SICP 9: Safe disposal of waste (including sharps)

S.P.I.C.E the Strategy: Prevention, Isolation, Containment and Elimination  

All care homes and nursing homes will have a range of different waste that requires safe disposal. It is important that waste is disposed of appropriately and as close to the point of use as possible to reduce the risk of an infection being transmitted. This is a fundamental safety process. Waste must be viewed as potentially hazardous. If waste is not disposed of correctly it may lead to an injury or infection.

Waste has a timeline of events to consider from the point the waste is collated to the point it is disposed, to ensure infection risks are reduced as far as possible.

Waste Streams

Through this SICP three types of waste streams are going to be considered.

Type of Waste	Description
Yellow Clinical Bags	Infectious Waste Items contaminated with urine, faeces, vomit, sputum, wound exudate. This could be from a known infection source or a potential infection source. PPE is disposed of in the yellow clinical bags. Offensive/hygiene waste is also disposed of in the yellow clinical waste bags. All items disposed in the yellow clinical bags are ‘contained’ through various infection prevention and control strategies in place
Black Bags	Black bags are for domestic waste. Items that do not contain any infectious or potentially infectious materials can be disposed of in the black bags. This can include disposable paper towels. Food waste can also be disposed into black bags
Recycling Materials	Recycling all recyclable materials is a preferred option as it helps to support the environment This includes newspapers, rinsed cartons, plastic milk bottles, cardboard, food packaging’s.

The waste streams detailed in the following table are the waste streams of most care and nursing homes. The waste management company are to be contacted if alternative colour bags are supplied.

Safe Management of Waste

The threat and actual presence of COVID 19 within care home has seen a significant increase in the waste generated by a care home. The need to have an increase in safe waste disposal has seen an increase in the number of clinical waste bins in individual ensuite bathrooms and dedicated doffing areas [areas where PPE is removed]. All clinical waste bins are to be operated by a foot pedal.

All clinical waste is treated as though it is infected. This is major strategy in reducing the risk of infections being transmitted once materials such as PPE, incontinence products, dressing bodily fluids have been disposed of in a yellow clinical waste bin.

Owing to the increase in the number of clinical waste bins and through the periods of sustained transmission the operating systems to ensure the safe removal of waste is mow different than before the pandemic.  

Standard operating Procedure for the Disposal of Clinical Waste

Availability of Clinical Waste Bins

1. If a person has an ensuite room and they are being cared for in their room for isolation or choice, then a clinical waste bin is to be placed in their ensuite.
2. Dedicated doffing areas are identified throughout the different zones of the care home. A clinical waste bin is to be accessible in each doffing area
3. The additional requirements for clinical waste bins require an increase in the supply of yellow bags to ensure a short fall does not occur.

Containing Potential and Confirmed Infections before Disposing Products in the Clinical Waste Bin

The Evolve guidance when managing clinical waste is that infected waste is to be double bagged prior to disposal. By having used PPE ‘contained’ when disposed lowers the risk of potential transmission from re-aerosolisation of virus particles from contaminated PPE.

1. Aprons are doffed into the used gloves which prevents any tail ends of aprons hanging out of the clinical waste bins. This practice also offers additional protection when the clinical waste bag is removed from the bin should the bag spilt on removal. If the bag were to split on removal, there is then the opportunity for contents to be shaken/disturbed which increase the risk of re-aerosolisation.
2. All materials used to support incontinence are placed into a white bag and tied before being disposed in the clinical waste bin, therefore contained before disposal.

Refer to SICP 4, Personal Protective Equipment for further information on doffing and containing PPE.

Disposal and Storage of Clinical Waste on the Premises of the Care Home

1. All clinical waste is to be stored in the appropriate bins, segregated from other waste.
2. The clinical waste containment units are to be stored away from public access, visitors and people living in the care home.
3. The yellow clinical waste units are appropriately labeled and colour coded.
4. The yellow clinical waste bags are to be emptied when they are ¾ full. This allows enough space for the waste bag to be tied and secured.
5. If there is any split in the yellow bag or signs of the material becoming thin then the tied yellow bag is to be placed immediately into a new yellow bag, tied and secured.
6. The yellow clinical waste bags are to be taken directly to the containment bins.
7. The yellow bag is to be placed inside the containment bin and the lid closed
8. Staff disposing of the yellow clinical waste bins are to wear PPE when removing from the building. This must include a face mask [FRSM], apron and gloves.
9. They are required to move to the nearest outside doffing area and remove PPE safely and complete the handwashing process.

COVID 19 Outbreak – Enhanced Management of Clinical Waste  

In addition to the measures outlined above when managing a COVID 19 outbreak and the waste is coming from a RED house then the yellow bags are placed immediately into a second yellow bag on removal from the clinical bin. This additional measure to reduce the risk of transmission of COVID 19 during the outbreak.

Black Bag Waste

The kitchen areas of the houses within the homes have black household waste bins.

1. All black waste should be removed at the point of the black bag being ¾ full, to ensure the bag can be tied securely.
2. The black household bins have a lid and are foot operated.  
3. Staff are required to wear PPE when removing household rubbish form the house to the identified waste segregated area.
4. If there is a split in the bag then the black bag is to be placed into a new black bag, tied and secured.
5. The black household waste bag is to be take directly to the containment area for the safe storage of household waste until the point of collection.
6. The lids of the containment bins must be securely closed. Black rubbish bags cannot be left on the floor beside the bins owing to the risks of attracting vermin.
7. Staff disposing of all rubbish are required to wear PPE. This must include a face mask [FRSM], apron and gloves.
8. They are required to move to the nearest outside doffing area and remove PPE safely and complete the handwashing process.

Bins in Individual Bedrooms

People living in the care homes can have their own individual waste bin in their bedroom for general domestic use. The bins must be lined with a bin liner but are not required to have a lid in place.

 Documentation and Record Keeping

1. A record of all clinical waste is required to be kept for all clinical waste removed.
2. For Evolve homes this information is stored at Central Support for each home
3. If the number of yellow bags exceeds the maximum amount of agreed clinical waste within the contract, then additional waste removal will be required.

Safe Management and Disposal of Sharps

Sharps are items that can cause injury, a cut, or a puncture wound. They do not only cause injury if handled and disposed of incorrectly, but they can also transmit infections. The guidelines on the safe management of sharps are clear that it is the responsibility of the user to dispose of sharps correctly.

CQC_Guidance on Sharps Management in Care Home January 2021 …

Health and Safety Executive guidance says an employer will need to act to manage the risks if workers:

• use sharps to provide care or other services to people.
• provide care or other services to people who are likely to use sharps.
• are involved in handling such equipment after use – for example in sterile services and waste disposal.
• are likely to inadvertently come across used sharps – for example during laundering.

Employers are legally required to assess risks from sharps injuries and put appropriate control measures in place.

Best Practice in the Management of Sharps

1. Clear communication of this section of SICP 9 as sharps are likely to be used by staff working in the care home and by visiting professionals, i.e., District Nurses.
2. Assess the Need for the Use of Sharps
3. Only use sharps when necessary, avoid unnecessary use of sharps
4. Wherever possible needle free processes, equipment, are to be used

When It is Assessed that the Use of Sharps is Necessary

How is the person going to cope with the procedure? Will they confusion present an additional safety risk? How is this going to be managed? These questions are to be considered and an action plan written if these factors are actual risks

Ensure the right equipment is available. This consists of

1. A sharps tray 
2. A sharps box for instant disposal Carry sharps away from the body

Handle sharps for the minimum amount of time possible

Disposing of Sharps

1. The sharps disposal box is required to be dated and signed when opened. The sharp boxes in use have yellow or orange lids.
2. Sharps are to be disposed of as soon as possible.
3. The needle and syringe are to be disposed as a complete unit and not separated in any way.
4. Never attempt to depress the contents in the Sharps disposal box.
5. Never fill a sharps box about the maximum line of disposal.
6. When the sharps box is full to the maximum line close and seal the box. The date of closure is to be documented on the sharp disposal box. 

Safe Disposal of Waste [including sharps] and the Chain of Infection.

How does the Safe Disposal of Waste [including sharps] fit into the Strategy of S.P.I.C.E? The management of waste and the disposal of sharps requires preventative action to reduce the risk of infection when handling and disposing of waste and sharps. Waste can act as a reservoir for infection and enable various modes of transmission to potentially occur if waste is not handled following the correct infection control precautions. Through isolating and containing waste in the correct manner the spread of infection can be prevented and infectious agents can be eliminated through correct disposal process