Hospital Equipment and Supplies
Clinical Waste Discussion Forum – a new resource
Clinical wastes are notoriously variable in composition. They comprise potentially infectious used swabs and dressings, syringes and needles, blades and other “sharps”, laboratory and pharmaceutical wastes, and many sanitary wastes. Disposal is a complex undertaking, and is inevitably costly. The complexity of regulations governing disposal present can be overwhelming, while the risks to health & safety, hospital hygiene, and to infection control present an often profound challenge.
Public, political and professional concerns about environmental protection, and the rising infection rates and standards of hygiene in hospitals, drive improvement in the management of clinical wastes. Deficiencies undoubtedly exist. Waste segregation in hospitals is often inadequate, in breach of the Hazardous Wastes Regulation 2005, and incurring additional cost in disposal. Bulk waste carts are located in insecure areas accessible to the public. Waste carts obstruct fire exits. Though official guidance is available, this generally lacks the detail necessary to ensure an adequate standard of performance. An impending revision of clinical waste management procedures across the NHS proposes considerable change to the segregation, packaging and processing of wastes, and the introduction of additional colour schemes for the identification of “new” waste streams. These proposals, if accepted, will dramatically increase costs. Waste containers and their holders will require replacement to support new colour coding schemes; additional signage will be essential, as part of a comprehensive retraining process to ensure change is managed effectively. But how might this be managed? What are the wider ramifications for waste contractors and the manufacturers of key equipment and supplies? And what about the often critical space constraints in clinical areas that may have to accommodate additional coded waste containers? Of the greatest concern is the possibility that the NHS proposals, and the Hazardous Waste Regulations 2005, may undermine the CDC Universal Precautions since this will have profound Health & Safety implications and increase the risks to all those handling clinical wastes.
Though considerable expertise exists throughout the disposal chain, there is a tendency for professional groups to work largely in isolation. In the commercial sector, issues of confidentiality and market sensitivity have a negative impact and impede development at the expense of market sector advantage. Customer representation is almost unknown, and waste producers have neither a voice to express their concerns, nor an opportunity to learn from the experience of the commercial sector. As regulatory bodies, the Environment Agency and the Health & Safety Executive, together with the Department of Health and the Department for Environment Food and Rural Affairs (DEFRA), sit largely apart from waste producers and waste disposal contractors, having their own agendas that impact on or dictate policy, though not always in conformity with essential waste management practice. Clearly, there is need for more effective information interchange, to share knowledge and opinion, news and views, among sometimes disparate groups, and this has prompted the creation of the Clinical Waste Discussion Forum. Accessible at http://www.ianblenkharn.com, the Forum is free, independent and non-commercial, with a fully open editorial policy. Participation is invited from all those involved in the management of clinical wastes, the designers, manufacturers and suppliers of waste disposal equipment and consumables, and from the legislators and representatives of regulatory bodies. Of equal importance are the patients’ organisations, and those who feel they are affected by clinical waste issues in their community since these individuals have almost no voice at all.
Funded by a generous development grant from Cliniserve Limited, a specialist clinical waste management company operating across the UK (Cliniserve Limited, Chichester PO20 6QH, http://www.cliniserve.co.uk), the Forum seeks to bring together a range of views, concerns, opinions and expertise not available within any one discipline or professional organisation. This should become a key resource for those who share our aims, to ensure the widest possible exchange of information, and bring together people from many different disciplines in order to develop and promote best practice. Though in its infancy, items posted to the Forum include issues of waste security in hospital premises, clinical waste composition and the suitability of different disposal technologies, and the application of new packaging technologies to replace the ubiquitous yellow waste sack. It is, intentionally, a multi-disciplinary forum that seeks to bring together producers, contractors, legislators and others. We invite everyone to take part in discussions, to share information, use the Forum as a sounding board for new ideas, ask a question, or offer answers to assist others. Visit the Forum, bookmark the site, and come back regularly to share thoughts and experiences with others.
Ian Blenkharn is an independent healthcare and environmental microbiologist specialising in clinical wastes management, bio-safety, hospital hygiene and the prevention of healthcare-associated infection. He is moderator of the Clinical Waste Discussion Forum, which is accessible at http://www.ianblenkharn.com
