What is healthcare waste?

Clinical wasteThe regulatory and legislative requirements surrounding the management of clinical waste can be confusing at times. This confusion can be further compounded by the differing legislative and regulatory regimes experienced across the UK’s devolved administrations.

Although there are a few subtle differences in the way The Scottish Environment Protection Agency (SEPA) regulates the management of healthcare waste in Scotland, the majority of the guiding principles are consistent throughout the UK.

In the UK, clinical waste or healthcare waste is the term used to describe waste produced from healthcare and similar activities that may pose a risk of infection or may prove hazardous.

Different meaning
It can have different meanings to different people and can be defined in different ways, however, the most commonly used definition, can be found in the Controlled Waste Regulations 1992. In practice, healthcare waste can be divided into two categories of waste materials:
• waste which poses a risk of infection
• medicinal waste.

There is no specific legislation pertaining to healthcare wastes other than paragraph 28 (use of autoclaves) and 39 (secure storage) exemptions found in the Waste Management Licensing Amendment (Scotland) Regulations 2006. Non-hazardous healthcare wastes will be subject to the usual Duty of Care whilst hazardous healthcare waste will be subject to the provisions of the Special Waste Regulations 1996 as amended.

Classification and assessment
UK waste producers (except those producing domestic waste) have a legal requirement (Duty of Care) to describe any waste it produces or disposes of using a classification system called the European Waste Catalogue (EWC). This catalogue classifies waste materials and categorises them according to what they are and how they were produced. Healthcare wastes can be found in sub chapters 18 01 (wastes from natal care, diagnosis, treatment or prevention of disease in humans) and 18 02 (wastes from natal care, diagnosis, treatment or prevention of disease in animals) of the EWC.

The codes assigned by the waste producer should reflect the practices that give rise to the waste. If a container contains a number of wastes then care must be taken to assign the most appropriate code, normally the absolute hazardous waste code if any such waste is present. Assigning the most appropriate code is essential to ensuring that the waste is handled, treated and disposed of appropriately.

Clinical or healthcare waste may be hazardous or non hazardous and like all wastes it must be classified and assessed appropriately. Guidance on the classification and assessment of clinical waste as special (hazardous) waste can be found in the guidance document ‘Hazardous Waste: Interpretation of the definition and classification of hazardous waste (WM2)’.

SEPA takes the view that unless it can be satisfactorily demonstrated that healthcare wastes, i.e. those described by Chapter 18 of the EWC and EWC 20 01 31, have been adequately segregated and categorised then its default position is that “healthcare waste should be assumed to be special (hazardous) waste until and unless proved otherwise”.

Prescription only medicines
Since July 2004 most prescription only medicines (POMs) ceased to be special waste, although they may still fall under other regimes, e.g. be controlled drugs, only cytotoxic and cytostatic medicines are now classified as special (hazardous) waste. However, each individual medicine should be assessed fully as other dangerous substances may be present potentially making it hazardous or special waste.

Hygiene wastes, which generally comprise of used sanitary towels, disposable nappies from toilets and baby changing areas in places of work, leisure and entertainment facilities etc. are neither clinical nor hazardous waste. This is because these wastes are assumed to arise from a generally healthy population and hence the risk of infection is very low. This is very important as there is often pressure to (mis)classify san-pro waste as hazardous healthcare waste for aesthetic reasons.

The Scotland and Northern Ireland Forum for Environmental Research (SNIFFER) has produced a guidance document, which provides assistance to those managing hygiene waste produced as a direct result of healthcare and non-healthcare activities.

Management of healthcare waste
Clinical waste should be segregated from other types of waste and be treated and disposed of appropriately in suitably permitted, licensed or exempt facilities on the basis of the hazard it poses. The majority of clinical or healthcare waste producers will devise and implement their own policies and procedures however the NHS, the biggest producer of clinical/healthcare waste in the UK, is an excellent source of guidance.  

NHS Scotland has produced the Scottish Hospitals Technical Note 3 (SHTN3) guidance on the segregation arrangements for all wastes, healthcare and otherwise, arising at NHS Scotland premises.

In brief, SHTN3 specifies that NHS Scotland’s wastes (not only healthcare/clinical wastes) are segregated into colour coded groups as follows:
• Green – recyclable waste (newspapers, drinks cans and bottles etc)
• Black – mixed municipal (non hazardous) waste
• Orange – ‘low risk’ special waste
• Yellow – ‘high risk’ special waste
• Red – ‘irregular’ special waste.

Elsewhere in the UK, guidance is taken from a Department of Health (DH) document entitled ‘Health Technical Memorandum 07-01: Safe Management of Healthcare Waste’. This document has been produced by the DH as a best practice guide to the management of healthcare waste.

In Scotland, and elsewhere in the UK, infectious wastes from any source is prohibited from being landfilled, i.e. pre-treatment (be rendered safe) prior to landfilling is required. In practice pre-treatment will involve either incineration or the use of alternative technologies such as microwaves, autoclaves and hot oil or steam injection augers etc.

Special waste v hazardous waste
The majority of healthcare waste produced in Scotland is likely to be classified as special waste, elsewhere in the UK and the EC it will be referred to as being hazardous waste. In Scotland, the terms special waste and hazardous waste mean the same thing and are interchangeable.

Under Scottish law, special waste is any waste that is defined as hazardous by the European Hazardous Waste Directive. Special waste has hazardous properties that may make it harmful to human health or the environment and, consequently strict laws control how it is managed.

The Special Waste and hazardous regimes differ across the various UK borders. The key differences being that in Scotland there is no need for premises producing special waste to register with SEPA as producers of hazardous waste. Furthermore, the requirement to pre-notify for some movements of special waste still exists. Further guidance on the UK’s hazardous waste or special waste regimes can be found on the NetRegs website.

In Scotland all movements of special waste must be accompanied by a Special Waste Consignment Note (SWCN). The SWCN consists of five different coloured, self carbonising pages, each with five sections, which refer to a different aspect of the waste transfer.

Changing face of waste management
Earlier this year the Scottish Government published their plans for a zero waste society. It’s a vision where all types of waste are dealt with, regardless of where they are produced, from households to businesses to public sector organisations.

Everyone has their part to play in this vision, including those producing hazardous and non-hazardous healthcare waste, and make sure Scotland benefits from the economic and environmental advantages to be gained from zero waste. Zero Waste Scotland is the organisation created to support delivery of the Zero Waste Plan. It will serve as a one-stop-shop for businesses and individuals looking for advice or support on how to use resources more efficiently, reduce waste and recycle more.

Achieving zero waste will make a positive contribution to Scotland’s climate change and renewable energy targets as more waste is prevented, less waste is sent to landfill, and more resources are reused, recycled and recovered. A zero waste society will also support sustainable economic development as new waste facilities mean new investment and job opportunities and as businesses become more resource efficient, costs are reduced and a competitive advantage is gained.

Managing waste through modern and effective regulation is essential to Scotland’s success both now and for the future. In order to reduce waste production and to significantly increase the reuse, recycling and sustainable treatment of Scotland’s waste, a modern and effective approach to regulation is required. We also need a system that people and businesses can trust and respect, however, the situation is complex as there are local, regional, national and global issues to consider.

Nevertheless, both SEPA and the Scottish Government wish to simplify the current system and maintain our current high levels of environmental and human health protection.

SEPA and the Scottish Government remain committed to the principles of better regulation. A regime designed around better regulatory principles should:
• eliminate outdated or unnecessary provisions in legislation
• consolidate, streamline or merge regulatory regimes where possible
• base regulatory permitting, inspection and enforcement on sound risk principles
• ensure where companies break the law that enforcement can be swift and effective
• minimise the administrative burdens on companies and regulators wherever possible
• empower regulators to enforce regulations in a fair, consistent and proportionate manner
• promote best practice and advice to regulated companies wherever possible.

For more information
Web: www.sepa.org.uk