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WASTE MANAGEMENT


Dealing responsibly with COVID-19 PPE waste


Graham Flynn, managing director of technology-based clinical waste management company, Anenta, says that ‘the most pertinent and repeated’ question the company has received in recent days is ‘How should we manage clinical waste in relation to COVID-19 crisis?’ Here he explains how such waste can be safely and responsively disposed of.


A biohazard bin and sign.


The question of how to safely deal with and dispose of COVID-19-related clinical waste has become particularly acute following the rapid establishment of Clinical Decision Units, COVID-19 testing sites, and Nightingale hospitals. Up and down the country, plans have been rolled out to set up centres to treat and look after individuals affected by the pandemic. From the most senior management tiers of NHS England, to NHS Trusts, NHS Property Services, and CCGs, all are asking the same question: ‘How should clinical waste generated by coronavirus be disposed of safely?’


Paradoxically, the amount of clinical waste is actually decreasing. GPs are not seeing patients in any great volume, so the overall amount of clinical waste is falling. However, the quantity of PPE used in COVID-19 testing centres and hospitals is rising dramatically, with predictions of up to 15 million bags being used per month. Traditionally – if not contaminated with bodily fluid or infectious substances – classified as offensive waste, PPE would typically be disposed of through the offensive waste stream, which is either landfilled, or sent to waste to energy facilities (WTE). However, with the onset of the COVID-19 pandemic, all gloves, gowns, face protectors, and other forms of PPE, are now being treated as Cat B clinical waste. As such, all PPE waste, alongside waste related to possible or confirmed cases of COVID-19, needs to be placed in orange collection bags, which


34 Health Estate Journal July 2020


should be sealed with a swan neck and cable tie. Doing this correctly removes the need for double bagging, as the swan neck and cable tie method prevents air escaping from bags when they are moved or collected. Failure to do this correctly, or the practice of simply tying knots in orange bags, could lead to the potential spread of infection, as trapped air can be expelled from poorly sealed bags.


Recommendation for double bagging


It is for this reason that we recommend double bagging where poor management practices are identified, as double bagging when knots are applied reduces the risk of any infection escaping. It also diminishes the chance of contamination from the exterior of the original bag being passed on, protecting the safety of all those involved in the storage, collection, and processing of clinical waste. However, with


concerns mounting over the potential shortage of orange Cat-B bags, our updated recommendation as of 17 April 2020 - which has been shared with the NHS’s National Waste Teams working on clinical waste management – is to ensure that all staff responsible for disposing of PPE into the Cat B waste stream are trained to adopt the swan neck and cable tie solution, a film of which can be seen at https://www.youtube.com/ watch?v=3afvrpuRbrI This enhances the protection of all from the potential transmission of COVID-19, while reducing the number of orange bags being used.


Safe storage in carts


Over the past two years, the price for the treatment and disposal of clinical waste via incineration has increased from £650 to £1,500 per tonne.


Once correctly tied, all bags should be stored safely in carts tagged with the appropriate clinical waste consignment – in line with latest NHS guidance at https://tinyurl.com/ycl2h7hk – ready for collection and disposal, preferably through ‘alternative treatment’ to destroy the virus or, where appropriate, via incineration. Given that ‘alternatively treated’ PPE can be used for energy generation, this is by far the favoured option. Just as well too, as this is a disposal method that has yet to hit capacity. What has changed is that under the Environment Agency’s recent Regulatory Position Statement C4, published on 15 April, operators of permitted municipal waste incinerators used for residual waste to energy can accept and incinerate COVID-19 infectious waste. This follows on from the NHS


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