Unit 12
Cleaning, decontamination and waste management
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About this unit
In this unit the learner will develop an understanding of the correct way of maintaining
a clean environment in accordance with national policies and to understand the
procedures to follow to decontaminate an area from infection. The unit also covers
good practice when dealing with waste materials.
The learner will:
1. Understand how to maintain a clean environment
2. Understand the principles and steps of the decontamination process
3. Understand the importance of good waste management practice
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1.1 General principles for environmental cleaning
Environmental cleaning reduces the accumulation of dust, dirt and liquid residues which
increase the risk of infection.
Decontamination
Decontamination is very important in infection prevention and control measures.
Decontamination is the safe cleaning, disinfection, inspection and sterilisation (if
required) of a re-usable medical device to make it safe for further use on individuals, and
for handling by staff.
The term ‘decontamination’ is used to cover the different methods of removing or
destroying micro-organisms from the environment or from equipment.
1.2 The purpose of cleaning schedules
Cleaning schedules maximise the decontamination by regular timed cleaning to minimise
the risk of infection. This can be recorded and monitored.
All health related organisations should have a cleaning schedule which specifies what to
clean, when to clean and who is responsible. These schedules should be written down as
part of infection control policies and procedures and should include all three types of
decontamination. All staff should be aware of these and understand their responsibilities
and the consequences of not adhering to these schedules and routines.
All staff should also be aware of the schedules for disinfection and sterilisation and their
roles and responsibilities for their implementation. COSHH regulations and all aspects of
safe use of materials and equipment should be adhered to. This may include safe moving
and handling techniques.
Decontamination certificate
The NHS Management Executive introduced protocols and documentation (HSG(93) 26
June 1993) relating to inspecting, servicing or transporting medical equipment. It states the
requirement of a decontamination of equipment certificate. This certificate should be
issued with all equipment leaving the health care setting. It must clearly state the
decontamination status of the equipment and should be signed by the person who has
cleaned the equipment prior to its despatch.
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1.3 What is “clean”? - The correct management of the environment to
minimise the spread of infection
Bacteria are all around us and in our bodies. Most are completely harmless and may
even be important to maintaining good health. It is important that the “good” bacteria are
not killed by unnecessarily excessive and inappropriate use of disinfectants. It is often
forgotten that the basic hygiene measure of removing visible dirt with water and
detergent is a central part of control of infection. Disinfection and sterilisation processes
are not effective when applied to objects that have not been properly cleaned, as the dirt
(blood, mucus, faeces) shield micro-organisms from the process.
Clean is:-
Without dirt or impurities
Without dirt in it or on it
Recently washed -fresh
Without “foreign” matter
Reducing offensive odours.
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The purpose of cleaning
We clean to remove dust, dirt and micro-organisms using energy, hot water and
appropriate detergent. This removes most bacteria, or nutrients on which they thrive,
from any surface or piece of equipment. A further reduction in numbers of bacteria
occurs as the surface dries.
Detergents are needed to dissolve grease, fat and dirt in water so that it can be easily
removed.
Training should take place to ensure that all cleaning is carried out effectively, and that
service users, themselves, visitors and other staff members are safe whilst cleaning
takes place. This will include:
Safe moving and handling of furniture and equipment
Safe and efficient use of equipment; cleaning solutions
Use of warning signs for wet floors/cleaning procedures.
The aim of cleaning is to:
Remove conditions conducive to the growth of bacteria
Reduce the numbers of active bacteria remaining
Prevent offensive odour
Minimise cross-contamination from one surface to another
Satisfy legal requirements
Provide a safe and pleasant environment.
1.4 Colour-coding of cleaning equipment
From September 2007, a colour-coding scheme was introduced for all hospital and
care home cleaning materials and equipment.
The introduction of the scheme followed guidance from the National Patient Safety
Agency, which recommended that all care organisations adopt a single code in order to
improve the safety of cleaning.
Colour-coding of hospital cleaning materials ensures that items are not used in multiple
areas. This reduces the risk of cross-infection and is also a major help if people work on
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several different sites, or if they move to a new job elsewhere. They will always know that
yellow materials should be used for isolation areas, and green materials for catering and
kitchens.
All cleaning materials and equipment, such as cloths, mops, buckets, aprons and
gloves, should follow the new colour-coding scheme.
In the colour-coding scheme, red materials are used for bathrooms, washrooms,
showers, toilets, basins and bathroom floors. Blue cleaning materials are used for
general areas including wards, departments, offices and basins in public areas. Isolation
areas should be cleaned with yellow materials. Green denotes catering departments,
kitchen areas and food service. The guidance from the National Patient Safety Agency
states that cleaning products such as bleach and disinfectants do not need to be colour-
coded. Also, the code does not extend to catering equipment (for example, chopping
boards and knives) where there is already a well-recognised and well-established
procedure to ensure food hygiene, and food separation issues, are addressed.
The colour-coding scheme is set out in a poster from the National Patient Safety
Agency. This can be viewed via the following link-
http://www.nrls.npsa.nhs.uk/resources/?entryid45=59810
The Waste Framework Directive was implemented in England through the Waste
Regulations 2011 however at present England’s waste strategy is based around the
Government Review of Waste Policy in England 2011 this can be viewed via the following
link - https://www.gov.uk/government/publications/government-review-of-waste-policy-in-
england-2011
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2.1 The Decontamination Process
Decontamination within health related environments are graded into three sections:
Cleaning - for low-risk items
Disinfecting - for medium risk items
Sterilising - for high-risk items.
2.2 The Cleaning Process
There will be guidelines within your health care environment that must be
followed appropriately for the surface/equipment that is to be cleaned.
It is a good idea to colour code mops and buckets for kitchens, toilet/dirty
areas and general areas
The following outlines a step by step approach to the cleaning process:
Step 1 - INITIAL CLEAN - to remove loose dirt (e.g. scraping, rinsing under running
water).
Step 2 - MAIN CLEAN - to remove main body of dirt and bacteria (e.g. scraping,
pressure wash, scrubbing, detergent to remove grease)
Step 3 - RINSE - to remove loosened dirt and detergent residue (especially
important when powerful and potentially dangerous chemicals have been used)
Step 4 - DRY - it is important to ensure drying is complete as bacteria need
moisture to multiply.
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2.3 The Purpose of Disinfecting
The purpose of disinfecting is to bring micro-organisms to a safe level.
The first three steps of the cleaning process must be carried out as part of the
decontamination process. This is before disinfecting, which is not a part of the actual
cleaning process.
DISINFECT - to bring remaining micro-organisms down to a safe level
FINAL RINSE - to remove any chemical residues
DRY - it is important to ensure drying is complete as bacteria need moisture to multiply
Precautions when using disinfectants
Using too little will make it ineffective
Too strong may cause skin damage or inhalation of dangerous
fumes. Using too much causes chemical wastage
Detergents should never be mixed as they may give off poisonous gases.
Disinfectants
Disinfection is never an alternative to cleaning, whether on floors, equipment, skin, or, on
wards. It was once the case that liberal use of disinfectant around health care settings was
unduly practiced with a view to “killing germs”. It is now generally accepted that good
maintenance and thorough cleaning of floors, walls, ceilings and equipment is sufficient
except in specific instances, such as the cleaning of rooms after being used for isolation
nursing. It is important to follow the cleaning policy in your own workplace.
If disinfection is appropriate, it is important that it should be used at the correct concentration.
The disinfectant must be freshly prepared for each use and changed regularly before
dirt or organic matter discolours it. Antimicrobial resistance to disinfectant agents can
develop and misuse of disinfectants is likely to speed this development.
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The Purpose of Sterilising
Sterilisation means making an object free from all viable micro-organisms including
spores. Sterilisation may use exposure to heat, radiation or chemicals and is mainly
used for high risk items such as surgical instruments which break through the skin,
mucous membranes or enter sterile body areas.
AUTOCLAVE - items for sterilisation are cleaned mechanically then prepared/packed/
labelled before being placed in the autoclave. The autoclave uses steam under pressure
to sterilise; the higher the steam under pressure the higher the temperature.
RADIATION - is used to sterilise most disposable items of equipment e.g. needles and
scalpel blades. It can be used for those items that cannot withstand very high
temperatures e.g. catheters, tubing.
CHEMICALS - may be used under specifically defined conditions. It is possible to
achieve sterilisation with chemicals e.g. Milton Fluid. Chemicals may be used in
combination with temperatures of 50 - 70oC.
How should equipment be cleaned?
ITEM HOW OFTEN METHOD
Buckets After use Wash with hot water and detergent. Dry and store
upside down.
Cloths/dusters Daily Use disposable if possible, if not clean in a washing
machine and store dry. Do not leave to soak.
Dishcloths Daily As above or according to your cleaning schedule
Vacuum
cleaners
As per
manufacturer’s
instructions
Wipe tools with hot water and detergent, check filters
regularly
Basins and
taps
After use Clean with hot water and detergent, disinfectant
should be used after initial cleaning process if
contaminated with bodily fluids
Baths and
showers
As above As above
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Mops After use and
weekly
Mop heads should be detachable and washed in
hot soapy water.
Commodes After use Wipe pan and seat with hot water and detergent. Rinse
dry.
Commodes Weekly clean Remove commode from frame and room. Clean legs
and frame with hot water and detergent. Turn upside
down and clean underneath.
Bins Daily Clean with hot water and detergent
ITEM HOW OFTEN METHOD
Carpets Vacuum daily There should be a schedule for cleaning carpets; at least
six
monthly. Any spills should be removed immediately;
body fluids should be removed using disposable paper
towels with gloves on and then shampoo the area.
Drains Clean regularly
with hot water
and detergent
Do not put disinfectant down drains.
Floors Daily and
as
necessar
y
All floors should be vacuumed to prevent dust
dispersing. Clean with hot water and detergent. Rinse
and dry.
Furniture As required or
following your
cleaning schedule
Surfaces should be damp dusted with disposable type
cloth.
Bowls After use Clean with hot water and detergent. Rinse and store
dry, inverted, and above floor level.
Catheter
stands
Weekly or after
use
There should be individual catheter stands. Clean with
hot water and detergent.
Crockery
and cutlery
After use A dishwasher with a final rinse of 80°C is preferred. If
washing by hand use very hot water, detergent and a
disposable cloth. Change the water frequently, rinse
and allow to dry in racks, or use disposable paper
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towels. Tea towels should not be used.
Face flannels
and towels
Between use Flannels and towels must never be shared. If rooms are
shared, personal towels and toiletries should be
allocated to each resident. In communal areas such as
bathrooms and toilets, disposable towels should be
provided.
Mattress/pillow
s
When soiled or
when change of
patient/ service
user.
Soiling of mattresses and pillows can be avoided by
covering with a mattress or pillow cover. The covers
should be cleaned thoroughly. If a plastic cover use hot
water and detergent.
Contamination
In the health related environment contamination can occur by a number of ways, including:
Changing beds, handling soiled linen, linen coming into contact with floors, hard
surfaces and clean bed linen
Contact with service users when attending to personal hygiene and toileting
Collection of specimens, spillages, incorrect procedures, poor hand hygiene
Food preparation, storage and serving - poor procedures, poor hand washing
techniques
Invasive procedures or procedures that involve contact with body fluids
Death of a service user - poor hygiene procedures, inadequate contaminated
waste and linen disposal; contact with a deceased person who has an infectious
disease
Pets - bedding, excreta, illnesses, lice, skin conditions
Disposal of waste
Illness of service user, health worker (or their family),visitors.
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Because of the diversity of day-to-day tasks carried out in a health setting, infection can
occur in a number of ways, especially in the following situations:
Moving between different work areas
Disposal of different types of waste
Disposing of protective clothing appropriately after use
Cleaning beds, trolleys, bed tables, equipment, surfaces
Storing used cleaning equipment separately as appropriate.
There are several sources within your organisation where questions can be answered
and further knowledge gained on the prevention and control of infection.
Contamination of Body Fluids
It is the responsibility of the finder of a body spillage to a) clean it up, and b) report it, as
blood and other body fluids pose a high risk of contamination.
Changing beds/Laundry disposal
The following points should be considered in order to minimise risk of spread of
infection when dealing with bed linen:
Protective clothing (gloves and apron) is required as infection can be spread
from damp, soiled and infected bed linen
No linen should be sluiced by hand
Contaminated linen should be placed in an appropriately colour-coded bag
(usually red alginate bag, which dissolves in the washing machine), tied effectively
to ensure that there will be no leakage. Bed linen should not be placed or sorted
on furniture or floors, but removed carefully and put straight into an appropriate
laundry bag. Used linen should not be moved from room to room
Hands should also be washed thoroughly after handling used linen.
Service User hygiene
When carrying out tasks which involve direct contact with service users and their
body fluids, ensure effective protection by wearing an apron and gloves. After use,
discard them into an appropriate clinical waste container and use effective hand
washing routine.
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Washing
Risk of infection can be reduced by observing an effective washing procedure:
Wash areas such as face and arms first, then torso, legs and finally genital and buttock
areas
Use fresh water and colour-coded or disposable flannels and towels for
each area. Disposable flannels should be used for washing the groin areas
Pay particular attention to the cleaning of eyes, mouth and teeth
Care must also be taken to ensure that bed linen is laundered properly after bed
bathing.
Helping Service Users to use the toilet
This includes use of bedpans, urinals and commodes, so to reduce risks associated
with the disposal of human waste it is important to:
Always wear gloves and apron
Cover body waste while in transit
Discard excreta safely into toilet, disinfectant or macerator
Use an effective, well maintained bedpan washer
Ensure that bed linen is laundered properly.
Specimen collection and handling
To help minimise the risk of spreading infection whilst collecting, handling or
transporting specimens, the following points should be considered:
Use only dedicated sterile containers and do not decant from one to another
Aprons and gloves should be worn while collecting specimens
Avoid contamination of the outside of specimen containers
Do not send off leaking specimens - discard as clinical waste as they present
a risk to those handling the specimen
Specimens must not be placed in areas where food is eaten or stored, e.g. bed
tables or domestic fridges
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Hands should be thoroughly washed both before and after specimen collection
and the number of staff handling the specimen kept to a minimum
The specimen must be clearly and correctly labelled and put into double plastic
bags or a specific collection container.
Food hygiene
To reduce the risk of these sources of contamination, anyone working in a food
preparation area should obey the following simple rules:
Use old food stock before new food stock
Observe “sell by” and “best before” dates on food
Avoid using dented or rusty canned foods
Store raw and high risk foods at the correct temperatures
Ensure that refrigerators and freezers maintain correct temperatures
Use clean utensils
Don’t handle food except with clean utensils or gloved hands
Don’t mix raw and cooked foods when storing
Look for signs of damage or physical contamination when opening food packages
Check that food is thoroughly cooked
Keep hot food hot
Keep cold food cold
Avoid re-heating food
Remove rubbish from food preparation areas
Observe good persona lhygiene
Always wash hands before handling food
Wash hands after preparing high risk foods.
This is just a sample of the precautions which should be taken.
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If your job requires you to prepare or handle food, you should undertake a specific
course of training in food handling.
As in all other areas of the healthcare environment there is both a moral and legal duty to
minimise cross infection by adhering to the highest standards of infection control.
Single use instruments and sterile equipment
Single use instruments and equipment are useful in infection control because:
They minimise the risk of infection
Aseptic hand washing is carried out before the use of these and gloves worn
before the use of these, thus keeping hand borne infection to a safe level
However, it is important to know that these items are designed for SINGLE USE
ONLY and must be discarded once opened, even if not used. In fact, if it is labelled
by the manufacturer as “single use”, potential liability under manufacturers’ legal
obligations will cease if it is re-used, and if such a device causes damage, infection
or injury the re- processor/re-user is likely to become personally liable.
The symbol for sterilised single use is:
This symbol is shown on the packaging of a product that is intended only for
single use. These products are not single patient/service user use, they are
single use only and should not be re-used.
BS EN 980 sets down a number of graphical symbols for use in the
labeling of medical devices.
Examples would include:
Dressing packs (with the two strike-out symbol as above)
Urinary catheters (with the two strike-out symbol as above)
Syringes and needles (with the two strike-out symbol as above).
The body may continue to secrete fluids after death. This can be a hazard for staff coming
into contact with the body. The bladder can be emptied by gently pushing the lower
abdomen and any other leaking orifice should be covered with an appropriate dressing.
Again PPE should be worn.
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Good hygiene and hand washing are essential to reduce the risk of infection. This will
help the health of your service user and assist in the enjoyment of the pet.
2.4 The role of Personal Protective Equipment (PPE) in decontamination
Depending on the method of decontamination, certain types of PPE may be required. The
purpose of PPE is to protect the individual carrying out the decontamination and to avoid
re-contamination of sterile areas or instruments.
PPE should be easily recognisable, hard wearing and resistant to high temperature
washing. It should act as an additional barrier for the wearer against infection and the
effects of chemicals used in decontamination. PPE must be changed after each service
use contact and disposed of, or decontaminated as per manufacturer’s instructions:
Aprons - protect the wearer from being contaminated by, for example, waste
matter. Also protects individual from contaminants present on uniforms, clothes
Gloves - prevent the wearer from contaminating sterile areas or protect the
wearer and others from contamination
Masks - protect the wearer and others from airborne pathogens or
splashes from contaminated matter
Hair protection - prevents hair, dandruff, grease from contaminating food, open wounds.
Foot protection; disposable shoe covers - covers or replaces outdoor footwear
preventing contamination in sterile areas such as operating theatres and injury to
foot
Gowns/protective suits - may be either used to protect the wearer from
infection or to protect the individual from contamination carried by the wearer
Eye protection - to protect from injury from machinery, heat, chemical or
body fluid splashes.
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Use of cleaning and disinfecting agents
Control of Substances Hazardous to Health (COSHH)
This is part of the Health and Safety at Work Act. COSHH Regulations are designed to
ensure that chemicals which may be hazardous to health are managed and controlled
properly. This includes the labelling of harmful products and the precautions that need to
be taken when handling them.
Precautions should be clearly displayed in all areas where chemicals/disinfectants are being
used.
The most commonly used substances are chemicals used for cleaning and disinfection
of equipment. All substances that have a potential to cause harm will carry COSHH
information on the container describing the hazard as well as basic first aid information in
case of spillage, splashing or swallowing.
To comply with COSHH you need to follow these eight steps:
1. Assess the risks
2. Decide what precautions are needed
3. Prevent or adequately control exposure
4. Ensure that control measures are used and maintained
5. Monitor exposure
6. Carry out appropriate health surveillance
7. Prepare plans and procedures to deal with incidents and emergencies
8. Ensure employees are properly informed, trained and supervised.
Storage of chemicals
Cleaning chemicals must be stored in a secure locker in closed containers, preferably the
original manufacturer’s container with instructions for use and safety precautions easily
readable on the label. Chemicals should be stored in their original container and must be
clearly and accurately labelled.
COSHH (Control of Substances Hazardous to Health Regulations) are designed to
ensure that chemicals which may be hazardous to health are managed and controlled
properly. This includes the labelling of harmful products and the precautions that need to
be taken when handling them.
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Precautions should be clearly displayed in all areas where chemicals/disinfectants are
being used. Further information can be found via the following link -
http://www.hse.gov.uk/coshh/
2.5 Concept of risk
The word risk, in a health and safety context, means the likelihood that someone or the
environment may be harmed by a hazard. When dealing with contamination, the risk is
the chance that you, other people, the wider community or the environment might suffer
the harmful effects of the contamination.
The level of risk increases depending on the severity of harm that may be caused, the
number of people who might be affected and the possibility that the contamination may be
responsible for the spread of infection.
Contamination risk
Activities such as dealing with soiled linen and the disposal of waste are hazardous and
have risks associated with them. You must be able to recognise the risks and take the
appropriate actions to eliminate or at least minimise them. Appropriate actions may be
referred to as precautions or control measures and should be in place within your
organisation as a result of risk assessment.
2.6 Types of agents required for the level of risk
All care workers should be aware of the level of risk related to contamination.
Low risk areas Medium risk High risk
Shared fixtures and
equipment
Mobility aids
Bathroom equipment
Surfaces
Furnishings
Floors
Toilets
Commodes
Bedpans
Urinals
Re-useable equipment
that comes into
contact with individuals
Instruments used for
invasive procedures
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General equipment - Low risk
Low risk items used in health settings should be washed regularly and thoroughly with
appropriate detergent and hot water following procedures laid down by employers. These
include beds, furniture, baths, wash basins, crutches, infusion stands, bed cradles, bins.
Any excess soiling of equipment or spillage of body fluids should be dealt with as per
local procedure guidelines. All equipment should be well maintained in order to prevent
risk of injury or source of infection to those who come into contact with it.
Medium risk items should be disinfected with agents recommended by the
manufacturers and in accordance with organisational policy and procedures. High risk
items should be sterilised according to manufacturer’s instructions and organisational
policies and procedures.
The employer has a duty to ensure that faulty equipment is condemned or stored until
repair or removal, and to ensure the safety of staff using any equipment as part of their
job role. Standards exist, covered in the “Standards for Better Health” policy; these are
monitored by the Health Care Commission. The Medicines and Health Care Regulatory
Agency (MHRA) is responsible for recalling faulty medical products and equipment where
problems are identified.
2.7 The cleaning and storage of equipment
It is important to keep equipment clean to avoid contamination and bacterial growth. Safe
storage is vital to avoid tripping or chemical hazards and to comply with the requirements
of COSHH.
Equipment should not be stored where it may cause an obstruction, for example, at the
top of the stairs or blocking fire exits. All chemicals should be stored in their original
containers in a locked cupboard.
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3.1 Different categories of waste and associated risks
Health care environments generate a broad range of waste, including clinical,
infectious and chemical waste, which could pose a chemical or biological hazard. Duty
of care requirements demands the proper management of waste materials to ensure
that potentially infectious or hazardous waste does not affect any individuals’ health or
environment.
Categories of waste
It is important that waste is properly identified so that it can be efficiently managed. In health
care environments we normally identify four different types of waste:
Household waste
Clinical waste and sharps
Confidential waste
Specific waste.
Efficient and effective waste segregation is an essential part of infection control. Waste
disposal through an inappropriate channel could create risk to human life and/or the
environment and could also lead to prosecution.
Colour-coding
The European Waste Catalogue Codes (as implemented in England, Ireland, Scotland
and Wales) includes the use of colour-coding to indicate the type of waste contained in
bags/containers.
Display the colour coding chart for waste disposal in a prominent place and on sack-holder
lids.
Do not tie up bags, use label ties which indicate source of the waste. *These bags are
laundered whole and the alginate dissolves in the washing machine to release the
contents.
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Waste
Type
Classification Colour
Coding
Description
Infectious
Clinical Waste
Hazardous
This type of waste poses a known/potential
risk of infection
Examples: anatomical waste, diagnostic
specimens, test vials
Infectious
Clinical Waste
Hazardous
This type of waste is potentially infectious
waste Example: autoclave and laboratory
waste
Offensive
/non-
infectious
waste
Non
Hazardous
This type of waste is generated by healthcare
waste which is classed as non-infectious
Examples: nappy, incontinence, sanitary
waste and other waste produced from human
hygiene.
Pharmaceuti
cal waste
Non
Hazardous
This type of waste relates to pharmaceutical
drugs
Examples: products and vaccines. Including
bottles, boxes or vials with residues. Also
including products contaminated from the use
of handling pharmaceuticals including gloves,
masks, connecting tubes, syringe bodies and
drug vials
Cytotoxic
and
Cytostatic
drugs
Hazardous
This type of waste relates to hormone and
cancer treatment medicinal waste and must
be separated from other medicinal waste as
they are classed as hazardous
To check if the waste is this type you can find
a list in a copy of the BNF or NIOSH list of
medicines
Controlled
drugs
Non
Hazardous
This type of waste relates to controlled
drugs it is important that these are
denatured to make them safer to dispose of
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Categories of clinical waste
The categorisation of clinical waste used below is based on that quoted in the Health
and Safety Commission publication “Safe Disposal of Clinical Waste”.
GROUP A
All human tissue including blood (whether infected or not), animal carcasses, tissue from
hospitals and laboratories and all related swabs and dressings.
Waste materials, where the risk assessment indicates a potential hazard to staff handling
them, for example, from infectious disease cases.
Soiled surgical dressing, swabs or other soiled waste from treatment areas.
GROUP B
Discarded syringes, needles, cartridges, broken glass and other contaminated
disposable sharp instruments or items such as broken ampoules.
3.2 Safe disposal of waste
Household waste
This includes general household type waste including food, flowers, waste paper and
packaging, aerosols, plastics and wood.
Household waste must be collected regularly in (usually) black plastic sacks tied securely.
Sack colour may vary according to locality. It is removed by the local authority and is
taken to landfill sites for disposal as it is a low risk source of infection. You must follow
your local work place policy on colour-coding and handling of waste bags.
Local Authority Collected Municipal Waste (LACMW)
Household waste (LACMW) must be collected regularly in (usually) black plastic sacks
and tied securely. Sack colour may vary according to locality. It is removed by the local
authority and is taken to landfill sites for disposal as it is a low-risk source of infection.
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You must follow your local work place polity on colour-coding and handling of waste
bags.
Clinical Waste
Clinical waste is usually placed in yellow bags for disposal (check policy and guidelines for
specific procedures in your health care environment). Appropriate disposal, or
incineration, will be carried out by specialist personnel as per local policy.
ALL WASTE IN THESE GROUPS MUST BE INCINERATED AS PER HEALTH AND
SAFETY EXECUTIVE (HSE) REQUIREMENTS.
Staff handling waste must:
Check that waste bags and sharps boxes are correctly filled, sealed and identified
Handle bags with due care, in line with procedures covering manual handling risks
Correctly use all protective equipment issued as well as reporting any defects in these
Correctly follow relevant procedures in case of incident or accident
Ensure that waste is not left in unsecured public areas.
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Safe handling and disposal of body fluids
Strict Precautions are needed when anyone is in direct contact with body fluids or when
handling contaminated articles because all of these may be a source of infection if not
handled appropriately. This is a high-risk situation therefore a high level of cleaning is
required. A full cleaning method is required, including steps 1 - 4 of the cleaning
process.
The term “bodily fluids” includes blood, mucous, urine, vomit, faeces, semen,
respiratory secretions and saliva.
Why do we need to handle these safely?
All contact with body fluids presents a risk of infection, however, the level of risk is
dependent upon the type of body fluid, whether from a known source of infection or
not.
The transmission of communicable diseases is more likely to occur from contact with
infected body fluids of unrecognised carriers rather that recognised sources simply
because appropriate precautions and procedures are not carried out.
How can we take precautions?
By ensuring that staff have adequate training
By the appropriate use of protection such as gloves, aprons
By cleaning up spillages safely in accordance with local policy
By safe disposal of contaminated items in accordance with local policy.
All staff should cover any cuts and abrasions using waterproof dressings. Staff with skin
lesions or broken skin from eczema or psoriasis should seek advice from their GP as they
may pose a risk of contamination both to themselves and to residents.
Each situation should be assessed using staff skills, procedures and facilities
available to determine precautions required.
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3.3 Storage of waste prior to collection
Health related waste should be stored in an area which is free from pests and the
elements and which is locked and inaccessible to the public prior to collection by the
registered carrier. It is important that you make yourself aware of your organisation’s
policies and procedures and refer to these when storing waste in your workplace. In order
to store waste safely:
The storage area should be kept clean
Full waste bags should not be thrown but placed carefully to avoid splitting of
bags or spilling of contents.
3.4 Legislation
Clinical waste
The Control of Waste Regulations 2012 (S.I. 588) define clinical waste as:
a) “Any waste which consists wholly or partially of human or animal tissue, blood or
any other body fluids, excretions, drugs or other pharmaceutical products, swabs or
dressings, syringes, needles or other sharp instruments, being waste which unless
rendered safe may prove hazardous to any person coming into contact with it”.
b) “Any other waste arising from medical, nursing, dental, veterinary, pharmaceutical
or similar practice, investigation, treatment, care, teaching or research or the
collection of blood transfusion being waste which may cause infection to any person
coming in contact with it.”
Hazardous Waste Regulations 2011
These are the most dangerous wastes. They can cause the greatest environmental
damage or are dangerous to human health.
The regulations require that most premises producing hazardous waste be notified. There
are some exceptions and premises such as offices, shops, farms, schools/colleges,
prisons, residential and nursing homes, hospitals, dental, veterinary and other medical
practices, premises used by charities and places used for the purposes of collecting
waste electrical and electronic equipment do not need to notify if they produce less than
200 kg of hazardous waste.
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If notification is needed the Regulator for England and Wales is the Environment Agency.
The Environmental Protection (Duty of Care) Regulations 1991 place obligations on
those producing waste to ensure that any waste they produce is handled safely and in
accordance with the law.
List of typical hazardous wastes:
Acids
Alkaline solutions
Batteries
Industrial solvents
Oily sludges
Pesticides
Pharmaceutical
compounds
Photographic chemicals
Waste oils
Wood preservatives
TVs
Computer monitors
Paint
Fluorescent tubes.
The Health and Social Care Act 2008: Code of Practice on the prevention and control of
infections and related guidance set out a number of criteria that facilities should consider
and include in the formulation of infection control policies and procedures. Good infection
control policies should make sure that staff and patients are protected from infections
acquired in the course of the provision of treatment, and there must be policies in place
for the prevention and control of infections, effective hand decontamination procedures,
wearing sterile gloves, dress code, safe use and disposal of sharps also staff must be
aware of their role. There must also be a person identified as the infection control lead,
and good management systems must be in place to ensure infection control issues are
dealt with.
3.5 How to reduce the risk of sharps injury
Sharps - Accidents involving risk of blood borne infection
Risk of accidental injury by sharps resulting in penetration of the skin or larger wounds,
may put the individual at risk of blood borne infection. Blood and blood products can
transmit a large number of infections.
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The major causes of concern are HIV (Human Immuno Virus), HBV (Hepatitis B
Virus), HCB (Hepatitis C Virus) and CJD (Creutzfeldt-Jakob Disease).
Such accidents include:
All sharps/needles injuries
Contamination of cut or abrasions with blood or body fluids
Human scratches/bites breaking the skin
Splashes of body fluids on to mucous membranes, e.g. eyes, mouth.
If you acquire a sharps injury the following IMMEDIATE ACTION must be taken:
BLEED - bleeding from wounds should be encouraged
CLEAN - the wound should be washed in soap and warm running water
COVER - the wound should be covered with a sterile dressing
REPORT - the incident should be reported to your line supervisor and procedures followed
RETAIN - only at this stage should an attempt be made to identify the source of the
needle/sharp
SEEK MEDICAL ADVICE - within 24 hours or IMMEDIATELY where there is a risk of
blood borne infection as treatment may be required within 2 hours of the injury
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Reducing the risk of sharps injuries
Safe handling and disposal of sharps
To minimise risk of accidental injury/infection:
Correct and safe disposal of needles and sharps into sharps disposal boxes
(BS7320) in order to protect staff, patients/individuals and waste handlers
Sharps boxes should be available and the lid secure
Never re-sheath needles - dispose of syringe and needle as one item even if not used
Never put your hands inside sharps boxes and do not overfill
Dispose of sharps into bin immediately after use - never lay them down on
surfaces or amongst dressings or towels.
Conclusion
The information you have read within this unit should increase your knowledge and
understanding, which will benefit you, the individuals you care for, key people and others.
Now complete the assessment questions for this unit in the workbook section.
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