Document Reference Code: IC/016/14

This document is only valid on the day of printing Title:

Waste Management Policy

Purpose:

To ensure all staff are aware of their direct responsibility for the safe and legal disposal of wastes within Cornwall Partnership NHS Foundation trust in a safe manner that protects the public, staff, patients and contractors at all times whilst complying with relevant UK Health & safety, transport and environmental legislation

Applicable to:

All permanent and temporary Trust Staff including Locum, Bank Agency, Volunteers and Contracted appointments.

Document Author:

Judith Van Horn (Waste Services Manager) Sharon Butler (Previous Head of Environmental services, Utilities & Courier)

Ratified by and Date:

Sharon Linter – Director of Quality and Governance / Executive Nurse 7 May 2014

Review Date:

November 2016 6 months prior to the expiry date

Expiry Date:

May 2017 3 years after ratification unless there are any changes in legislation or changes in clinical practice

Document library location:

Safety and Risk: Infection Control

Related legislation national guidance:

and             

Control of Pollution Act 1974 Health and Safety at Work etc. Act 1974 Environmental Protection Act 1990 Carriage of Dangerous Goods & Use of Transportable Pressure Equipment Regulations 2009 Control of Substances Hazardous to Health Regulations 2002 ADR Hazardous Waste Regulations 2005 Environmental Protection (Duty of Care) Regulations 1991 Reporting of Injuries, Diseases & Dangerous Occurrences Regulations 1995 The Waste Management (England & Wales) Regulations 2006 The Landfill (England and Wales) Regulations 2002 (amended 2004, 2005) The Landfill (Maximum Landfill Amount) Regulations 2011 Controlled Waste (England & Wales) Regulations 2012 Page 1 of 87

Document Reference Code: IC/016/14  Controlled Waste (registration of Carriers and Seizure of Vehicles) Regulations 1991  The Lists of Waste Regulations 2005  Genetically Modified Organisms (Contained use) Regulations 2000 amended 2002 & 2005  Animal By-Products (Enforcement England) Regulations 2011  Environmental Permitting Regulations 2010  Management of Health & Safety at Works Regulations 1999  Health & safety (consulting with employees) Regulations 1996  The Safety Representatives and safety Committee Regulations 2003  Waste Electrical and Electronic Equipment (WEEE) Regulations 2006  Restriction of Hazardous Substances (ROHS) Regulations 2006  „Safe Management of Healthcare Waste‟ issued by DoH 2012  Site Waste Management Plans Regulations 2008  The Health & Social Care Act 2012  Integrated Pollution Prevent Control 2008  The Waste Batteries & Accumulators Regulations 2009 Associated Trust Policies  Health & Safety Policy and Documents:  Fire Safety Policy  Medical Devices Decontamination Policy  Security Management - General Security Policy Equality Impact Assessment:

The Equality Impact Assessment Form was completed on 28 March 2014

Training Requirements:

Up to date training should be at a minimum of every two years or as legislation and policy updates dictate. Any additional training requirements identified through the risk assessment process should be referred to the respective Training Manager for the Trust. The organisation trains staff in line with the requirements set out in its training needs analysis and published in its Corporate Curriculum. Training which is categorised as statutory or essential must be completed in line with the training needs analysis and Corporate Curriculum. Compliance with statutory and essential training is monitored through the Learning and Development team with monthly manager’s reports and staff individual training records twice yearly. Training reports are also submitted quarterly through the Trust Quality and Governance Committee Meeting. Staff failing to complete this training will be accountable and could be subject to disciplinary action.

Monitoring Arrangements:

 Infection control Audits conducted annually by the Infection control team have a Waste Monitoring section. Page 2 of 87

Document Reference Code: IC/016/14  Waste pre-acceptance audits, part of which is conducted annually as part of the Trusts legal obligations.  Standardised methodology as dictated by the Environment Agency and Infection control standards apply to frequency and methodology of the audit  Reviewing results and ensuring improvements in performance occur would be reported and managed via the Health & Safety Committee. Implementation:

Version Control Version V1.0

Date Reviewed December 2013

Changes By Whom Policy updated in line with current legislation Judith Van Horn and specific to Cornwall Partnership NHS Foundation Trust

This document Replaces: HS.IC/028/09 – Generic Waste Management Policy for Cornwall & Isles of Scilly NHS Trusts.

This document can be released under the Freedom of Information Act.

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Document Reference Code: IC/016/14 Contents 1.

Introduction ......................................................................................................................... 6

2.

Reduce, Reuse and Recycle. .............................................................................................. 6

3.

Purpose .............................................................................................................................. 6

4.

Training ............................................................................................................................... 7

5.

Legislative Compliance ....................................................................................................... 7

6.

Waste Management ............................................................................................................ 8

7.

Roles & Responsibilities ...................................................................................................... 9

8.

Relationships with Other Policies ...................................................................................... 11

9.

Risk Management ............................................................................................................. 11

10.

Waste Segregation............................................................................................................ 12

11.

Identifying and Description of Waste ................................................................................. 15

12.

Hazardous Groups ............................................................................................................ 16

13.

Hazardous Waste Producer Registration .......................................................................... 16

14.

Storage of Waste .............................................................................................................. 16

15.

Waste Licensing ................................................................................................................ 17

16.

Transportation ................................................................................................................... 17

17.

Monitoring, Audit and Review ............................................................................................ 18

18.

Emergency / Contingency Plans ....................................................................................... 18

Procedures for Safe Handling and Disposal............................................................................. 20 Procedure 1 – Safe Handling and Disposal of Sharps .................................................................. 21 Procedure 2 – Safe Handling and Disposal of Clinical Waste ....................................................... 24 Procedure 3 – Safe Handling and Disposal of Hazardous Waste ................................................. 31 Procedure 4 – Safe Handling and Disposal of Municipal or Domestic Waste and Recycling ......... 37 Procedure 5 – Safe Handling and Disposal of Confidential Waste ................................................ 39 Appendices ................................................................................................................................. 47 Appendix 1 – Confidential Waste Collection Form ........................................................................ 48 Appendix 2 – Legislation, References and Further Information ..................................................... 51 Appendix 3 – Indicative examples of Category A Clinical Waste ................................................... 53 Appendix 4 – COSHH Assessment for Healthcare Waste............................................................. 55 Appendix 5 – Colour Coding ......................................................................................................... 58 Appendix 6 – European Waste Catalogue codes .......................................................................... 61 Appendix 7 – Hazard Codes ......................................................................................................... 64 Appendix 8 – Hazard Signage for COSHH and Transporting Purposes ........................................ 65 Page 4 of 87

Document Reference Code: IC/016/14 Appendix 9 - COSHH Assessment for Healthcare Waste ............................................................. 70 Appendix 10 – Disinfected Equipment – Medical Devices ............................................................. 73 Appendix 11 – Application for the collection of Clinical Waste ...................................................... 74 Appendix 12 – Blank Waste Assessment Form ............................................................................ 77 Appendix 13 – Protocol for Disposal of Building wastes................................................................ 79 Equality Impact Assessment Proforma Initial Screening ............................................................... 82

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Document Reference Code: IC/016/14 1.

Introduction

Cornwall Partnership NHS Foundation Trust (CFT) is the principle provider of mental health, children's and learning disability services to people living in Cornwall and the Isles of Scilly. These services include drug and alcohol and eating disorder services to both adults and children. The Trust was approved as a Foundation Trust on 1 March 2010 by Monitor. Monitor is the governing body of all NHS Foundation Trusts. The Foundation Trust super cedes the Cornwall Partnership NHS Trust which was established on 1 April 2002. The Trust employs nearly 1,900 people and with an annual budget in the region of £75 million is one of the largest local employers. Waste is described in the Waste Framework Directive as „any substance or object… which the holder discards or intends or is required to discard‟. The Trust generates similar types of wastes at all sites across a wide range and this policy is written to recognise these types and indicate usual areas of production. All waste generated by the Trust is controlled waste and therefore all waste must be disposed of according to UK legislation. This policy applies to all staff as the Duty of Care Regulations places a duty on everyone to dispose and store waste safely and in a legally compliant manner. The Trust, as a public sector organisation, is also required to report on any and all developments to adapt to climate change. Waste, the transportation of waste and the disposal of waste can all have a significant carbon footprint so is considered a high priority. Consequently this policy is written to include current legislation and address the management of waste in a manner which protects the Global Environment. To the extent that the Trust can influence suppliers through information and advice, operating environmentally sound practices and through adherence, where cost effective, to the basic principles of the waste hierarchy: 2.

Reduce, Reuse and Recycle.

Effective stock control can play an important part of this process. 3.

Purpose

The purpose of this policy is to ensure all staff are aware of their direct responsibility for the safe and legal disposal of wastes within Cornwall Partnership Trust in a manner that protects the public, staff, patients and contractors at all times whilst complying with relevant UK Health and Safety, transport and environmental legislation. It also provides a framework for local policies and procedures at Trust level to develop compliance with the Department of Health (DoH) best practice guidance - „Safe Management of Healthcare Waste‟ version 2: England. In addition compliance will also assist in assurances required under the Health and Social Care Act 2012, in particular relating to the Care Quality Commission essential standards, outcome 10B, (Regulation 15).

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Document Reference Code: IC/016/14 4.

Training

All staff are required to comply with the safe segregation, handling and disposal procedures detailed in this policy. They must be provided with adequate and sufficient information, instruction and training relating to each waste type, to ensure that they can correctly identify each waste type, handle it safely and dispose of it without risk to their health or other person‟s health. The training requirements relating to this policy and the individual procedures on each site must be documented and a record must be kept of those who have received this training. The Trust should ensure that new staff are inducted and provided with information on the risks associated with healthcare waste, handling, storage, collection, personal hygiene, use of PPE, procedures for segregation and safe disposal as well as information on spillage and accidents. The Trust is responsible for ensuring periodic review of training through the training and infection control departments to ensure staff are kept up to date with relevant legislation and Trust policy. Up to date training should be at a minimum of every two years or as legislation and policy updates dictate. Waste Management training elements should be included in induction, e-learning, Infection Control and IOSH Managing Safely in Healthcare but should also be included in the Trust essential/mandatory training programme. However, each training package should be job specific and may include specific training in Carriage of Dangerous Goods, NVQ training in transfer of waste. Any additional training requirements identified through the risk assessment process should be referred to the respective Training Manager for the Trust. 5.

Legislative Compliance

The Trust is committed to complying in full with all UK Legislation relating to Environmental/Waste Management, Health & Safety, Transportation and Procurement. The diagram below shows the three pillars of regulation which has formed the basis of this policy: A list of this legislation and references can be viewed in Appendix II

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Document Reference Code: IC/016/14

Effective Procurement of Goods and Services

Waste Legislation

Carriage Legislation

Health & Safety Legislation

Separate policies/procedures are being formulated for Carriage of Dangerous Goods and reference should be made to specific health and safety procurement department‟s policies. The Trust will also support and assist the appropriate enforcement authorities responsible for enforcing the above legislation. 6.

Waste Management

The Trust recognises that waste disposal is the least cost efficient and least environmentally acceptable method of waste management. It is therefore Trust policy that methods of resource and materials minimisation are introduced to reduce the consumption of energy, water and materials within the Trust. Where it is acceptable and does not compromise infection prevention, materials will be re-used. The potential for directing waste material into recycling routes will be regularly reviewed and implemented. This will apply to paper, cardboard, plastics, scrap metal, printer cartridges, fridges/freezers, IT equipment and other materials as cost effective recycling or reuse as new recycling sites become available. Where responsible disposal is the only viable option, the waste will be disposed of in a manner which minimises the risk to human health and adverse impact on the environment whilst being cost effective. All contracts for waste disposal will be negotiated through the Purchasing and Supplies department to ensure compliance with procurement law. Whilst risk assessments will be undertaken for the specific overall waste types generated for the Trust, by the Waste Management Advisor, it is the responsibility of the respective departmental managers to ensure specific risk assessments are undertaken to include the procedures in their own areas also any specific hazardous substances in use. In order to support this, please refer to “Operational Health and Safety Policy for the use and management of Hazardous Substances” available on the document library. Page 8 of 87

Document Reference Code: IC/016/14

Where contractors are employed to carry out work on site it is the responsibility of the Project Manager to ensure that any waste produced is disposed of in accordance with this policy and the appropriate Protocol for Disposal of Building Wastes is completed and retained for reference by the Project Manager. See appendix XIII. If the value of this contract is in excess of £300,000 Site Waste Management Plans MUST be produced by the contractor and monitored for compliance at contract meetings, there are also additional requirements for projects over £500,000. 6.1

Documentation

All waste disposed of will be documented on either a transfer note or consignment note and will comprise of a full description of the waste (including EWC number and quantity), name of consignor, carrier and consignee with signatures of all parties. In addition, to comply with the Hazardous Waste Regulations, a site register should be held at each site, details of these requirements are provided in the procedural documentation for hazardous waste disposal at the end of this document. All transfer notes and consignment notes must be retained by the department/site for a minimum of 3 years and must be accessible for inspection by the Environment Agency. In order to monitor compliance, copies should be sent to the Waste Management Advisor and he/she will ensure that they are retained centrally for 3 years. All sites that generate hazardous waste should maintain a Site register that should be held by a nominated person but known by all on site. Detail of the information required is shown in Procedure 3: Safe handling and disposal of hazardous waste. 7.

Roles & Responsibilities

Chief Executive / Board of Directors The Chief Executive is ultimately responsible for the health and safety within the organisation and ensuring compliance with all UK legislation. He/she must ensure that an up-to-date waste management policy exists, and is effectively implemented in all areas within the organisation through policy development, organisational arrangements, implementation, performance monitoring, audit and review. The Waste Management Policy should be reviewed at a minimum every two years or when legislative changes occur. Executive Directors are responsible, through the Chief Executive, for ensuring support for the waste segregation and safe handling of waste within the Trust. Senior Managers / Department Heads are responsible for ensuring that each member of staff is aware of this policy and that they have received adequate training and instruction necessary to comply with it, to ensure the safety of staff, members of the public, contractors on site and the Environment. This includes risk assessments for each waste type produced on each site.

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Document Reference Code: IC/016/14 Managers / Supervisors are responsible for ensuring that:               

All waste related documentation i.e. transfer notes and consignment notes are completed fully and accurately. Consignee returns are checked against consignment notes, documented and any discrepancies reported promptly. A site register is maintained with all waste documents from the previous three years and available to on site staff and the Environment agency if required. All employees receive documented information, instruction, training and supervision on all aspects of safety, including waste handling and disposal. they have an understanding of the Trust‟s safety policies. they participate in the development and regular revision of local policies, procedures, guidelines and best practice. any amendments are bought to the attention of new, existing employees and bank staff. they assume day to day responsibilities for the health and safety at work of staff under their control. staff are informed of all hazards and significant risks connected with their work activities and how to safeguard themselves they participate in completing all risk assessments for their areas, ensuring that they are recorded and updated in accordance with procedures and statutory legislation. Any corrective action to rectify any shortfalls should be identified by action planning. all injuries are properly treated and that subsequently all accidents and incidents are reported, recorded and investigated as appropriate using the official Trust method and lessons learned. their areas are in a clean and tidy condition and that any potential hazards, unsafe working practices or conditions are rectified. personal protective equipment (PPE) when necessary is appropriate and fit for purpose, readily available and used. that waste collection receptacles meet the needs for the site. that risk to contractors is minimised. That where possible waste minimisation is embraced and the requirement for single use items is minimised (subject to meeting and Health & Safety or Control of Infection issues).

Employees are responsible for ensuring that they:        

Attend the Trust Induction on commencing employment. Attend relevant training with the object of raising and maintaining standards of health and safety and meeting their statutory obligations. Receive documented information, instruction, training and supervision on all aspects of safety. Fully co-operate with management in carrying out their legislative duties. Take reasonable care for the health and safety of themselves and of any other persons, including contractors who may be affected by their acts or omissions at work. Fully co-operate with the Waste Management Advisor and Health and Safety representatives. Observe and conform to all safety rules and procedures at all times by always working safely and efficiently. Wear or use the personal protective safety equipment and clothing where provided.

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Document Reference Code: IC/016/14    

Report any accidents/incidents, near misses or hazards immediately to their respective manager or supervisor. Read and familiarise themselves with this and other related health & safety policies. by their own example, influence employees to adopt and maintain safe working practices and procedures and actions to minimise waste, practice effective waste segregation and dispose of waste safely. do not intentionally or recklessly interfere with or misuse anything provided in the interests of health, safety or welfare

Head of Cornwall Healthcare Estates and Support Services Is responsible for arranging for relevant staff, with specific training in waste management issues, to effectively modify the attitudes and behaviour of staff in the Trust to comply with the Trust Waste Management Policy and thus ensure that the Trust is legally compliant. Waste Management Advisor Responsible for ensuring that:        8.

They maintain their competency to perform their specialist duties through continuing professional development, consultation, update and review. They amend the Waste management policy taking into account legislation changes, new technology, recent research and information on infectious wastes and carry out a Trust Waste management audit across Trust sites as agreed with the Trust. Advise the Trust on levels of compliance at each site through audit programs. Identify training requirements for staff and liaise with the Training managers to ensure suitable training is available for use. Work closely with Infection Control to minimise the risk of infection relating to incorrectly segregated waste. Administer the relevant paperwork for compliance. All relevant information is available and maintained in the document library.

Relationships with Other Policies

The Trust Waste Management Policy covers the safe handling, transportation and disposal of all wastes generated by the Trust in a manner which protects the environment. There are therefore overlaps with other policies such as Control of Infection, Health & Safety Policy, Occupational Health, Quality, Fire Safety, Decontamination of Medical Devices and the Security Policy. If any of these policies are compromised advice should be sought from the relevant departments and following risk assessment, the highest priority risk will decide how to proceed and which policy to follow. 9.

Risk Management

Local Waste Management Procedures for each site should allow collection, containment, transport and disposal of all waste streams in a manner which eliminates or minimises the risk of health and safety of Trust employees, patients, visitors, contractors and other members of the public. Consequently adherence to the site procedures will deliver compliance with UK Health and Safety legislation and waste regulations. Page 11 of 87

Document Reference Code: IC/016/14 These procedures should also be designed to protect the environment and to meet the requirements of UK environmental legislation as listed in this document and should at least cover the types of waste produced, colour of containment receptacles, procedures for collection and disposal together with responsibilities for each staff group and or contractors (including audit), transport arrangements, storage, PPE, Accident & incident reporting, spillages and contact details for emergency situations. However, any changes, alterations, deletions or additions to any procedures may affect the safe systems of work or the environmental protection aspect they deliver. It is therefore essential that alterations are approved only after a risk assessment has been completed using the risk assessment tools provided by the Trust. Standard Procedures are provided appended to this policy. In addition to site responsibilities a waste assessment form has been devised and is shown in Appendix XII. This should be completed and updated at least annually and cover all types of waste generated in your ward/department, to ensure that all risks are considered, safe systems are implemented and waste is correctly identified for segregation according to this policy. However, if ward changes are made a risk assessment review should be undertaken at that time. Health & Safety issues like risk assessment, accidents/incidents, COSHH, RIDDOR, spillages, PPE, Basic hygiene and immunisation should be carried out according to relevant Trust policy. 10.

Waste Segregation

10.1

Colour coding

In order to effectively identify different types of waste generated within the NHS a national colour coded system has been agreed. It is essential that all members of staff are aware of this and correctly segregate waste to ensure that it is disposed of legally, within locally agreed contracts set up via the Waste Management Advisor and Supplies Manager. In particular, it is the responsibility of clinicians to correctly identify the infectious fraction of clinical waste, this could be implemented by colour coding on medical records, where infection has been identified and is in the process of treatment. It is important to ensure that appropriate colour coded receptacles are available in order to ensure effective segregation

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Document Reference Code: IC/016/14 BEST PRACTICE COLOUR CODING Category A Highly Infectious waste and non-hazardous medicines - yellow Minimum treatment/disposal is incineration in a suitably licensed or permitted facility. This includes: anatomical waste, untreated laboratory waste, solidified bodily fluids. Infectious waste - orange Minimum treatment/disposal required is to be „rendered safe‟ in a suitably licensed or permitted facility. This includes: all treatment waste not contaminated with medicines. Cytotoxic/cytostatic waste – purple stripe on a yellow background Minimum treatment/disposal is incineration in a suitably licensed or permitted facility. This includes: all waste contaminated with cytotoxic or cytostatic drugs (if in doubt check details with the pharmacy). Anatomical waste – red lidded rigid bin Minimum treatment/disposal required is incineration in a suitably licensed or permitted facility. Specific heavy duty bags are available to order for awkward shaped body parts. Offensive/Hygiene waste – black stripe on yellow Minimum treatment/disposal required is landfill in a suitably licensed or permitted site. This waste should not be compacted in un-licensed/permitted facilities and includes non-infectious clinical treatment waste, sanitary products, nappies and incontinence products. Domestic Waste - black Minimum treatment/disposal required is landfill in a suitably licensed or permitted site.

Amalgam waste - white For recovery

In addition, locally we also use the following: Domestic Recyclables - clear For recycling at a permitted site. keeping „like with like‟ and includes: shredded paper, card, plastic bottles, cans, textiles, newspaper & magazines Confidential waste for shredding – Hessian sack OR locked bin For shredding and pulping and includes: paper/card documents with patient information, confidential Trust details, CD, fax rolls, video tapes, boxed files, laminated data.

CYTOTOXIC & CYTOSTATIC MEDICINES: PLEASE NOTE THAT THE COLOUR CODING FOR SHARPS BINS IS REPLICATED BY THE COLOUR OF THE LID. I.e. SHARPS CONTAMINATED WITH CYTOTOXIC OR CYTOSTATIC MEDICINES SHOULD BE CONTAINED IN A YELLOW BIN WITH A PURPLE LID & LABEL.

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Document Reference Code: IC/016/14 10.2

Other items not colour coded

There will be other items that are impossible to colour code within a bag, these include large cardboard boxes which must be flat packed to ensure minimum space is used prior to collection. This also reduces the risk of fire and slip, trip fall. Waste Electrical and Electronic Equipment (WEEE) will bear the symbol below:

To restrict it being disposed of in a domestic bin this has been prohibited by law in 2007. It is required therefore to be disposed of through an Authorised Treatment Facility. All ridges/freezers, IT equipment, batteries, redundant furniture and other equipment, fixer/developer, chemicals etc should be stored safely in a designated safe area and be referred to the Waste department to arrange specialist removal. Where these items contain hazardous components, this will be following the completion of a Hazardous waste Form/consignment request shown in Appendix IV or with information from any materials data sheets, if applicable, which can then be sent to the following email address: Community enquiries:

[email protected]

In some instances where equipment or furniture has not been condemned, it may be possible to sell or send these items for aid but documentary evidence of their decontamination and an indemnity form MUST be completed to record this process. In addition, it is essential that items are removed from the asset register by the department, prior to disposal or reuse. 10.3

Disinfection and making safe of equipment

Large pieces of equipment and medical devices, where practical, should be disinfected before disposal following manufacturer‟s guidance. This can include safety measures effected by Estates or Medical Physics personnel to avoid reuse and removal from the asset register. See Appendix X for decontamination certificate. Definition of a medical device in the medical device and equipment management policy is „Equipment that is used in the diagnosis or treatment of a disease, or for the monitoring of patients‟. Infusion pumps, syringes, medical instruments, catheters, X-ray sets and Pathology analysers are all Medical Devices. „Low-tech‟ items such as wheelchairs, patient hoists, beds and walking frames are also Medical Devices and must be managed in the same way as more „hi-tech‟ equipment. It is important that this equipment is described in full for disposal purposes listing all hazardous or infectious components.

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Document Reference Code: IC/016/14 10.4

Containers

Receptacles for the use of waste disposal should be approved by infection control, waste department, health & safety and fire departments and are available on EROS via the supplies department for purchase. A list of approved bin types is available on request. It is essential that these containers are not used for any other purpose than they are intended as this can compromise Health & Safety standards. As a minimum standard foot operated bins should be used in all clinical area to reduce the risk of infection by not handling lids. 10.5

Replacement and Labelling     

10.6

All waste bags should be replaced, at a minimum, daily or when sacks are ¾ full, any deviation from this should be risk assessed and recorded. All receptacles should be securely sealed to prevent waste from escaping and thus compromising infection control. This can be done by either using a swan neck closure or by the use of plastic ties, which can be marked with the name of the site. All sacks should be labelled with name of ward or area, site and date. Collections should be appropriate to the demand of the area. Waste bins should be wiped and visibly clean each time sacks are replaced.

Waste Contractors

No contractor should be used unless they have been checked and authorised by the Waste Management Advisor to ensure suitable carriers certificates are held and authorised licences or appropriate Integrated Pollution Prevention Certificate (IPPC) for the disposal site. 10.7

Discharge to sewer

Waste should not be discharged to sewer unless suitable „Consents to discharge to sewer‟ are obtained from the water company. 11.

Identifying and Description of Waste

In accordance with the Duty of Care Regulations and the Lists of Waste Regulations, all waste must be transferred to contractors with a full description of the waste and an allocated six-digit EWC (European Waste Catalogue) number. Where this six-digit number is prefixed with an *asterisk it will only be collected by arrangement with the Waste Management Advisor and will, in accordance with the Hazardous Waste Regulations be accompanied with a hazardous waste consignment note. This note will include all details of hazards which could put other persons at risk during the disposal process. Where more than one EWC code applies „duel coding„ should be used e.g. redundant pacemakers which contain lithium batteries but have been removed form a client and are therefore contaminated with bodily fluids. It will be the responsibility of each producer to provide all the relevant information to the Waste Management Advisor to manage and reduce risk whilst being transported and its ultimate safe disposal. For this purpose a Hazardous Waste Form must be completed for all hazardous waste. See Appendix VI, VII, VIII, IX and IV reference should also be made to the COSHH sheet and/or Materials Data Sheet where waste is considered hazardous.

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Document Reference Code: IC/016/14 12.

Hazardous Groups

The recognised hazard groups H1 to H15 applicable to waste generated within the NHS are shown in appendix VII. Further information on these hazard codes and specific risks can be found in the guidance document on the classification of hazardous waste WM2 available on the Environment Agency website: http://www.environment-agency.gov.uk/business/topics/waste/32180.aspx 13.

Hazardous Waste Producer Registration

In accordance with hazardous waste regulations all sites that generate more than 500kg of hazardous waste per year must register in order to be able to dispose of the waste legally. The Waste Management Advisor will record volumes of hazardous waste from each site and annually register the sites as appropriate. A list of registered sites and their respective registration codes will be listed on the intranet website „Waste Minimisation‟. In conjunction with this and the Hazardous Waste Regulations, consignment notes and consignee returns will be co-ordinated and data will be a provided and available from the Waste team for each site upon request if required. 14.

Storage of Waste

14.1

Storage at point of production

Storage areas at ward level should be secure and located away from public areas. Storage areas should be sufficient in size to allow packaged waste to be segregated and to avoid waste of different classifications being stored in the same container/area. 14.2

Bulky Storage

All sites/areas should have adequate storage facilities to safely contain all types of waste that is likely to be generated in that area between collection schedules. This can range from a single lockable, wheelie bin to a secure compound area dependant on the volume and types of waste produced. All bulk storage areas should be / provide:           

reserved for healthcare waste only; well lit and ventilated; sited away from food preparation and general storage areas, and away from routes used by the public; totally enclosed and secure; separate storage for sharps bins, anatomical waste and waste medicines that need a higher degree of security to prevent unauthorised access; wash down facilities; sited on well drained, impervious hard standing; readily accessible but only to authorised personnel; kept locked when not in use; secure from entry by animals and free from insects or rodent infestation; clearly marked with warning signage; Page 16 of 87

Document Reference Code: IC/016/14   

provided with separate, clearly labelled areas for waste destined for different treatment / disposal options; Provided with access to first aid facilities; Wheelie bins should have functional locks that remain locked when in use.

In addition, larger sites where dedicated staff collect waste there should be provision for:   

wash down facilities for containers drained to sewer (with discharge consent) washing facilities for employees; easy vehicular access.

Refrigerated storage should be provided for all human tissue waste including placenta‟s generated by midwifery. 15.

Waste Licensing

In accordance with Waste Licensing legislation, any site involved in the treatment of waste will apply for a waste license from the Environment Agency to cover its use and ensure that a suitably qualified technically competent person is available to manage the license. Also any site that wishes to accept waste from another site must apply for a transfer licence from the Environment Agency and comply with their requirements. 16.

Transportation

Many of the types of waste generated in a healthcare setting are classed as hazardous or dangerous and therefore need to comply with the relevant transport legislation when being moved, either by staff or by the contractors that are used for disposal. 16.1

Internal Transport

Dedicated trucks or containers should be used to transport waste on site, preferably enclosed to reduce the risk of infection. The containers should be regularly cleaned on a pre-programmed rota with drainage to a main sewer. 16.2

External transport

Waste being transported by staff in cars must be packaged in accordance with the Carriage of Dangerous Goods Regulation and carried in rigid containers suitably tested to ensure compliance and safety. Bagged infectious Healthcare waste must not be carried in vehicles and preferably, waste generated by community nurses should have a written agreement from the householder to leave it on the premises, when this is undertaken the form attached in Appendix XI must be completed and forwarded to Cornwall Council to arrange a specialist clinical waste collection. The alternative to this is for community nurses to return waste to base in UN approved rigid containers which are available on EROS. All such staff are required to carry proof of the Trusts Carriage licence at all times by December 2013. Drivers who transport waste in dedicated vehicles must receive training in ADR specific to the class of hazard they are transporting, ensure that vehicles comply with legislation, carry consignment notes, Transport Emergency cards (TREM), have adequate PPE and fire fighting equipment and display hazard signs as appropriate.

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Document Reference Code: IC/016/14 Where bulk movement of clinical waste is carried out by the Trust, drivers will be ADR trained for the transport of Class 6 Infectious Substances and vehicles will be specified in ADR. All goods considered hazardous for transportation purposes will, in addition to the other requirements of this policy, be identified by the UN number and the appropriate name on the package or bin containing the waste. 17.

Monitoring, Audit and Review

Waste audits form an essential, mandatory requirement in monitoring performance, reviewing waste management procedures and ensuring statutory compliance. Within the context of this policy the following audits and frequency should be undertaken: Type of Audit

Undertaken by whom

Frequency

Infection control audit and observation of practice

Ward Manager / Staff nurse/infection control lead

Annual

Pre-acceptance audits

Waste team / ward manager

Annually, each area

Internal audit

South West Audit team or other Approved provider Environment Agency or other Suitable organisation Waste Management Advisor Waste Management Advisor Waste Management Advisor

As per agreed schedule With the Trust

External audit Staff questionnaire Waste Contractor/Duty of Care Audits Building contractor audits

Site Waste Management Plan Checks/audit

Project Manager

For construction projects: Over £300K Over £500K

Waste management Advisor & Health & Safety Advisor

Place

Hotel services

As agreed. As required Annual with 6 monthly checks on practice Building contractors to be checked as agreed with the Trust. Update on Site Waste Management Plan at each Project update 1 annual check on Site Waste Management Plans Annual

The outcome of these audits should be tabled at Health & Safety committee meetings for Governance purposes. 18.

Emergency / Contingency Plans

In the event of a disruption to service for waste collection, extra wheelie bins could be provided or rented to the larger sites. Small sites may also need extra storage or if not practical they could designate one room for temporary bulk storage which should be cleared of other items first and lockable. A deep clean would then be required when the room returns to service. Page 18 of 87

Document Reference Code: IC/016/14 Temporary rental of a lockable skip or a sea container for bulk storage might also be an option, depending on the site if a separate room could not be released. Tiger bags produced on site could be diverted to deep landfill, if applicable, to reduce the total quantity and even compacted using a dedicated compactor if available, and that would also require deep cleaning before returning to service. This would need to be co-ordinated by the site manager in agreement with the waste contractor. Advice could be obtained from a suitably trained person with agreement from the collection contractor, Cornwall Council and or the Environment Agency.

Page 19 of 87

Document Reference Code: IC/016/14 Procedures for Safe Handling and Disposal Procedure 1 – Safe Handling and Disposal of Sharps Procedure 2 – Safe Handling and Disposal of Clinical Waste Procedure 3 – Safe Handling and Disposal of Hazardous Waste Procedure 4 – Safe Handling and Disposal of Municipal or Domestic Waste and Recycling Procedure 5 – Safe Handling and Disposal of Confidential Waste

Page 20 of 87

Document Reference Code: IC/016/14 Procedure 1 – Safe Handling and Disposal of Sharps 1.

Waste Stream Definition

This waste stream includes all sharp objects which may puncture the skin and which are or may be contaminated with harmful or infectious agents. Sharps therefore include syringes, hypodermic needles, intravenous needles, scalpels, razors and other blades, pins, glass ampoules, broken glass and other sharp objects. All hypodermic needles, intravenous needles, scalpels, razors and other blades should be regarded as sharps for disposal purposes, even if it is known that they are uncontaminated. This waste stream can also include broken glass which is clean and uncontaminated and could be recycled or disposed of through the domestic waste route but does not include broken bulbs etc. that could be generated by Estates. 2.

Safe Handling and, Storage of Sharps    



    

Sharps must be disposed of in a sharps bin at the point of origin wherever possible take the sharps bin with you on a tray to the patient when you use sharps rather than transport it across a room or ward for disposal. Never attempt to re-sheath a needle Do not remove the needle from the syringe prior to disposal; both should be disposed of intact in the appropriate colour coded container shown in the appendix. The sharps containers must be capable of being handled and moved while in use with minimal danger of the contents spilling or falling out. They must also be fitted with a handle that is not part of any closure device. The position of the handle must not interfere with the normal use of the container. The sharps container must have an aperture which, in normal use, will inhibit the removal of the contents but will ensure that it is possible to place items intended for disposal into the sharps container using one hand, without contaminating the outside of the container. Sharps boxes must be assembled by a staff member who has received instruction before use. Faulty boxes must not be used; any faults should be reported to the area manager. Sharps boxes must not be left on the floor. Should be closed when not in use and preferably they should be located in areas‟ out of reach of children, using brackets where available. The box must be marked with the name of the ward, site, date and time it is locked together with the name of the person responsible for assembling and closing it. All sharps boxes have a maximum fill line printed on the side. When this level is reached the box must be locked. The box must be stored in a secure area prior to collection. Waste collection staff will transport sharps containers to the central storage facility. Sharps boxes are stored separately here awaiting collection by the waste contractor.

SHARPS BOXES MUST KEPT SECURE AT ALL TIMES.

Page 21 of 87

Document Reference Code: IC/016/14 3.

Spillage Arrangements 

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 



  4.

Personnel cleaning up clinical waste spillages must be equipped with suitable Protective Clothing which may include the following: surgical gloves, heavy duty rubber gloves and a plastic apron. The surgical gloves should be worn inside the rubber gloves. Where there may be splashing of liquids, a face visor or goggles should also be worn. Spilled sharps should not be picked up by hand. The spillage should be swept onto a hand held scoop using a hand held brush. The collected sharps should then be deposited into an empty sharps container. The original sharps container should be carefully resealed. The area of the spillage should be carefully inspected for small sharps items such as detached needles and shards of glass. These should be swept up. Once the area is visually clear of sharps, any residual liquid should be soaked up using absorbent paper or towels. Any spillage should be treated as a possible risk of infection and the surface should be cleaned with hypochlorite 10,000 ppm solution or hypochlorite granules. The scoop and brush should be washed with the above mix and thoroughly rinsed with water and dried if possible. The rubber gloves should be removed and the external surfaces washed with the above and thoroughly rinsed with water. The paper, apron and gloves if infected should be disposed of in the appropriate colour coded bag i.e. colour of lid of sharps box. Trust accident/incident policy should be followed In the event of an employee receiving a needle stick injury reference should be made to the Management of Body Fluid Exposure Incidents policy Colour Coding

In accordance with the Waste Management Policy the colour coding for sharps bins will reflect the DoH guidance and is summarised in the appendix 5.

Disposal Routes

Sharps identified as infectious or containing cytotoxic or cytostatic medicines will be disposed of as hazardous waste in accordance with the waste policy.

Page 22 of 87

Document Reference Code: IC/016/14 Sharps Box Colour Coding Orange lidded bin Sharpsguard orange for the disposal of sharps, excluding those contaminated with medicinal products and their residues Yellow lidded bin Sharpsguard yellow for the disposal of sharps contaminated with medicinal products and their residues (excluding cytotoxic and cytostatic medicines) Purple lidded bin Sharpsguard cyto for the disposal of sharps contaminated with cytotoxic and cytotstatic medicinal products and their residues

Solid orange bin Sharpsguard Dani for the disposal of uncontaminated broken glass not suitable for recycling

Applicable European Waste Codes (EWC) Suitable for phlebotomists, podiatry and other sharps 18.01.01 instruments not in contact 18.01.03 with chemicals or medicines

Suitable for area‟s where taking blood and giving 18.01.01 medicines as a general all 18.01.03 purpose container 18.01.09

Suitable for area‟s treating patients with cancer or other drugs identified as cytotoxic or cytostatic by the pharmacy department

18.01.01 18.01.03 18.01.08 18.01.09

20 01 02

Page 23 of 87

Document Reference Code: IC/016/14 Procedure 2 – Safe Handling and Disposal of Clinical Waste 1.

Waste Stream Definition

Clinical Waste is defined as: “any waste which consists wholly or partly of human or animal tissue, blood or other bodily fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, 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” This waste stream includes surgical dressings, swabs, contaminated theatre wraps and any item from a treatment area or department which is, or may be, hazardous to health or infectious. It also includes anatomical waste, clinical waste fluids, sharps, pharmaceutical waste and microbiological wastes but each waste stream is colour coded for identification purposes using the national colour coded system shown in the Waste Management Policy. Waste that is generated in a treatment area that is NOT contaminated with any bodily fluids should be disposed of through the other disposal routes. This can include things like paper towels, newspapers, magazines, card, packaging material etc. 2.

Safe Handling and Storage Requirements 



 

 



Clinical waste should be contained in the appropriately coloured plastic bags or lidded containers by the producer of the waste at point of generation. See colour coding posters shown in the containment section at the end of this document. Bags should be mounted in foot operated bins with stickers on the lid to identify the correct contents. Depending on the site arrangements porters/cleaning staff/ancillaries/nursing staff are usually responsible for ensuring the frequency of changing these receptacles meets the needs of the department. However the minimal frequency for a bag is generally once daily. Containers must however be exchanged when they are 2/3rd full to avoid overfilling. Bags/sharps bins should be labelled when first in use to identify the following:  Ward  Hospital/site  Dated to identify when it was in use At time of removal bags and sharps bins should be securely sealed, bags preferably with a tie and swan neck type closure. Visual checks should be made on the containment to ensure that it doesn‟t leak or the receptacle is defective. If it is necessary for the bag to be re-bagged/double bagged, the labelling and resealing should be carried out as above. Defective sharps containers should be placed into larger containers and must NOT under any circumstances be emptied into another container. Any defects should be reported to the Waste adviser, refer to sharps policy for further details Once a bag is removed it must not be left on the floor as this presents an unacceptable slip, trip and fall risk as well as a possible infection risk. It should be immediately placed into a secure, locked wheelie bin/store allocated to the area. Page 24 of 87

Document Reference Code: IC/016/14          3.

When handling bags that contain potentially infectious waste it is important not to hold the bag close to the body to avoid risk of sharp instruments protruding from the bag and piercing the skin. Sealed clinical waste bags should never be manually crushed, compacted, thrown or deliberately punctured to exclude air. No mixing of hazardous clinical waste (i.e. orange and yellow) and non-hazardous clinical waste (i.e. tiger bags) must be allowed. Arrangements should be made for collection operatives to empty any storage on a regular basis, according to demand. This will ensure that these bins/stores do not become overfull resulting in waste being placed on top or beside bins. Clinical waste should not be collected or stored in the same container as domestic or non-hazardous clinical waste. Clinical waste must not be stored in public areas Where clinical waste is in orange/yellow bags and identified as infectious the hazardous waste procedure must be followed Wheelie bins should remain locked unless loading is taking place to avoid unauthorised access and risk of fire Wheelie bins used for hazardous and non-hazardous waste should be clearly labelled and the appropriate EWC code used on all paperwork concerned.

Site Transportation

Any Waste collection operatives/GSA/cleaners/porters should circulate around the hospital to collect waste either by exchange wheelie bins or use clean dedicated wheeled containers used only for waste collection. If clinical waste is collected with other waste, the container must have a separate compartment to segregate the clinical waste from any other waste collected. The wheeled containers should be cleaned on a regular basis. Once full the locked wheeled containers should be moved and taken to the clinical waste holding area to await collection by the clinical waste disposal contractor. All containers provided by the clinical waste contractor should be checked to ensure that they are „fit for purpose‟ i.e. lockable, clean and functional 4.

Spillage Arrangements

All staff involved in cleaning up a spillage should be made aware of the potential infection risks and should be provided with suitable protective clothing.    

Personnel cleaning up clinical waste spillages must at a minimum be equipped with protective rubber gloves and a plastic apron. Where there may be splashing of liquids, a face visor or goggles should also be worn. Damaged clinical waste bags and their contents should he lifted and placed into a sound empty clinical waste bag or one way container, sealed, relabelled and taken to the disposal point. Either use paper towels to absorb liquid or sprinkle Presept granules over the spillage and leave for ten minutes. Scoop up the soaked up liquid and granules, placing them in the appropriately coloured clinical waste bag or one way container. Wipe any contaminated surfaces with hypochlorite (10,000 ppm is recommended) and wipe dry with absorbent paper. The paper, apron and gloves should then be placed in Page 25 of 87

Document Reference Code: IC/016/14



5.

the appropriately coloured clinical waste bag. This procedure is appropriate for all clinical waste liquid spillage‟s including blood. Any spillage that poses a threat to the environment or to the Health & Safety of any member of staff or any other person should be notified to the Waste Manager and Health & Safety Department. An Accident/Incident form should be completed.

Disposal Routes

Storage Arrangements All clinical waste awaiting collection by the clinical waste disposal contractor must be held in secure areas which are reserved solely for the bulk storage of clinical waste. The storage areas must have warning notices and arrangement for preventing access by unauthorised persons. They should be enclosed with well drained hard standing. The capacity of the storage areas should be sufficient to accommodate at least the volume of waste generated in three days. The contents of the wheeled containers must be protected from birds, insects, vermin and other scavenging animals. The clinical waste storage areas should be sited away from food preparation, general storage areas and routes used by the public. The areas should be well lit and have adequate vehicular access. Where anatomical waste, including placenta‟s, is stored, cold/refrigerated storage must be provided to prevent this waste from decaying and causing odour problems. Low grade radioactive waste must be stored separately until decayed to the appropriate level as dictated by current guidance from the Radiation Protection Adviser. It can then be stored in the clinical waste area to await collection. Transport Hazardous clinical waste is designated a dangerous goods under the Carriage of Dangerous Goods Regulations and therefore must be packaged in accordance with these regulations and labelled accordingly with the appropriate UN number (UN3291) and the signage below. It is essential that the containment meets the classification packaging and labelling regulations and therefore only approved containers displaying the signage below are to be used. These containers must be sealed securely labelled accordingly. Non-hazardous clinical waste is not subject to the Carriage of Dangerous Goods Regulations and therefore does not need this signage but good practice dictates that the containers are locked securely and labelled according to its contents. Clinical waste bags should be transported to the appropriately licensed disposal site in yellow wheelie bins or other rigid containers to comply with the Carriage of Dangerous Goods unless the vehicle and drivers meet the full compliance of this legislation. This will be at an incinerator in Liskeard unless they experience a breakdown in which case the written contingencies will be implemented.

Page 26 of 87

Document Reference Code: IC/016/14 6.

Documentation and Records Required

Infectious clinical waste and cytotoxic/cytostatic medicines will be consigned on a legal consignment note to comply with the Hazardous Waste Regulations and will use the following European Waste Classification and identified hazard codes. Other non-hazardous waste will be transferred to the contractor on a Duty of Care transfer note. This information will be based on waste assessments undertaken by each unit and site and will be handled by the waste manager and contractor. European Waste Catalogue codes

Type of Waste

European Waste Classification

Sharps (except 18 01 03)

18 01 01

Body parts and organs 18 01 02 including blood bags and blood preserves(except 180103)

Likely Hazard Codes and UN Numbers for carriage MAY OR MAY NOT BE HAZARDOUS IF INFECTIOUS 18 01 03 APPLIES

MAY OR MAY NOT BE HAZARDOUS IF INFECTIOUS 18 01 03 APPLIES

Areas waste likely to be produced and colour coding Clinical areas, i.e. wards, theatres, clinics, outpatients, labs undertaking venepuncture Or acupuncture ORANGE LIDDED SHARPS BIN Clinical areas: i.e. Theatre, haematology, wards, maternity Red lidded bin for placentas and YELLOW SOLID COLOUR BAG OR BIN Clinical areas YELLOW/ORANGE DEPENDING ON CONTENTS Clinical areas: i.e. orthopaedics, baby clinics, public toilets

Wastes whose collection *18 01 03 and disposal is subject to special requirements in order to prevent infection Wastes whose collection 18 01 04 and disposal is not subject to special requirements in order to prevent infection (e.g. plaster casts, dressings, linen, disposable clothing, diapers) Chemicals consisting of or *18 01 06 containing dangerous substances

H6,H9 UN3291 Clinical Waste, Unspecified, Nos Non-Hazardous

H2,H3a,H3b,H4, H5,H6,H7,H8, H10,H11,H12, H13, H14

ALL i.e. labs, pharmacy SEPARATE CONTAINMENT CLEARLY IDENTIFIED

Chemicals other than those 18 01 07 contained in 180106 Cytotoxic and cytostatic *18 01 08

Non-Hazardous

Labs, pharmacy

H6,H7,H10,

Clinical areas:

TIGER BAG

Page 27 of 87

Document Reference Code: IC/016/14 medicines

Medicines other than those 18 01 09 mentioned in 180108

Amalgam waste from dental *18 01 10 care

i.e. any area treating UN3291 Clinical cancer patients OR Waste, Unspecified, using cytostatic Nos medicines PURPLE STRIPE BAG OR PURPLE LIDDED SHARPS BIN Clinical areas: i.e. wards, pharmacy

H13 mercury Vapour H6, H14 UN2025 Waste Containing Mercury compound, solid.Nos

SOLID YELLOW BIN Dental WHITE POT, CLEARLY LABELLED, WITH COLOUR CODED LID.

Page 28 of 87

Document Reference Code: IC/016/14 Waste Colour Coding Colour

Description Orange bag Infectious clinical waste NO MEDICINAL PRODUCTS

Suitable For

EWC code

Normal treatment waste from 18 01 03* clinical rooms. Soiled dressings, contaminated incontinence products.

Yellow lidded bin/bag Highly Infectious and identifiable Anatomical waste, blood 18 01 02 human tissue. bags, redundant non- 18 01 03* hazardous pharmaceutical 18 01 09 products. Yellow with Purple stripe bag Cytotoxic and cytostatic Any material soiled with 18 01 08* contaminated waste Cytotoxic and cytostatic medicinal products and their residues as identified by pharmacy Yellow bag with black stripe (Tiger Bag) Non infectious clinical waste Any NON-INFECTIOUS 18 01 04 sanpro waste e.g. nappies, inco pads or sanitary products. Or non-infectious treatment waste. Most suitable for toilets and female changing rooms. Black bag For domestic waste only, not Suitable for flowers, food 20.03.01 clinical waste or recyclables. waste, paper towels etc.

Seal with a numbered tie.

Clear

Hessian sack marked confidential waste Sometimes separate, locked For confidential waste only. 120L wheelie bin in situ labelled Confidential waste only IF NOT ABLE TO USE ON SITE SHREDDER Clear plastic bag Recycling

20.01.01

Clean cans, plastic bottles, 20.01.01 small card, office paper, 20.01.40 newspaper/magazines. 20.01.39 Keep like with like.

Page 29 of 87

Document Reference Code: IC/016/14 SHARPS BINS Yellow bin with yellow lid Sharps with medicinal For use in clinical treatment 18 01 01 contamination rooms 18 01 03* 18 01 09 OR redundant non-hazardous medication

Yellow bin with purple lid Sharps contaminated with Use only if treating patient 18 01 08* cytotoxic or cytostatic medicine with cytotoxic or cytostatic medicine as indicated by pharmacy

Yellow bin with orange lid Sharps contaminated with blood Area‟s where only 18 01 01 only venepuncture or acupuncture 18 01 03* takes place or for sharp object NO MEDICINAL PRODUCTS like lances

Page 30 of 87

Document Reference Code: IC/016/14 Procedure 3 – Safe Handling and Disposal of Hazardous Waste 1.

Waste Stream Definition

Hazardous waste is defined in the Hazardous Waste Regulations 2005 as any waste identified as hazardous in the List of Wastes or waste that displays one or more of the following hazardous properties, which loosely is that identified as a COSHH regulated item. The hazardous groups identified in this legislation are shown in the table below: H1 H2 H3A H3B H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15

Explosive Oxidising Highly Flammable Flammable Irritant Harmful Toxic Carcinogenic Corrosive Infectious Toxic for Reproduction Mutagenic Substances that release toxic gases Sensitising Ecotoxic Substances capable of yielding substances listed above i.e. leachate, which possess a hazardous property.

The types of waste that could be hazardous within a healthcare setting are shown below, however this list is not exhaustive and it is the responsibility of the producer of the waste to identify any hazards that might be in the waste for disposal.                 

Infectious clinical waste Chemicals consisting of/or containing dangerous substances Cytotoxic and cytostatic medicines Dental amalgam Aerosol containers containing residues of hazardous substances Solvents Alkalines Acids Photochemicals Pesticides Florescent tubes and other mercury contaminated waste Oils/fats Paints/inks Detergents Batteries Electrical equipment containing hazardous properties like fridges, freezers, monitors, TV‟s Wood containing dangerous substances Page 31 of 87

Document Reference Code: IC/016/14 2.

Safe Handling and Storage

Obviously each type of hazardous waste can be vastly different in the type, size and where it will be disposed of. However safe handling and storage is of paramount importance to ensure the safety of staff, patients and visitors and to protect the environment. In order to provide some procedural guidance the following applies to the waste streams identified above, however, this will be a working document and amendments will be added from time as safe procedures are implemented: Infectious clinical waste Identify by colour coding yellow or orange bag or lid of sharps container. Refer to colour coding chart. Hazard code for infectious H9

Chemicals consisting of or containing dangerous substances Generally these should be identified in original packaging, sealed securely and like kept with like. A list of chemicals should be attached to any consignment note together with any data sheets that might be appropriate. The outer packaging should describe the waste in full i.e. Chemicals contaminated with the following….. and use the European Waste Catalogue number 18 01 06 and may consist of the following hazard codes: H2, H3a,H3b, H4, H5, H6, H7, H8,H10, H11, H12, H13, H14 Cytotoxic and cytostatic medicines This waste stream is identified in the clinical waste procedures and forms part of our colour coding. The colour that is designated for this type of waste is a yellow bag with a purple stripe or a sharps bin with a purple lid. This waste stream will be for all waste contaminated with these medicines during the treatment process. As it is deemed to be treatment waste it is also likely that this waste could be contaminated by infection. Therefore the procedure for clinical waste should be followed. Hazard codes likely to be: H4,H5, H6, H9 Dental Amalgam This waste stream is generally limited to oral and dental units. This waste is covered by our colour coding and should be contained in a white container. The description should be dental amalgam waste and use the EWC 18 01 10. The applicable hazard codes are likely to be H13, H6, H9, H14 and transportation code UN 2025

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Document Reference Code: IC/016/14

Aerosol containers containing residues of hazardous substances Generally these should be identifiable by original packaging, sealed securely and like kept with like. A list of chemicals should be attached to any consignment note together with any data sheets that might be appropriate. The outer packaging should describe the waste in full i.e. Aerosols containing residues of (whatever the hazardous substance is) and use the European waste catalogue number 15 01 10. The applicable hazard codes and UN transportation code will be ascertained from any data sheets. Solvents Generally these should be identified in original packaging, sealed securely and like kept with like. A list of solvents should be attached to any consignment note together with any data sheets that might be appropriate. The outer packaging should describe the waste in full i.e. solvents containing (whatever the hazardous substance is) and use the European waste catalogue number 20 01 13 The applicable hazard codes are likely to be H3, H14, H8, H7, H10, H3b, H4, H8, H12 and UN transportation code will be ascertained from any data sheets. Florescent tubes and other mercury contaminated waste Florescent tubes will be replaced by Estates staff who will then place the removed tube into a collection tube placed on each Hospital site. The outer packaging should describe the waste as Florescent tubes containing mercury and use the European Waste Catalogue number 20 01 21 Other mercury contaminated waste may require safe packaging prior to disposal. The applicable hazard codes are likely to be H5, H6, H7, H10, H11, H14

Batteries Battery boxes are available on each hospital site but where this is not accessible a small box should be used to safely store them until a sensible number have been accumulated to arrange a collection. Small containers are available form the Waste Manager on request. The outer packaging should describe the waste as Unsorted Batteries containing hazardous materials and use the European Waste Catalogue number 20 01 33 The hazard codes will vary but are likely to include H2, H4, H5, H6, H8, H14

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Document Reference Code: IC/016/14

WEEE Electrical equipment containing hazardous properties like fridges, freezers, monitors, TV‟s Much of this type of equipment is difficult to contain but it is essential that large items are moved as a whole by a minimum of 2 people The description of this type of equipment will be Discarded electrical and electronic equipment containing hazardous properties and the European Waste Catalogue number 20 01 35 should be used The hazard codes will vary but likely to include H5, H6, H14 The following hazardous items will require information from data or COSHH sheets to enable safe disposal: Alkalines &Acids Photochemicals Pesticides Oils/fats By specialist tanker removal unless contained in a drum Paints/inks Detergents Wood containing dangerous substances 3.

Collection / Storage

Clinical waste and cytotoxic/cytostatic waste This type of waste is generally stored in secure area or locked wheelie bin. Within a healthcare setting this waste is generated on a daily basis and therefore all orange and yellow bags MUST be consigned each time a collection takes place. For this purpose a preprinted Hazardous Waste Consignment note has been prepared for use by hospital sites. The pre-printed details include the registration number, site details, where the waste is being taken, the description of the waste and hazardous codes but will require the consignor to complete the following: 1. Part A, complete a sequential number after the consignment code 2. Part B to fill in the quantity of each type of waste or delete, as applicable. For information, if you do not have access to scales, as a guide a 660L wheelie bin is likely to hold approximately 33kg of clinical waste and a 1100L wheelie bin 55kg of clinical waste bags Also to enter the container size and number i.e. 2 X 1100L bins 3. Part C - signed by the person that collects the waste. 4. Part D - must be signed by the nominated person on site 5. The producers copy must be retained in the Site Register held on site and should be kept up to date in case the Environmental Agency inspect.

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Document Reference Code: IC/016/14 Other waste streams Other waste streams may vary in quantities and regularity, therefore collection and storage cannot be undertaken without completing a Hazardous Waste request form to the waste department to: [email protected] This documentation will provide all relevant details in order to arrange safe collection and disposal at a suitably authorised site identified by the Waste Manager. However, waste should be stored safely, away from the public, not restrict access and egress in any way, away from sources of ignition and in a way that will prevent the risk of cross contamination. As collection cannot always be arranged immediately, storage on site should be dedicated for this purpose. 4.

Disposal Routes

Disposal routes for hazardous waste will vary according to the type of waste however, Peake (GB) Ltd have a contract to remove hazardous waste to their transfer station at Liskeard prior to onward transmission to a suitable and authorised disposal site. 5.

Registration and Documentation

Registration Each site generating more than 500kgs of hazardous waste must register with the Environment Agency. Provided these procedures are followed the Waste Manager will be able to identify these sites and register on your behalf if required. Each year details of your new registration will be made available for inclusion in the Site Register. Documentation All hazardous waste must be consigned using the Environmental Agency specified documents. By completing the pre-printed paperwork or submitting a hazardous waste request form (shown as the end of this document) details will be used to complete this documentation on your behalf. 6.

Records Required

The records identified in the documentation stated above must be retained for a minimum of 3 years and should be made available should the Environment Agency request access. 7.

Site Register

A Site Register MUST be retained on site, this file should include: 1. Details of hazardous waste generated on site, copies of waste assessments for each area would be ideal. 2. Names of contractors with contact details, types of waste and frequency of collection. 3. Details of where waste is being taken. 4. Registration details. 5. Copies of all consignment notes and hazardous waste request forms, retained for a period of at least 3 years. 6. Copies of any carrier‟s schedule. 7. Copies of consignee returns. Page 35 of 87

Document Reference Code: IC/016/14

Copies of the hazardous waste request form or consignment note and other documents left by the contractor must be checked as accurate and signed and MUST be kept in the site register which is usually located with the site manager. Also copies of Consignee returns used to confirm disposal. This must be kept up to date and copies of all documents must be sent to the Waste Manager in order that further legal obligations can be met. This will include checking registration, updating details of disposal sites, names of contractors and payment of fees.

Page 36 of 87

Document Reference Code: IC/016/14 Procedure 4 – Safe Handling and Disposal of Municipal or Domestic Waste and Recycling 1.

Waste Stream Definition

The waste stream includes wastes that would normally be regarded as household and commercial wastes. For statutory reasons it does not include clinical wastes, special wastes, radioactive wastes, industrial or construction wastes. In addition the trust deals separately with confidential wastes. 2.

Handling and Storage Requirements

This includes any waste that would normally be regarded as municipal waste unless it has been excluded above. The following types of waste may therefore be treated as municipal waste. a) Packaging, including cardboard which is separated for recycling. b) Glass, ceramics, provided it is not contaminated with hazardous or infectious substances and includes recyclable glass jars. c) Vegetable matter, flowers, etc. d) Waste food, except that which is disposed of to sewer via the kitchen waste macerators. e) Paper and newspapers, including those that are kept for recycling but excluding confidential waste still to be shredded. f) Paper towels, provided that they are not contaminated with hazardous or infectious materials. g) Aerosol cans. h) General office waste, paper cups, food packaging, etc. or some of these wastes that can be recycled such as paper, cups, newspaper/magazines. i) Floor sweepings, provided there are no hazardous or infectious constituents. Municipal waste should be in black sacks unless it is to be recycled, in which case it should be placed into clear sacks, keeping „like with like‟. A sufficient number of domestic sack holders should be placed in offices, kitchens and administration areas. Black bags should be placed in office waste paper bins. Municipal sack holders/bins should be located in wards and treatment area offices for the disposal of this waste. However care should be taken to site them in locations where there is no possibility of contamination by clinical waste being put in them. General Services Assistants should remove black domestic waste sacks from bins and sack holders when they are three quarters full. The sacks should be securely tied at the top. The black domestic waste sacks should be removed from bins and sack holders on a daily basis, at a time that is agreed with the GSA‟s and the ward or unit concerned. Provided waste for recycling has been properly cleaned or flattened it may not be necessary for a daily collection of recyclables and staff in the area should exchange these sacks when 2/3 full. Sacks awaiting collection should not be left obstructing corridors or doors which can prevent access/egress.

Page 37 of 87

Document Reference Code: IC/016/14 3.

Documentation

All municipal waste and/or recycling should be covered by an Annual Transfer note between both the site and the contractor. A copy of this should be forwarded to the Waste Manager for recording. 4.

Disposal Routes

Municipal waste will be sent for landfill at suitably licensed sites within the County. Recyclables will be collected for bulking within the County and then transported to suitable reprocessing sites within the UK. 5.

Records Required

The Waste Manager should be sent copies of all transfer notes for municipal waste and recyclables to ensure that they are in order and that compliance and volumes can be monitored. These records should be retained for a minimum of 3 years.

Page 38 of 87

Document Reference Code: IC/016/14 Procedure 5 – Safe Handling and Disposal of Confidential Waste 1.

Waste Stream Definition

This stream includes paper, card, fax roll and disc on which confidential information is recorded on patient histories, appointments, tests, treatment records and departmental, staff information or commercially confidential information. It also includes CCTV tapes, computer back up, x-ray, dictaphone tapes, CD‟s and floppy discs requiring safe disposal. 2.

Safe Handling and Storage Requirements

For retention periods please refer to Trust policy      

  

 

  

Confidential waste must be held securely within the users department until it has been shredded. Each department, ward or unit should be equipped with, or have access to, a shredder of appropriate size to meet the day to day need of the department. If on site shredding is provided the shredder must shred to the expectations of the information governance lead for the Trust with a minimum of cross shredding. It is the responsibility of the Manager in each department, ward or unit to ensure that confidential papers do not leave the department unless shredded, or it is in the hands of a service provider that has been approved by the Trust. Records must be kept of all documents that are either shredded on site or sent for disposal to comply with information governance requirements. It is not acceptable for shredded paper to be removed by a non-approved contractor and must not be taken home for animal bedding as this leaves the Trust without proper documentation. Confidential papers and card should be shredded within the users department, ward or unit where possible. If however, this is not possible agreement can be made with another department, ward or unit to shred the confidential waste provided it is still under the control of the user. Once confidential waste is shredded, it is no longer confidential waste and may be included in the recycled paper waste stream provided the material is sent for pulping. If large volumes of confidential waste require disposal or access to a shredder is not possible it may be disposed of in Hessian sacks marked „Confidential Waste‟. These bags should be sealed with numbered seals prior to leaving the department to ensure that there is no likelihood that the waste can escape from the bag and a label stating the name and address of the originator and should be no more than 2/3 full to ensure they can be sealed and to ensure safe handling. The bags should be stored in a safe, locked, central area awaiting collection by the service provider. The bags can then either be accompanied by a representative from the department, ward or unit to witness shredding by the service provider, or, the bags will be collected and a certificate of destruction sent to the Trust to confirm that the contents have been shredded or destroyed It is important to ensure that any person purporting to collect confidential waste is bona fide by checking their identification. The current service provider approved by the Trust is Cory Environmental Services The paperwork appended to this document must be completed prior to the collection Bags not sealed securely will be refused by the contractor

Page 39 of 87

Document Reference Code: IC/016/14 3.

Disposal Routes

Confidential paper shredded within departments will be disposed of as paper for recycling. Large consignments of confidential paper or card may be collected by a recognised service provider that has been approved by the Waste Manager. This service provider should shred the confidential waste and recycle the paper to pulping contractors. 4.

Documentation and Records Required

All confidential waste for disposal should be accompanied by a Transfer note/destruction certificate detailing the numbers of bags and appropriate seal numbers. The Waste Manager should receive details of all transfer notes for confidential waste that is sent to any contractor for disposal in order that compliance and volumes of confidential waste for recycling can be monitored. This can be forward by the Trust representative that receives Certificates of Destruction, as shown on the record sheet. These records should be retained for a minimum of 3 years.

Page 40 of 87

Document Reference Code: IC/016/14 Trust Name: tick as appropriate CPFT

GP

KCCG

NHS England

PCH

RCHT

SBS

Multiple

NHS PS

Locality Site: Collection Date:

Collection time:

CONFIDENTIAL WASTE COLLECTION Bin/Bag Seal Number

Bin

Bag

Service/Location

Seal/Bin Damaged

Total number of items:

DRIVER SIGNATURE ------------------------- PRINT NAME --------------------------(CORY ENVIRONMENTAL) RELEASED BY ---------------------------------- PRINT NAME -------------------------Number of new bags and seals delivered: (Required for billing purposes) Email confirmation of destruction to: CFT [email protected] RCHT [email protected] PCH & Others [email protected] 2 copies required:

1 copy to be retained and copied to above Trust rep and 2nd copy for Cory

Page 41 of 87

Document Reference Code: IC/016/14 Guidance Note for the completion of the Confidential Waste Seal Number Recording Template 1. Under the Trust name tick the applicable Trust 2. Under the Locality site enter a building title or name in order for us to be able to distinguish the premises. E.G. Sedgemoor or CRCH. 3. Under collection date enter the date on which the collection is to be made. 4. Under collection time record the time at which collection was made. 5. Under seal number record all the seal numbers displayed on the tags around the tops of the confidential waste sacks. Bags with seal numbers not recorded or incorrectly sealed will be refused 6. Ensure that the driver signs for collection and also prints their name where indicated. All drivers must report to reception areas prior to collecting the waste so that the releasing officer can ensure that the necessary paperwork is completed. 7. Confidential waste awaiting collection should be ready on the designated day at an agreed collection point 8. Only designated people should be releasing the confidential waste to Cory and they should sign and print their name on the completed sheet where indicated. 9. It is essential that for every confidential waste collection a form is completed and the driver is given a copy to return to the Cory office. A copy should be retained and an electronic copy of the completed form must be sent to the Trust representative shown at the bottom of the form Cory will email confirmation of destruction to the named personnel within a 48 hour period, the named personnel will contact each site if there is an issue over destruction or if the bag has not been notified as having been destroyed. Produced by: Records Management office Shared Services – Waste Cory Environmental

Page 42 of 87

Document Reference Code: IC/016/14 Hazardous Waste Form

Consignment Request Part A - Notification Details 2.The waste described below is requested to be removed from (name, address, postcode. tel, email, fax)

4. The Waste will be taken to (name, address, postcode)

Peake (GB) Ltd. Liskeard Cornwall Budget Code: 3. Premises code (where applicable): or write " EXEMPT"

5. The waste producer was (if different from2) (name, address, postcode)

Part B - Description of Waste 1. The process giving rise to the waste(s) was:

2. SIC for the process giving rise to the waste

HEALTHCARE

5

8

/

/ 1

1

0

3.Waste details (where more than one waste type is collected all the information given must be completed for EWC identification) Description of

List of Wastes

waste

EWC code (6 digits)

Qty

Chemical/Bio components Component

Concentration

Physical Form ie Gas

Hazard

Container type

Code

Number & size

The information below is to be completed for each EWC identified (where appropriate for transport) EWC code

Packing groups

UN identification Number(s)

Proper shipping Names

UN

Special handing

classes

requirements

Guidance Notes for example only Part A To enable us to complete Hazardous Waste Consignment Notes prior to collection please fill in Part A 2, 3 (and 5 ifapplicable). If your premises are exempt from registration under the regulations write "EXEMPT" in box 3.

Part B We require a description of the Waste including European Waste Code (EWC) etc. To assist you we have listed below some examples. The regulations state that the producer must provide the collector with the description of the waste. Therefore, if your waste does not appear in this list or you are unsure of the relevant coding please contact us or the Environment Agency.

Example 1. The process giving rise to the waste(s) was;

2. SIC for the process giving rise to the waste

/

HEALTHCARE

Page 43 of 87

Document Reference Code: IC/016/14

3.Waste details (where more than one waste type is collected all the information given must be completed for EWC identification) Description of

List of Wastes

Component

Concentration

Physical Form ie Gas

8

Cytoxic

N/K or %

Mixed

H6, H7, H10

7

Cyoststic

N/K or %

Mixed

1

7

Fixer/Developer

N/K or %

Liquid

1

2

1

Mercury

N/K or %

Solid

H6, H7, H10 H3, H5, H14, H15 H3, H5, H14, H15

1

2

3

CFC

N/K or %

Mixed

H3, H5, H14

1

3

5

Non cfc

N/K or %

Mixed

H3, H5, H14

waste Cytotoxic & Cytostatic

1

8

0

1

0

Medicines

1

8

0

2

0

Photo Chemicals

2

0

0

1

Florescent tubes

2

0

0

ELF's (Fridges)

2

0

0

ELF's (Fridges)

2

0

0

Qty

EWC code (6 digits)

Chemical/Bio components

Hazard

Container type

Code

Number & size

Please ensure the coloured area is complete before sending When completed please email to: [email protected] or (if email not available) post to Envirionmental Services along with coversheet giving contact name and telephone number

Page 44 of 87

Document Reference Code: IC/016/14

1

2

3 4

5 6

7

8

9

10

11

12

13

14 15 16 17 18

Departmental Waste Handling and Disposal Clinical waste posters and/or a waste policy identifying waste segregation are available in all areas All bags are tied, labelled and secured before leaving the place of generation (e.g. ward) All waste bins are enclosed to minimise the risk of injury All waste bins in the area are foot operated, lidded and in good working order All waste bins are visibly clean Supplies of bins labelled as "Clinical", "Household", “Hazardous” or "Glass and Aerosol" are available Nursing staff are aware of waste segregation procedures (Randomly question a Nurse) Medical staff are aware of waste segregation procedures (Randomly question a Doctor) Allied Health Care Professionals (AHP) are aware of waste segregation procedures (Randomly question an AHP) Ancillary staff are aware of waste segregation procedures (Randomly question an Ancillary Staff member) Staff are using correct waste bags for household, glass, aerosols, batteries and clinical/hazardous waste (Visibly check bin contents) All prescription only medicines must be disposed of as hazardous/special waste and the bin labelled accordingly Glass and aerosol boxes are not used for prescription only medicine bottles Waste bags are removed at least daily There is no transfer of clinical waste from one bag to another There are no overfilled bags. Bags are no more than 2/3 full Waste bags are not tied onto containers/trolleys Suction waste must be disposed of in

Yes

No

N/A

Comments

Page 45 of 87

Document Reference Code: IC/016/14

19

20

21 22

a manner which prevents spillage UN approved rigid burn bins are available for disposal of body parts, equipment etc. Staff have attended a training session which includes the correct and safe disposal of clinical waste Internal storage is inaccessible to the public or locked Bags are not observed in corridors. They are stored in an appropriate holding area

Page 46 of 87

Document Reference Code: IC/016/14 Appendices Appendix 1 – Confidential Waste Collection Form Appendix 2 – Legislation References Appendix 3 – Category A Infectious Waste List Appendix 4 – Hazardous Waste Form Appendix 5 – Waste Colour Coding Appendix 6 – European Waste Catalogue Codes Appendix 7 – Hazard Codes Appendix 8 – Hazard Signage for COSHH and Transportation Purposes Appendix 9 – COSHH Assessment of Healthcare Waste Appendix 10 – Disinfection of Equipment (Medical Devices) Appendix 11 – Community Generated Clinical Waste: Cornwall Council Application Form Appendix 12 – Blank Waste Assessment Form Appendix 13 – Protocol for Disposal of Building Waste

Page 47 of 87

Document Reference Code: IC/016/14 Appendix 1 – Confidential Waste Collection Form Trust Name: tick as appropriate

□ PCH □ CPfT

GP

□

RCHT

□ SBS □ KCCG

□

NHS England Multiple

□

NHS Kernow

□

□

Locality Site: Collection Date:

Collection time: CONFIDENTIAL WASTE COLLECTION

Bin/Bag Seal Number

Bin

Bag

Service/Location

Seal/Bin Damaged

Total number of items:

DRIVER SIGNATURE ------------------------- PRINT NAME --------------------------(CORY ENVIRONMENTAL) RELEASED BY ---------------------------------- PRINT NAME -------------------------Number of new bags and seals delivered: (Required for billing purposes) Email confirmation of destruction to: CFT [email protected] RCHT [email protected] PCH & Others [email protected] Page 48 of 87

Document Reference Code: IC/016/14

Bin/Bag Seal Number

Bin

Bag

Service/Location

Seal/Bin Damaged

Total number of items:

Page 49 of 87

Document Reference Code: IC/016/14 Guidance Note for the completion of the Confidential Waste Seal Number Recording Template 1.

Under the Trust name tick the applicable Trust, if you are releasing confidential waste from multiple trusts, please indicate this in the Service/Location box

2.

Under the Locality site enter a building title or name in order for us to be able to distinguish the premises. E.G. Truro Health Park or CRCH.

3.

Under collection date enter the date on which the collection is to be made.

4.

Under collection time record the time at which collection was made.

5.

Under seal number record all the seal numbers displayed on the tags around the tops of the confidential waste sacks. Bags with seal numbers not recorded or incorrectly sealed will be refused.

6.

Under bin bag check boxes please indicate the appropriate collection method for each seal number.

7.

Under Service/Location indicate trust, if different from check box at top of form, and also what service the waste relates to. E.G. podiatry or District Nursing.

8.

Under Seal/Bin Damaged please check this box if the collection unit is not secured correctly or damaged, as this indicates tampering with the confidential waste. If this occurs it is your responsibility to report it on the incident management system applicable to your trust.

9.

Ensure that the driver signs for collection and also prints their name where indicated. All drivers must report to reception areas prior to collecting the waste so that the releasing officer can ensure that the necessary paperwork is completed.

10.

Confidential waste awaiting collection should be ready on the designated day at an agreed collection point

11.

Only designated people should be releasing the confidential waste to Cory and they should sign and print their name on the completed sheet where indicated.

12.

It is essential that for every confidential waste collection a form is completed and the driver is given a copy to return to the Cory office. A copy should be retained and an electronic copy of the completed form must be sent to the Trust representative shown at the bottom of the form

Cory will email confirmation of destruction to the named personnel within a 48 hour period; the named personnel will contact each site if there is an issue over destruction or if the bag has not been notified as having been destroyed.

Page 50 of 87

Document Reference Code: IC/016/14 Appendix 2 – Legislation, References and Further Information The legislation currently applicable in this policy includes the following Acts and their associated Regulations, Orders and approved Codes of practice.                            

Control of Pollution Act 1974 Health and Safety at Work etc. Act 1974 Environmental Protection Act 1990 Carriage of Dangerous Goods & Use of Transportable Pressure Equipment Regulations 2009 Control of Substances Hazardous to Health Regulations 2002 ADR Hazardous Waste Regulations 2005 Environmental Protection (Duty of Care) Regulations 1991 Reporting of Injuries, Diseases & Dangerous Occurrences Regulations 1995 The Waste Management (England & Wales) Regulations 2006 The Landfill (England and Wales) Regulations 2002 (amended 2004, 2005) The Landfill (Maximum Landfill Amount) Regulations 2011 Controlled Waste (England & Wales) Regulations 2012 Controlled Waste (registration of Carriers and Seizure of Vehicles) Regulations 1991 The Lists of Waste Regulations 2005 Genetically Modified Organisms (Contained use) Regulations 2000 amended 2002 & 2005 Animal By-Products (Enforcement England) Regulations 2011 Environmental Permitting Regulations 2010 Management of Health & Safety at Works Regulations 1999 Health & safety (consulting with employees) Regulations 1996 The Safety Representatives and safety Committee Regulations 2003 Waste Electrical and Electronic Equipment (WEEE) Regulations 2006 Restriction of Hazardous Substances (ROHS) Regulations 2006 „Safe Management of Healthcare Waste‟ issued by DoH 2012 Site Waste Management Plans Regulations 2008 The Health & Social Care Act 2012 Integrated Pollution Prevent Control 2008 The Waste Batteries & Accumulators Regulations 2009

Page 51 of 87

Document Reference Code: IC/016/14 References and websites for further information: Department of Health

www.dh.gov.uk

Environment Agency - Waste section Department of Farming and Rural Affairs NHS Purchasing and Supply Agency – waste section Healthcare Standards Unit

www.environment-agency.gov.uk/buisiness/topics/waste

Department of Trade and Industry

www.ukti.gov.uk

Waste management Industry Training and Advisory Board Chartered Institute of Waste Management Sanitary Medical Disposal Services Association Health & Safety Executive

www.wamitab.org.uk

Waste Watch

www.wastewatch.org.uk

National Performance group Lets recycle

Advisory

www.defra.gov.uk/environment/

www.hcsu.org.uk

www.ciwm.co.uk www.smdsa.com www.hse.gov.uk

www.npag.org.uk www.letsrecycle.com/index.jsp

Waste Resource Action Plan

www.wrap.org.uk

Recycle Now

www.recyclenow.com/

Cornish real Nappy Project

www.crnp.org.uk/

Paper pack

www.paper-pack.co.uk

Cory Environmental Ltd

www.coryenvironmental.co.uk

Peake (GB) Ltd

Home.btconnect.com/peake-gb-ltd/

Cornwall County Council

www.cornwall.gov.uk

ReMaDe Kernow

www.remadekernow.co.uk

Cornwall NHS – waste Minimisation website on Intranet Radioactive Protection Advisor: Trevelyan Foy

http://intra.cornwall.nhs.uk/Intranet/AZServices/W/WasteMa nagementServicesRCHT/WasteManagementServicesRCHT [email protected]

Page 52 of 87

Document Reference Code: IC/016/14 Appendix 3 – Indicative examples of Category A Clinical Waste                                              

Bacillus anthracis (cultures only) Brucellas abortus (cultures only) Brucellis melitensis (cultures only) Brucellis suis (cultures only) Burkholderia mallei – Pseudomanas mallei – Glanders (cultures only) Burkholderia Pseudomallei – Pseudomanas Pseudomallei (cultures only) Chlamydia psittaci – avian strains (cultures only) Clostridium botulinum (cultures only) Coccidioides immitis (cultures only) Coxiella burnetti (cultures only) Crimean-Congo hemorrhagic fever virus Dengue virus (cultures only) Eastern equine encephalitis virus (cultures only) Escerichia coli, virotoxigenic (cultures only) Ebola virus Flexal virus Francisella tularensis (cultures only) Guanarito virus Hantaan virus Hantaviruses causing hantavirus pulmonary syndrome Hendra virus Hepatitus B virus (cultures only) Herpes B Virus (cultures only) Human immunodeficiency virus (cultures only) Highly pathogenic avian influenza virus (cultures only) Japanese Encephalitis virus (cultures only) Junin virus Kyasanur Forest disease virus Lassa virus Machupo virus Marburg virus Monkeypox virus Mycobacterium tuberculosis (cultures only) Nipah Virus Omsk hemorrhagic fever virus Poliovirus (culture only) Rabies virus Rickettsia prowazekii (cultures only) Rickettsia rickettsii (cultures only) Rift valley fever virus Russian spring-summer encephalitis (cultures only) Sabia virus Shigella dysenteriae type 1 (cultures only) Tick-borne encephalitis (cultures only) Variola virus Venezuelan equine encephalitis virus Page 53 of 87

Document Reference Code: IC/016/14   

West Nile virus (cultures only) Yellow fever virus (cultures only) Yersinia pestis (cultures only)

Page 54 of 87

Document Reference Code: IC/016/14 Appendix 4 – COSHH Assessment for Healthcare Waste (Form applicable to specific Trust) Control of Substances Hazardous To Health Regulations 1999 SUMMARY OF COSHH ASSESSMENTS Hospital: Directorate: Item No

Ward/Dept: Ext: Substance

Quantity

Assessor: Title: Freq. Of Use

Duration of Exposure

Persons Exposed

Assessment Date: Review Date: Hazards to Health

Risk H/M/L

Note for substances with a significant risk - a detailed risk assessment should be completed i.e. High or Medium rated substances

Page 55 of 87

Document Reference Code: IC/016/14 EXAMPLE OF COSHH CONTROL SHEET PRODUCT: MANUFACTURER:

Healthcare Waste Healthcare premises i.e. GP, Tattooist, Dentist, Supported Homes, Hospitals, Clinics

SUPPLIER: POTENTIALLY HAZARDOUS CONTENT APPROVED USE/S? PHYSICAL PROPERTIES DATA:

Wastes produced by Healthcare Hazard Group 9, Infectious Infectious Bodily Fluids both wet and dry that have potential to contaminate through disease, microorganism, or toxins present in waste i.e. Blood, Semen, Vaginal Secretions, Cerebrospinal, Synovial, Plerual, Peritoneal, Pericardial, Amniotic

Hazard Groups H6, H7, H9, H10, H11 Cytotoxic waste and other pharmaceutical products excluding saline and other fluids Offensive waste not considered hazardous i.e. Faeces, nasal secretions, sputum, tears, urine, vomit provided not known to be contaminated with above HANDLING PRECAUTIONS:

Waste should be packaged in accordance with the UN guidance and colour coding agreed in the waste policy. i.e. Yellow bags for all anatomical, medicine contaminated waste. Orange bag for pre-treated or infectious treatment waste. Tiger bag for offensive waste. Yellow bag with Purple stripe for cytotoxic waste Sharps bins replicated with colour of lid. Management Policy for full details

STORAGE:

TRANSPORT:

SPILLAGE/DISPOSAL:

FIRE:

Refer to Waste

All healthcare waste should be segregated as above and from other waste types and should be stored safely and securely in locked wheelie bin or a specific storage area used solely for the storage of waste and sited away from public access. Only to be packaged and carried in UN approved containers for transportation, in designated, leak proof, vehicles subject to compliance with the Carriage of Dangerous Goods (ADR). All spillages to be reported through the accident/incident forms and immediate use of spillage kits located on vehicles. Dustpans and brushes supplied to sweep up any sharps spillage 2 x 2kg Dry Powder Fire extinguishers located in vehicle Page 56 of 87

Document Reference Code: IC/016/14 FIRST AID:

In the event of a sharps injury the „Pocket Guide to sharps in the community‟ should be followed. I.e. encourage wound to bleed and cover with waterproof plaster.

ASSESSMENT: DATE:

Take the details from the sharps bin (or retain it), attend the local hospital, contact Occupational Health department and line Manager. All reasonable precautions have been taken December 2013

Page 57 of 87

Document Reference Code: IC/016/14 Appendix 5 – Colour Coding ALL BAGS TO BE SEALED AND LABELLED WITH:

NAME OF WARD or AREA, SITE AND DATE

CLINICAL WASTES Clinical Waste is defined as: (a) “any waste which consists wholly or partly of human or animal tissue, blood or other bodily fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, syringes needles or other sharp instruments, being waste which unless rendered safe may prove hazardous to any person coming into contact with it; and (b) 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” However this can be broken down into the following categories for segregation purposes and to ensure safe disposal at correctly registered and licensed sites Colour of bag / Type of waste and Storage Disposal route container description Infectious waste Yellow bag In locked yellow Incineration only Anatomical waste and wheelie bin with other wastes infected with UN3291 pathogens in category A or „Incineration only‟ medicines marked on front Refer to (Environment Agency guidance) Orange bag

Yellow and black tiger bag

Potentially Infectious waste Pre-treated infectious waste i.e. laboratory waste that has been autoclaved, other treatment waste like soiled dressings

In locked yellow bin with UN3291 marked on front.

Offensive/Hygiene waste Human hygiene waste, In locked yellow bin nappies, and noninfectious waste like plaster casts, disposable equipment, bedding, clothing

Yellow container with Healthcare waste radioactive signage Contaminated with

Locked store in medical physics

Minimum requirement to be „rendered safe‟ Licensed/permitted treatment facility or incinerator

Minimum requirement Licensed Landfill but could also be licensed/permitted treatment facility or incinerator NOT TO BE COMPACTED Incineration at suitably licensed Page 58 of 87

Document Reference Code: IC/016/14

Sharps bin with Orange lid

radioactive material i.e. dressing, tubing from low level radioactive isotopes To be directed in 1st instance to Medical physics department Healthcare waste Consisting of sharps instruments contaminated with blood only i.e. phlebotomy

Pharmaceutical bin/ Medicinal products box yellow lid Cytotoxic bin or bag, Cytotoxic wastes Yellow with purple lid Waste contaminated with any cytotoxic or cytostatic medicinal products

Placenta bin Yellow with red lid

Infectious waste Placenta will be classed as anatomical waste

Amalgam box Clear/white

Amalgam waste Dental amalgam and extracted teeth containing amalgam Small batteries

Battery box White sealable bucket appropriately labelled with ECW codes Florescent tube Florescent tubes from container - black lighting fitments

dept.

facility subject to RSA 1993

Locked storage separate from bagged material

Licensed treatment facility

Locked storage Clearly labelled

Hazardous waste incineration

Yellow wheelie bin designated for this type of waste only with suitable markings

Incineration only

In locked yellow bin or by collection arrangement from a suitable designated cold storage area where collection exceeds 48 hours

Incineration only

Specialised and licensed recovery

Away from sources Licensed treatment of ignition and or hazardous waste public access disposal facility In tube container kept upright to avoid mercury leaching from damaged tubes

Clear bag Recyclable items. „Like In locked clearly with like‟ identifiable wheelie i.e. plastic bottles, cans, bin office paper, magazines & newspapers, small card Black bag

Municipal waste

or

Domestic In locked Cory wheelie bin or blue

Specialised and licensed recovery

Licensed Recycling facilities for recovery

Licensed landfill

Page 59 of 87

Document Reference Code: IC/016/14 General refuse i.e. Part wheelie bin eaten fruit, sandwiches, yoghurt pots, noncontaminated clinical items, crisp packets etc. Hessian sack „marked Confidential waste confidential waste‟ or Any paperwork with confidential waste bin confidential material where departmental shredding is not possible

Locked storage

Shredding and subsequent pulping for recovery

Page 60 of 87

Document Reference Code: IC/016/14 Appendix 6 – European Waste Catalogue codes Type of Waste

European Waste Classification

Sharps (except 18 01 03) 18 01 01 orange lid Body parts and organs including blood bags and blood preserves(except 180103) Wastes whose collection and disposal is subject to special requirements in order to prevent infection Wastes where collection and disposal is not subject to special requirements in order to prevent infection (e.g. plaster casts, linen, disposable clothing, nappies) Chemicals consisting of or containing dangerous substances Chemicals other than those contained in 180106 Cytotoxic and cytostatic medicines

Medicines other than those mentioned in 180108

18 01 02 Red lid / yellow bin

*18 01 03 yellow/orange

*18 01 06

*18 01 10 white pot

18 02 03

Clinical areas, i.e. wards, theatres, clinics, outpatients, labs Clinical areas: i.e. Theatre, haematology, wards, maternity

H6,H9 UN3291 Clinical Waste, Unspecified, Nos

Clinical areas: Isolation wards, GU clinic, labs (when not autoclaved) Clinical areas: i.e. orthopaedics, baby clinics

H2,H3a,H3b,H4, H5,H6,H7,H8, H10,H11,H12, H13, H14, H15

ALL i.e. labs, pharmacy

Labs, pharmacy

18 01 07 *18 01 08 purple lidded bin or purple striped yellow bag 18 01 09 yellow lidded bin

Areas waste likely to be produced

If infectious: See 18 01 03

18 01 04 tiger

Amalgam waste from dental care

Animal healthcare waste

Likely Hazard Codes and UN Numbers for carriage If infectious: See 18 01 03

H6,H7,H10, Clinical areas: UN3291 Clinical i.e. any area treating cancer Waste, Unspecified, patients Nos Clinical areas: i.e. wards, pharmacy H13, H14, H15 mercury Vapour H6, H14, H15 UN2025 Waste Containing Mercury compound, solid. Nos

Dental Units

Medical school Page 61 of 87

Document Reference Code: IC/016/14 Non- infectious Aerosol containers – empty (containing residues of nonhazardous products) Aerosol containers – empty (containing residues of hazardous products like ethanol) Paper and cardboard This will include CONFIDENTIAL WASTE Glass Biodegradable kitchen and canteen waste Clothes Textiles Solvents

yellow 15 01 04

Dental *15 01 10 ALL 20 01 01 20 01 02

Wards, laundry, site services Laundry ALL

20 01 10 20 01 11

Acids *20 10 14 Alkalines *20 01 15 Photochemicals *20 01 17

Florescent tubes and other mercury containing waste Discarded equipment containing chlorofluorocarbons Edible oil and fat Oil and fat other than that mentioned in 200125 Paint, inks, adhesives and resins containing dangerous substances Paint, inks and adhesives other than those mentioned in 200127 Detergents containing dangerous substances Detergents other than mentioned in 201029

ALL Kitchens, canteens

20 01 08

*20 01 13

Pesticides

i.e. pigs heads

*20 01 19 *20 01 21

H3, H14, H8,H7, H10, H3B,H4, H8, H12, H14, H15 H3, H14, H8,H7, Labs, pharmacy, estates H10, H3B,H4, H8, H12, H14, H15 H3, H14, H8,H7, Labs, pharmacy, estates H10, H3B,H4, H8, H12, H14, H15 H5,H6,H8,H14,H12, Dentist, X Ray H14, H15 Containing silver H1 to H14 Fixer H12 H3A,H3B, H4, H5, Estates H6,H8,H11, H14,H15

H5, H6, H7, H10, H11,H14, H15 H14

ALL ALL

*20 01 23 20 01 25 *20 01 26

H14

Kitchens Estates

H14

Printing dept, estates

*20 01 27 Printing dept, estates 20 10 28 *20 01 29 20 01 30

H14, H15

Cleaning dept., theatre, wards Cleaning dept., theatre, wards Page 62 of 87

Document Reference Code: IC/016/14 Batteries and accumulators and unsorted batteries and accumulators containing these batteries Batteries and accumulators other than mentioned in 20 01 33 Discarded electrical equipment and electronic equipment other than those mentioned in 20 01 21 and 20 01 23 containing hazardous components Discarded electrical and electronic equipment other than those mentioned in 20 01 21,20 01 23, 20 01 35 Wood containing dangerous substances Wood other than mentioned in 20 01 37 Plastics Metals Wastes from chimney sweeping Garden and park biodegradable waste Soil and stones Non-biodegradable waste from gardens and parks Mixed municipal waste (black bags) Street cleaning residues Septic tank sludge Waste from sewage cleaning Bulky waste

H14, H15

ALL

*20 01 33 ALL 20 01 34 H14, H15

ALL

*20 01 35

ALL 20 01 36

*20 01 37 20 01 38 20 01 39 20 01 40 20 01 41 20 02 01 20 02 02 20 02 03 20 03 01 20 03 03 20 03 04 20 03 06 20 03 07

To be determined

ALL ALL ALL ALL Estates Estates Estates Estates ALL Estates Estates Estates ALL

Page 63 of 87

Document Reference Code: IC/016/14 Appendix 7 – Hazard Codes H1 H2

H3A

H3B H4

H5 H6

H7 H8 H9

H10

H11 H12 H13 H14 H15

“Explosive” substances and preparations which may explode under the effect of flame or which are more sensitive to shocks or friction than dinitrobenzene “Oxidising” substances and preparations which exhibit highly exothermic reactions when in contact with other substances, particularly flammable substances “Highly Flammable”  liquid substances and preparations having a flashpoint of below 21C (including extremely flammable liquids), or  substances and preparations which may become hot and finally catch fire in contact with air at ambient temperature without any application of energy, or  solid substances and preparations which may readily catch fire after brief contact with a source of ignition and which continue to burn or to be consumed after removal of source of ignition, or  gaseous substances and preparations which are flammable in air at normal pressure, or  substances and preparations which, in contact with water or damp air, evolve highly flammable gases in dangerous quantities “Flammable”: liquid substances and preparation having a flashpoint equal to or greater than 21C and less than or equal to 55C “Irritant”: non-corrosive substances and preparations which, through immediate, prolonged or repeated contact with the skin or mucous membrane, can cause inflammation “Harmful”: substances and preparation which, if they are inhaled or ingested or if they penetrate the skin, may involve limited health risks “Toxic”: substances and preparations (including very toxic substances and preparations) which, if they are inhaled or ingested or if they penetrate the skin, may involve serious, acute or chronic health risks and even death “Carcinogenic” : substances and preparations which, if inhaled or ingested or if they penetrate the skin, may induce cancer or increase its incidence “Corrosive”: substances or preparations which may destroy living tissue on contact “Infectious” : substances containing viable micro-organisms or their toxins which are known or reliably believed to cause disease in man or other living organisms “Toxic for Reproduction” : substances and preparation which, if they are inhaled or ingested or if they penetrate the skin, may produce or increase the incidence of non-heritable adverse effects in the progeny and/or of male or female reproductive functions or capacity “Mutagenic”: an agent that can induce or increase the frequency of genetic mutation in an organism. “Substances releasing toxic gases” “Sensitising”: substances that may render a sensitivity to a it after exposure “Ecotoxic”: substances that may be harmful to the environment or an ecosystem Substances after disposal that yield another substance e.g. a leachate, which may have a hazardous property

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Document Reference Code: IC/016/14 Appendix 8 – Hazard Signage for COSHH and Transporting Purposes

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Document Reference Code: IC/016/14

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Document Reference Code: IC/016/14

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Document Reference Code: IC/016/14 Consignment Request

Consignment Request Part A - Notification Details 2.The waste described below is requested to be removed from (name, address, postcode. tel, email, fax)

4. The Waste will be taken to (name, address, postcode)

Peake (GB) Ltd. Liskeard Cornwall Budget Code: 3. Premises code (where applicable): or write " EXEMPT"

5. The waste producer was (if different from2) (name, address, postcode)

Part B - Description of Waste 1. The process giving rise to the waste(s) was:

2. SIC for the process giving rise to the waste

HEALTHCARE

8

5

1

1

3.Waste details (where more than one waste type is collected all the information given must be completed for EWC identification) Description of

List of Wastes

waste

EWC code (6 digits)

EWC code

Qty

Chemical/Bio components Component

Concentration

Physical Form ie Gas

Hazard

Container type

Code

Number & size

The information below is to be completed for each EWC identified (where appropriate for transport) Proper Packing groups UN identification shipping UN Special handing Number(s)

Names

classes

requirements

Guidance Notes for example only Part A To enable us to complete Hazardous Waste Consignment Notes prior to collection please fill in Part A 2, 3 (and 5 ifapplicable). If your premises are exempt from registration under the regulations write "EXEMPT" in box 3.

Part B We require a description of the Waste including European Waste Code (EWC) etc. To assist you we have listed below some examples. The regulations state that the producer must provide the collector with the description of the waste. Therefore, if your waste does not appear in this list or you are unsure of the relevant coding please contact us or the Environment Agency.

Example 1. The process giving rise to the waste(s) was;

2. SIC for the process giving rise to the waste

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0

Document Reference Code: IC/016/14 HEALTHCARE 3.Waste details (where more than one waste type is collected all the information given must be completed for EWC identification) Description of

List of Wastes

waste

EWC code (6 digits)

Qty

Chemical/Bio components Component

Concentration

Physical Form ie Gas

Hazard

Container type

Code

Number & size

Cytotoxic & Cytostatic

1

8

0

1

0

8

Cytoxic

N/K or %

Mixed

H6, H7, H10

Medicines

1

8

0

2

0

7

Cyoststic

N/K or %

Mixed

H6, H7, H10

Photo Chemicals

2

0

0

1

1

7

Fixer/Developer

N/K or %

Liquid

H3, H5, H14, H15

Florescent tubes

2

0

0

1

2

1

Mercury

N/K or %

Solid

H3, H5, H14, H15

ELF's (Fridges)

2

0

0

1

2

3

CFC

N/K or %

Mixed

H3, H5, H14

ELF's (Fridges)

2

0

0

1

3

5

Non cfc

N/K or %

Mixed

H3, H5, H14

Please ensure the coloured area is complete before sending When completed please email to: [email protected] or (if email not available) post to Envirionmental Services along with coversheet giving contact name and telephone number

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Document Reference Code: IC/016/14 Appendix 9 - COSHH Assessment for Healthcare Waste (Form applicable to specific Trust) Control Of Substances Hazardous To Health Regulations 1999 SUMMARY OF COSHH ASSESSMENTS Hospital: Directorate: Item No

Ward/Dept: Ext: Substance

Quantity

Assessor: Title: Freq. Of Use

Duration of Exposure

Persons Exposed

Assessment Date: Review Date: Hazards to Health

Risk H/M/L

Note for substances with a significant risk - a detailed risk assessment should be completed i.e. High or Medium rated substances

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Document Reference Code: IC/016/14 Example of COSHH Control Sheet PRODUCT: MANUFACTURER:

Healthcare Waste Healthcare premises i.e. GP, Tattooist, Supported Homes, Hospitals, Clinics

Dentist,

SUPPLIER: POTENTIALLY HAZARDOUS CONTENT APPROVED USE/S? Wastes produced by Healthcare PHYSICAL PROPERTIES Hazard Group 9, Infectious DATA: Infectious Bodily Fluids both wet and dry that have potential to contaminate through disease, micro organism, or toxins present in waste i.e. Blood, Semen, Vaginal Secretions, Cerebrospinal, Synovial, Plerual, Peritoneal, Pericardial, Amniotic

Hazard Groups H6, H7, H9, H10, H11 Cytotoxic waste and other pharmaceutical products excluding saline and other fluids Offensive waste not considered hazardous i.e. Faeces, nasal secretions, sputum, tears, urine, vomit provided not known to be contaminated with above HANDLING PRECAUTIONS:

Waste should be packaged in accordance with the UN guidance and colour coding agreed in the waste policy. i.e. Yellow bags for all anatomical, medicine contaminated waste. Orange bag for pre-treated or infectious treatment waste. Tiger bag for offensive waste. Yellow bag with Purple stripe for cytotoxic waste Sharps bins replicated with colour of lid. Refer to Waste Management Policy for full details

STORAGE:

TRANSPORT:

SPILLAGE/DISPOSAL:

All healthcare waste should be segregated as above and from other waste types and should be stored safely and securely in locked wheelie bin or a specific storage area used solely for the storage of waste and sited away from public access. Only to be packaged and carried in UN approved containers for transportation, in designated, leak proof, vehicles subject to compliance with the Carriage of Dangerous Goods (ADR). All spillages to be reported through the accident/incident forms and immediate use of spillage kits located on vehicles. Page 71 of 87

Document Reference Code: IC/016/14

FIRE: FIRST AID:

Dustpans and brushes supplied to sweep up any sharps spillage 2 x 2kg Dry Powder Fire extinguishers located in vehicle In the event of a sharps injury the „Pocket Guide to sharps in the community‟ should be followed. i.e. encourage wound to bleed and cover with waterproof plaster.

ASSESSMENT: DATE:

Take the details from the sharps bin (or retain it), attend the local hospital, contact Occupational Health department and line Manager. All reasonable precautions have been taken December 2013

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Document Reference Code: IC/016/14 Appendix 10 – Disinfected Equipment – Medical Devices Declaration of Contamination Status Hospital:

Hospital:

Ward or Unit:

Ward or Unit:

Equipment Asset number or other identification: Fault description or other instructions:

I certify that this item of equipment has been decontaminated in accordance with the current Trust Policy. Please note that equipment that has not been decontaminated, or is believed to be internally contaminated, must not be transported without the prior agreement of the recipient.

Name:

Position:

Signature:

Date: From:

Telephone: To:

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Document Reference Code: IC/016/14 Appendix 11 – Application for the collection of Clinical Waste Application for the collection of clinical waste (CLINICAL WASTE UN3291) I request a collection of clinical waste from the premises below, and I agree to my nurse named: …….…………………..contact no. ……………………leaving the waste on my premises pending collection. Name

………………………………………………………

Address:………………………………………………………………………………………………………………….. Post code ………………………………………………… ……………………………………..

Telephone number:

Commencement date:……………………… until further notice (please contact the council when this service is no longer required) I hereby agree to allow the council‟s clinical waste collection contractor to collect the waste from the above property. Please advise the location of the pickup point, taking into consideration safety and security as it is your responsibility to keep waste safe. ……………………………………………………………………………………………………………………………… Sign: ………………………………………….

Date: ………………………………………………

How is your waste contained? If unsure please see list of items below.** Orange bag Yellow bag □ Sharps container

Is the waste considered infectious? (Delete as applicable) Tiger bag (Yellow □ with black stripes)

Y/N

□

□

What is the average quantity of waste per week/month in bags? ……………

Sharps bins Frequency of collection? ……………

** Tiger bags should contain things like incontinence pads, nappies and sanitary ware that is not infectious. All other blood contaminated waste should be placed in an orange/yellow bag for incineration. Orange/yellow bags should contain things that are likely to be infectious i.e. dressings, tubing, gloves etc. If in doubt, please check with your nurse. Sharps bins are for sharps items that may protrude from a bag.

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Document Reference Code: IC/016/14

CLINICAL WASTE AND SHARPS COLLECTION This collection is covered under the Environmental Protection Act. It is recommended that you retain a copy of this document to enable you to contact your council should you need to change the arrangements. It is a requirement that you seal and label the bag or sharps container and must include:  

Address. The date.

The following items must not be placed in bags: Sharps or sharps containers Aerosol containers Glass of any sort Pharmaceuticals Non-Clinical Waste

THIS FORM SHOULD BE RETURNED TO: THE WASTE MANAGER CORNWALL COUNCIL ROOM 301 NEW COUNTY HALL TRURO TR1 3AY TEL : 0300 1234 141 FAX : 01209 820922 E- MAIL : [email protected]

FOR OFFICIAL USE ONLY To be completed by healthcare practitioner, tick EWC‟s that apply: 180101 (sharps) 180103 (infectious) 180104 (non-infectious) 180108 (cytotoxic)

□ □ □ □

For council use COLLECTION AUTHORISED SIGNED COMMENTS REQUESTED START DATE

What colour bag has been left with patient?

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Document Reference Code: IC/016/14 Under the Data Protection Act these details provided will only be used by the Councils and NHS Trusts to provide the services outlined in this form.

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Document Reference Code: IC/016/14 Appendix 12 – Blank Waste Assessment Form Assessment to determine waste disposal categories of waste in department/ward Ward and Site and Trust Details: Hazard:

Waste segregation

Risk: 1. Non-compliance of environmental legislation, DoH guidance and Trust policy 2. Risk of prosecution 3. Increased costs 4. Control of infection 5. Fire 6. staff awareness 7. Standards for Better Health compliance 8. manual handling 9. needlestick injuries Current Control Measures provision of colour coded bags/sharps bins Current Risk level

Consequence major (4) likelihood possible (3) = HIGH RISK (12)

Proposed control measures: All staff have been adoption of new policy and colour coding made aware ,in mandatory training folder Nominated lead – (enter name) Yearly mandatory training

Date complete

Awareness and training of staff Provision of posters, stickers

In folder

Number required …………………………….. Details of new ordering codes Proposed Implementation date: (enter date) ……… ………… Removal of old stock Separate storage of foul linen bags and waste bags to avoid mixing Lockable secure storage

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Document Reference Code: IC/016/14

Risk level when Consequence minor (2) likelihood possible MODERATE completed actions (3) RISK (6) Please see over for full details of waste production Details and descriptions of waste produced. Types of Waste i.e. domestic

EWC 20 03 01

Description Tea bags Plastic packaging

Colour coding Black bag

Is it suitable for clinical waste only i.e. yellow or orange bags to be contained in sluice only to avoid access by patients/visitors? Y / N Does this present any additional risks? Training / awareness to be undertaken by nominated person, numbers and details to be attached. Additional Comments/recommendations: ? Storage of linen bags/orange bags Risk assessment completed by:

Representing Waste Dept. Representing ward / dept. / area

Dated: To be retained with Risk assessments and made available for inspection as required Page 78 of 87

Document Reference Code: IC/016/14 Appendix 13 – Protocol for Disposal of Building wastes DISPOSAL OF BUILDING WASTES PROTOCOL FOR CONTRACTORS & PROJECT MANAGERS Legislation on waste disposal is tightly controlled and as a result all Trusts have a duty of care to ensure that all wastes produced on this site are disposed of in a correct manner. This includes waste generated by contractors as well as waste from directly managed inhouse projects. Building wastes are strictly controlled under the Hazardous Waste / List of Wastes Regulations 2004 and it is the duty of the manager responsible for any project to ensure that waste is taken off-site and that the manner in which it is dealt with complies with the legislation. In addition any project over £300,000 to produce Site Waste Management Plan Disposal of Contractor‟s Waste Contractors cannot deposit waste in any of the Trusts compounds or other disposal vehicles on the site due to the following issues: 1.

The waste is generated by Contractors and is therefore their waste. By disposing of it on this site the Trust becomes a Waste Broker. The Trust is not a licensed Waste Broker.

2.

Any waste disposed of from this site has to be done so in accordance with the Regulations. The Trust will not have detailed knowledge or control of the content of Contractor‟s waste and therefore cannot ensure correct disposal.

To ensure the Trust is compliant with legislation a Waste Control Form (proforma attached) must be completed by the Main Contractor for each project and a selected audit will be undertaken annually by the Waste Manager Disposal of Waste – In-House Projects Where a member of staff is responsible for in-house projects that produce waste e.g. departmental re-organisations or clearances, they must ensure wastes are disposed of appropriately. This includes ensuring general wastes do not contain hazardous substances or electrical equipment. The attached Waste Control form shall be completed by the member of staff managing/organising the work requiring waste disposal. If there is any doubt regarding safe disposal of building wastes or any type of waste produced by a contractor or in-house on this site, please contact the Waste Department for advice – ex 3813.

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Document Reference Code: IC/016/14 WASTE CONTROL FORM 1

Contractor or Department producing the waste.

2

Project Title.

3

Project Manager. (This is the person responsible for managing the project but is not necessarily an Estates Manager).

4

Date contract/in-house works commenced.

5

Waste description (e.g. general building waste or specific type).

6

State any special or hazardous wastes (e.g. bituminous mixtures, any material containing a dangerous substance – please contact the Env. Dept. for a full list.

7

Method of disposal.

8

If via a waste contractor please provide name. Disposal site name and location. (e.g. United Mines, Connon Bridge)

9

10 11 12 13 14

Self Waste contractor

□ □

Are copies of consignment notes available? Will water be disposed of on the project site? Where will this be discharged to? Will the water be contaminated with building wastes? (e.g. cement, oils etc.) Are you satisfied any water pollutants will be controlled?

15

Are you satisfied particulate emissions will be controlled (e.g. damping)?

16

If damping is being used: Will the water be contaminated with building wastes? (e.g. cement, oils etc.).

17

Are you satisfied any water pollutants will be controlled? Does the company have a contingency or emergency action plan in the event of accidental release of any controlled Page 80 of 87

Document Reference Code: IC/016/14 pollutant? Are you satisfied this plan is robust? Have you notified the company that in the event of an accidental release they must immediately notify the project manager and Environment Department?

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Document Reference Code: IC/016/14 THIS DOCUMENT IS BEING CIRCULATED FOR A FORMAL CONSULTATION EXERCISE AND IS IN DRAFT FORMAT

Equality Impact Assessment Proforma Initial Screening Section

Safety and Risk: Infection Control

Officer responsible for the assessment

Judith Van Horn

Name of Procedural document to be assessed

Waste Management Policy

Date of Assessment

28.03.2014

Is this a new or existing procedural document?

E

1. Briefly describe the aims, objectives and Purpose of the document is to ensure all staff are aware of their direct responsibility for the safe purpose of the procedural document. and legal disposal of wastes within Cornwall Partnership NHS Foundation Trust in a manner that protects staff, patients and contractors at all times whilst complying with relevant UK Health & Safety, transport and environmental legislation. 2. Are there any associated objectives of the No procedural document? Please explain. 3. Who is intended to benefit from this The Trust plus all staff, patients, visitors, contractors and the general public. procedural document, and in what way? 4. What outcomes are wanted from this Compliance with relevant UK legislation and the provision of a safe environment for all. procedural document? 5. What factors/forces could contribute/detract Non-compliance. from the outcomes? 6. Who are the main stakeholders in relation All trust employees to the procedural document? 7. Who implements the procedural document, Cornwall Partnership NHS Foundation Trust and who is responsible for the procedural document? N Please explain 8. Are there concerns that the procedural Y document could have a differential impact on RACIAL groups? √

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Document Reference Code: IC/016/14 THIS DOCUMENT IS BEING CIRCULATED FOR A FORMAL CONSULTATION EXERCISE AND IS IN DRAFT FORMAT

What existing evidence (either presumed or otherwise) do you have for this? 9. Are there concerns that the procedural document could have a differential impact due to GENDER What existing evidence (either presumed or otherwise) do you have for this? 10. Are there concerns that the policy could have a differential impact due to DISABILITY? What existing evidence (either presumed or otherwise) do you have for this? 11. Are there concerns that the policy could have a differential impact due to SEXUAL ORIENTATION? What existing evidence (either presumed or otherwise) do you have for this? 12. Are there concerns that the procedural document could have a differential impact due to their AGE? What existing evidence (either presumed or otherwise) do you have for this? 13. Are there concerns that the procedural document could have a differential impact due to their RELIGIOUS BELIEF? What existing evidence (either presumed or otherwise) do you have for this?

Y

N √

Y

N √

Y

N √

Y

N √

Y

N √

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Document Reference Code: IC/016/14 THIS DOCUMENT IS BEING CIRCULATED FOR A FORMAL CONSULTATION EXERCISE AND IS IN DRAFT FORMAT

14. Are there concerns that the procedural document could have a differential impact due to their MARRIAGE OR CIVIL PARTNERSHIP STATUS? (This MUST be considered for employment policies). What existing evidence (either presumed or otherwise) do you have for this? 15. Are there concerns that the procedural document could have a differential impact due to GENDER REASSIGNMENT OR TRANSGENDER ISSUES? What existing evidence (either presumed or otherwise) do you have for this? 16. Are there concerns that the procedural document could have a differential impact due to PREGNANCY OR MATERNITY? What existing evidence (either presumed or otherwise) do you have for this?

Y

N √

Y

N

Y

N √

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Document Reference Code: IC/016/14 THIS DOCUMENT IS BEING CIRCULATED FOR A FORMAL CONSULTATION EXERCISE AND IS IN DRAFT FORMAT

17. How have the Core Human Rights Values of: This document applies equally to all trust employees.     

Fairness; Respect; Equality; Dignity; Autonomy

Been considered in the formulation of this procedural document/strategy If they haven‟t please reconsider the document and amend to incorporate these values.

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Document Reference Code: IC/016/14 THIS DOCUMENT IS BEING CIRCULATED FOR A FORMAL CONSULTATION EXERCISE AND IS IN DRAFT FORMAT

18. Which of the Human Rights Articles does The right: this document impact?  To life;  Not to be tortured or treated in an inhuman or degrading way;  To be free from slavery or forced labour;  To liberty and security;  To a fair trial;  To no punishment without law;  To respect for home and family life, home and correspondence;  To freedom of thought, conscience and religion;  To freedom of expression;  To freedom of assembly and association;  To marry and found a family;  Not to be discriminated against in relation to the enjoyment of any of the rights contained in the European Convention;  To peaceful enjoyment of possessions and education;  To free elections What existing evidence (either presumed or otherwise) do you have for this? N/A How will you ensure that those responsible for implementing the Procedural document are aware of the Human Rights implications and equipped to deal with them? N Please explain 19. Could the differential impact identified in 8 – Y 13 amounts to there being the potential for √ adverse impact in this procedural document?

Y

N √ √ √ √ √ √ √ √ √ √ √ √ √ √ √

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Document Reference Code: IC/016/14 THIS DOCUMENT IS BEING CIRCULATED FOR A FORMAL CONSULTATION EXERCISE AND IS IN DRAFT FORMAT

20. Can this adverse impact be justified on the grounds of promoting equality of opportunity for one group? Or any other reason? If Yes, describe why, and then proceed to a full EIA. 21. Should the procedural document proceed to a full equality impact assessment? If No, are there any minor further amendments that should take place? 22. If a need for minor amendments is identified, what date were these completed and what actions were undertaken

Y

N

Please explain for each equality heading (questions 8 –13) on a separate piece of paper.

√

Y

N √

Not required

Y

N

N/A

Signed (completing officer)

Date

Signed (Service Lead)

Date

28/03/2014

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