Managing healthcare wastes

Managing healthcare waste safely through appropriate waste classification, segregation and treatment.

Healthcare practices must follow the guidance Healthcare Technical Memorandum 07-01: safe management of healthcare waste, which explains how to segregate healthcare wastes. They should also use colour-coded packaging (bags and rigid containers) into which they only put the waste types specified.

Correctly classifying and segregating healthcare waste at source makes sure that the right waste goes to the right place for appropriate storage and treatment. Segregating waste based upon type and properties means that it can be treated effectively and efficiently. It also helps divert certain wastes (for example, offensive wastes) away from more costly and energy intensive treatment processes. This means that more waste can be sent to alternative recycling and recovery operations.

The most important step in this process is that healthcare practices producing the waste make sure they rigorously segregate their wastes at source. They must check and confirm through an audit that they are doing this on an ongoing basis.

As part of your waste pre-acceptance procedures you must obtain and assess the results of the waste audits carried out at producer premises. You must do this before you first accept waste from a producer and then at regular intervals, as set out in this guidance.

When you receive waste at your permitted healthcare waste facility, you must inspect the contents of each cart or similar bulk container and check to see that the contents match those expected.

In this document, the term ‘bulk container’ means a large, rigid, enclosed secondary container. For example, this includes 770 litre wheeled carts used to store and transfer healthcare wastes packaged in bins, bags or boxes. This is a different definition to the one specified in UN 3291, and the European Agreement concerning the International Carriage of Dangerous Goods by Road (ADR), because it does not include vehicles or vehicle trailers.

Because healthcare wastes are potentially infectious, it is difficult to open each container or bag at waste sites to check that they contain only the correct waste. If you comply with the requirements of this guidance, the Environment Agency has agreed that you do not need to check the contents of individual containers or bags received at your site. In these instances, you can check and confirm that the waste is appropriate for storage and treatment based on its colour-coded packaging. If it is you can accept it.

The waste types listed in the healthcare waste table cover the typical range of wastes produced at sites that provide human and animal healthcare. For each waste type, the table provides the:

  • relevant List of Waste (LoW) code(s)
  • appropriate waste management activity (storage includes transfer)
  • colour-coding of the packaging

Some wastes are given 2 or more LoW codes. If you receive multi-coded wastes (for example, medicinally contaminated infectious sharps), your site must have a permit that allows you to receive all of the individually identified LoW codes. If you move waste specified in the table from one site to another, you must include all of the LoW codes relevant to the waste on the consignment note or transfer note.

Energy from waste (municipal waste incineration) or landfill are acceptable disposal methods for carefully segregated offensive hygiene wastes. In England, these wastes are put into yellow bags with a black stripe, otherwise known as ‘tiger’ bags. You must provide justification if you want to use your alternative treatment plant for the treatment of offensive hygiene wastes, or other non-infectious wastes. You will need to demonstrate that the alternative treatment will enhance the recovery or recycling of waste and is an efficient use of energy.

For carefully segregated infectious healthcare wastes you can use chemical or heat-based disinfection as an alternative treatment to incineration. These wastes are put into orange bags, or orange-lidded rigid yellow containers. The waste must not contain or be contaminated with:

  • anatomical waste
  • chemicals
  • medicines

You should send for incineration all anatomical, chemical and medicinal wastes, including wastes that are medicinally or chemically contaminated. Wastes containing cytotoxic or cytostatic medicines require high temperature incineration (that is at temperatures greater than 1,000°C).

You must provide a detailed justification for the alternative treatment of any anatomical waste, or waste containing or contaminated with medicines or chemicals. Your justification must demonstrate that:

  • all pharmaceutically active substances (hazardous or non-hazardous) will be destroyed
  • chemicals will be fully treated and not diluted and released to the environment
  • anatomical waste will be fully destroyed and any chemicals (for example, preservatives) will be fully treated

The appropriate measures set out in this guidance apply to all waste received at permitted healthcare waste facilities, including waste received from producers outside of England. If you receive waste from producers outside of England, you must make sure you will still comply with all the waste pre-acceptance requirements, for example, by obtaining waste producer audit reports.

You must also make sure that the approved testing and validation of your treatment plant (based upon worst-case challenge load) remains valid, taking into account the type(s) and composition of waste you will accept for treatment.