15% of healthcare waste is classified as hazardous (WHO 2018).

In order to minimise the risk of harm from hazardous healthcare waste, it is crucial to have policies and procedures in place to ensure waste is handled, stored, packaged, labelled and transported correctly (QLD Government 2019).

What is Hazardous Waste?

The term healthcare waste describes any waste generated through clinical activity, with the majority of this waste (about 85%) being considered ‘general’ (non-hazardous). Healthcare waste that poses a risk of injury, infection or harm to human health is classified as hazardous (NSW DoH 2018).

Hazardous waste includes:

• Infectious waste
  • Waste contaminated by bodily fluids
  • Laboratory waste (e.g. cultures and stocks)
  • Waste from clients who have infections (e.g. bandages, swabs)
• Pathological waste
  • Human tissue, organs or fluids (not including hair, teeth and nails)
  • Contaminated animal carcasses
• Sharps (needles, syringes, disposable scalpels and blades)
• Chemical waste (e.g. disinfectants, batteries, heavy metals in medical devices)
• Pharmaceutical waste (expired, unused or contaminated medicines and vaccines)
• Cytotoxic waste that contains genotoxic agents (e.g. cancer medications)
• Radioactive waste.

(WHO 2018; QLD Government 2019)

Note: Urine, faeces, vomit, sputum and meconium are not considered bodily fluids. Therefore, they need not be treated as hazardous waste and can be flushed or disposed of in landfill without treatment. The only exceptions are if they visibly contain blood, or if the client has a known or suspected communicable disease (VIC DoH 2020).

The Risks of Hazardous Waste

Adverse effects may result from exposure to hazardous waste or inadvertent release into the environment, including:

• Infections
• Antimicrobial resistance
• Injuries from sharps
• Air pollution
• Thermal injuries
• Radiation burns
• Environmental contamination
• Environmental damage.

(WHO 2018)

Waste Management in the NDIS Practice Standards

Waste management is a requirement of the NDIS Practice Standards under Core Module 4: Provision of Supports Environment.

This Practice Standard aims to protect clients, providers and other parties from hazardous healthcare waste during the provision of care, minimising the risk of harm (NDIS 2019).

Under these standards, NDIS providers must meet the following quality indicators:

• Providers establish policies and procedures to ensure healthcare waste is stored and disposed of safely and appropriately
• If an incident related to hazardous waste occurs, it is reported, recorded, investigated and reviewed
• Providers establish an emergency plan to respond to issues or accidents involving hazardous healthcare waste. This plan is evaluated and reviewed
• Providers ensure staff are trained to handle hazardous healthcare waste safely and appropriately, including training related to PPE.

(NDIS 2019)

Waste Segregation

Segregation is an integral component of safe waste, allowing different types of waste to be easily identified. It must be maintained during storage and transportation (NSW DoH 2017).

Waste is segregated using a standardised colour-coding system. Each type of waste should be disposed of into a bin of the designated colour. Staff should separate waste at the time and place it is generated (WA DoH 2016).

Type of Waste	Colour	Symbol
Clinical (infectious, pathological and sharps waste)	Yellow
Cytotoxic	Purple
Radioactive	Red

(Adapted from QLD Government 2019)

Safe Collection of Hazardous Waste

At the time and place of generation, hazardous waste should be bagged, packaged or placed into the designated container. After this initial collection, there should be no more direct contact with the waste (WA DoH 2016).

When collecting waste in a plastic bag, ensure the bag is strong enough to contain the waste and is appropriately labelled depending on the type of waste. Do not fill the bag beyond two-thirds of its capacity (WA DoH 2016).

The following are important considerations for waste collection:

• If the container is to be incinerated, use non-PVC plastic liners
• Do not secure bags with closure devices (e.g. metal staples) that could puncture them
• Waste must be transported in containers. Do not use bags to transport waste
• Containers used to store cytotoxic waste must be strong enough to resist spillage, leakage or breakage. They must not be reusable
• Containers used to store pharmaceutical waste must be non-reactive, tamper-proof, able to resist impact rupture and able to contain spills. Once the waste is ready to be disposed of, you should not be able to remove it from the container
• Double-bagging may be used to increase strength when transporting heavy loads. However, this will need to be performed carefully to avoid spillage or accidental exposure to waste.

(WA DoH 2016; QLD Government 2019)

Collecting Sharps

Sharps containers must have rigid walls (hard, unbendable sides that are resistant to breakage). Some are reusable and must be emptied, cleaned and disinfected appropriately. Single-use sharps containers must never be reused (WA DoH 2016).

When collecting sharps:

1. Ensure a sharps container is in close proximity when handling sharps so that the sharp can be immediately disposed of.
2. Always wear PPE when handling sharps.
3. Ensure the sharps container has adequate space to accommodate the sharp.
4. Place the needle and syringe (still connected) into the sharps container.
5. Do not try to recap the needle or separate the needle and syringe.

(Monash University 2011)

Sharps Containers

Sharps containers must only be used for objects that can puncture the skin, including:

• Hypodermic needles
• Syringes
• Scalpels
• Lancets
• Wires.

(Stericycle 2020)

Do not put other objects or non-sharp components of sharps (e.g. IV bags) into sharps containers.

Safe Storage of Hazardous Waste

Hazardous waste should have designated storage areas away from food and clean storage areas. Storage areas are expected to be enclosed spaces such as sheds, garages or fenced areas. They must be cleared routinely and provide access to the necessary cleaning materials (NSW DoH 2017; WA DoH 2016).

Storage areas must be inaccessible by the public or other unauthorised persons, labelled with appropriate signage and ideally segregated by a lockable door. The flooring of the storage area should be a rigid, impervious surface (e.g. concrete). Certain waste may require refrigeration to prevent decomposition and odour (NSW DoH 2017; QLD Government 2019; WA DoH 2016).

Hazardous waste must be stored in bags and containers according to the colour-coding system (QLD Government 2019).

Safe Disposal of Hazardous Waste

There are a variety of treatment methods for hazardous waste. The most appropriate method will depend on the type of waste, with the goal being to:

• Make the waste as safe as possible
• Minimise harm to the environment
• Reduce the volume of the waste
• Render the waste non-recognisable by altering its physical nature.

(WA DoH 2016)

Furthermore, the treatment and disposal process should:

• Limit the creation of hazardous or toxic by-products
• Have automatic controls and fail-safe mechanisms
• Ensure no waste can bypass the process.

(QLD Government 2019)

Methods of waste treatment include:

• Incineration
• Autoclave (steam sterilisation) and shredding
• Chemical disinfection (using either hypochlorite or peroxide and lime) and shredding
• Microwave disinfection and shredding.

(QLD Government 2019)

Once treated, the waste is generally sent to landfill. Compaction can be used to decrease the volume of some types of waste before treatment and disposal, but it is not an appropriate standalone method (QLD Government 2019).

The following table outlines the appropriate treatment and disposal options for each type of hazardous waste:

(Adapted from QLD Government 2019)

Note: Waste disposal chutes must not be used for hazardous waste as they pose a risk of spillage, breakage or harm to staff.

Conclusion

In order to protect staff and NDIS participants from harm when they encounter hazardous waste, providers must ensure policies and procedures are in place to inform the safe collection, storage and disposal of these materials.

Note: This article is intended as a refresher and should not replace best-practice care. Always refer to your facility's policy on waste management.

Additional Resources

• NDIS Practice Standards: NDIS Practice Standards and Quality Indicators | NDIS
• Clinical and Related Waste Management for Health Services | NSW DoH
• Clinical and Related Waste | QLD Government
• Clinical and Related Waste Guidance | VIC DoH
• Operational Directive: Clinical and Related Waste Management Policy | WA DoH

References

• Monash University 2011, Syringes and Needles: Use, Disposal and Incident Follow-up, Monash University, viewed 17 July 2020, https://www.monash.edu/ohs/info-docs/safety-topics/biosafety/syringes-and-needles-use,-disposal-and-incident-follow-up
• NDIS Quality and Safeguards Commission 2020, NDIS Practice Standards: NDIS Practice Standards and Quality Indicators, NDIS Quality and Safeguards Commission, viewed 16 July 2020, https://www.ndiscommission.gov.au/sites/default/files/documents/2019-12/ndis-practice-standards-and-quality-indicators.pdf
• New South Wales Department of Health 2017, Clinical and Related Waste Management for Health Services, New South Wales Department of Health, viewed 16 July 2020, https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2017_026.pdf
• New South Wales Department of Health 2018, Clinical Waste Management, New South Wales Department of Health, viewed 16 July 2020, https://www.health.nsw.gov.au/environment/clinicalwaste/Pages/default.aspx
• Queensland Government 2019, Clinical and Related Waste, Queensland Government, viewed 16 July 2020, https://environment.des.qld.gov.au/__data/assets/pdf_file/0029/89147/pr-gl-clinical-and-related-waste.pdf
• Stericycle 2020, Sharps 101: Understanding Sharps Waste and Proper Needle Disposal, Stericycle, viewed 17 July 2020, https://www.stericycle.com/knowledge-center/newsletter/sharps-needles-disposal-faqs
• Western Australia Department of Health 2016, Operational Directive: Clinical and Related Waste Management Policy, Western Australia Department of Health, viewed 16 July 2020, https://ww2.health.wa.gov.au/~/media/Files/Corporate/Policy%20Frameworks/Public%20