Welsh Health Technical Memorandum - Health in …

1 WHTM 07-01 Welsh Health Technical Memorandum Safe management of healthcare wasteDisclaimerThe contents of this document are provided by way of general guidance only at the time of its publication. Any partymaking any use thereof or placing any reliance thereon shall do so only upon exercise of that party s own judgementas to the adequacy of the contents in the particular circumstances of its use and application. No warranty is given asto the accuracy, relevance or completeness of the contents of this document and NHS Wales Shared ServicesPartnership Facilities Services shall have no responsibility for any errors in or omissions therefrom, or any use madeof, or reliance placed upon, any of the contents of this :Heath Building Notes (HBNs) and Health Technical Memoranda (HTMs) issued by the Department ofHealth in England are being superseded by specific Welsh editions which will be titled Welsh Heath Building Notes(WHBNs) and Welsh Health Technical Memoranda (WHTMs).

2 Until this process is complete, where a WHBN orWHMT is referred to in the text but has not yet been published, refer to the relevant publications page on the NHSW ales Shared Services Partnership Facilities Services website for the latest approved document. Intranet: : by NHS Wales Shared Services Partnership Facilities ServicesNHS Wales Shared Services Partnership Facilities Services acknowledges the input of the Department of HealthThis publication can be accessed from the NHS Wales Shared Services Partnership Facilities Services 978-1-909899-03-2 Copyright NHS Wales Shared Services Partnership Facilities Services 2013 Welsh edition published 2013 Supersedes Health Technical Memorandum 07-01 2006 Cover image by courtesy of Aneurin Bevan Local Health BoardPhotography by Stewart Brooks.

3 NHS Wales Shared Services Partnership Facilities ServicesCover designed by Keith James2 Welsh Health Technical Memorandum 07-01 - Safe management of healthcare wasteWelsh Health Technical Memorandum 07-01 Safe management of healthcare waste3 This guidance was produced and updated in partnership with DH, Defra and the Department for Transport and with the full support and cooperation of the Regulators (Environment Agency and the Health and Safety Executive) and the devolved administrations. It provides an update to Health Technical Memorandum 07-01 first published in 2006. The key areas of change include: updates to legislation, specifically for environmental permitting and transport/carriage regulations; a focus on the waste hierarchy through procurement practices, and the elimination, minimisation, recycling and recovery of waste ; a drive to address the carbon impact related to waste through resource efficiency, transport impacts and disposal arrangements; the integration of new sector guides on GPs and dental practices as well as incorporating Health Technical Memorandum 07-06: Disposal of pharmaceutical waste in community pharmacies as a sector guide (see the Community pharmacies sector guide).

4 A focus on practical advice and examples for classifying waste , in particular the infectious and offensive waste streams, including case studies to highlight best practice; a review of the terminology used for healthcare, clinical and non-clinical wastes. This edition supersedes previous from the direct environmental benefits achieved by the compliant management of healthcare waste , this guidance presents opportunities for introducing cost savings, safer working practices and reducing carbon emissions related to managing Health Technical Memorandum 07-01 Safe management of healthcare waste4 The following individuals and organisations have contributed to the production of this guidance: Mick Fanning WSP Group Louise Wood WSP Group Catherine Lynas WSP Group Peter Hoffman Health Protection Agency Jeff Hart Department for Transport Christopher Lewis NHS Wales Shared Services Partnership Facilities Services Bob McIntyre Environment Agency Tony Ryan Buying Solutions Martin Castle Vehicle Certification Agency Gul Root Department of Health Lorraine Holme Department of Health Steve Lutener Pharmaceutical Services Negotiating Committee John Newbold Health and Safety Executive Mark Heggie Scottish Environment Protection Agency Allison Townley Northern Ireland Environment Agency Teena Patel Department for Environment, Food and Rural Affairs Alison Gadsby Department for Environment.

5 Food and Rural Affairs Dave Wiltshire Thames Water Brian Latham IHEEM Howard Stevens Abertawe Bro Morgannwg University Health BoardAcknowledgementsWelsh Health Technical Memorandum 07-01 Safe management of healthcare waste5 ContentsOverview 3 Acknowledgements 41 Introduction, scope and applicability 12 Who should use this Health Technical Memorandum ? What is provided in the Health Technical Memorandum ? Update to Health Technical Memorandum 07-01 (2006) and key changes Guidance status and implementation Essential standards of quality and safety 2 Glossary and acronyms 163 Legislation and healthcare waste 18 Overview of regulatory regimes Environment and waste legislation waste Framework Directive Duty of care and controlled waste Local authorities responsibilities Environmental permitting and waste management licensing Hazardous waste (England and Wales) Consignment notes European waste Catalogue (EWC) Controlled drugs Producer responsibility Infection control Health and safety legislation Management responsibilities Control of Substances Hazardous to Health (COSHH)

6 Health and safety at work Consulting employees Transport and carriage legislation Carriage Regulations Procurement regulations European procurement regulations Procurement guidance 4 Healthcare waste definitions and classifications 28 Typical wastes produced by healthcare activities Clinical and hazardous waste Healthcare waste classification and assessment framework Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Specific waste types Amalgam waste Welsh Health Technical Memorandum 07-01 Safe management of healthcare waste6 Medical devices Implants Radioactive waste Domestic (municipal) waste Blood transfusion bags Gypsum and plaster casts 5 waste minimisation, segregation, colour-coding and storage 57 waste minimisation Importance of waste segregation Colour-coding Container labelling Infectious waste : yellow stream Anatomical waste red-lidded receptacles Infectious waste : orange stream Infectious liquid waste : yellow or orange receptacles Medicinal products blue-lidded receptacle Cytotoxic/cytostatic waste yellow with purple stripe or purple stream Sharps waste receptacles with yellow, purple and orange lids Fully discharged syringes Offensive/hygiene waste yellow/black bags Domestic waste (usually black bags) Specialist arrangements for segregation Chemical waste .

7 Fixer and developer Amalgam white containers Radioactive waste Large equipment and mattresses Implanted devices Successful waste segregation Implementing waste segregation systems waste receptacles Storage and frequency of collection 6 Managing compliance 75 Healthcare waste policy waste audit Audit scope and procedure Frequency of audits Audit techniques Observation and recording of practice Observation of waste receptacles Detailed examination of waste Staff questionnaire waste audit trails Use of contractors Training procedures Training records Induction training Job-specific training Delivery of training Framework contract for the delivery of waste management training within the healthcare sector Specification for personal protective equipment (PPE) Immunisation waste collection documentation Welsh Health Technical Memorandum 07-01 Safe management of healthcare waste7 Transport documentation waste transfer note Dual transfer/transport notes Consignment notes Accidents and incidents Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) Spillages Disinfectants Mercury 7 Transport packaging and operations 91 Transport.

8 Packaging, marking, labelling and documentation Transport of packaged goods Limited quantities Specific packaging issues Clinical waste (UN 3291) Category A clinical waste Soiled surgical instruments Used linen waste medicines (including amalgam waste ) Sharps packaging Batteries including those used for implants/medical devices Radioactive material Other chemicals Cleaning receptacles Examples of typical rigid packagings Marking and labelling of packagings Bulk transport Transport on the road Documentation Dangerous goods safety adviser (DGSA) Carriage on ships in UK waters On-site transport 8 waste management licensing and permitting 104 Environmental Permitting Regulations (England and Wales) Exemptions from environmental permitting Healthcare-related exemptions Small clinical waste treatment plant (on the producer s premises) Laboratory autoclaves 9 Treatment and disposal 108 Rendered safe Criterion A: reduction in pathogen numbers Criterion B: destruction of anatomical waste Criterion C: unusable and unrecognisable Criterion D.

9 The rendering safe of pharmaceuticals and chemicals within the waste Treatment and disposal systems Discharge to sewer Specific treatment/disposal requirements TSE-infected waste Cytotoxic and cytostatic waste waste containing genetically modified microorganisms (GMMs) Mercury Amalgam 10 Sector guides 112 Welsh Health Technical Memorandum 07-01 Safe management of healthcare waste8 Ambulance services 113 Scope and target audience waste risk assessment Example waste streams Limbs and body parts waste receptacles and storage Disposal options Option 1 emergency response Option 2 waste in the community Option 3 ambulance transport services Research and laboratory facilities 117 Brief description of the sector activities waste classification and segregation Microbiological cultures Clinical specimens Environmental samples Autoclaved laboratory waste waste packaging and labelling Packaging of infectious waste for transport Marking and labelling of infectious waste waste storage and transport On-site transport Off-site transport waste treatment and disposal

10 General provisions Transport security Community healthcare 124 Scope and target audience waste risk assessment Infectious waste Management of Category A infectious waste in the community Management of Category B infectious waste in the community Assessing whether waste poses a risk of infection Offensive/hygiene waste arising from healthcare Example waste streams Self-medicating patients and sharps disposal Single-use instruments Stoma/catheter bags Maggots waste packaging and receptacles Transporting offensive or infectious waste from patients homes Option 1 collection from the premises/householder Option 2 healthcare worker transports waste Community pharmacies 133 Responsibilities of the pharmacy waste segregation, packaging, classification and labelling Classification of waste medicines Segregation, sorting and unpacking of medicines Controlled drugs Glass/plastic medicinal containers Sharps Other healthcare wastes Offensive wastes Welsh Health Technical Memorandum 07-01 Safe management of healthcare waste9 Chemicals Domestic and trade waste Incompatible substances Storage of waste Transport/carriage regulations waste transfer and documentation Who completes the consignment note and when?