30/08/2016

1

Waste and sharps management

Liz Forde, Infection Prevention and Control,Cork Community Hospitals & Cork Community Nursing

2016

Use Standard Precautions for ALL Residents at ALL times #safepatientcare

Outline

• Guidance available

• Lifecycle of Healthcare Risk Waste (HCRW)-• Segregation, packaging, storage & disposal

• Consequences of incorrect disposal

• Safe Use of Sharps

• Safe Disposal of Sharps

• Resources available

Waste Management Guidance

30/08/2016

2

Producer responsibility

Ensure that waste contractors hold a valid waste collection permit

1. Obtain a copy of the waste collection permit

2. Check that the waste permit lists your local Authority

3. Check the vehicle used to carry the waste is listed on the waste collection permit

4. Waste categories - Individual waste codes permitted

5. Waste Transfer form documentation is completed for all hazardous or risk waste

6. Ensure your waste is being brought to an EPA licensed facility for processing

September 2016Use Standard Precautions for ALL Residents at ALL times

#safepatientcare

Waste Segregation

September 2016

€822 per tonne

€1,871 per

tonne

€ 177 per

tonne

Healthcare Risk Waste Packaging

•Provides protection to personnel

•Identifies the type of waste generated &

•Disposal stream employedADR Regulations- Health & Safety driven

• Secondary Packaging• Wheeled bins

30/08/2016

3

DoH&C Poster - 2014

• All primary packaging for

HCRW must have

• diamond shaped risk label

with Class no.6

• Information label to

include e.g UN No. 3291-

Clinical Waste

• Permanent mark showing

UN type-testing e.g.

4H2/Y3/S/99/NL/VL823

Safe handling

• Staff training on segregation and handling procedures

• Yellow bags must not be used for sharps or breakable

items or for fluid

• Do not overfill bags or bins – close securely with cable tie

when 2/3 full.

• Carrying bags/bins through the clinical area should be kept to a minimum

• Carry bags/bins away from your body & by the neck only

• Bags should not be decanted from one to another, thrown or dropped to avoid damaging the bag

Swan Neck Closure for HCRW Bags

3. Put the bag individual tagged tie on the loop to

make a handle and pull

tightly.

Change when bags are 2/3 full

1. Twist the end to make a neck 2.Fold the neck into a loop

30/08/2016

4

Closing Instructions for Rigid Bins

1. Push down opposite corners

2. Push down the other corners

3. Check all sides are closed and apply tagged tie

Risk Waste Traceability

Must be

Tagged

Complete

label

Records of tags issued - kept for at least 3 years

External Storage

• Suitable sited

• Lockable & enclosed

• Well ventilated & Hygienic

• Secure from interference from unauthorised persons

• ADR Road Transport doc -signed by the contractor collecting the waste and a member of staff on site.

• Kept for 5 years

30/08/2016

5

Prior to disposal, infectious and sharps waste

goes for treatment in

SRCL, Dublin

And finally…

Replacing fossil fuel in cement kilns

Suitable for landfill

Outline

• Guidance available

• Lifecycle of HCRW-• Segregation, packaging, storage & disposal

• Consequences of incorrect disposal

• Safe Use of Sharps

• Safe Disposal of Sharps

• Resources available

30/08/2016

6

Unnecessary cost

Non risk disposed as risk - approx 6 times greater cost

Make waste segregation easier

September 2016Use Standard Precautions for ALL Residents at ALL times

#safepatientcare

• Only provide the correct type & size of bin needed

• Put the waste bin in the correct location

Remove risk bin if not needed

Place the non risk bin beside the sink

If needed, use a smaller risk bin

•Sharps Management

30/08/2016

7

Nurse

43%

Technician

15%

Student

4%

Dental

1%

Housekeeping/

Maintenance

3%

Clerical /

Admin

1%

Other

5%

Physician

28%

Occupational Groups of Healthcare Personnel Exposed to Blood/Body

Fluids,

NaSH June 1995—December 2003

(n=23,197)

Sharps injuries - Who gets injured?

http://www.cdc.gov/sharpssafety/PPT/2PreventingNeedlesticksPartI.ppt#291,12,Who Gets Injured?

When are sharps injuries most likely to occur?

•During use of a sharps device on a patient - 41%

•After use and before disposal of a sharp device - 40%

•During or after appropriate or inappropriate disposal of sharps device - 15%

• CDC 2008

Safe Use of Sharps – Be prepared

• Be prepared to use the device the moment the sharps are first exposed

• Receive training on how to use sharps safety devices

• Before undertaking any procedure, assess any risk of exposure

30/08/2016

8

Safe Use of Sharps – Be prepared

• Organise your equipment at the point of use

• Locate a sharps container/bring tray with integral bin within reach

• Work in well lit areas

• Assess patient’ ability to cooperate• Get help if needed

• Ask the patient to avoid sudden movement

Safe Use of Sharps – Be aware

During a procedure

• Keep the exposed sharps in view

• Be aware of people around you

• Stop if you feel rushed or distracted

• Focus on your task

• Needles should not be recapped

• Needles must not be bent, broken or removed from the syringe after use

• Sharps must not be passed from hand to hand & handling should be kept to a minimum (NICE, 2012)

Safe Use of Sharps – Be aware

During a procedure

• Activate safety feature of device as soon as the procedure is completed

• Observe audible or visual cures that confirm the feature is locked in place

30/08/2016

9

Safe Disposal of Sharps

• Be responsible for the device you use

• Dispose of sharps with care• Discard immediately at the point of use into an approved sharps bin by the user

• Use temporary closure on sharps bin when carrying a bin

•While disposing• Inspect container

• Keep hands behind sharps

• Never put fingers/hands into container

• If you are disposing sharps with attached tubing

• Be aware that tubing attached to sharps can recoil and lead to injury

• Maintain control of both tubing and the device during disposal

Clean Up and Dispose With Care

While disposing of Sharps (cont’d)

Safe Disposal of Sharps

Sharps containers

•Keep sharps bin in a safe place • Out of reach of children• At a height that allows safe disposal• Secure position to avoid spillage

•Fill sharps container to 3/4 fill line

•Close & Remove from use once fill line is reached

•Complete sharps bin label with• Date of assembly & signature• Date of Closure & signature• Location

30/08/2016

10

Safe storage of sharps bins

Photo 1: Difficult to access Sharps bin on lower shelf of trolley

Photo 2:Bin stored on shelf in clean utility, opening not visible

If bin overfull or a sharps not properly

disposed may pose needle stick injury to next user

Suggest trolley mount for easy access

Remember clean bins and trays

Risk of exposure to bloodborne viruses (HBV, hepatitis C virus, and HIV) through contaminated equipment and supplies

Hepatitis B virus

•remains viable for up to 7 days or more

Hepatitis C Virus

•is viable in the environment for at least 6 – 23 hours

WHO (2010) Best practices for injections and related procedures toolkit

Safe use of sharps bins poster

30/08/2016

11

Trolley Mount

“Kickabout”

Wall Mount

Consider

•Where do you use your sharps bin?

•What do you need to make it safer?

• Appropriate sizes

• Safer Storage of Sharps Bins

• Wall mounting sharps bins

•Following are resources available

September 2016Use Standard Precautions for ALL Residents at ALL times

#safepatientcare

www.greenhealthcare.ie

Sample signage

Green Healthcare Network:

Platform for healthcare staff to ask questions, seek advice and share information

Contact : eileen.oleary@ctc.ie

30/08/2016

12

Guidance documents and case studies developed by the programme –individual and combined booklets.

www.greenhealthcare.ie

September 2016Use Standard Precautions for ALL Residents at ALL times

#safepatientcare

PCCC: 16% of landfill bag comprised of mixed recyclables

To conclude

Always handle sharps with care•Be prepared

•Be aware

•Dispose with care

Have a Safe Day!

30/08/2016

13

References

Department of Health and Children (2010) Segregation, Packaging and Storage- Guidelines

for HealthcareRisk Waste - Working Draft. 4th Edition: Department of Health and Children, Dublin:

Stationary Office

Environmental Health Agency - Reducing Waste in Irish Healthcare Facilities

EU Council Directive 2010/32/EU of 10th May 2010 implementing the Framework agreement

in prevention from sharps injuries in hospital and healthcare sector

Health and Safety Authority (2014) Guide to the European Union (Prevention of Sharps Injuries in the Healthcare Sector) Regulations 2014

Health Service Executive (2014) Waste Management Awareness Handbook

National Institute of Clinical Excellence (2012) Infection: prevention and control of healthcare-associated infections in primary and community care

S.I. 135 (2014) Prevention of Sharps Injuries in the Healthcare Sector Regulations 2014

World Health Organisation (2010) Best practices for injections and related procedures toolkit