The Management of Healthcare Waste

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The Management of Healthcare Waste

• Robert Lowe
• Director
• Quality Assurance Specialist Services
• NHS East of England

• Clinical Pharmacy
• Clinical Governance Technical Services
• Community Health
• Community Pharmacy
• Medicines Management Strategy Development
• Medicines Information
• Medicines Procurement
• Prescribing Support
• Quality Assurance
• Workforce Development Education Training

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Waste management regulations have changed.
Official DH guidance on the handling and
destruction of healthcare waste is outlined in
HTM 07-01
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Main responsibilities of the wasteproducer in
line with the duty of care

• Describe the waste fully and accurately.
• Complete and sign a waste transfer note (or
• consignment note for hazardous waste) prior
  to waste being transferred to another party.
• Pack waste securely (where appropriate) in line
  with the Carriage Regulations.
• Store waste safely on-site.
• Register as a waste carrier (if required), and
  make all reasonable checks on waste carriers.
• Select an appropriate recovery or disposal
  method.
• Ensure waste falls within the terms of the waste
  contractors waste management licence, permit or
  exemption.

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How do you know it is a cytotoxic or cytostatic
drug?
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How do you know it is a cytotoxic or cytostatic
drug?
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NIOSH list of Cytotoxic Cytostatic Drugs

• Pipobroman
• Piritrexim isethionate
• Plicamycin
• Podoflilox (Not found)
• Podophyllum resin
• Prednimustine
• Procarbazine
• Progesterone
• Progestins
• Raloxifene
• Raltitrexed
• Ribavirin
• Streptozocin
• Tacrolimus
• Tamoxifen
• Temozolomide
• Teniposide
• Testolactone
• Testosterone

• Thalidomide
• Thioguanine UK name - Tioguanine
• Thiotepa
• Topotecan
• Toremifene citrate
• Tositumomab
• Tretinoin
• Trifluridine
• Trimetrexate glucuronate
• Triptorelin
• Uracil mustard UK name - Uramustine
• Valganciclovir
• Valrubicin
• Vidarabine
• Vinblastine sulfate
• Vincristine sulfate
• Vindesine
• Vinorelbine tartrate
• Zidovudine

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Healthcare waste incinerators come in a variety
of designs, but all are required to meet
temperature and emission limits. Generally they
have a primary combustion chamber operating at
8001000C and a secondary chamber operating at
850 1100C
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How do the waste management regulations sit with
the DH Guidance on the destruction of Controlled
Drugs?
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Destruction of Controlled Drugs

• Unwanted CDs should be denatured and disposed of
  in a pharmacy.
• CDs should be disposed of in such a way that the
  drug is denatured or rendered irretrievable so
  that it cannot be reconstituted or used again.
• There should be a local policy for disposal of
  CDs and this policy must be in accordance with
  current Home Office guidance, Waste Management
  Regulations and Environment Agency guidance. The
  methods used for denaturing should be in
  accordance with RPSGB guidance.
• (See - RPSGB guidance Guidance for Pharmacists
  on the safe destruction of Controlled Drugs
  England, Scotland and Wales.
• www.rpsgb.org.uk/pdfs/cdsafedestructionguid.pdf)

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Destruction of Controlled Drugs

• The Environment Agency (EA), which covers England
  and Wales, has decided that itis not in the
  public interest to expect pharmacies to obtain a
  waste management license for denaturing CDs as
  this is seen by the EA as a low risk activity.
• The EA emphasises, however, that it may amend or
  revoke its position at any time and will continue
  enforcement in all circumstances where activity
  has or is likely to cause pollution or harm to
  health. It is therefore essential that local
  policies and procedures for destruction of CDs
  not only ensure effective destruction but also
  protect the environment and workers and others
  within the pharmacy.