Clinical Waste

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In recent weeks there has been considerable Scottish press coverage on clinical waste services, and particularly the company Healthcare Environmental Services (HES). The Scottish Government updated the Parliament on the current situation in a statement on Wednesday 23rd January 2019.

Clinical waste requires specialist equipment, facilities and staff to manage the process from collection to transportation and storage and on to final disposal and incineration.

This blog post will set out a definition of clinical waste, and explain how it is managed in Scotland.

 What is Clinical Waste?

Clinical waste is the term used to describe waste produced from healthcare and similar activities that may pose a risk of infection (for example swabs, bandages, dressings, human or animal tissue), or may prove hazardous (for example medicines).

The Controlled Waste Regulations 1992 define clinical waste as:

  • any waste which consists wholly or partly of human or animal tissue, blood or other body fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, or syringes, needles or other sharp instruments, being waste which unless rendered safe may prove hazardous to any person coming into contact with it; and
  • any other waste arising from medical, nursing, dental, veterinary, pharmaceutical or similar practice, investigation, treatment, care, teaching or research, or the collection of blood for transfusion, being waste which may cause infection to any person coming into contact with it.

Clinical waste should be distinguished from healthcare waste, a wider term covering all waste arising from human and animal healthcare, for example from hospitals, GP surgeries, dental surgeries, and veterinary surgeries. Not all healthcare waste is clinical waste though, as not all healthcare waste is hazardous or poses a risk of infection.

Human healthcare is the main source of clinical waste, with NHS Scotland being the largest producer. Animal healthcare produces around ten per cent of clinical waste.

How should clinical waste be managed in Scotland?

There are special requirements for the disposal of clinical waste, arising from both health and safety legislation and environmental protection regulations. Bodies producing clinical waste (such as NHS boards) are required to undertake risk assessments and put in place policies for safe disposal.

Scottish Government guidance on waste management emphasises that clinical waste must be segregated and stored securely where it cannot be accessed by the public.

Legislative requirements include the fulfilment of a ‘duty of care’.  This requires all those in the chain of production, transport, treatment and disposal of clinical waste to take reasonable measures to ensure it is managed and disposed of properly.

All clinical waste needs to be ‘rendered safe’ before it can be disposed of, or used for another purpose. This might include incineration of pharmaceuticals to render them safe, or incinerating or otherwise treating (e.g. heat treating) waste to reduce pathogens.

Zero Waste Scotland produced an NHS Scotland Waste Prevention and Re-use Guide which emphasises that waste prevention represents a significant financial opportunity for NHS Scotland. It states that:

“Once segregated clinical waste requires expensive treatment and disposal and the cost to NHS Scotland is significant. Clinical waste typically costs are typically 3½ times the cost of managing domestic waste suitable for recycling and recovery.”

Guidance for reducing the quantity of clinical waste includes avoiding domestic waste being incorrectly placed in the clinical waste stream, segregating recyclables and ensuring that staff are aware of what should be treated as clinical waste.

Who is responsible for regulating clinical waste in Scotland?

Waste is a devolved area and the management and disposal of clinical waste is regulated under the Environmental Protection Act 1990 and related legislation. As Scotland’s environmental regulator, SEPA regulates the parties involved in the management of clinical waste (producers, waste carriers and operators of waste management facilities).

The storage and treatment of clinical waste is a waste management activity and requires a waste management licence or permit (or suitable exemption). The majority of waste management facilities are licensed via a Waste Management Licence under the Waste Management Licensing Regulations 1994.  However, SEPA guidance notes that, as much healthcare waste is deemed to be hazardous, sites treating this type of waste generally fall under the Pollution Prevention & Control (PPC) regime.

Most clinical wastes are also classified as ‘special wastes’ and therefore must also be consigned in accordance with the Special Waste Regulations 1996 (as amended).

Health and safety legislation is also relevant in this area, although health and safety legislation is reserved. When SEPA considers that a waste management licence needs a condition related to health and safety, it should consult with the Health and Safety Executive (HSE).

Some NHS Heath Boards will transport waste to a Waste Transfer Station or treatment facility. There is no restriction on who can transport clinical waste. The minimum requirement is a Waste Carrier Licence issued by SEPA. However, as some clinical waste is deemed to be ‘dangerous goods’, there are specific requirements around packaging and transportation.

The most recent guidance on clinical waste management is published by Health Facilities Scotland who are responsible for providing technical and operational guidance to the Scottish Government Health and Social Care Directorate and NHSScotland bodies in relation to all aspects of healthcare facilities.

Their Scottish Health Technical Note (SHTN) 3: NHS Scotland Waste Management Guidance, covers regulatory requirements and guidance on waste classification, segregation, storage, packaging, transport, treatment and disposal.

Edna Stirrat, Collections Officer, SPICe