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The NHS is Britain’s backbone – propping us up when we need it. It’s a vital resource that’s free at the point of use. However, the NHS does come at a cost – not only to taxpayers but also to the environment. Waste disposal in hospitals is something that not many of us think about.
We visit the nurse for a vaccine or cervical screening appointment, go to Accident and Emergency for a broken limb, or deliver a baby in the maternity unit without so much as a thought for all the hospital waste produced as a result.
According to BRE, the NHS produces a staggering 600,000 tonnes of waste each year. This adds up to over 1% of all domestic waste in the UK. Indeed, it comes as no surprise clinical waste is on the increase, thanks to Covid-19 and the fact that NHS services that were postponed for two years are now resuming.
What is hospital waste?
Hospital waste can also be known as medical waste or clinical waste. Specifically, clinical waste is any waste that poses a risk of contamination or infection. There are many other places besides hospitals that produce similar waste such as dental surgeries, doctors’ surgeries, research laboratories, funeral parlours, veterinary clinics, blood banks and nursing homes.
Other places that do not come under the remit of health practices, such as piercers, tattooists and complementary therapists, may also produce similar waste. Essentially, such waste includes anything that could have come into contact with a person’s body during examination, treatment or research, for example, or as a by-product of such work.
What are the different types of hospital waste?
Hospital waste is essentially categorised in two different ways: whether it is hazardous or non-hazardous.
There are lots of subcategories too that fall into both hazardous and non-hazardous types of hospital waste:
- Infectious waste.
- Anatomical waste.
- Offensive/hygiene waste.
- Chemical waste.
- Pharmaceutical waste.
- Cytotoxic waste.
- Mixed municipal waste.
Infectious waste is any waste that has been contaminated with bodily fluids such as blood, infectious cultures from laboratories and waste from patients who have infections. This includes bandages, swabs, or other medical devices that are disposable.
This is sometimes called pathological waste. Essentially, anatomical waste is any waste that contains parts of the anatomy – body tissues. This includes waste such as body parts, organs and fluids such as blood. In a veterinary clinic, animal carcasses would come into this remit too. Anatomical waste is further separated into infectious and non-infectious anatomical waste and is also labelled as to whether it contains any chemicals.
Offensive waste is anything that is likely to cause an ‘offence’ to the senses and is unpleasant, i.e. due to its smell. This type of waste is not classed as clinical or hazardous waste and it includes things like sanitary protection, nappies and incontinence pads.
As you may have guessed, sharps waste is anything sharp such as needles, syringes, scalpels and blades. However, sharps waste is also separated into subcategories depending on the risk posed.
Sharps containers are specific for sharps that have been contaminated with cytotoxic and cytostatic substances, sharps that have been medically contaminated or non-medically contaminated. Sharps that are not contaminated with bodily fluids are also categorised differently and are classed as ‘non-hazardous’ waste.
Chemical waste can be both hazardous and non-hazardous depending on its properties. Most chemical waste in hospitals is considered hazardous. Such waste includes reagents and solvents used in laboratory work as well as X-ray fixers and developers. It also includes cleaning and sterilising agents and batteries.
Pharmaceutical waste refers to medication and drug waste and is largely considered non-hazardous with the exception of cytotoxic and cytostatic medications. Hospitals dispose of medication that has expired or has been unused in open containers or packaging.
This also includes prescribed medications that have not been used or medication that belonged to someone who has died or who no longer has use for it.
Cytotoxic and cytostatic waste
Cytotoxic and cytostatic waste is always considered hazardous regardless of whether it has come into contact with a person. This is because it is hazardous due to its ‘genotoxic properties’. This means that the waste may be mutagenic (capable of causing a genetic mutation), carcinogenic (cancer-causing), teratogenic (causing damage to an embryo or foetus) or hazardous for reproduction.
Many hospital departments use products that are cytotoxic as they’re often used in treating cancers and other illnesses. This category includes radioactive wastes that are produced during diagnostic procedures and in radiotherapy.
Mixed municipal waste
Mixed municipal waste is standard domestic waste. Like our homes, hospitals generate a lot of waste that does not pose any risks to those who handle it. This waste comes from the hospital’s general and public bins, office waste, and food and catering waste.
Many items that are used in hospitals are not able to be recycled as they fall into the category of clinical waste or hazardous waste. Some organisations, such as the Waste and Resources Action Programme (WRAP), suggest that hospitals do not recycle nearly enough of their waste, with only 7% of healthcare plastic waste being recycled.
However, there are an increasing number of recycling bins for suitable items, particularly cardboard and plastic packaging items. Thanks to specialised shredders, hospitals can recycle paper waste even if it contained sensitive information.
Many of the general public are also unaware of recycling schemes – such as recycling used inhalers for asthma. These contain recyclable plastic and aluminium and can be returned to pharmacies for recycling.
How hospitals dispose of medical waste
It is important to differentiate the types of hospital waste so that hospitals and other medical or laboratory facilities are able to dispose of their waste correctly and safely. This is to protect healthcare workers, refuse workers and the general public.
The Health and Safety Executive and the Department of Health offer guidance and support on how healthcare waste can be managed safely. Hospitals and other establishments dealing with similar waste have a colour system to help waste handlers identify how to dispose of hospital waste correctly.
|Waste that needs to be incinerated. This must be done in a permitted facility.|
|Waste that should be treated before disposal to render it safe. This waste can also be incinerated.|
|Waste that contains cytotoxic or cytostatic substances and must be treated and/or incinerated.|
|Yellow and Black||Waste that is offensive or hygiene waste. This can be placed in landfill or incinerated.|
|Red||Anatomical waste that must be incinerated.|
|Black||Municipal waste. This waste can go to landfill or be incinerated in the same way as usual domestic waste.|
|Blue||Medicinal waste which must be incinerated.|
|White||This waste is for amalgam (such as is used in dental fillings). It can be recycled.|
As is clear, most hospital waste requires incineration with some waste requiring specialist medical incinerators. This is to ensure that all traces of pathogens or infection are destroyed completely.
What are the hazards associated with hospital waste?
Hospital waste contains microorganisms that are potentially harmful and can infect healthcare workers and other patients as well as the public. There is a particular concern surrounding drug-resistant microorganisms that can spread from a hospital to other places. As they are drug-resistant, this makes them hard to treat.
Some of the hazards associated with hospital waste include:
- Injuries caused by sharps.
- Exposure to toxic products such as cytotoxic substances and drugs, whether directly or through the environment during handling or disposing of such waste.
- Burns caused by disinfection protocols and waste treatment.
- Air pollution due to incineration and the particulate matter released in emissions.
- Radiation burns from radioactive substances.
- Injuries associated with disposing of the waste, including burns when operating incinerators.
The Health and Safety Executive carried out an inspection of NHS organisations in 2015–16 to identify common causes of non-compliance with the Sharps Regulations that are in place to protect staff from the risk of exposure to blood-borne viruses (BBVs). The HSE found that 83% of the organisations failed to comply fully with the regulations.
According to research, sharps injuries are the most common injury that healthcare workers experience. However, the researchers believe that such injuries often go unreported and that the injury occurrence may actually be ten times that of what is reported. Thankfully, the research also notes that confirmed viral transmission due to a needlestick injury has been relatively rare.
As well as the risk of direct contact with a pathogen, hospital waste also poses health risks by its release into the environment either directly or due to how it is disposed of.
Some of the indirect hazards associated with hospital waste include:
- The incorrect disposal of waste in landfills can contaminate water supplies.
- Chemical wastes can be released into the environment if they are not disposed of correctly.
- Incineration of unsuitable hospital waste can lead to air pollution which includes furans and dioxins. These are harmful carcinogens and have adverse effects on humans. The incineration of metals such as mercury, cadmium and lead can also cause a spread of toxic substances in the environment.
How to manage hospital waste
Hospital waste management is something that must be taken extremely seriously. As outlined, disposing of hospital waste correctly reduces the risks to both people and the environment. It requires diligence and proactivity to prevent adverse risks to health that are often associated with the poor management of waste, including exposure to toxic substances and infectious materials.
According to the HSE, health providers must consider infection control and health and safety legislation, environmental and waste legislation and transport legislation when managing healthcare waste. Particular focus should be on ensuring that hospitals are compliant in how they manage waste by classifying, storing and transporting their waste appropriately as outlined in the Health Technical Memorandum 07-01.
Waste management failure
Unfortunately, hospital waste management is not always done effectively or properly. Often, this is due to a lack of awareness or training of those responsible for disposing of items. However, sometimes a hospital’s waste management systems and protocol are at fault.
They can be overly complicated or too vague, or they may not exist at all. In some cases, waste management is not a priority, often due to insufficient resources – both in terms of staffing and finances. Indeed, some nations do not have regulations regarding hospital waste or, if they do, they do not enforce these regulations.
How hospital waste management could be improved
To improve hospital waste management, organisations should promote practices that not only reduce the amount of waste that they generate but also ensure that waste is segregated appropriately. Hospitals must develop systems that meet all standards, both nationally and internationally.
Alternatives to incineration
The World Health Organization recommends that, where possible, hazardous waste should be treated by methods other than incineration to reduce the risks to the environment and indirect exposure to hazardous substances. These methods can include microwaving, autoclaving, chemical treatments and steaming treatments.
Create a system
Hospitals should ensure that they have the organisation required to dispose of waste correctly. This means that there should be a hierarchy of those responsible at each step in the process when it comes to clinical waste disposal. This system may take time to embed as all staff within a hospital or other care setting must be trained in its proper implementation and use for it to work effectively.
Those responsible for handling healthcare waste must also be made aware of the hazards and risks associated with their role. Full training should be given to all workers in hospitals and other clinical environments to ensure that safe practices are maintained at all times.
This training applies equally to volunteers, hospital café workers and cleaners all the way up to consultants and managers. Those handling substances that are hazardous to health should receive full COSHH training.
Introducing environmentally friendly practices
As mentioned, hospital waste is largely non-recyclable. However, even recyclable waste is often thrown away with municipal waste. For hospitals to manage their waste effectively and become sustainable in a world where climate change is an increasing concern, opting for environmentally friendly practices is paramount. Hospital leaders should investigate potential waste management options that are more sustainable and reduce environmental hazards.
Hospital waste management and clinical waste disposal pose hazards to people and the environment. And, with almost 600,000 tonnes produced each year, it must be disposed of correctly. Having strong management and systems is the key to handling hospital waste correctly.
With strategies in place and forward-thinking from leaders, hospitals should be able to reduce their waste and find some environmentally friendly alternative to its disposal, at least in part.