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a. Contaminated dressings from a wound assessed by the healthcare worker as non-infectious can be treated as non-hazardous and should be contained and disposed of in the offensive/ hygiene stream.

b. Any recognisable item of non-infectious

healthcare waste cannot legally be disposed of in the black-bag waste stream and should therefore be disposed of in the offensive/hygiene waste stream.

c. Mixed domestic waste does contain small numbers of plasters, small dressings and incontinence products. Where the healthcare worker produces the same or similar items, these – with the following considerations – can be double-bagged and placed in the domestic waste (with the householder’s permission). The following should be considered:

(i) type of healthcare waste – if it looks like a healthcare waste, and is not obviously a normal constituent of domestic waste, then it should not go in the black bag;

(ii) the quantity produced – where a number of small dressings are produced regularly over a period of time, it may be appropriate to dispose of these as offensive/hygiene waste. If, however, the amount produced is relatively small and consistent with that likely to be found in the household waste stream (for example that bought from a local pharmacy or supermarket by the

householder), it may be discarded in the domestic waste;

(iii) packaging – where such waste is placed in the domestic refuse, the waste should be wrapped in a plastic bag. The wrapping should not be yellow or orange, as the waste is not deemed to be infectious – thin opaque plastic bags such as sandwich bags and bin liners are appropriate.

Offensive/hygiene waste arising from

healthcare

20 Many items classified as healthcare waste produced in the community by a healthcare worker are unlikely to be classified as infectious waste and should be segregated and managed as offensive/ hygiene waste. This requires item- and patient- specific assessment. Examples are provided in

Table 15 under ‘Management of Category B infectious waste in the community’.

21 This waste should be segregated at source and packaged and treated as offensive/ hygiene waste. In principle, this should not be placed in the domestic waste; however, exceptions to this have been noted above in paragraph 19 and below at

paragraph 35, ‘Stoma/catheter bags’.

Notes

1. Any offensive waste arising from a patient being treated with cytostatic or cytotoxic drugs should be sent for incineration in yellow bags with purple stripes (yellow bags are also acceptable), as traces of these medicines may appear in contaminated items. The incineration of such wastes will ensure

complete destruction. Alternative arrangements may be made following expert advice on the behaviour of the particular pharmaceutical which indicates that the medicine or dangerous

breakdown products will not be present in the waste item in question.

2. Any liquid waste classified as offensive following a risk assessment will most likely be disposed of at the premises via the foul sewer. Liquid wastes are banned from landfill; therefore, non-infectious body fluids (for example urine/vomit), although classified as offensive, should not be disposed of in the offensive yellow/black waste stream if this is being sent to landfill. They can, however, be absorbed onto a cloth (for example kitchen towel) or solidified with absorbent or gelling granules, for example, and placed in the offensive bag whilst ensuring there is no free-flowing liquid present.

Example waste streams

22 Examples are provided in Table 16 for typical waste arising from activities in the community sector. Healthcare workers will produce the following waste types and require the following colour for segregation:

• yellow- or purple-lidded sharps receptacle; • orange bags for infectious waste;

• black/clear bags for domestic waste; • yellow/black bags for offensive waste;

• red-lidded container for anatomical waste (for example placentas).

23 The colour of the waste receptacle will depend on how the waste should be treated and disposed of as detailed in Table 16 (further details on classification are provided in this sector guide).

Notes

1. Sharps receptacles must be UN-type-tested and approved, tested and certified to BS 7320 (see ‘Transport packaging and operations’).

2. Sharps receptacles should be collected when filled to the fill line and should never exceed the

permissible marked mass. If the sharps receptacle is seldom used, it should be collected after a

maximum of three months, regardless of the filled capacity.

Self-medicating patients and sharps disposal

24 Where the householder is a self-medicating patient who uses injectables (for example a person with diabetes) with no healthcare worker involved in the administration, the GP or healthcare worker should prescribe the householder a sharps receptacle relevant to the medication being administered and advise them of local disposal options.

25 The householder should be trained in how to use the sharps receptacle before it has been prescribed, to ensure that they understand its use and ensure it is correctly sealed and labelled.

26 Once the sharps receptacle is filled to the “fill line”, it should be sealed by the householder and taken back either to the GP surgery or to the local pharmacy for disposal, or arrangements for collections should be made with the PCT or local authority. For self-medicating housebound patients, the GP or healthcare worker responsible for

prescribing treatment should advise on collection arrangements.

27 Local authorities have specific duties in relation to healthcare waste as detailed in paragraph 3.19, ‘Local authorities’ responsibilities’. Authorities have a duty to collect household waste including healthcare waste from domestic properties. Under the Controlled Waste Regulations, the authority may charge for the collection of specific waste streams, which includes clinical waste (that is, healthcare waste from a householder’s sharps receptacle).

Note

It is no longer acceptable to advise self-medicating patients to dispose of their sharps and lancets into the household black-bag waste stream.

Case Study: Partnership Working and Benefits for all

28 Contaminated needles and sharps produced in the community can cause problems for Local

Authorities and PCTs unless a robust storage and collection system is in place. Diabetics and other sharps users have in some instances in the past been advised to place sharps in a plastic bottle for disposal; however, this presents a potential risk to council staff during collection. In addition to this, it was felt there was a general lack of awareness of how to dispose of clinical waste by residents and holidaymakers, especially needles and sharps.

29 Cornwall NHS Trust brokered a joint agreement with Cornwall County Council, NHS trusts, infection control and the Environment Agency to implement a new initiative to provide sharps receptacles through GPs to diabetic and renal patients. To support the initiative, they produced a pamphlet on the safe disposal of clinical waste to cater for all users of the scheme.

30 Key benefits are:

• raised awareness across Cornwall of safe management of sharps

• improved safety systems for waste operatives collecting municipal solid waste (MSW) and clinical waste

• synchronised response to request collection • financial control across “Cornwall Plc” by

Table 16 Typical waste streams (see also ‘Transporting offensive or infectious waste from patients’ homes’) Activity/cause Waste type Classification and

colour coding

Justification Disposal route

Healthcare visits of, for example, post-operative wounds that are infected

Vast majority of soft infectious waste such as dressings, bandages and some plastic single- use instruments can be treated

Waste from an infection or is infectious is disposed of in orange bags

EWC: 18 01 03*

The vast majority of “bagged” infectious waste produced in the community will be placed in the orange waste stream. Therefore, the use of orange bags in the community is recommended

Alternative treatment to render it safe

Healthcare visits of, for example, post-operative wounds that are not infected

Non-infectious dressings, single-use instruments, stoma bags, catheter bags, incontinence pads¹ Waste classified as offensive/hygiene waste disposed of in yellow/ black bags EWC: 18 01 04

Used for recognisable healthcare waste that is neither infectious waste nor hazardous waste and is classified as non-hazardous offensive waste. Municipal incineration/ energy from waste/landfill

Midwifery and delivery (e.g. anatomical waste such as placentas)²

Anatomical waste such as placentas

Placed in an

appropriate red-lidded container

EWC: 18 01 03*

A relatively small amount of waste produced in the community

Disposal by incineration only

Medicinal injections – for the administration of chemotherapy, antiviral and/or hormonal drugs

Associated sharps and liquid residues of the medicinal products that are cytotoxic /cytostatic

Placed in an appropriate purple- lidded leak-proof sharps receptacle EWC: 18 01 03* 18 01 08 Sharps contaminated with cytotoxic/cytostatic medicinal products Disposal by incineration only Medicinal injections with non-cyto drugs

Associated sharps and medicinal products that are determined to be non-cyto

Yellow-lidded sharps receptacle. If the syringe contains residual liquid medicines, this container needs to be leak-proof

EWC: 18 01 03*

Likely to be medicinally- contaminated sharps in the community

Incineration

Packaging as a result of treating a patient Or

other municipal wastes i.e. mixed domestic waste

Uncontaminated mixed waste e.g. cardboard, plastic³ If not contaminated and non-infectious EWC: 20 03 01 Domestic disposed of in black/clear bags

Used packaging, whilst carrying out patient treatments in the home will in most circumstances not be infectious/clinical waste Non-hazardous municipal incineration/ energy from waste or landfill/ material recycling facilities/reuse Notes:

1. There are exemptions to this (see paragraph 19).

2. Where anatomical, placenta or other waste that requires incineration is being generated, it will be appropriate for healthcare workers to carry yellow packaging. As most “incineration only” waste is either anatomical or sharps and/or contains free liquid, the use of small rigid leak-proof yellow containers is recommended.

3. Not applicable to recognisable healthcare waste (e.g. plastic equipment); however, there are exemptions to this (see

paragraph 19)

Community nurses should use the sharps receptacle appropriate to the waste they generate, e.g. a yellow leak-proof sharps receptacle with a purple lid for cytotoxic or cytostatic waste. Orange-lidded sharps receptacles are generally not advisable for use in the community in England and Wales, unless the community nurse can ensure they are not used for medicinally contaminated sharps. In Scotland and Northern Ireland, orange-lidded sharps receptacles may be used for both medicinally uncontaminated or fully discharged syringes.

Note

At the time of writing, Defra is reviewing Schedule 2 of the Controlled Waste Regulations, with a view to establishing a simpler and more equitable system.

Single-use instruments

31 Single-use instruments are now commonly being used in the community by a number of healthcare professionals (for example chiropodists). Single-use instruments can take the form of plastic, wood or metal instruments.

32 Contaminated single-use plastic or wood

instruments – where there is no risk of sharps and they are deemed to be infectious – can be safely disposed of as infectious waste in the orange-bag waste stream.

33 Single-use metal instruments – where there is no risk of sharps and they are deemed to be infectious – should be put into a rigid yellow container clearly marked either for decontamination or for

incineration. This will vary depending on the arrangement with the waste contractor and facilities

available. Large metal instruments, if placed in the alternative treatment process, may damage the equipment at the facility.

34 Where the instruments are deemed to be non- infectious, they should be sent for disposal as offensive/hygiene waste. In the case of metal instruments, they should be sent for metal reclamation and recovery where available.

Note

Single-use instruments cannot legally be disposed of in the black-bag waste stream.

Stoma/catheter bags

35 If a healthcare worker is involved in the care of a stoma site, the waste from a stoma patient can be disposed of in the black-bag waste stream (see

paragraph 19, ‘Management of Category B infectious waste in the community’ (Part 2)).

36 If used in bulk (that is, large quantities of waste as a result of the healthcare worker or by the

for disposal in yellow/ black bags for landfill or municipal incineration.

37 However, if the person develops any type of gastrointestinal infection or the site becomes infected, the bag needs to be disposed of as infectious waste into the orange-bag waste stream (see Table 16 above)).

38 If the householder is self-medicating with no healthcare worker involved, they are able to dispose of their own waste into the black-bag waste stream.

Note

Waste arising as a result of treatment undertaken by the healthcare worker does not constitute mixed municipal waste. It should therefore not be deposited in the household black-bag stream for collection as EWC 20 03 01 mixed municipal waste. By placing such waste in the householder’s black bag, the classification of this waste will need to change to incorporate the presence of healthcare waste. Also the duty of care arrangements and permit requirements of the receiving waste management facility will change – this may now include waste classified as offensive EWC 18 01 04. For exemptions to this, please see ‘Management of Category B infectious waste in the community’ (Part 2).

There are certain healthcare waste streams, even when produced by the householder, that should not be placed in the black-bag domestic waste stream. For example, wound vacuum drains should be treated as infectious waste and disposed of in the orange-bag waste stream. The householder should have the relevant procedures explained and training given at the time of prescription.

Maggots

39 All maggots used for wound management should be secured in a rigid yellow container or double- bagged in yellow bags and marked as UN 3291.