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Are you managing your waste properly?

My article in June of this year focused on the newly updated management and disposal of healthcare waste guidelines (HTM 07-01) and what you can expect from it. In this month’s article, I wanted to continue on from this and delve a little bit deeper into some of the specifics of the document.

The newly updated version, in its executive summary, states:

  • This document has been produced to replace the 2013 version of Safe management of healthcare waste

  • Since 2013 there have been many subsequent changes to environmental legislation and regulation that need to be reflected in the new guidance. In line with NHS clinical waste strategy, there is a need for the guidance to better reflect the principles of circular economy, environmental safeguarding, improved social outcomes, and reducing our carbon emissions from the production/processing of our waste, as well as other new policies from across the waste, health, and environmental sectors. The impact of these is reflected in the revised document

  • The new document supports the NHS’s drive to be a net zero health system, prioritising decarbonisation and circular economy measures.

The key changes within the new document focus on trying to eliminate avoidable waste, supporting a drive to prevent offensive waste being incorrectly classified and to improve the effectiveness of waste management systems. This is outlined in the following changes targets:

  • A total of 20% of waste segregated to be sent to incineration, with only 4% of that being hazardous/clinical incineration

  • A total of 20% of waste segregated to be sent to alternative treatment

  • And 60% of waste segregated to be classified as offensive waste.

Waste hierarchy

HTM 07-01 outlines the waste hierarchy which was introduced as part of the European Union’s Waste Framework 1975 to emphasise the importance of waste minimisation to reduce negative environmental impacts. It outlines seven points: prevention, repurpose, recirculate back into use, recycle, energy generation, dispose and landfill.

The waste hierarchy forms part of a practice’s waste management procedure in respect of looking at the following:

  • Prevention by repurposing: Before discarding an item we need to decide whether or not the item can be repurposed. Does it need to be discarded? Anything that is repurposed would then be recirculated back into use

  • Recycling or energy generation: This involves practices ensuring appropriate segregation of waste for either recycling or energy generation

  • Dispose or landfill: Anything remaining would then be either disposed of and sent to landfill. 

The update also includes new actions that are required to reduce the use of single-use plastic items. This is aligned with government policy and supported by the commitment to be net zero across the whole of the NHS by 2050.

The five R’s

The document also discusses something called the five ‘Rs’. This is a way of practices assessing the sustainability of items when making purchasing decisions. It is designed to help minimise unnecessary waste by looking at:

  • Reduce – do we need the product or can we do without it?

  • Reuse – could we give the product a second life?

  • Reprocess – can you purchase reprocessed items instead of single use?

  • Repurpose – can the items be used for alternative energy sources?

  • Recycle – can the item be recycled to make something else?

Classifying waste

All healthcare waste produced in practices can be classified as clinical waste, offensive waste and other non-clinical waste. Resources with them can be categorised as either non-hazardous waste or hazardous waste.

Non-hazardous waste includes items such as any rubbish or recycling that causes no harm to humans or environmental health. These are also waste items produced from the treatment of non-infectious patients and not contaminated with infectious body fluid.

Hazardous waste is waste that is considered hazardous under environmental legislation and could be harmful to human health or the environment. This waste could come from the treatment of infectious patients, those suspected of having an infection, or those who are contaminated with bodily fluids of known infectious patients.

Waste segregation

In line with the 20-20-60 waste protocol, practices will start to see the introduction of tiger bags from their waste carriers. Currently all clinical waste items, whether used on infectious or non-infectious patients, are placed into the orange clinical bags. The 20-20-60 process looks to change this way of thinking.

The yellow and black ‘tiger’ bags will now be used for offensive waste. Offensive waste is waste that has been produced from the treatment of non-infectious patients and is contaminated with body fluid.

Items that can be disposed of in the ‘tiger’ bags are:

  • Non-infectious PPE

  • Non-infectious dressings, plasters, bandages, for example

  • Non-infectious nappy and incontinence waste

  • Non-infectious sanitary waste.

Items that must not be disposed of in the ‘tiger’ bags are:

  • Infectious waste

  • Paper hand towels

  • Medicines and sharps

  • General and recycling.

Waste disposal

Any items that have been used on known infectious patients should be disposed of within either your orange clinical waste bags or yellow sharps containers. Sharps are subjected to no change and continue to be disposed of using the yellow bins.

In order to meet the new standards, practices will introduce the offensive waste stream and this will form part of the practices waste segregation which will help to improve the environmental performance. Training is an important area to be addressed in order to implement the new streams.

Implementing the new strategy will ultimately see a reduction in the quantity of hazardous waste (orange bags) by 20% and an increase in the quantity of offensive waste (tiger bags) by 60%. This will also mean that in treatment and decon areas, another bin for the newly adopted tiger bags will be introduced. These areas will now provide space for black, orange, tiger and sharps bins where space allows.

If you don’t have a copy of the newly updated version, it can be downloaded here: Health Technical Memorandum 07-01.

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