audiometry

Handling and disposing of clinical and other waste


Waste refers to materials we need to dispose of. Much of the waste generated in a health care situation can be safely disposed of in the same way as we dispose of normal household waste. But some waste from health care establishments can pose infection and other public health risks. This includes any waste contaminated with blood or body fluids.

Clinical waste includes the following categories:
• discarded sharps
• laboratory waste directly associated with specimen processing
• human tissues, including material or solutions containing free-flowing blood
• animal tissue or carcasses used in research.

Related waste includes:
• cytotoxic waste (waste that is poisonous to living cells)
• pharmaceutical waste
• chemical waste
• radioactive waste.

General waste includes other wastes that do not fall into the above categories. Most waste generated by health care establishments such as a hearing clinic is general waste and is of no more public health risk or concern than household waste.

Risks

Waste that includes blood or other body fluids or body tissue may carry infection. For example, blood from a patient infected with HIV, HBV or HCV can transmit these viruses to a non-infected person if it comes in contact with non-intact skin, or enters their body through the mouth, eyes or other mucous membranes.

Waste involving sharps can be hazardous to handle because of:
• direct injuries it can cause through cuts and body penetrations
• infection that may be transmitted from blood or other body fluids the sharps have come in contact with.

Cytotoxic waste may be harmful to touch or inhale.
Radioactive waste can be harmful if there is prolonged exposure or if high levels of radiation are involved. This can have genetic effects or contribute to the development of cancer.

Standards and guidelines

Waste from the hearing clinic should be handled with care. All occupational health and safety precautions as well as State and Territory legislation and environment protection policies and regulations must be followed when dealing with waste.
If you are able to access the Australian standard AS/NZ 3816:1998 – ‘Management of clinical and related wastes’, familiarise yourself with it. It may be available in your workplace or at a TAFE library.
To find out about the scope of this standard: www.saiglobal.com/shop/Script/Details.asp?DocN=stds000020780

The following document can be downloaded:
NSW Health (1998) Waste management guidelines for health care facilities (PD2005_132) NSW Health, North Sydney
www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_132.pdf

Environmental protection agencies


Visit the website of the environmental protection agency in your state or territory:
Department of Environment and Climate Change, NSW - www.epa.nsw.gov.au

Environmental Protection Agency, Queensland - www.epa.qld.gov.au

Environment Protection Authority, South Australia - www.epa.sa.gov.au

Environment Protection Authority, Victoria - www.epa.vic.gov.au

Environmental Protection Authority, Western Australia - www.epa.wa.gov.au

Before looking at the various types of wastes we deal with in the hearing clinic we should keep waste minimisation in mind. Appropriately sorted waste will reduce the overall cost to the practice. Re-use and recycle where possible.
Wear appropriate personal protective clothing and equipment in accordance with occupational health and safety policies and procedures when handling waste

Personal protective equipment (PPE) and clothing refers to any protective item designed to minimise the effects of hazards and reduce risks of injury to staff in the workplace. The appropriate use of PPE should be vigorously enforced and the choice of PPE and clothing should be appropriate for the task. PPE should be well maintained and appropriate signage should be positioned in areas where PPE should be used. All PPE and clothing should comply with current, relevant Australian Standards.
Remember that when dealing with waste, appropriate gloves must be worn where recommended. These may include general purpose utility gloves for cleaning and emptying waste bins or non-sterile gloves used when dealing with clinical waste. Clinics that generate reasonably large amounts of clinical waste such as a large medical clinic should, in addition to providing gloves, provide other PPE items to staff such as masks and/or face shields, gowns or fluid-resistant aprons.

Separate waste at the point where it has been generated and dispose of into waste containers that are colour-coded and identified
Waste should be separated according to its category as close to the point of use as possible.
Waste should be bagged or contained and clearly labelled.

Waste categories
Colour coding of waste disposal containers:
Normal waste - Black, white or green containers are used for normal waste, which is waste that has not been contaminated with blood or blood-contaminated body fluids.

Disposal of normal waste - This waste is disposed of by landfill (or recycling if appropriate).
Remember to recycle any office waste where appropriate.

Clinical/infectious waste - Yellow containers are used for clinical/infectious waste. Yellow rigid-walled containers are used for sharps. Both of these types of containers should be labelled with the clinical waste symbol.

Clinical waste
Clinical waste is waste that has the potential to cause sharps injury, infection or offence. When packaged and disposed of appropriately there is virtually no public health significance
climicalwaste.png

Clinical waste includes the following types of waste:
• sharps
• human tissue (excluding hair, teeth and nails)
• bulk body fluids and blood
• blood stained fluids and blood stained disposable material and equipment.

Clinical waste should be segregated and contained at the source of generation.
Clinical waste bags:
• must have sufficient strength to contain the waste safely
• should not be overfilled
• should be tied or sealed, and then stored in a secure place for collection
• should not be transported in chutes
• should be yellow with the “bio-hazard” symbol printed on the bag.

All waste should be handled with care to avoid injury. Heavy duty gloves and protective clothing must be work when handling clinical waste bags and containers.
Workers involved in disposal of blood or body substances (including emptying of urine and other fluid collection bags) must:
• wear appropriate PPE
• minimize splashing or contamination to mucosa or skin
• ensure that disposable products containing liquids are sealed, not emptied, before disposal into clinical waste bags and containers.

Disposal of clinical/infectious waste - Sharps require incineration by a licensed contractor.
Non-sharps may be incinerated or steam sterilised by autoclaving, and then disposed of in supervised landfills.
In office-based practices, small volumes of blood, urine or faeces can be disposed of via the sewerage system, but disposal of a large volume of clinical waste must follow local regulations.

Cytotoxic waste
cytotoxic.png
Purple containers with the cytotoxic waste symbol are used for cytotoxic waste.
Disposal of cytotoxic waste - Cytotoxic waste requires incineration at 1100°C. This must be carried out by a licensed contractor.

Radioactive waste
radioactive.png
Red containers with the radiation symbol are used for radioactive waste.
Disposal of radioactive waste - Radioactive waste must be disposed of by a licensed contractor.
Dilute isotopes may be disposed of via the sewerage system in accordance with relevant guidelines.

Source: Infection Control (Health) Toolbox. © Australian National Training Authority (ANTA) 2004. All rights reserved

Store clinical or related waste in an area that is accessible only to authorised persons
The collection and disposal of clinical waste depends on the location and size of the health care establishment.
Depending on the size of the hearing clinic, waste may be removed daily, weekly, or less often. Adequate waste storage facilities must be available. Clinical waste should be stored in a locked area (such as a cage) located in a suitable site/area. This area should be suitably signposted and kept secured at all times. There should be clear access to waste facilities and these areas must only be accessed by trained personnel.
Handle, package, label, store, transport and dispose of waste appropriately to minimize potential for contact with the waste and to reduce the risk to the environment from accidental release

Storage and transport of waste

Containers storing clinical waste should be securely closed and clearly labelled. Labels should make it clear what type of material is stored inside (eg infectious, cytotoxic).
Trolleys used for transport of infectious or other hazardous waste should be clearly labelled as such, and should only be used for waste transport. They should be:
• fitted with drip trays to contain leaks or spills
• never overfilled
• cleaned daily.

After collection from clinical areas waste should be stored in a central area which:
• has a non-absorbent floor and an impervious surface that can contain any spillage from waste containers
• is vermin-proof
• is used only for storage of waste
• is kept locked, with access only to authorised people
• is signposted with appropriate biohazard symbols
• has an adequate spills kit
• is adequately cleaned
• is refrigerated for clinical waste.

Procedures for disposal of waste should follow national guidelines or Codes of Practice and must comply with state/territory and local regulations. Generally, this requires collection by contractors accredited by the Environment Protection Authority (EPA) in trucks which have appropriate transport permits and biohazard signage.
Dispose of waste safely in accordance with policies and procedures of the organisation and legislative requirements

What are some specific wastes in your clinic?

Compare your list with the following:
• general waste such as office waste or paper towels, food scraps.
• clinical waste such as items contaminated by blood or pus which were used during ear cleaning or ear spearing procedures
• soiled nappies, if in large amounts
• sharps.

Remember:
• Any discarded sharps must be disposed of as close to the site of use as possible. The latest guidelines state that ‘whoever generates the sharp is responsible for its disposal’.
• Recycle or re-use where possible things such as photocopying paper.
• Use non-disposal items such as crockery and utensils, wherever possible.

Now discuss this information with your employer and other staff. Remember to refer to the material safety data sheets for the products that you use. Local councils and states and territories sometimes vary with their requirements. Add this information to your practice’s policy if you haven’t already done so. For information on local ordinances relating to your area contact your local council.