What is Clinical Waste?
Editor’s note: This post was originally published in September 2019 and has been completely revamped and updated for accuracy and comprehensiveness.
Defining Clinical Waste
Clinical waste is commonly defined as a type of waste that has the potential to cause infection or disease. Such waste is generated by healthcare service providers such as GP surgeries, hospitals, nursing homes, health clinics or centres, and dental practices. It also applies to veterinary practices, pharmacies, and research and development labs.
Some examples of clinical waste include:
- Sharps waste such as syringes, needles, lancets, scalpels, and other items defined as ‘sharps’ that have been potentially contaminated with infectious organisms or medicines.
- Anatomical waste such as blood bags or tissue samples taken from humans or animals.
- Pharmaceutical waste such as any medicines or pharmaceutical products and/or drugs that aren’t cytotoxic or cytostatic.
- Infectious waste such as gloves, aprons, masks or visors, as well as dressings and IV tubings that have come into contact with infectious bodily fluids such as blood, saliva, phlegm, bile, urine or faeces. This also includes waste generated from the care of a patient diagnosed with any type of communicable disease.
Cytotoxic or cytostatic waste such as any medicinal product that possesses any one, or more of the following hazardous properties: toxic, carcinogenic, toxic for reproduction, or mutagenic. This also includes waste generated from the care of a patient prescribed a cytotoxic or cytostatic drug i.e. in a chemotherapy centre.
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The Official Definition of Clinical Waste
The Controlled Waste (England and Wales) Regulations 2012 define clinical waste as: "… waste from a healthcare activity (including veterinary healthcare) that – a) contains viable micro-organisms or their toxins which are known or reliably believed to cause disease in humans or other living organisms, (b) contains or is contaminated with a medicine that contains a biologically active pharmaceutical agent, or (c) is a sharp, or a body fluid or other biological material (including human and animal tissue) containing or contaminated with a dangerous substance within the meaning of Council Directive 67/548/EEC on the approximation of laws, regulations and administrative provisions relating to the classification, packaging and labelling of dangerous substances."
In other words, clinical waste is any type of waste generated in a medical, veterinary, treatment, research, or other practice where the waste poses a risk of infection or hazard, or can otherwise cause harm or illness to a person coming into contact with it.
The Most Common Healthcare Waste Streams
Familiarity with governmental regulations regarding healthcare waste is recommended for healthcare providers. One important document regarding waste classification is the Waste Classification Technical Guidance written and published under the umbrella of multiple agencies.
Among the most common healthcare and related wastes streams include:
- Offensive waste – recognisable waste that is non-infectious. This is the most common healthcare waste stream. It cannot contain pharmaceutical or chemical substances but may be unpleasant to those who may come into contact with it.
Examples include PPE and wastes generated from the care of a non-infectious patient, as well as nappies, incontinence pads and period dignity washes.
- Pharmaceutical waste – non-hazardous medicines such as tablets, capsules, liquid suspensions, and powders.
- Sharps waste – any sharp item that could risk puncturing a clinical waste sack is considered a sharp; such as syringes, single-use metal items, and end-of-life surgical instruments.
The presence of infectious organisms, chemical contamination, or a cytotoxic or cytostatic drug determines whether a sharp is hazardous. Sharps may also contain pharmaceutical residues.
- Anatomical waste – any identifiable body part such as limbs, organs and placentas as well as full or partially used blood bags. Also includes pathological and biopsy specimens.
Anatomical waste may be hazardous if it has come from an infectious source or been chemically preserved.
- Infectious waste for incineration – waste that is classified as being highly infectious and requires high-temperature incineration due to a secondary contamination, be that medicinal or chemical.
- Infectious waste suitable for alternative treatment – such as PPE, dressings, and IV tubings that have come into contact with infectious bodily fluids such as blood, saliva, phlegm, bile, urine or faeces and is not medicinally or chemically contaminated.
This also includes waste generated from the care of a patient diagnosed with any type of communicable disease.
How to Classify Healthcare Waste
If waste in your hospital isn’t correctly categorised, it can’t be properly disposed of.
In order to determine the classification of waste, healthcare employees must be able to assess the properties of waste at the time of its generation for:
- Infectious properties
Other hazardous properties
You can correctly classify different waste types by understanding the EWC Codes for healthcare waste. Waste can be deemed clinical waste if it has been contaminated with or contains any dangerous substance that, in sufficient concentrations, can lead to it being considered a hazardous property.
Is All Clinical Waste Hazardous?
Whilst not all clinical waste is hazardous, such as medicines other than those that are cytotoxic or cytostatic; hazardous clinical waste is broken into three classifications or categories of material:
- Any healthcare waste that poses a risk of infection.
- Certain healthcare wastes that may trigger a chemical hazard.
Medicines and medicinally-contaminated waste that contains a hazardous pharmaceutically active agent.
The Health Technical Memorandum clearly states that: “The only healthcare wastes that can be both clinical and non-hazardous waste are non-cytotoxic and non-cytostatic medicines.”
It’s also worth noting that hazardous clinical waste has the potential to be both infectious and chemically contaminated, such as the type found in a diagnostic kit, and as such, requires packaging in a yellow UN-certified sack or rigid container.
The Basics for Healthcare Waste Storage, Segregation, and Handling
The UK standards are clear that to be compliant, all waste streams must be properly segregated, stored and handled from point of production through to final disposal. Due to its unique properties, each waste steam comes with its own set of handling, transferring, and processes for disposal.
All producers of clinical waste should follow the colour coding guidance published in the Department of Health’s Health Technical Memorandum 07-01: Safe and Sustainable Management of Healthcare Waste:
- Yellow sack with black stripe - offensive waste.
- Orange sack – infectious waste suitable for alternative treatment.
- Yellow sack – infectious waste requiring high-temperature incineration.
- Purple (sacks or sharp) – cytotoxic and/or cytostatic waste.
- Red – anatomical waste.
Blue – non-hazardous pharmaceutical waste.
All wastes should be securely closed and labelled to state the origin of the waste. Best practice is to use the swan-neck method and a sequentially numbered sack tie when closing a clinical waste sack. There should be sufficient space allocated to temporarily store waste near the point of production. For example, within a hospital, most wards or departments will have access to a waste hold. Within each waste hold, containers (typically wheeled bins) must be provided for the different waste streams produced by that department. Both the waste hold and any containers used for hazardous waste should be lockable. Clear signage is key to ensuring the correct waste goes into the correct container. Following the above enables you to treat waste in the most environmentally friendly and economical way possible. It also permits waste contractors such as Sharpsmart to compliantly collect and treat your waste.
What About Healthcare Waste Contractors?
The Environment Agency defines the appropriate measures for waste storage, segregation, and handling that all waste contractors must adhere to.
Those measures include:
- Any bagged waste on-site must be fully enclosed in rigid, leak-proof, weather-proof and lockable bulk containers such as UN-certified yellow wheeled bins, such as carts.
- Maximum storage capacity of a site must be clearly established with a designated storage area that cannot exceed those maximum capacities.
- Anatomical waste and/or animal carcasses must be stored in a designated refrigeration unit (below 5°C), unless they are stored on-site for less than 24 hours (or 72 hours if over a weekend).
- Anatomical waste can be refrigerated for up to 14 days.
- The integrity of waste packaging must be maintained and designed in such a way as to minimise waste handling.
- Healthcare waste must be stored based on waste type and ultimate destination.
- Separate storage areas or containers are required for clinical waste bags destined for incineration as well as those for alternative treatments.
Prioritise the treatment of waste or off-site transfer procedures based on recommendations for the duration of storage on site.
Disposal Options for Clinical Waste
The improper disposal of clinical waste has detrimental effects on people and the environment so to prevent that from happening, the collection of clinical waste from hospitals is handled privately through certified healthcare waste management companies, such as Sharpsmart.
It’s the duty of care of the healthcare facility or waste producer to ensure the proper licensing, certification, and disposal permits are in place for any company used before the transfer of any waste occurs.
The disposal options available are determined by the type of waste and its hazardous properties. For example, according to HTM 07:01: “Clinical waste that is considered infectious for carriage purposed must possess the hazardous property H9: Infectious designation.”
If there are no further hazards present the waste should be placed in orange, UN-certified clinical waste sacks and sent for alternative treatment.
The Safe Management of Healthcare Waste
The Safe and Sustainable Management of Healthcare Waste (HTM 07-01) document published by the Department of Health is the most valuable resource for healthcare facilities. It provides detailed guidance and recommended implementation practices, as well as basic, yet essential quality and safety standards when dealing with healthcare waste.
It details the environmental benefits of the safe management and disposal of healthcare waste, provides an understanding of best practices for waste management and offers ways to improve the environmental and carbon impacts of managing waste. By following the guidance outlined in this document you’ll not only be meeting legislative requirements, but also encouraging safer working practices and opportunities for cost savings.
The document also stresses one of the most important foundations of compliant healthcare waste; knowing the difference between infectious and offensive waste and ensuring the correct segregation and classification of it. With this knowledge, you can avoid the costly over-treatment of waste and make your waste management activated more sustainable.
Avoid the Fines and Penalties for Non-Compliance
Unfortunately, the majority of common healthcare waste violations and offences occur as a result of staff not being properly trained in healthcare waste management.
Some common areas for improvement are:
- Understanding how to correctly segregate waste at point of care, particularly the difference between orange (infectious) and tiger stripe (offensive) sacks.
- The colour coding outlined in HTM 07-01 and keeping them segregated in wheeled containers.
- Segregating cytotoxic and cytostatic wastes from other streams.
- Healthcare waste paperwork, how to check and complete it, and how long to store it.
Ensure Your Compliance Today
Sharpsmart provides fully managed healthcare waste management solutions that include waste optimisation, enhanced safety procedures, and training on compliant waste segregation. Contact us for support with compliant segregation and guidance in educating your staff on classifying healthcare waste; leading to a more sustainable approach to waste management.
We’re dedicated to exceeding sustainability benchmarks, reducing the volume of clinical waste that ends up being treated via high-temperature incineration, and supporting our partners on the route to net zero. For more information about healthcare waste compliance, contact us today.