or aching limbs. Symptoms

usually appear one to two days after

becoming infected, but they can start

sooner. Undertaking appropriate measures

for infection control is now a requirement

of the GOS contract. Below is some

practical advice on how to improve hygiene

standards within the practice and reduce the

risk of employees contracting the illness:

• Ensure regular, thorough cleaning takes

place in communal areas such as the

shared kitchen and washroom facilities

and undertake a professional deep clean

(recommended twice yearly) to prevent

the build-up of hidden embedded dirt

and contamination, and the associated

microorganisms

• Encourage staff to practise good hygiene

with posters and signs as constant

reminders. It is recommended that you

should wash your hands for the same

length of time it takes to sing ‘happy

birthday’ twice (approximately 30 seconds)

• Clean any workstations and disinfect

any potentially contaminated surfaces

regularly. Use a surface sanitiser afterwards

to ensure longevity of protection

• Remember that hand sanitisers should not

be used to try and remove visible dirt or

contamination from hands; they are purely

designed to be used for disinfection and

also as added protection after proper hand

washing and drying. The most effective

kind of hand sanitiser is non-alcohol based,

which forms a gentle but longlasting

barrier across hands, protecting against

a wide range of bacteria and viruses,

including Norovirus

• Try not to share items such as tea towels

when using communal areas. These items

can be the source of high levels of bacteria

and are often not cleaned regularly. Good

alternatives include using tissues or hand

towel dispensers

• Ensure that staff contracted with a virus

stay away from work for at least 48 hours

after the symptoms have resolved to avoid

wider contamination within the workforce.

ConclusionIt is important for practitioners to take

responsibility for appropriate waste

management and infection control. This

article has demonstrated that taking a few

simple steps helps to safeguard patients

and staff from the potential risks of

contamination.

Figure 3 Blue lidded box for waste medicines suitable for disposal by incineration