Waste management

When developing a waste management policy, employers need to consider and identify optimal strategies for:

• minimising human contact with waste (including strategies to reduce or avoid double handling)
• incorporating standard precautions, including appropriate use of personal protective equipment
• avoiding manual compaction of any waste
• ensuring safe transfer of waste from clinical areas to the waste storage area
• safe storage
• ensuring correct documentation for clinical waste transporter, as required by the relevant environmental protection authority.

The policy must incorporate and align with the practice’s procedures to deal with spills and protocols for managing exposure to blood or other body substances.

The practice must nominate a person responsible for waste management. Their responsibilities may include:

• monitoring appropriate waste disposal (eg checking that waste is being appropriately segregated)
• acting as the contact person for waste transport/disposal companies
• providing task-specific waste management education for staff.

Monitoring can involve photographing the visible contents (top layer) of each bin at random intervals to assess content.

Waste needs to be segregated into the waste streams required by local authorities. Categories and requirements differ between jurisdictions. Practice waste typically falls into the categories of general waste, clinical waste, and clinical-related waste (Table 9.7. Examples of waste streams).

Staff must segregate waste as it is generated. The practice must provide a separate bin for each waste stream. Bins must be made of appropriate material, big enough, placed in the right position, and emptied regularly.

The correct packaging is the responsibility of the practice, and staff must have training in the handling and disposal of wastes.

Waste segregation and handling in the practice may be subject to specific requirements of the state or territory environmental protection authority. This may include documentation of waste composition. Waste transport and disposal companies may be required to notify practices in writing of waste segregation requirements, and may refuse to collect waste that is incorrectly segregated or unsafely presented.

Table 9.7. Examples of waste streams

All practices must meet national standards for waste management, but specific categories and requirements differ between jurisdictions. Practices must consult their state or territory environmental protection authority or other relevant local authority responsible for waste management.

Clinical waste containers must be puncture-resistant and leak-proof.

Standard clinical waste containers must be:

• rigid-walled
• located in an area that prevents unauthorised access
• sealable with a secure lid or lined with a standard labelled bag that can be tied off
• safe for disposal – no swing lids or loose lids (ideally with hands-free operation)
• appropriately labelled: yellow, displaying a biohazard symbol, and labelled ‘clinical waste’.

Liquid clinical waste must be absorbed using an absorbent (‘clumping’) agent such as cat litter or polymerising beads, then bagged (preferably double-bagged) to avoid leakage and potential for splash.

Sharps containers must meet the current Australian standard. They should be mounted either on a wall or bench or trolley at the point of care. The recommended height above the ground is 1.3 m to limit child access but allow the user to see the opening. Mounted sharps containers may be designed specifically to remove blades. The ‘do not fill above this line’ instruction must be strictly followed for the safety of all staff.

Cytotoxic waste containers for sharps must have the same properties as sharps containers. They must be purple, display the telophase symbol on white background, and be labelled ‘cytotoxic waste’.

Cytotoxic waste containers for non-sharps must have the same properties as clinical waste containers. They must be purple, display the telophase symbol on white background, and be labelled ‘cytotoxic waste’.

Unused or expired pharmaceuticals can be returned to pharmacies for safe disposal. Full or partial vaccine vials can alternatively be disposed of in a sharps container. These items must be managed as clinical waste.

Practices must consider their waste segregation practices and decide on what type of containers are required.

Practices may provide receptacles for disposal of recyclables (eg appropriately placed separate waste and confidential waste bins, glass and plastic recyclables bins).

Before collection and disposal, clinical and related waste must be appropriately stored:

• The storage area should be dedicated to waste storage (no mixing with other stored materials such as supplies). Separate spaces should be designated for clinical waste and general waste (eg by tape or paint on the floor).
• The storage area should be appropriately signed.
• Clinical waste bags may need to be removed from small bins and tied off safely and transferred to the storage bin. Double-bagging when transferring will reduce leakage of bags. Clinical waste should not be decanted from one bag to another.
• Bags should remain within secure outer containers that are appropriately labelled.
• The waste storage area should be secure (not accessible to the public). Accessible free-standing or secured bins, even with locked lids, may still pose a risk if placed in a yard at the rear of the practice. The waste collection company may require after hours access via code or key.

A spill kit could be located in the storage area or nearby.

General waste must be stored in covered receptacles such as rubbish bins in a secure location. This can be in the same area as the clinical waste bins, but each should be in a separate, defined area.

Practices that provide services off site (eg aged care or home visits) will need to manage and safely store clinical waste such as sharps in private vehicles. Practices must check regulations for transporting waste in their state or territory.

The waste collection company replaces full bins with clean empty lined bins. Contractors do not debag any bins on site – this is done mechanically at the waste treatment site.

Clinical and related waste must be transported by a licensed transport and disposal company that offers appropriate treatment and disposal services. The practice is responsible for waste it has generated until it has been rendered safe.

The transport/disposal company may refuse to collect from overflowing, wrongly segregated or unlabelled bins.

Practices must document clinical waste collection and keep these records.