Making resources last, whilst reducing infection risk
Improving waste management procedures is a serious issue that care home facilities need to tackle. Cromwell Polythene Managing Director, James Lee explores what can be done.
The UK government forecasts that, between 2015 and 2020 the number of people aged over 85 will increase by 18% (300,000 people). While this is a triumph when it comes to life expectancy, many of these people may require some form of long-term care, including community and residential care.
A wide variety of waste is generated in care home environments including used medical gloves, swabs and dressings, needles and sharps, and incontinence and sanitary waste. Managing this waste, particularly hazardous material, safely in accordance with the law can be a complex task.
According to the World Health Organization (WHO), about 85% of the total waste generated by healthcare activities is classed as general and non-hazardous. The remaining 15% is considered hazardous – potentially infectious, or toxic, for instance. Wherever possible, non-hazardous waste should be recovered, into energy use for example, or recycled.
In fact, the most common type of waste produced in care homes is not specifically related to healthcare, but municipal waste. These materials, including cardboard, paper, plastics, glass and food waste should be separated and recycled.
It is essential to manage all types of waste effectively, not only for infection control and prevention, but also to make the best use of our resources. Many materials can be recovered and recycled into new products at the end of their service life. This concept, known as the circular economy approach, reduces environmental impact as well as being efficient and cost-effective.
Safe management of healthcare waste is the responsibility of every healthcare professional. It is of crucial importance that infectious wastes are always separated from recyclables and domestic/residual waste streams, ready for safe disposal through alternative treatment or incineration.
Department of Health (DoH) guidance is provided under ‘The safe management of healthcare manual’ (previously known as the Health Technical Memorandum 07-01). This provides a framework for the process of classifying types of waste. The next step is to use the right type of container for each separate type of waste, including various colour coded sacks, for instance:
Yellow bags – infectious waste which must be sent for incineration
Orange bags – infectious waste which can be sent for alternative treatment to render it safe prior to disposal
Tiger bags – offensive waste that does not pose an infection risk which may be sent for energy recovery. These can include items with bodily fluids such as stoma or catheter bags, incontinence pads and hygiene waste.
According to the WHO, the most common problems connected with healthcare waste include the low priority given to the topic, lack of awareness about the health hazards related to health-care waste, and inadequate training in proper waste management.
At the same time, the Sanitary Medical Disposal Services Association (SMDSA) highlights a growing problem of infectious waste sometimes being compacted and disposed of together with non-infectious (black bag waste). This potentially illegal activity results in waste being compacted just to be reclassified as pre-treated waste rather than hazardous infectious waste. This means that the waste goes to an energy from waste plant for incineration, but in some cases the plants are not licenced to accept/handle infectious waste. If the waste is rejected, this leaves the SMDSA member with the problem of transporting and disposing of correctly. The Association recommends that all healthcare providers follow the DoH guidance for the secure and legally compliant management and disposal of clinical waste.
Poor segregation of materials will lead to increased costs of disposal and may result in prosecution if the waste is considered to be ‘mixed’ and is deemed no longer suitable for the waste treatment or disposal option you have chosen to use.
Four steps to success
There are four steps to follow when it comes to waste segregation at source in healthcare; ensuring there are enough bins, that they are in the right place, that they are clearly marked, and finally that instructions are being followed. It is all too apparent that the last step is a stumbling block for some healthcare staff, patients and visitors.
Staff training is fundamental to making good waste management second nature in healthcare, and while basic training need only cover the identification and separation of different waste types and the bins provided, in order to be effective the point needs to be driven home that correct use of the bins is mandatory, not optional.
However, a lot of care home providers rely heavily on agency staff, and this is where education and re-education is key. All staff – including temporary agency staff – should receive proper training on the crucial importance of correct waste management.
It is essential that any liner used in a healthcare facility – regardless of whether it is a hazardous waste, sanitary waste or general waste liner – has been independently tested to prove its effectiveness and safety. Buyers in the healthcare industry should ensure that the products they are investing in not only work, but also hold recognised quality standards such as the CHSA Refuse Sack Standard and EN standards such as EN13592, alongside ISO quality management principles.
Products should have a performance rating, contents description, quantity, accurate dimensions, batch reference, and minimum net box weights, clearly marked on the outer packaging. These details are the buyers’ guarantee that they are getting what they pay for and that the liner will perform.
There is also no trade-off between effective products and sustainable products. Poor quality liners could burst, risking hygiene and health and safety. Responsibly produced bin liners bring value and efficiencies to the supply chain – weighing less than other non-viable alternatives like glass and metal, they are highly efficient at retaining fluids, and help to eliminate environmental leaching. The best producers offer bin liners produced using high levels of recycled polythene, even up to 100% recycled material.
Thankfully there is a lot of expert guidance available to help the care sector. As well as resources provided by the WHO, information from the Chartered Institution of Wastes Management (CIWM) includes the Introductory Guide to Healthcare Waste Management in England & Wales, which provides a comprehensive overview of healthcare waste management. The CIWM’s guide to Managing Healthcare-Type Waste from Non-Healthcare Activities also provides valuable information.
Waste management should not be an afterthought. Working together, our industries can help change perceptions and inspire staff, visitors and patients to give this issue the respect and attention it deserves.
Cromwell Polythene is a major supplier of waste management solutions to the healthcare sector and an active member of the Sanitary Medical Disposal Services Association. www.cromwellpolythene.co.uk