VIEWPOINT Thoughts and reflections on issues of interest to perioperative practitioners KEYWORDS Waste / Waste disposal / Hazardous waste / Clinical waste Provenance and Peer review: Unsolicited contribution; Not peer reviewed; Accepted for publication February 2013.

Perioperative practitioners. Does waste segregation and disposal within your theatre meet the required legal standard? The management of waste disposal is an important area of healthcare practice and is governed by both European and UK legislation. The Department of Health (DH) Memorandum (HTM 07-01) Safe Management of Healthcare Waste sets out the guidance. Theatre practitioners in Northern Ireland, Wales and Scotland would also need to refer to the following documents: Northern Ireland: (Control Assurance Standard Waste Management, April 2009). Scotland: Scottish Hospital Technical Note (SHTN) No 3 Management and Disposal of Clinical Waste, October 2002. Wales: Healthcare Standards for Wales, 2005. Hazardous waste is defined as ‘waste with hazardous characteristics’ in line with the European Hazardous Waste Directive (DH 2006). In Scotland the term ‘special waste’ is used as the requirement of the European Hazardous Waste Directive are implemented by the Special Waste Amendments (Scotland) Regulations (DH 2006) A healthcare waste disposal policy should be in place and accessible to all whom may be involved in this process. The policy needs to comply with three separate areas of regulation: 1. Health and Safety 2. Environment and waste 3. Transport A duty of care exists for all those involved in the management of waste, from the point at which it is generated until the final disposal. It requires that all concerned take a reasonable standard of care in this process and minimise the risk of spillage and damage to waste receptacles which

may lead to waste escaping, for example bags splitting by overfilling or bursting when placed in storage or transport containers. It also requires practitioners to dispose of waste in the correct containers thereby ensuring that there is no inappropriate disposal. All practitioners working within the perioperative environment should have clear guidance and awareness regarding the disposal of both clinical and non-clinical waste. In the event that practitioners do not feel confident within this area of practice, they should assume personal responsibility either individually or within the team, to source the most up to date information from their line managers or the infection prevention team within the facility. Waste management includes not only the segregation of waste but also responsibility for the storage and frequency of collection. Healthcare waste should be stored securely to prevent the escape of waste and potential harm to the environment and public. Failure to do so is a breach of the statutory duty of care (HTM 07-01 DH 2010). The term clinical waste has traditionally been used to describe waste from healthcare settings that may pose a hazard/ risk of infection to others. It is defined in the controlled waste regulations 1992, section 1.2 as follows: (a) ‘any waste which consists wholly or partly of human or animal tissue, blood or other bodily fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, syringes, needles or other sharp instrument, being waste which unless rendered safe may prove hazardous to any person coming into contact with it;’ and (b) ‘any other waste arising from medical, nursing, dental, secondary, pharmaceutical

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or similar practice, investigation, treatment, care, teaching or research or by the collection of blood for transfusion, being waste which may cause infection to any person coming into contact with it’. Clinical waste is also classified as infectious waste and it is mandatory to segregate such waste in England (DH 2006). No such legal requirement is applicable to Northern Ireland, Scotland or Wales, but the relevant documents recommend best practice, and therefore infectious waste should be segregated in order to comply with this requirement. AfPP standard 5.1.43 (AfPP 2011) states that waste should be segregated into suitable containers as follows: n Black sacks- may be used for non clinical waste such as paper wrapping and packaging. n Yellow sacks/leak proof rigid containers- should be used for anatomical waste from theatres that requires disposal by incineration. n Orange sacks- should be used for clinical waste that may be treated to ‘render it safe’ by treatment in a suitable authorised and licensed centre or alternatively to be incinerated. In addition, Orange sacks may be used to segregate known or potentially infected waste. n Tiger sacks yellow/black striped- may be used for offensive/hygiene//sanitary waste and disposal is via land fill or incineration within a suitable permitted facility. Sacks should not be filled to more than three quarters full and should be tied at the neck to ensure a sufficient seal. All waste



Perioperative practitioners. Does waste segregation and disposal within your theatre meet the required legal standard? Continued

stated, this waste must be disposed of by incineration. If therefore as a practitioner in this environment you are disposing of anatomical waste in anything other than a yellow bag/yellow rigid container… are you in breach of your legal duty of care? Can you be assured that the waste you are disposing of will end up in the appropriate place? Organisations such as the NHS have corporate responsibility in this respect; practitioners however have an equal individual responsibility enshrined in Common and Statute Law, and additionally in their Codes of Professional Conduct. A place for every waste and every waste in its place. And for that we are all responsible! n Mona Guckian Fisher Vice President and Trustee AfPP

References and further reading Association for Perioperative Practice 2011 Standards and Recommendations for Safe Perioperative Practice Harrogate, AfPP Department of Health 2010 Environment and sustainability HTM 07-01: Safe Management of Healthcare Waste Department of Health 2011 Safe Management of Healthcare Waste Version 2.0: England [online] Available from: publications/safe-management-of-healthcarewaste--2 [Accessed May 2013] Health and Safety at Work Act 1974 Norwich, The Stationery Office Human Tissue Act 2004 Norwich, The Stationery Office The Control of Substances Hazardous to Health Regulations (COSHH) 2002 Norwich, The Stationery Office Health and Care Professions Council 2012 Standards of Conduct, Performance and Ethics [online] Available from: standardsofconductperformanceandethics/ [Accessed April 2013]

Colour coding key to segregation system (DH 2011, p 131)

for segregation must be labelled at the point of origin, (clinical area and hospital in some instances) (AfPP 2011, Standard 5.1.47). The safe management of healthcare waste cannot be effective unless it is applied carefully, consistently and universally. This requires that all perioperative staff should be aware of the policy/procedure and that the policy is implemented by trained and competent people. If perioperative staff are in any doubt regarding the risks or practices 128

within their operating theatres they should seek the expertise of the competent personnel within the organisation whose role it is to provide this support. The areas to access are generally the direct line manager, infection prevention and control practitioners and the ‘facilities’ or similar department. As perioperative practitioners we need to be satisfied that we understand and concur on what constitutes anatomical waste in our environment and the means by which this is being disposed. As previously

Nursing and Midwifery Council 2008 The code: Standards of Conduct, Performance and Ethics for Nurses and Midwives [online] Available from: The-code/Introduction/ [Accessed April 2013]

June 2013 / Volume 23 / Issue 6 / ISSN 1750-4589

Perioperative practitioners. Does waste segregation and disposal within your theatre meet the required legal standard?

VIEWPOINT Thoughts and reflections on issues of interest to perioperative practitioners KEYWORDS Waste / Waste disposal / Hazardous waste / Clinical w...
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