Unit 12

Cleaning, decontamination and waste management

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About this unit

In this unit the learner will develop an understanding of the correct way of maintaining

a clean environment in accordance with national policies and to understand the

procedures to follow to decontaminate an area from infection. The unit also covers

good practice when dealing with waste materials.

The learner will:

1. Understand how to maintain a clean environment

2. Understand the principles and steps of the decontamination process

3. Understand the importance of good waste management practice

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1.1 General principles for environmental cleaning

Environmental cleaning reduces the accumulation of dust, dirt and liquid residues which

increase the risk of infection.

Decontamination

Decontamination is very important in infection prevention and control measures.

Decontamination is the safe cleaning, disinfection, inspection and sterilisation (if

required) of a re-usable medical device to make it safe for further use on individuals, and

for handling by staff.

The term ‘decontamination’ is used to cover the different methods of removing or

destroying micro-organisms from the environment or from equipment.

1.2 The purpose of cleaning schedules

Cleaning schedules maximise the decontamination by regular timed cleaning to minimise

the risk of infection. This can be recorded and monitored.

All health related organisations should have a cleaning schedule which specifies what to

clean, when to clean and who is responsible. These schedules should be written down as

part of infection control policies and procedures and should include all three types of

decontamination. All staff should be aware of these and understand their responsibilities

and the consequences of not adhering to these schedules and routines.

All staff should also be aware of the schedules for disinfection and sterilisation and their

roles and responsibilities for their implementation. COSHH regulations and all aspects of

safe use of materials and equipment should be adhered to. This may include safe moving

and handling techniques.

Decontamination certificate

The NHS Management Executive introduced protocols and documentation (HSG(93) 26

June 1993) relating to inspecting, servicing or transporting medical equipment. It states the

requirement of a decontamination of equipment certificate. This certificate should be

issued with all equipment leaving the health care setting. It must clearly state the

decontamination status of the equipment and should be signed by the person who has

cleaned the equipment prior to its despatch.

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1.3 What is “clean”? - The correct management of the environment to

minimise the spread of infection

Bacteria are all around us and in our bodies. Most are completely harmless and may

even be important to maintaining good health. It is important that the “good” bacteria are

not killed by unnecessarily excessive and inappropriate use of disinfectants. It is often

forgotten that the basic hygiene measure of removing visible dirt with water and

detergent is a central part of control of infection. Disinfection and sterilisation processes

are not effective when applied to objects that have not been properly cleaned, as the dirt

(blood, mucus, faeces) shield micro-organisms from the process.

Clean is:-

Without dirt or impurities

Without dirt in it or on it

Recently washed -fresh

Without “foreign” matter

Reducing offensive odours.

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The purpose of cleaning

We clean to remove dust, dirt and micro-organisms using energy, hot water and

appropriate detergent. This removes most bacteria, or nutrients on which they thrive,

from any surface or piece of equipment. A further reduction in numbers of bacteria

occurs as the surface dries.

Detergents are needed to dissolve grease, fat and dirt in water so that it can be easily

removed.

Training should take place to ensure that all cleaning is carried out effectively, and that

service users, themselves, visitors and other staff members are safe whilst cleaning

takes place. This will include:

Safe moving and handling of furniture and equipment

Safe and efficient use of equipment; cleaning solutions

Use of warning signs for wet floors/cleaning procedures.

The aim of cleaning is to:

Remove conditions conducive to the growth of bacteria

Reduce the numbers of active bacteria remaining

Prevent offensive odour

Minimise cross-contamination from one surface to another

Satisfy legal requirements

Provide a safe and pleasant environment.

1.4 Colour-coding of cleaning equipment

From September 2007, a colour-coding scheme was introduced for all hospital and

care home cleaning materials and equipment.

The introduction of the scheme followed guidance from the National Patient Safety

Agency, which recommended that all care organisations adopt a single code in order to

improve the safety of cleaning.

Colour-coding of hospital cleaning materials ensures that items are not used in multiple

areas. This reduces the risk of cross-infection and is also a major help if people work on

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several different sites, or if they move to a new job elsewhere. They will always know that

yellow materials should be used for isolation areas, and green materials for catering and

kitchens.

All cleaning materials and equipment, such as cloths, mops, buckets, aprons and

gloves, should follow the new colour-coding scheme.

In the colour-coding scheme, red materials are used for bathrooms, washrooms,

showers, toilets, basins and bathroom floors. Blue cleaning materials are used for

general areas including wards, departments, offices and basins in public areas. Isolation

areas should be cleaned with yellow materials. Green denotes catering departments,

kitchen areas and food service. The guidance from the National Patient Safety Agency

states that cleaning products such as bleach and disinfectants do not need to be colour-

coded. Also, the code does not extend to catering equipment (for example, chopping

boards and knives) where there is already a well-recognised and well-established

procedure to ensure food hygiene, and food separation issues, are addressed.

The colour-coding scheme is set out in a poster from the National Patient Safety

Agency. This can be viewed via the following link-

http://www.nrls.npsa.nhs.uk/resources/?entryid45=59810

The Waste Framework Directive was implemented in England through the Waste

Regulations 2011 however at present England’s waste strategy is based around the

Government Review of Waste Policy in England 2011 this can be viewed via the following

link - https://www.gov.uk/government/publications/government-review-of-waste-policy-in-

england-2011

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2.1 The Decontamination Process

Decontamination within health related environments are graded into three sections:

Cleaning - for low-risk items

Disinfecting - for medium risk items

Sterilising - for high-risk items.

2.2 The Cleaning Process

There will be guidelines within your health care environment that must be

followed appropriately for the surface/equipment that is to be cleaned.

It is a good idea to colour code mops and buckets for kitchens, toilet/dirty

areas and general areas

The following outlines a step by step approach to the cleaning process:

Step 1 - INITIAL CLEAN - to remove loose dirt (e.g. scraping, rinsing under running

water).

Step 2 - MAIN CLEAN - to remove main body of dirt and bacteria (e.g. scraping,

pressure wash, scrubbing, detergent to remove grease)

Step 3 - RINSE - to remove loosened dirt and detergent residue (especially

important when powerful and potentially dangerous chemicals have been used)

Step 4 - DRY - it is important to ensure drying is complete as bacteria need

moisture to multiply.

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2.3 The Purpose of Disinfecting

The purpose of disinfecting is to bring micro-organisms to a safe level.

The first three steps of the cleaning process must be carried out as part of the

decontamination process. This is before disinfecting, which is not a part of the actual

cleaning process.

DISINFECT - to bring remaining micro-organisms down to a safe level

FINAL RINSE - to remove any chemical residues

DRY - it is important to ensure drying is complete as bacteria need moisture to multiply

Precautions when using disinfectants

Using too little will make it ineffective

Too strong may cause skin damage or inhalation of dangerous

fumes. Using too much causes chemical wastage

Detergents should never be mixed as they may give off poisonous gases.

Disinfectants

Disinfection is never an alternative to cleaning, whether on floors, equipment, skin, or, on

wards. It was once the case that liberal use of disinfectant around health care settings was

unduly practiced with a view to “killing germs”. It is now generally accepted that good

maintenance and thorough cleaning of floors, walls, ceilings and equipment is sufficient

except in specific instances, such as the cleaning of rooms after being used for isolation

nursing. It is important to follow the cleaning policy in your own workplace.

If disinfection is appropriate, it is important that it should be used at the correct concentration.

The disinfectant must be freshly prepared for each use and changed regularly before

dirt or organic matter discolours it. Antimicrobial resistance to disinfectant agents can

develop and misuse of disinfectants is likely to speed this development.

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The Purpose of Sterilising

Sterilisation means making an object free from all viable micro-organisms including

spores. Sterilisation may use exposure to heat, radiation or chemicals and is mainly

used for high risk items such as surgical instruments which break through the skin,

mucous membranes or enter sterile body areas.

AUTOCLAVE - items for sterilisation are cleaned mechanically then prepared/packed/

labelled before being placed in the autoclave. The autoclave uses steam under pressure

to sterilise; the higher the steam under pressure the higher the temperature.

RADIATION - is used to sterilise most disposable items of equipment e.g. needles and

scalpel blades. It can be used for those items that cannot withstand very high

temperatures e.g. catheters, tubing.

CHEMICALS - may be used under specifically defined conditions. It is possible to

achieve sterilisation with chemicals e.g. Milton Fluid. Chemicals may be used in

combination with temperatures of 50 - 70oC.

How should equipment be cleaned?

ITEM HOW OFTEN METHOD

Buckets After use Wash with hot water and detergent. Dry and store

upside down.

Cloths/dusters Daily Use disposable if possible, if not clean in a washing

machine and store dry. Do not leave to soak.

Dishcloths Daily As above or according to your cleaning schedule

Vacuum

cleaners

As per

manufacturer’s

instructions

Wipe tools with hot water and detergent, check filters

regularly

Basins and

taps

After use Clean with hot water and detergent, disinfectant

should be used after initial cleaning process if

contaminated with bodily fluids

Baths and

showers

As above As above

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Mops After use and

weekly

Mop heads should be detachable and washed in

hot soapy water.

Commodes After use Wipe pan and seat with hot water and detergent. Rinse

dry.

Commodes Weekly clean Remove commode from frame and room. Clean legs

and frame with hot water and detergent. Turn upside

down and clean underneath.

Bins Daily Clean with hot water and detergent

ITEM HOW OFTEN METHOD

Carpets Vacuum daily There should be a schedule for cleaning carpets; at least

six

monthly. Any spills should be removed immediately;

body fluids should be removed using disposable paper

towels with gloves on and then shampoo the area.

Drains Clean regularly

with hot water

and detergent

Do not put disinfectant down drains.

Floors Daily and

as

necessar

y

All floors should be vacuumed to prevent dust

dispersing. Clean with hot water and detergent. Rinse

and dry.

Furniture As required or

following your

cleaning schedule

Surfaces should be damp dusted with disposable type

cloth.

Bowls After use Clean with hot water and detergent. Rinse and store

dry, inverted, and above floor level.

Catheter

stands

Weekly or after

use

There should be individual catheter stands. Clean with

hot water and detergent.

Crockery

and cutlery

After use A dishwasher with a final rinse of 80°C is preferred. If

washing by hand use very hot water, detergent and a

disposable cloth. Change the water frequently, rinse

and allow to dry in racks, or use disposable paper

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towels. Tea towels should not be used.

Face flannels

and towels

Between use Flannels and towels must never be shared. If rooms are

shared, personal towels and toiletries should be

allocated to each resident. In communal areas such as

bathrooms and toilets, disposable towels should be

provided.

Mattress/pillow

s

When soiled or

when change of

patient/ service

user.

Soiling of mattresses and pillows can be avoided by

covering with a mattress or pillow cover. The covers

should be cleaned thoroughly. If a plastic cover use hot

water and detergent.

Contamination

In the health related environment contamination can occur by a number of ways, including:

Changing beds, handling soiled linen, linen coming into contact with floors, hard

surfaces and clean bed linen

Contact with service users when attending to personal hygiene and toileting

Collection of specimens, spillages, incorrect procedures, poor hand hygiene

Food preparation, storage and serving - poor procedures, poor hand washing

techniques

Invasive procedures or procedures that involve contact with body fluids

Death of a service user - poor hygiene procedures, inadequate contaminated

waste and linen disposal; contact with a deceased person who has an infectious

disease

Pets - bedding, excreta, illnesses, lice, skin conditions

Disposal of waste

Illness of service user, health worker (or their family),visitors.

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Because of the diversity of day-to-day tasks carried out in a health setting, infection can

occur in a number of ways, especially in the following situations:

Moving between different work areas

Disposal of different types of waste

Disposing of protective clothing appropriately after use

Cleaning beds, trolleys, bed tables, equipment, surfaces

Storing used cleaning equipment separately as appropriate.

There are several sources within your organisation where questions can be answered

and further knowledge gained on the prevention and control of infection.

Contamination of Body Fluids

It is the responsibility of the finder of a body spillage to a) clean it up, and b) report it, as

blood and other body fluids pose a high risk of contamination.

Changing beds/Laundry disposal

The following points should be considered in order to minimise risk of spread of

infection when dealing with bed linen:

Protective clothing (gloves and apron) is required as infection can be spread

from damp, soiled and infected bed linen

No linen should be sluiced by hand

Contaminated linen should be placed in an appropriately colour-coded bag

(usually red alginate bag, which dissolves in the washing machine), tied effectively

to ensure that there will be no leakage. Bed linen should not be placed or sorted

on furniture or floors, but removed carefully and put straight into an appropriate

laundry bag. Used linen should not be moved from room to room

Hands should also be washed thoroughly after handling used linen.

Service User hygiene

When carrying out tasks which involve direct contact with service users and their

body fluids, ensure effective protection by wearing an apron and gloves. After use,

discard them into an appropriate clinical waste container and use effective hand

washing routine.

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Washing

Risk of infection can be reduced by observing an effective washing procedure:

Wash areas such as face and arms first, then torso, legs and finally genital and buttock

areas

Use fresh water and colour-coded or disposable flannels and towels for

each area. Disposable flannels should be used for washing the groin areas

Pay particular attention to the cleaning of eyes, mouth and teeth

Care must also be taken to ensure that bed linen is laundered properly after bed

bathing.

Helping Service Users to use the toilet

This includes use of bedpans, urinals and commodes, so to reduce risks associated

with the disposal of human waste it is important to:

Always wear gloves and apron

Cover body waste while in transit

Discard excreta safely into toilet, disinfectant or macerator

Use an effective, well maintained bedpan washer

Ensure that bed linen is laundered properly.

Specimen collection and handling

To help minimise the risk of spreading infection whilst collecting, handling or

transporting specimens, the following points should be considered:

Use only dedicated sterile containers and do not decant from one to another

Aprons and gloves should be worn while collecting specimens

Avoid contamination of the outside of specimen containers

Do not send off leaking specimens - discard as clinical waste as they present

a risk to those handling the specimen

Specimens must not be placed in areas where food is eaten or stored, e.g. bed

tables or domestic fridges

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Hands should be thoroughly washed both before and after specimen collection

and the number of staff handling the specimen kept to a minimum

The specimen must be clearly and correctly labelled and put into double plastic

bags or a specific collection container.

Food hygiene

To reduce the risk of these sources of contamination, anyone working in a food

preparation area should obey the following simple rules:

Use old food stock before new food stock

Observe “sell by” and “best before” dates on food

Avoid using dented or rusty canned foods

Store raw and high risk foods at the correct temperatures

Ensure that refrigerators and freezers maintain correct temperatures

Use clean utensils

Don’t handle food except with clean utensils or gloved hands

Don’t mix raw and cooked foods when storing

Look for signs of damage or physical contamination when opening food packages

Check that food is thoroughly cooked

Keep hot food hot

Keep cold food cold

Avoid re-heating food

Remove rubbish from food preparation areas

Observe good persona lhygiene

Always wash hands before handling food

Wash hands after preparing high risk foods.

This is just a sample of the precautions which should be taken.

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If your job requires you to prepare or handle food, you should undertake a specific

course of training in food handling.

As in all other areas of the healthcare environment there is both a moral and legal duty to

minimise cross infection by adhering to the highest standards of infection control.

Single use instruments and sterile equipment

Single use instruments and equipment are useful in infection control because:

They minimise the risk of infection

Aseptic hand washing is carried out before the use of these and gloves worn

before the use of these, thus keeping hand borne infection to a safe level

However, it is important to know that these items are designed for SINGLE USE

ONLY and must be discarded once opened, even if not used. In fact, if it is labelled

by the manufacturer as “single use”, potential liability under manufacturers’ legal

obligations will cease if it is re-used, and if such a device causes damage, infection

or injury the re- processor/re-user is likely to become personally liable.

The symbol for sterilised single use is:

This symbol is shown on the packaging of a product that is intended only for

single use. These products are not single patient/service user use, they are

single use only and should not be re-used.

BS EN 980 sets down a number of graphical symbols for use in the

labeling of medical devices.

Examples would include:

Dressing packs (with the two strike-out symbol as above)

Urinary catheters (with the two strike-out symbol as above)

Syringes and needles (with the two strike-out symbol as above).

The body may continue to secrete fluids after death. This can be a hazard for staff coming

into contact with the body. The bladder can be emptied by gently pushing the lower

abdomen and any other leaking orifice should be covered with an appropriate dressing.

Again PPE should be worn.

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Good hygiene and hand washing are essential to reduce the risk of infection. This will

help the health of your service user and assist in the enjoyment of the pet.

2.4 The role of Personal Protective Equipment (PPE) in decontamination

Depending on the method of decontamination, certain types of PPE may be required. The

purpose of PPE is to protect the individual carrying out the decontamination and to avoid

re-contamination of sterile areas or instruments.

PPE should be easily recognisable, hard wearing and resistant to high temperature

washing. It should act as an additional barrier for the wearer against infection and the

effects of chemicals used in decontamination. PPE must be changed after each service

use contact and disposed of, or decontaminated as per manufacturer’s instructions:

Aprons - protect the wearer from being contaminated by, for example, waste

matter. Also protects individual from contaminants present on uniforms, clothes

Gloves - prevent the wearer from contaminating sterile areas or protect the

wearer and others from contamination

Masks - protect the wearer and others from airborne pathogens or

splashes from contaminated matter

Hair protection - prevents hair, dandruff, grease from contaminating food, open wounds.

Foot protection; disposable shoe covers - covers or replaces outdoor footwear

preventing contamination in sterile areas such as operating theatres and injury to

foot

Gowns/protective suits - may be either used to protect the wearer from

infection or to protect the individual from contamination carried by the wearer

Eye protection - to protect from injury from machinery, heat, chemical or

body fluid splashes.

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Use of cleaning and disinfecting agents

Control of Substances Hazardous to Health (COSHH)

This is part of the Health and Safety at Work Act. COSHH Regulations are designed to

ensure that chemicals which may be hazardous to health are managed and controlled

properly. This includes the labelling of harmful products and the precautions that need to

be taken when handling them.

Precautions should be clearly displayed in all areas where chemicals/disinfectants are being

used.

The most commonly used substances are chemicals used for cleaning and disinfection

of equipment. All substances that have a potential to cause harm will carry COSHH

information on the container describing the hazard as well as basic first aid information in

case of spillage, splashing or swallowing.

To comply with COSHH you need to follow these eight steps:

1. Assess the risks

2. Decide what precautions are needed

3. Prevent or adequately control exposure

4. Ensure that control measures are used and maintained

5. Monitor exposure

6. Carry out appropriate health surveillance

7. Prepare plans and procedures to deal with incidents and emergencies

8. Ensure employees are properly informed, trained and supervised.

Storage of chemicals

Cleaning chemicals must be stored in a secure locker in closed containers, preferably the

original manufacturer’s container with instructions for use and safety precautions easily

readable on the label. Chemicals should be stored in their original container and must be

clearly and accurately labelled.

COSHH (Control of Substances Hazardous to Health Regulations) are designed to

ensure that chemicals which may be hazardous to health are managed and controlled

properly. This includes the labelling of harmful products and the precautions that need to

be taken when handling them.

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Precautions should be clearly displayed in all areas where chemicals/disinfectants are

being used. Further information can be found via the following link -

http://www.hse.gov.uk/coshh/

2.5 Concept of risk

The word risk, in a health and safety context, means the likelihood that someone or the

environment may be harmed by a hazard. When dealing with contamination, the risk is

the chance that you, other people, the wider community or the environment might suffer

the harmful effects of the contamination.

The level of risk increases depending on the severity of harm that may be caused, the

number of people who might be affected and the possibility that the contamination may be

responsible for the spread of infection.

Contamination risk

Activities such as dealing with soiled linen and the disposal of waste are hazardous and

have risks associated with them. You must be able to recognise the risks and take the

appropriate actions to eliminate or at least minimise them. Appropriate actions may be

referred to as precautions or control measures and should be in place within your

organisation as a result of risk assessment.

2.6 Types of agents required for the level of risk

All care workers should be aware of the level of risk related to contamination.

Low risk areas Medium risk High risk

Shared fixtures and

equipment

Mobility aids

Bathroom equipment

Surfaces

Furnishings

Floors

Toilets

Commodes

Bedpans

Urinals

Re-useable equipment

that comes into

contact with individuals

Instruments used for

invasive procedures

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General equipment - Low risk

Low risk items used in health settings should be washed regularly and thoroughly with

appropriate detergent and hot water following procedures laid down by employers. These

include beds, furniture, baths, wash basins, crutches, infusion stands, bed cradles, bins.

Any excess soiling of equipment or spillage of body fluids should be dealt with as per

local procedure guidelines. All equipment should be well maintained in order to prevent

risk of injury or source of infection to those who come into contact with it.

Medium risk items should be disinfected with agents recommended by the

manufacturers and in accordance with organisational policy and procedures. High risk

items should be sterilised according to manufacturer’s instructions and organisational

policies and procedures.

The employer has a duty to ensure that faulty equipment is condemned or stored until

repair or removal, and to ensure the safety of staff using any equipment as part of their

job role. Standards exist, covered in the “Standards for Better Health” policy; these are

monitored by the Health Care Commission. The Medicines and Health Care Regulatory

Agency (MHRA) is responsible for recalling faulty medical products and equipment where

problems are identified.

2.7 The cleaning and storage of equipment

It is important to keep equipment clean to avoid contamination and bacterial growth. Safe

storage is vital to avoid tripping or chemical hazards and to comply with the requirements

of COSHH.

Equipment should not be stored where it may cause an obstruction, for example, at the

top of the stairs or blocking fire exits. All chemicals should be stored in their original

containers in a locked cupboard.

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3.1 Different categories of waste and associated risks

Health care environments generate a broad range of waste, including clinical,

infectious and chemical waste, which could pose a chemical or biological hazard. Duty

of care requirements demands the proper management of waste materials to ensure

that potentially infectious or hazardous waste does not affect any individuals’ health or

environment.

Categories of waste

It is important that waste is properly identified so that it can be efficiently managed. In health

care environments we normally identify four different types of waste:

Household waste

Clinical waste and sharps

Confidential waste

Specific waste.

Efficient and effective waste segregation is an essential part of infection control. Waste

disposal through an inappropriate channel could create risk to human life and/or the

environment and could also lead to prosecution.

Colour-coding

The European Waste Catalogue Codes (as implemented in England, Ireland, Scotland

and Wales) includes the use of colour-coding to indicate the type of waste contained in

bags/containers.

Display the colour coding chart for waste disposal in a prominent place and on sack-holder

lids.

Do not tie up bags, use label ties which indicate source of the waste. *These bags are

laundered whole and the alginate dissolves in the washing machine to release the

contents.

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Waste

Type

Classification Colour

Coding

Description

Infectious

Clinical Waste

Hazardous

This type of waste poses a known/potential

risk of infection

Examples: anatomical waste, diagnostic

specimens, test vials

Infectious

Clinical Waste

Hazardous

This type of waste is potentially infectious

waste Example: autoclave and laboratory

waste

Offensive

/non-

infectious

waste

Non

Hazardous

This type of waste is generated by healthcare

waste which is classed as non-infectious

Examples: nappy, incontinence, sanitary

waste and other waste produced from human

hygiene.

Pharmaceuti

cal waste

Non

Hazardous

This type of waste relates to pharmaceutical

drugs

Examples: products and vaccines. Including

bottles, boxes or vials with residues. Also

including products contaminated from the use

of handling pharmaceuticals including gloves,

masks, connecting tubes, syringe bodies and

drug vials

Cytotoxic

and

Cytostatic

drugs

Hazardous

This type of waste relates to hormone and

cancer treatment medicinal waste and must

be separated from other medicinal waste as

they are classed as hazardous

To check if the waste is this type you can find

a list in a copy of the BNF or NIOSH list of

medicines

Controlled

drugs

Non

Hazardous

This type of waste relates to controlled

drugs it is important that these are

denatured to make them safer to dispose of

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Categories of clinical waste

The categorisation of clinical waste used below is based on that quoted in the Health

and Safety Commission publication “Safe Disposal of Clinical Waste”.

GROUP A

All human tissue including blood (whether infected or not), animal carcasses, tissue from

hospitals and laboratories and all related swabs and dressings.

Waste materials, where the risk assessment indicates a potential hazard to staff handling

them, for example, from infectious disease cases.

Soiled surgical dressing, swabs or other soiled waste from treatment areas.

GROUP B

Discarded syringes, needles, cartridges, broken glass and other contaminated

disposable sharp instruments or items such as broken ampoules.

3.2 Safe disposal of waste

Household waste

This includes general household type waste including food, flowers, waste paper and

packaging, aerosols, plastics and wood.

Household waste must be collected regularly in (usually) black plastic sacks tied securely.

Sack colour may vary according to locality. It is removed by the local authority and is

taken to landfill sites for disposal as it is a low risk source of infection. You must follow

your local work place policy on colour-coding and handling of waste bags.

Local Authority Collected Municipal Waste (LACMW)

Household waste (LACMW) must be collected regularly in (usually) black plastic sacks

and tied securely. Sack colour may vary according to locality. It is removed by the local

authority and is taken to landfill sites for disposal as it is a low-risk source of infection.

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You must follow your local work place polity on colour-coding and handling of waste

bags.

Clinical Waste

Clinical waste is usually placed in yellow bags for disposal (check policy and guidelines for

specific procedures in your health care environment). Appropriate disposal, or

incineration, will be carried out by specialist personnel as per local policy.

ALL WASTE IN THESE GROUPS MUST BE INCINERATED AS PER HEALTH AND

SAFETY EXECUTIVE (HSE) REQUIREMENTS.

Staff handling waste must:

Check that waste bags and sharps boxes are correctly filled, sealed and identified

Handle bags with due care, in line with procedures covering manual handling risks

Correctly use all protective equipment issued as well as reporting any defects in these

Correctly follow relevant procedures in case of incident or accident

Ensure that waste is not left in unsecured public areas.

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Safe handling and disposal of body fluids

Strict Precautions are needed when anyone is in direct contact with body fluids or when

handling contaminated articles because all of these may be a source of infection if not

handled appropriately. This is a high-risk situation therefore a high level of cleaning is

required. A full cleaning method is required, including steps 1 - 4 of the cleaning

process.

The term “bodily fluids” includes blood, mucous, urine, vomit, faeces, semen,

respiratory secretions and saliva.

Why do we need to handle these safely?

All contact with body fluids presents a risk of infection, however, the level of risk is

dependent upon the type of body fluid, whether from a known source of infection or

not.

The transmission of communicable diseases is more likely to occur from contact with

infected body fluids of unrecognised carriers rather that recognised sources simply

because appropriate precautions and procedures are not carried out.

How can we take precautions?

By ensuring that staff have adequate training

By the appropriate use of protection such as gloves, aprons

By cleaning up spillages safely in accordance with local policy

By safe disposal of contaminated items in accordance with local policy.

All staff should cover any cuts and abrasions using waterproof dressings. Staff with skin

lesions or broken skin from eczema or psoriasis should seek advice from their GP as they

may pose a risk of contamination both to themselves and to residents.

Each situation should be assessed using staff skills, procedures and facilities

available to determine precautions required.

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3.3 Storage of waste prior to collection

Health related waste should be stored in an area which is free from pests and the

elements and which is locked and inaccessible to the public prior to collection by the

registered carrier. It is important that you make yourself aware of your organisation’s

policies and procedures and refer to these when storing waste in your workplace. In order

to store waste safely:

The storage area should be kept clean

Full waste bags should not be thrown but placed carefully to avoid splitting of

bags or spilling of contents.

3.4 Legislation

Clinical waste

The Control of Waste Regulations 2012 (S.I. 588) define clinical waste as:

a) “Any waste which consists wholly or partially of human or animal tissue, blood or

any other body fluids, excretions, drugs or other pharmaceutical products, swabs or

dressings, syringes, needles or other sharp instruments, being waste which unless

rendered safe may prove hazardous to any person coming into contact with it”.

b) “Any other waste arising from medical, nursing, dental, veterinary, pharmaceutical

or similar practice, investigation, treatment, care, teaching or research or the

collection of blood transfusion being waste which may cause infection to any person

coming in contact with it.”

Hazardous Waste Regulations 2011

These are the most dangerous wastes. They can cause the greatest environmental

damage or are dangerous to human health.

The regulations require that most premises producing hazardous waste be notified. There

are some exceptions and premises such as offices, shops, farms, schools/colleges,

prisons, residential and nursing homes, hospitals, dental, veterinary and other medical

practices, premises used by charities and places used for the purposes of collecting

waste electrical and electronic equipment do not need to notify if they produce less than

200 kg of hazardous waste.

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If notification is needed the Regulator for England and Wales is the Environment Agency.

The Environmental Protection (Duty of Care) Regulations 1991 place obligations on

those producing waste to ensure that any waste they produce is handled safely and in

accordance with the law.

List of typical hazardous wastes:

Acids

Alkaline solutions

Batteries

Industrial solvents

Oily sludges

Pesticides

Pharmaceutical

compounds

Photographic chemicals

Waste oils

Wood preservatives

TVs

Computer monitors

Paint

Fluorescent tubes.

The Health and Social Care Act 2008: Code of Practice on the prevention and control of

infections and related guidance set out a number of criteria that facilities should consider

and include in the formulation of infection control policies and procedures. Good infection

control policies should make sure that staff and patients are protected from infections

acquired in the course of the provision of treatment, and there must be policies in place

for the prevention and control of infections, effective hand decontamination procedures,

wearing sterile gloves, dress code, safe use and disposal of sharps also staff must be

aware of their role. There must also be a person identified as the infection control lead,

and good management systems must be in place to ensure infection control issues are

dealt with.

3.5 How to reduce the risk of sharps injury

Sharps - Accidents involving risk of blood borne infection

Risk of accidental injury by sharps resulting in penetration of the skin or larger wounds,

may put the individual at risk of blood borne infection. Blood and blood products can

transmit a large number of infections.

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The major causes of concern are HIV (Human Immuno Virus), HBV (Hepatitis B

Virus), HCB (Hepatitis C Virus) and CJD (Creutzfeldt-Jakob Disease).

Such accidents include:

All sharps/needles injuries

Contamination of cut or abrasions with blood or body fluids

Human scratches/bites breaking the skin

Splashes of body fluids on to mucous membranes, e.g. eyes, mouth.

If you acquire a sharps injury the following IMMEDIATE ACTION must be taken:

BLEED - bleeding from wounds should be encouraged

CLEAN - the wound should be washed in soap and warm running water

COVER - the wound should be covered with a sterile dressing

REPORT - the incident should be reported to your line supervisor and procedures followed

RETAIN - only at this stage should an attempt be made to identify the source of the

needle/sharp

SEEK MEDICAL ADVICE - within 24 hours or IMMEDIATELY where there is a risk of

blood borne infection as treatment may be required within 2 hours of the injury

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Reducing the risk of sharps injuries

Safe handling and disposal of sharps

To minimise risk of accidental injury/infection:

Correct and safe disposal of needles and sharps into sharps disposal boxes

(BS7320) in order to protect staff, patients/individuals and waste handlers

Sharps boxes should be available and the lid secure

Never re-sheath needles - dispose of syringe and needle as one item even if not used

Never put your hands inside sharps boxes and do not overfill

Dispose of sharps into bin immediately after use - never lay them down on

surfaces or amongst dressings or towels.

Conclusion

The information you have read within this unit should increase your knowledge and

understanding, which will benefit you, the individuals you care for, key people and others.

Now complete the assessment questions for this unit in the workbook section.