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[[Category:Tonnage & Waste Types]]
[[Category:Tonnage & Waste Types]]
[[Healthcare Waste]] is waste produced during human or animal healthcare, or related research activity, and covers both '''Clinical Waste''' and '''Offensive Waste''' as defined in the [[Controlled Waste (England and Wales) Regulations 2012]]<ref>[https://www.gov.uk/guidance/healthcare-waste-appropriate-measures-for-permitted-facilities/definition-of-healthcare-waste .GOV definition of Healthcare Waste]</ref> and further listed below. Helathcare Waste containing radioactive materials requirements compliance with specific guidance<ref>[https://www.gov.uk/government/collections/radioactive-substances-regulation-for-non-nuclear-sites The Radioactive Substances Regulation Guidance]</ref>.
[[Healthcare Waste]] is waste produced during human or animal healthcare, or related research activity, and covers both '''Clinical Waste''' and '''Offensive Waste''' as defined in the [[Controlled Waste (England and Wales) Regulations 2012]] <ref>[https://www.gov.uk/guidance/healthcare-waste-appropriate-measures-for-permitted-facilities/definition-of-healthcare-waste Definition of Healthcare Waste]</ref> and requires specific management measures. Healthcare Waste containing radioactive materials requirements compliance with specific guidance<ref>[https://www.gov.uk/government/collections/radioactive-substances-regulation-for-non-nuclear-sites The Radioactive Substances Regulation Guidance]</ref>.
[[File:Healthcare waste pic.jpg|280px|left|Picture of Healthcare Waste packaging from Herefordshire CGC report]]__TOC__
[[File:Healthcare waste pic.jpg|280px|left|Picture of Healthcare Waste packaging from Herefordshire CGC report]]__TOC__
<br clear='left'/>
<br clear='left'/>
==Clinical Waste==
==Clinical Waste==
'''Clinical Waste''' is [[Healthcare Waste]] that:  
'''Clinical Waste''' is [[Healthcare Waste]] that:  
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==Offensive Waste==
==Offensive Waste==
'''Offensive Waste''' is:
'''Offensive Waste''' is non-infectious waste which is unpleasant and may cause offence to those coming into contact with it. It includes<ref name="Net">[https://www.netregs.org.uk/environmental-topics/waste/managing-waste-materials/offensive-waste/ NetRegs]</ref>:
*is not clinical waste
*outer dressings and protective clothing e.g. masks, gowns and gloves that are not contaminated with body fluids
*contains body fluids, secretions or excretions
*hygiene waste and sanitary protection e.g. nappies and incontinence pads
*falls within [[EWC]] waste codes [[EWCChap18 | 18 01 04]], [[EWCChap18 | 18 02 03]] or [[EWCChap20 | 20 01 99]]
*autoclaved laboratory waste.
*falls within [[EWC]] waste codes [[EWCChap18 | 18 01 04]], [[EWCChap18 | 18 02 03]] or [[EWCChap20 | 20 01 99]].


==Types of Healthcare Waste - Packaging Colour==
Offensive waste does not include <ref name="Net" />:
The types of [[Healthcare Waste]] are grouped and designated by packaging colour, set out in high level guidance<ref>[https://assets.publishing.service.gov.uk/media/5f05a7fae90e0712d0206e88/Types_of_healthcare_waste_table.pdf Types of Healthcare Waste]</ref> updated and published by the [[EA]] in July 2020 for regulated facilities with an [[Environmental Permit]] to [[Treatment|treat]] or [[Waste Transfer Station |transfer Healthcare Waste]]. These groupings are set out in a table in the guidance, captured below:
*sharps
*anatomical waste e.g.body parts, organs or blood
*chemicals, medicines
*dental amalgam
*any waste that is infectious (i.e. a clinical waste)
 
==Management of Healthcare Waste==
The management of Healthcare Wastes is set out in '''Healthcare Technical Memorandum 07-01 - Safe Management of Healthcare Waste'''<ref name='Tech1'>[https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/167976/HTM_07-01_Final.pdf Link to pdf document]</ref> which replaced the Safe Management of Healthcare Waste in 2013 <ref>Published in 2006, this removed the clinical waste classification system categorising into 5 types; A to E</ref>. Management of Healthcare Waste for regulated facilities with an environmental permit is the subject of guidance issued in July 2020 <ref>[https://www.gov.uk/guidance/healthcare-waste-appropriate-measures-for-permitted-facilities Healthcare Waste:Appropriate Measures for Permitted Facilities]</ref> by the [[EA]] which sets out appropriate measures in the following sections: 
 
* When appropriate measures apply
* Definition of Healthcare Waste (as set out in the table below)
* Managing healthcare wastes
* General management appropriate measures
* Waste pre-acceptance, acceptance and tracking appropriate measures
* Waste storage, segregation and handling appropriate measures
* Waste treatment appropriate measures (including assessment and validation requirements)
* Emissions control appropriate measures
* Emissions monitoring and limits appropriate measures
* Process efficiency appropriate measures
 
==Healthcare Waste - Packaging Colour and Appropriate Waste Management==
The types of [[Healthcare Waste]] are grouped and designated by packaging colour set out in the table below (can be bag colour or lid colour)<ref>[https://assets.publishing.service.gov.uk/media/5f05a7fae90e0712d0206e88/Types_of_healthcare_waste_table.pdf Types of Healthcare Waste]</ref> <ref name ='Tech1'/>:


{| class="wikitable"
{| class="wikitable"
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!colspan="3"| Colour of Packaging: Orange
!colspan="3"| Colour of Packaging: Orange
|-
|-
|Appropriate healthcare waste management activities||Storage, alternative treatment or incineration
|Appropriate healthcare waste management activities||Storage, '''alternative treatment or [[Incineration]]'''
|-
|-
|rowspan=5|Waste types and List of Waste (LoW) code(s)||rowspan=5|Infectious waste, not contaminated with chemicals or medicines
|rowspan=5|Waste types and List of Waste (LoW) code(s)||rowspan=5|'''Infectious waste''', not contaminated with chemicals or medicines
|-
|-
|human healthcare (may contain sharps) - [[EWCChap18|18 01 03*]]
|human healthcare (may contain sharps) - [[EWCChap18|18 01 03*]]
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! colspan="3"|Colour of Packaging: Yellow
! colspan="3"|Colour of Packaging: Yellow
|-
|-
|Appropriate healthcare waste management activities||Storage and incineration
|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''
|-
|-
|rowspan=6|Waste types and List of Waste (LoW) code(s)||rowspan=3|Infectious waste, contaminated with chemicals:
|rowspan=6|Waste types and List of Waste (LoW) code(s)||rowspan=3|'''Infectious waste''', contaminated with chemicals:
|-
|-
|human healthcare - [[EWCChap18|18 01 03*]] and [[EWCChap18|18 01 06*]] or [[EWCChap18|18 01 07]]
|human healthcare - [[EWCChap18|18 01 03*]] and [[EWCChap18|18 01 06*]] or [[EWCChap18|18 01 07]]
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|animal healthcare - [[EWCChap18|18 02 02*]] and [[EWCChap18|18 02 05*]] or [[EWCChap18|18 02 06]]
|animal healthcare - [[EWCChap18|18 02 02*]] and [[EWCChap18|18 02 05*]] or [[EWCChap18|18 02 06]]
|-
|-
|rowspan=3|Infectious waste, medicinally contaminated (not cytotoxic or cytostatic):
|rowspan=3|'''Infectious waste''', medicinally contaminated (not cytotoxic or cytostatic):
|-
|-
|human healthcare (may contain sharps) - [[EWCChap18|18 01 03*]] and [[EWCChap18|18 01 09]]
|human healthcare (may contain sharps) - [[EWCChap18|18 01 03*]] and [[EWCChap18|18 01 09]]
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! colspan="3"|Colour of Packaging: Red
! colspan="3"|Colour of Packaging: Red
|-
|-
|Appropriate healthcare waste management activities||Storage and incineration
|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''
|-
|-
|rowspan=12|Waste types and List of Waste (LoW) code(s)||rowspan=3|Infectious anatomical waste, chemically preserved:
|rowspan=12|Waste types and List of Waste (LoW) code(s)||rowspan=3|Infectious '''anatomical waste''', chemically preserved:
|-
|-
|Human healthcare – [[EWCChap18|18 01 03*]] and [[EWCChap18|18 01 06*]] or [[EWCChap18|18 01 07]]
|Human healthcare – [[EWCChap18|18 01 03*]] and [[EWCChap18|18 01 06*]] or [[EWCChap18|18 01 07]]
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|Animal healthcare – [[EWCChap18|18 02 02*]] and [[EWCChap18|18 02 05*]] or [[EWCChap18|18 02 06]]
|Animal healthcare – [[EWCChap18|18 02 02*]] and [[EWCChap18|18 02 05*]] or [[EWCChap18|18 02 06]]
|-
|-
|rowspan=3|Infectious anatomical waste, not chemically preserved:
|rowspan=3|Infectious '''anatomical waste''', not chemically preserved:
|-
|-
|Human healthcare – [[EWCChap18|18 01 03*]]
|Human healthcare – [[EWCChap18|18 01 03*]]
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|Animal healthcare – [[EWCChap18|18 02 02*]]
|Animal healthcare – [[EWCChap18|18 02 02*]]
|-
|-
|rowspan=3|Non-infectious anatomical waste, chemically preserved:
|rowspan=3|Non-infectious '''anatomical waste''', chemically preserved:
|-
|-
|Human healthcare - [[EWCChap18|18 01 02]] and [[EWCChap18|18 01 06*]] or [[EWCChap18|18 01 07]]
|Human healthcare - [[EWCChap18|18 01 02]] and [[EWCChap18|18 01 06*]] or [[EWCChap18|18 01 07]]
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|Animal healthcare - [[EWCChap18|18 02 03]] and [[EWCChap18|18 02 05*]] or [[EWCChap18|18 02 06]]
|Animal healthcare - [[EWCChap18|18 02 03]] and [[EWCChap18|18 02 05*]] or [[EWCChap18|18 02 06]]
|-
|-
|rowspan=3|Non-infectious anatomical waste, not chemically preserved:
|rowspan=3|Non-infectious '''anatomical waste''', not chemically preserved:
|-
|-
|Human healthcare - [[EWCChap18|18 01 02]]
|Human healthcare - [[EWCChap18|18 01 02]]
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! colspan="7"|Colour of Packaging: Purple
! colspan="7"|Colour of Packaging: Purple
|-
|-
|Appropriate healthcare waste management activities||Storage and incineration
|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''
|-
|-
|rowspan=6|Waste types and List of Waste (LoW) code(s)||rowspan=3|Cytotoxic and cytostatic medicines:
|rowspan=6|Waste types and List of Waste (LoW) code(s)||rowspan=3|'''Cytotoxic and cytostatic''' medicines:
|-
|-
|Human healthcare – [[EWCChap18|18 01 08*]]
|Human healthcare – [[EWCChap18|18 01 08*]]
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|Animal healthcare – [[EWCChap18|18 02 07*]]
|Animal healthcare – [[EWCChap18|18 02 07*]]
|-
|-
|rowspan=3|Infectious waste, contaminated with cytotoxic and cytostatic medicines:
|rowspan=3|Infectious waste, contaminated with '''cytotoxic and cytostatic''' medicines:
|-
|-
|Human healthcare (may contain sharps) - [[EWCChap18|18 01 03*]] and [[EWCChap18|18 01 08*]] or [[EWCChap20|20 01 31*]]
|Human healthcare (may contain sharps) - [[EWCChap18|18 01 03*]] and [[EWCChap18|18 01 08*]] or [[EWCChap20|20 01 31*]]
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! colspan="3"|Colour of Packaging: Blue
! colspan="3"|Colour of Packaging: Blue
|-
|-
|Appropriate healthcare waste management activities||Storage and incineration
|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''
|-
|-
|Waste types and List of Waste (LoW) code(s)||Other waste medicines, excluding cytotoxic and cytostatic medicines||[[EWCChap18|18 01 09]], [[EWCChap18|18 02 08]] or [[EWCChap20|20 01 32]]
|Waste types and List of Waste (LoW) code(s)||Other '''waste medicines''', excluding cytotoxic and cytostatic medicines||[[EWCChap18|18 01 09]], [[EWCChap18|18 02 08]] or [[EWCChap20|20 01 32]]
|-
|-
! colspan="3"|Colour of Packaging: Black and Yellow ('tiger bags')
! colspan="3"|Colour of Packaging: Black and Yellow ('tiger bags')
|-
|-
|Appropriate healthcare waste management activities||Storage, incineration or landfill. Compaction, where specifically permitted.
|Appropriate healthcare waste management activities||Storage, '''[[Incineration]]''' or '''[[Landfill]]'''. Compaction, where specifically permitted.
|-
|-
|rowspan=4|Waste types and List of Waste (LoW) code(s)||rowspan=3|Non-infectious offensive waste:
|rowspan=4|Waste types and List of Waste (LoW) code(s)||rowspan=3|Non-infectious '''offensive waste''':
|-
|-
|Human healthcare – [[EWCChap18|18 01 04]]
|Human healthcare – [[EWCChap18|18 01 04]]
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! colspan="3"|Colour of Packaging: Not Specified
! colspan="3"|Colour of Packaging: Not Specified
|-
|-
|Appropriate healthcare waste management activities||Storage, incineration or landfill. Compaction, where specifically permitted.
|Appropriate healthcare waste management activities||Storage, '''[[Incineration]]''' or '''[[Landfill]]'''. Compaction, where specifically permitted.
|-
|-
|rowspan=4|Waste types and List of Waste (LoW) code(s)||rowspan=3|Non-infectious offensive waste:
|rowspan=4|Waste types and List of Waste (LoW) code(s)||rowspan=3|Non-infectious '''offensive waste''':
|-
|-
|Human healthcare – [[EWCChap18|18 01 04]]
|Human healthcare – [[EWCChap18|18 01 04]]
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|Municipal, separately collected fractions of absorbents, wiping cloths and protective clothing ||[[EWCChap15|15 02 03]] not contaminated by infectious substances
|Municipal, separately collected fractions of absorbents, wiping cloths and protective clothing ||[[EWCChap15|15 02 03]] not contaminated by infectious substances
|}
|}
==Treatment and Disposal of Healthcare Waste==
With regard to the table above, it can be seen that there are options for '''incineration''' and '''alternative treatment''' and in some specific cases [[landfill]] is acceptable.
===Incineration===
For [[incineration]], Healthcare Waste will normally be incinerated in [[High Temperature and Clinical Waste Incineration]]. Some [[Residual Waste EFW]] incinerators are able to dispose of specific Clinical Waste streams, and as a result of the COVID-19 pandemic the [[EA]] published a Regulatory Position Statement (RPS C23) clarifying the circumstances where COVID-19 waste can be [[Incineration|incinerated]] with Municipal Waste Waste ([[MSW]]) until July 2021. <ref>[https://www.gov.uk/government/publications/incinerating-specified-healthcare-wastes-at-a-municipal-waste-incinerator-rps-c23/incinerating-specified-healthcare-wastes-at-a-municipal-waste-incinerator-rps-c23#conditions-you-must-comply-with RPS C23]</ref>
===Alternative Treatment===
There are several types of Alternative Treatments (AT) available for the treatment of [[Healthcare Waste]] all of which must demonstrate that the [[Healthcare Waste]] is 'rendered safe'<ref name='Tech1'/>. 'Rendered safe' means:
* demonstrates the ability to reduce the number of infectious organisms present in the waste to a level at which no additional precautions are needed to protect workers or the public against infection from the waste;
* destroys anatomical waste such that it is no longer generally recognisable;
* renders all Clinical Waste (including any equipment and sharps) unusable and unrecognisable as Clinical Waste;
* destroys the component chemicals of chemical or medicinal and medicinally-contaminated waste.
such treatments include:
* [[Autoclaving]]
* [[Microwaves]]
* [[Irradiation]]
* [[Chemical Disinfection]]
* [[Dry Heat]]
* [[Thermal Disinfection]]
Mechanical Treatment is also available as a pre-treatment option for any of the AT's outlined above. By pulverising, shredding, crushing etc the [[Healthcare Waste|waste]] this results in a reduction of the volume of the [[Healthcare Waste|waste]] by 60% plus although it does not kill any pathogens, microorganisms or disinfect equipment<ref>[https://www.malsparo.com/treat2.htm Malsparo]</ref>.
==NHS Management of Healthcare Waste [[ERIC]]==
The [[wikipedia:National Health Service| NHS]] report their management of Healthcare Waste via the Estates Returns Information Collection ('''[[ERIC]]''') dataset<ref>https://digital.nhs.uk/data-and-information/publications/statistical/estates-returns-information-collection</ref> which gives a break down the tonnage, management approach, and associated cost of waste - including Healthcare/Clinical Waste. The figure below for the ERIC data over the last four years shows a downward trend for Healthcare Waste going to incineration<ref>The data for 2017 and 2018 is on a different basis within ERIC and represents the total waste sent for incineration, leading to an exaggeration of the drop in incineration in the figure</ref><ref>For the data for 2020/21 the figure produced by Monksleigh adjusts the ERIC data for 4 NHS Trusts that appear to have reported in kg rather than tonnes. This is the subject of a review by NHS Digital as it also impacts the Clinical Waste tonnage treated as a whole by the NHS estate</ref> (against a backdrop of increasing tonnage overall, notwithstanding the impacts of the [[wikipedia: COVID-19|pandemic]], this means increasing tonnage has gone to treatment). The figure also shows that the proportion of waste incinerated from the [[wikipedia:National Health Service| NHS]] has dropped relative to the total Healthcare Waste incinerated - reflecting that non-NHS facilities (such as private hospitals, care homes etc)<ref>https://digital.nhs.uk/services/organisation-data-service/file-downloads/non-nhs-organisations</ref> have relied more heavily on incineration than treatment for the management of their waste over recent years.
[[File:NHS Tonnage Incinerated vs Total.png|500px|center|NHS Clinical Waste Incinerated vs total Clinical Waste Incinerated - all rights reserved Monksleigh Ltd]]


==References==
==References==
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<references />
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