Waste strategy
HSE ‘hierarchy of control’ The HSE’s general hierarchy of control sets out some practical steps to control any such exposure to risk as follows: The design and use of appropriate work processes, systems, and engineering controls, and the provision and use of suitable work equipment and materials, e.g. providing safer sharps devices.
The control of exposure at source, e.g. having a clinical waste policy that ensures safe collection, storage, transport, and final disposal, of waste.
Where adequate control of exposure cannot be achieved by other means, provision of suitable personal protective equipment (PPE), in addition to the measures required by the two measures above. (Source: HSE, online)
With increasing pressures on healthcare organisations to manage the disposal of sharps in a way that minimises injuries to healthcare workers, the approaches of specialist waste management companies need to consider these objectives, alongside the ever-looming demands of tightening costs and increasing sustainability. As sharps waste from a healthcare activity containing, or contaminated with, a bloodborne pathogen could pose serious risks to healthcare workers handling or disposing of the waste, it is clear that proper management of this activity is essential.
Inspection of NHS organisations The results of an HSE inspection of the practices and procedures of 22 NHS organisations (published in November 2012) describe how less than half of the organisations inspected actually undertook proactive monitoring to ensure that controls to prevent sharps injuries were implemented, and that such controls were actually working. Of those organisations that did monitor proactively, a reduction in injuries could be demonstrated. Although this inspection involved only a very small sample of NHS organisations, it did demonstrate the importance of a proactive approach to minimising the number of needlestick injuries.
Challenges faced by the NHS There are no two ways about this – these are challenging times for the NHS, with a number of significant pressures on the healthcare system. In England, the Department of Health has called on the NHS to make up to £20 billion worth of efficiency savings by 2015, in order to make more funds available for treating patients, and to allow the service to respond to changing demands and new technologies. Additionally, the NHS Sustainable Development Unit’s Carbon Reduction Strategy, which is aimed not just at the NHS, but also at the the wider
SRCL Bio Systems containers in the robotic wash line.
public health and social care system, defines paths to sustainable healthcare by 2020, and the measures and targets against which progress will be measured.
Waste challenges The Hospital Estates and Facilities Statistics is the ‘national data warehouse for England’, extracted from the ERIC (Estates Return Information Collection) return, which is collected and published by the Information Centre on behalf of the Department of Health. It is the main central data collection for estates and facilities services from the NHS, and enables analysis of estates and facilities information from NHS Trusts and (formerly) PCTs in England. The data is provided by NHS organisations. To put the ‘size’ of the waste reduction challenge into perspective, the ERIC return for the period 2011-2012 shows a staggering 81,117 tonnes of waste classed as ‘high temperature disposal waste’. Achieving sustainability is a prime
target for healthcare organisations, and there are a number of options that can help move them closer to the end goal. For instance, with better waste segregation,
clinical waste that does not require high temperature disposal can go towards other disposal routes, such as alternative treatment. This would apply to ‘infectious only’ clinical waste such as gloves, swabs, and contaminated dressings. Carbon can also be offset by energy
recovery, particularly when treating clinical waste that legally requires disposal via an incineration route only.
Proper waste segregation The HTM 07-01 guidance document (section 5) aptly advises: “Proper segregation of different types of waste is critical to safe management of healthcare waste, and helps control management costs. The use of colour-coded receptacles is key to good segregation practice (subsection 5.22).” The HTM 07-01 Memorandum goes on
to further advise how ‘Different wastes have different disposal options; segregating the waste allows better management of the material (the legal requirement to segregate waste cannot be avoided – choosing to incinerate everything is not an option). To dispose of mixed waste legally can be very expensive and problematical (Subsection 5.12)’. Proper waste segregation does not just
result in better waste management, but also can yield environmental benefits when waste undergoes alternative treatment, especially given the huge amount of waste that is sent to incineration.
A ‘real world’ example A case study illustrates how correct waste segregation can be beneficial.When one of our healthcare customers wanted to specifically reduce incineration by more than 50% over a period of three years, we spent a fair amount of time with them to audit each hospital ward and waste- producing area.We also worked closely with their infection control team to assess any high-risk areas, and to learn of any concerns they might have.We then utilised our BioTrack system to analyse the volumes of waste in each waste stream over a seven-day period, and to outline waste volumes over the previous 12 months, to reveal any key trends in disposal figures. What we discovered was astounding –
SRCL’s Bio Systems reuseable sharps containers, shown in 7.5 and 30.2 litre sizes, can reportedly be re-used up to 600 times.
operating theatres in particular were found to be classifying all their waste for incineration, which was contributing to high disposal costs.Weight was a particular issue, as the theatres were disposing of anatomical waste. SRCL suggested changing this practice to limb bins for all anatomical waste, orange bags for infectious-only soft clinical waste such as gloves and dressings, and metal recycling bins for single-use metal instruments. It was also discovered that all sharps were being placed into yellow-lidded
Health Estate Journal September 2013
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