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CLINICAL WASTE MANAGEMENT


Also, we see that refurbishment work conducted at the WasteCares East Kent incinerator will result in a capacity increase of 4000 tonnes per year. Taking a helicopter view, the market has


responded well to calls for assistance to improve disposal capacity across the country, albeit with some logistical challenges, and some genuinely better systems have already emerged. Most noticeably, NHS England has initiated a greater core focus on waste management in areas such as national infrastructure and supplier resilience while also focusing on procurement strategies. That is a good start, but we are not there yet. Much local attention is still focused on a


range of key areas where improvements and adjustments are well overdue. Perhaps top of the ‘to-do’ list is having competent waste managers or managing agents in place who are qualified and responsible for clinical waste. It is still not yet embedded in the minds of all the people who really need to know that waste must be segregated into core streams for compliance and effective, efficient management, as stated in the government’s safe management of healthcare waste guidance.2 It is clear that producers of healthcare


waste have a responsibility to ensure waste is disposed of in accordance with best practice and appropriate disposal methods. Municipal incineration should only be considered as a last resort after all standard methods have provided evidence that they have no further capacity. Standard methods are those such as alternative treatment and hazardous (clinical) waste incinerators. For compliance purposes, the UK


Environment Agency has issued advice to producers of healthcare waste who may have the need to use municipal incinerators. In summary, producers of


healthcare waste must limit waste to the below European Waste Catalogue (EWC) classifications. These waste types cannot include sharps waste. l 18 01 03 – orange bagged and containerised infectious waste from human healthcare activities.


l 18 01 03 and 18 01 07 – yellow bagged and containerised infectious waste from human activities dual coded with non- hazardous chemicals.


l 18 01 04 and 20 01 99 – offensive hygiene wastes (human).


l 15 02 02 – absorbents, filter materials (including oil filters not otherwise specified), wiping cloths, protective clothing, contaminated by hazardous substances (COVID-19 cleansing waste).


At the time of writing, with many hundreds of patients still being treated for coronavirus in our hospitals, the volume of clinical PPE is on the rise. You only have to look at the UK government’s COVID-19 guidance for primary care use: ‘Where the health or social care worker


assesses that an individual is symptomatic (of COVID-19) and meets the case definition, appropriate PPE should be put on prior to providing care. ‘Where the potential risk to health and


social care workers cannot be established prior to face-to-face assessment or delivery of care (within two metres), the recommendation is for health and social care workers in any setting to have access to and where required wear aprons, FRSMs, eye protection and gloves. ‘Health and social care workers should


consider the need for contact and droplet precautions based on the nature of care or task being undertaken. Risk assessment on the use of eye protection, for example, should consider the likelihood of encountering a case(s) and the risk of droplet transmission (risk of droplet


transmission to eye mucosa such as with a coughing patient) during the care episode. ‘Sessional use of FRSMs and eye


protection is indicated if there is perceived to be close or prolonged interaction with patients in a context of sustained community COVID-19 transmission. ‘Ultimately, where staff consider there is


a risk to themselves or the individuals they are caring for they should wear a fluid repellent surgical mask with or without eye protection, as determined by the individual staff member for the episode of care or single session.’ The guidance continues: ‘Aprons and


gloves are subject to single use as per Standard Infection Control Precautions (SICPs), with disposal and hand hygiene after each patient contact. Respirators, fluid-resistant (Type IIR) surgical masks, eye protection and disposable fluid repellent coveralls or long-sleeved disposable fluid repellent gowns can be subject to single sessional use in circumstances. ‘A single session refers to a period of time where a health and social care worker is undertaking duties in a specific clinical care setting or exposure environment. For example, a session might comprise a ward round, or taking observations of several patients in a cohort bay or ward. A session ends when the health and social care worker leaves the clinical care setting or exposure environment. Once the PPE has been removed it should be disposed of safely. The duration of a single session will vary depending on the clinical activity being undertaken.’ Combined, that has created the use of a phenomenal amount of PPE that needs to be treated and correctly processed. Government advice requires that all


Aprons and gloves are subject to single use as per SICPs. IFHE DIGEST 2021


clinical waste generated where suspected or confirmed cases are identified must be packaged and disposed of as Category B infectious waste, isolated from all other clinical waste. This requirement puts additional pressure on already overstretched resources. Our guidance is that such waste should be placed in orange collection bags and sealed with a swan neck and cable tie. Done correctly, this method prevents air escaping from bags when they are moved or collected and therefore removes the need for double bagging. It is for this reason that staff with responsibility for the disposal of PPE into the Cat B waste stream, should be trained to adopt the swan neck and cable tie method. This enhances the protection of all from the potential transmission of COVID-19, while reducing the volume of orange bags being used. Failure to do this correctly, or the adoption of knotting, could lead to the potential spread of infection as trapped air can leak from poorly sealed bags. Where poor management practices are identified, we continue recommend double


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