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Clinical waste management

and infection control
40

Rebecca Allen BSc (Hons)

03/10/14 CET

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.

Course code: C-37865 | Deadline: October 31, 2014

Learning objectives
To 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)

Learning objectives
To 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 1.1.11)

About the author

Rebecca 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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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 waste

Yellow Infectious waste for

disposal by incineration

Orange Infectious waste for disposal

by treatment or incineration

41
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

Clinical 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 regulations

The 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

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

For all transfers of waste, appropriate
documentation must be provided. For nonhazardous 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 waste

It is imperative that clinical waste is separated
out at the point of production, following
the Safe Management of Healthcare Waste

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03/10/14 CET

Introduction

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03/10/14 CET

42

CONTINUING
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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 Figure 2 Orange lidded
separation is
box for sharps that are
not contaminated with
best practise
medicines for disposal by
in Scotland
treatment or incineration
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.

optometrytoday

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 waste
There are special requirements regarding
the disposal of hazardous waste, which may

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enewsletter

VRICS

Important information for

domiciliary visits
From 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 business
The 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.

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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.

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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?

Infection control guidelines

Managing 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:
E nsure 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.

Conclusion
It 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.

Exam questions

References

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

Visit www.optometry.co.uk/

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

clinical, click on the article title

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

and then on references

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

to download.

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.

43

03/10/14 CET

their licences.
Most waste
management
companies will
offer a flexible
service to suit
the needs
of different
customers
Figure 3 Blue lidded box for
including
waste medicines suitable for
daily, weekly, disposal by incineration
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:
I s the waste carrier licensed to take away the
types of waste you are producing?
A
 re 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?
D
 o 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?
C
 an the clinical waste management company
guarantee your service delivery will happen
on time?