Continence waste

Nursing, care and residential homes produce many different waste types, some of which may require special handling and disposal.

Continence waste presents a daily requirement for assessment for waste disposal.

Those who are responsible for the disposal of continence waste will know that this is an area potentially subject to a plethora of regulatory regimes affecting waste management practices within healthcare and non-healthcare organisations.

Classifying incontinence pads correctly and separating them out is probably the biggest saving that can be made in waste management according to The Health Technical Memorandum 07-01: Safe Management of Healthcare Waste.

This highlights wasted energy in the unnecessary treatment of non-infectious wastes and the potential for significant costs savings.

The Health Technical Memorandum 07-01: Safe Management of Healthcare Waste was produced and updated in partnership with DEFRA and the Department for Transport with the supporting cooperation of the regulators (Environment Agency and the Health and Safety Executive).

It provides an update to the Health Technical Memorandum 07-01 first published in 2006. It was published by the Department of Health on 20 March 2013 and provides guidance on the safe management of healthcare waste.

Issues that commonly arise and which fall to be dealt with within the regulatory framework are health and safety, environmental, infection control and transport requirements.

If you produce, carry, import, keep, treat or dispose of waste, you have a legal ‘duty of care’ to make sure your waste is handled safely and only passed to people authorised to receive it.

The polluter pays principle means that producers of waste are responsible for its management and disposal. Failure to comply with the duty of care can result in a fine.

To effectively manage waste generated as a result of healthcare activities, those responsible for the management of the waste should understand and must comply with the requirements of the various regulatory regimes, which include:

1. environment and waste
2. controlled drugs
3. infection control
4. health and safety
5. transport

The EU Waste Framework Directive requires all member states to take the necessary measures to ensure waste is recovered or disposed of without endangering human health or causing harm to the environment and includes permitting, registration and inspection requirements.

In the UK, the requirements and responsibilities for waste management are largely contained in the Environmental Protection Act 1990 and regulations made thereunder:

• The Environmental Protection (Duty of Care) Regulations 1991;
• The Waste (England and Wales) Regulations 2011;
• The Environmental Permitting (England and Wales) Regulations 2010;
• The Hazardous Waste (England and Wales) Regulations 2005; and
• The List of Wastes Regulations 2005.

The definition and classification of waste is carried out in accordance with guidance from the Environment Agency.

WM2 is a guidance document based on supporting European Directives. WM2 uses a colour coded European Waste Catalogue (EWC) to identify hazardous and non-hazardous waste. The appropriate EWC code must be included on both waste transfer and consignment notes. Multiple coding is common in healthcare waste.

Classification of healthcare waste is carried out within a waste assessment framework. Disposal of waste will be by reference to classification.

Healthcare waste is assessed depending on the type of waste and the waste stream. Assessment is very different depending on the source.

Consideration will be given to whether the waste is a healthcare waste or similar type (i.e. waste arising from municipal sources which is similar to healthcare waste. This may be the case in some nursing settings).

Specifically included under chapter 20 of the EWC are human hygiene wastes (sanitary products, nappies, incontinence waste etc.).

Where it is considered to be healthcare waste, it will be necessary to assess each element of the waste for medicinal chemical and infectious properties as appropriate.

The waste item will be classified as clinical or non-clinical and hazardous or non-hazardous with reference to the definitions in the Controlled Waste Regulations 2012 and Waste Framework Directive (12.12.208).

This must be done before considering offensive properties unless where otherwise directed by the assessment process advised by the Department of Health.

Healthcare waste that is not clinical or hazardous after the assessment of medicinal chemical and infectious properties is subject to an assessment to determine if it is offensive/hygiene waste.

Care homes that provide nursing or medical care are considered to produce healthcare waste and are assessed as such through the assessment framework referred to above including determination of whether the waste is dangerous for carriage.

Incontinence pads are not always clinical/infectious waste and can often be classed as offensive. Incontinence pads are not generally regarded as infectious waste unless patients have a urinary tract infection.

Offensive/hygiene waste is healthcare waste or similar waste from municipal sources which meets the following criteria:

1. It is not clinical waste
2. It is not dangerous for carriage
3. The producer has identified, after segregation at source, that it is suitable for disposal at a non-hazardous land fill site without further treatment
4. It may cause offence to those coming into contact with it.

Offensive/hygiene waste is assessed differently depending on the source.

Offensive/hygiene waste includes waste previously described as human hygiene waste and sanpro waste. Potentially offensive/hygiene waste may include:

1. Incontinence and other waste produced from human hygiene
2. Sanitary waste
3. Disposable medical veterinary/medical veterinary items and equipment that do not pose a risk of infection, including PPE (that is items that are not clinical waste)
4. Animal faeces and soiled animal bedding.

Waste items classified as offensive/hygiene waste are classified as non-hazardous and non- clinical waste under the following EWC codes:

• 18 01 04 (Human Healthcare);
• 18 02 03 (Animal Healthcare); or
• 20 01 99 (Municipal).

Offensive/hygiene waste is not infectious; therefore for transport purposes, it is not classified as dangerous goods.

Healthcare waste generated as a result of activities undertaken by healthcare workers who provide services outside of the hospital to:

• Patients in their home;
• Residents of care homes (without nursing care);
• Householders who are self-medicating and self-caring is dealt with in accordance with community healthcare guidance in The Health Technical Memorandum 07-01: Safe Management of Healthcare Waste.

“Patients in their own homes” is stated to include those living in assisted living premises where there is onsite monitoring of residents’ activities to help to ensure their health, safety and wellbeing.

Where there is provision of healthcare services by NHS and non-NHS healthcare providers (for example group homes), the community sector guidance will apply.

A waste risk assessment will classify waste as infectious and/or offensive/hygiene waste.

Unless infectious (and assessments should be on a patient-specific basis), community healthcare waste should be segregated and managed as offensive/hygiene waste and segregated at source and packaged and treated as offensive/hygiene waste.

In principle, this should not be placed in domestic waste.

Incontinence pads used in healthcare visits in homes are potentially exempt depending on the quantity produced.

A quantity of less than 7kg is generally considered to be a reasonable indicator. This seems to be a weight, that is considered to be within domestic/householder usage. In this situation, it could be disposed of in the black bag stream with other waste.

The controllers of waste have a duty of care to ensure that waste is disposed of in accordance with the regulations. It is unfortunate that the guidance from the Department of Health is complex and does not easily provide answers to common queries which arise in practice.

The approach has to be that a correct assessment of the waste stream and classification of waste items has to take place at an early stage.

Systems should be in place that allow for easy identification of the waste in accordance with the regulatory framework and analysis of the requirements undertaken in accordance with the appropriate regime.

Time and costs can be saved by early identification of the waste stream and where there is any dispute with the authorities with regard to the appropriate waste management process, this should be raised early on with the local authority and their agencies to ensure that no penalties are incurred.

Local authorities have specific duties in relation to healthcare waste and in most cases should be the first port of call with queries. Care home managers should not be worried about querying the processes and making appropriate arrangements in relation to specific premises.