CIWM’s technical advisor, and Healthcare Waste Special Interest Group co-ordinator, Matthew Smith, took the opportunity to get hands-on with a pre-acceptance waste audit of a hospital… and this is what it entailed… CIWM Journal Online Exclusive
Being the co-ordinator of the CIWM Healthcare Waste Special Interest Group (SIG) I thought it would be a good idea to gain some practical experience in healthcare waste management, rather than just reading through the extensive HTM 07-01 (the Department of Health’s guidance document on managing healthcare waste), to better understand the sector.
In late July it was agreed that I would shadow Dr. Anne Woolridge, Technical Director of Independent Safety Services and vice-chair of the CIWM Healthcare Waste SIG, whilst she undertook a pre-acceptance waste audit of a hospital. For those who are unaware, sites that produce healthcare waste must carry out a waste pre-acceptance audit; in the case of a hospital this is an annual occurrence but the frequency can be up to every five years depending on the volumes of waste produced. Carrying out a pre-acceptance waste audit is a mandatory requirement within EPR 5.07, the Environment Agency guidance document on how to comply with your environmental permit. The main function of the audit is to inform the company that is treating this waste, what it contains.
The shadowing exercise was a very interesting experience and highlighted why good guidance and best practice are important. I was fairly surprised at the number of non-compliances I came across, such as an IV tube disposed of within an orange infectious bag which would normally go into the yellow sharps box due to the medicinal content within the tubing. In the ante-natal department, placentas were disposed of in a yellow container but should have gone into a red-lidded anatomical container, not something I had come across before!
These cases could be easily solved by undertaking a continuous training regime for the nurses in the department so that they were frequently reminded of the correct disposal routes. However, I also saw how busy some of the departments were, which demonstrated how overburdened the NHS staff are and where waste management sits on their priority list. This was also true of patients’ confidentiality which often overrules the correct pathway for waste management and helped me understand the aspects of a pre-acceptance audit that might not always be captured by written guidance.
For such a large site, with several hundred patient beds, I would have expected there to be an employee solely responsible for waste management. However, our guide for the day had multiple roles – head of waste management, head of security on the hospital grounds and in charge of overseeing parking and some aspects of estates management. This workload alone will surely impact on the potential success of any waste management system put in place, for example the requirement to regularly engage with the staff and to encourage uptake of training.
Another skill associated with undertaking an audit that became evident was having to very quickly build a relationship with the person whose ward or department is being audited. Tact and diplomacy were required whilst highlighting areas that require improvement. I saw how being an external auditor could have the potential to alienate the working staff who may not be receptive to being told that some aspects of waste management were not compliant , so developing a friendly and helpful working relationship is key to a successful, informative audit.
I thoroughly enjoyed the practical experience I gained from shadowing Dr. Anne Woolridge and seeing it first-hand opened my eyes to several different aspects of waste management and the issues involved. I would thoroughly recommend anyone who is interested in healthcare waste management, as well as any other part of the waste and resource sector, to get some practical experience under their belts. It will really help you to understand how strategy, policy and legislation impact upon those who are implementing waste management systems and working daily with these challenges.
Finally, there was one thought I wanted to leave with you that caught my attention whilst walking around the A&E department – if this reasonably compliant and hard-working hospital is struggling in some areas to adhere to a new separation system for healthcare wastes, how will they cope with the implementation of the separate collection of waste paper and card, plastics, glass and metals requirement come January 1st 2015? This is one to keep an eye on in the New Year.