Posted on: 9th May 2019
Andusia Explains Clinical Waste
Clinical waste sits in a strange space, between hazardous and non-hazardous waste. Some of it is hazardous, until it isn’t, and some of it is non-hazardous, but must be treated as if it is hazardous regardless. Andusia’s Hazardous Waste Manager, Fraser Cutting, explains:
Below, the main areas of the clinical waste spectrum have been broken down and explained in general terms. Contact Andusia for firm advice on your specific waste streams.
Offensive waste is by far the biggest clinical waste stream, making up about 40% of acute hospitals output, and 80% of care homes output. Offensive waste is healthcare waste that doesn’t carry a risk of infection. It is not classified as hazardous. The best example of this is a nappy; you may not get ill from it, but you still don’t want to put your hand in it! It can end up in special landfills, but there are several programs ongoing to try and develop a method to use the waste stream more effectively and get a product out of it.
The next waste stream is orange bag waste, often referred to as AT waste as it is treated via an alternative treatment plant, or autoclave. The waste is infectious and is classified as hazardous. An autoclave is a pressure vessel that utilises steam to sterilise the waste. It is pre-shred and shred-in-vessel to ensure that all the waste is treated evenly, allowing the steam to get to every part of the waste and sterilise it. Once a target temperature is reached (around 132 Celsius), it has to remain at this temperature for 15-20 minutes. The material generated is sterile and suitable for landfill. This type of waste represents about 30% of the waste stream from an acute trust, and maybe 5% from a care home.
The waste that is left is all destined for disposal via incineration – including yellow bag wastes and yellow, orange, blue, purple and red lidded boxes. White lidded boxes, which are for dental amalgam, are not suitable for incineration due to mercury content. This is sent for recovery.
Yellow bag material is for highly infectious waste and anatomical waste, disposed of via incineration. This waste usually consists of small pieces of flesh, rather than gross anatomical items that are easily recognisable as human body parts. It is important to have this material segregated at point of production, and sealed correctly using an approved method, like a swan neck closure. Only then does the bag become a UN approved container. Once sealed, it should not be re-opened.
The yellow and orange lidded boxes are for sharps material. This covers any items designed to cut, penetrate or lacerate the skin such as needles and scalpels, as well as glass ampoules and similar, that are empty but contaminated. According to HTM07-01 (the memorandum on best practices for healthcare waste), sharps in an orange lidded box should not be medicinally contaminated. Yellow boxes have to be sent for incineration, and orange boxes may be sent for incineration or AT.
Blue lidded boxes are for non-hazardous pharmaceutical waste. These are almost always large plastic boxes, but increasingly cardboard boxes, as the weight is lower, and there are fewer plastic fumes when incinerated. Disposal outlets prefer the cardboard boxes, especially if they are liquid proofed. Either way, they are very stackable on pallets, and this tends to be the way they are shipped out. This waste stream can go to domestic EFW plants, at a lower burn rate per tonne, than the other incineration wastes.
Purple lidded boxes are for cytotoxic and cytostatic drugs, used most commonly in the treatment of cancer. These are hazardous and have to be incinerated. However, the same comments apply to these as applied to the blue boxes.
Red lidded boxes are for recognisable human anatomy. A small non-hazardous waste stream that has to be dealt with via incineration and within time limits. Fridges and freezers have to be used in order to maintain the dignity of this waste stream. It is highly sensitive and attracts more attention than the waste streams quantities warrant.