WMRR outlines COVID-19 clinical waste guidance

The National Biohazard Waste Industry (BWI) committee, a division of the Waste Management and Resource Recovery Association of Australia (WMRR), has developed guidance to assist health care providers managing COVID-19 affected materials.

According to a WMRR statement, in the wake of the World Health Organisation’s pandemic declaration, stakeholders are considering additional measures to ensure the appropriate management of waste from patients, confirmed or suspected, to be infected with COVID-19.

“Under AS 3816:2018 Management of Clinical and Related Wastes, clinical waste is defined as any waste that has the potential to cause injury, infection, or offence, arising but not limited to medical, dental, podiatry, health care services and so forth,” the statement reads.

“At this time, we are not aware of any evidence that direct, unprotected human contact during the handling of healthcare waste has resulted in the transmission of COVID-19, nor is COVID-19 regarded as a Category A infectious disease.”

BWI understands that the World Health Organisation, and some Australian health officials, have declared that clinical waste from infected patients should be treated as normal clinical waste, “this however, may not be a uniform stance.”

“In light of the dynamic and evolving nature of the COVID-19 situation, along with the growing body of knowledge including the significant range of unknown characteristics, such as survival on surfaces, BWI feels it is prudent to suggest the adoption of additional measures,” the statement reads.

As governments evaluate the transmissibility and severity of COVID-19, BWI is aiming to offer a degree of precaution and assistance to staff who will be responsible for the management of higher than normal, and potentially more hazardous, clinical waste volumes.

“Additionally, it is hoped that these measures will also afford a greater level of protection to healthcare facility staff and waste handlers, both within and external to the facility, responsible for the management of clinical waste,” the statement reads.

Additional measures include: 

Health care workers are being urged to implement “double bagging” of waste from COVID-19 confirmed patients. According to the statement, this can be achieved by lining all clinical waste mobile garbage bins (MGBs) with clinical waste bin liners.

“By placing infected waste into a primary clinical waste bag and tying this bag up prior to disposal in the lined MGB – the bag lining the MGB must also be tied up – a significant increase in protection can be achieved,” the statement reads.

“For bins or containers that have been used in isolation rooms or in close proximity to patients confirmed as infected with COVID-19, the exterior surface should be wiped clean in accordance with World Health Organisation guidelines prior to collection.”

Discreet notification and identification of any bins carrying infected waste is also suggested, as clearly agreed upon with waste management providers.

“Understandably, there may be a reluctance to overtly label bins containing COVID-19 waste, therefore this could be as simple as the addition of a simple mark or sticker as clearly agreed and documented between the facility and your waste management provider,” the statement reads.

BWI recommends these measures be adopted alongside personal protective equipment and other relevant practices.

“BWI would like to reiterate the importance of all facilities continuing to work and engage with their waste management providers on the recommended additional measures,” the statement reads.

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High Temperature Incineration: Ace Waste

Waste Management Review talks to Metro North Hospital’s Waste Manager Gregg Butler about clinical waste regulations and the benefits of high temperature incineration.

Becoming one of the healthiest communities in the world by 2026 is the official vision of the Queensland Health Department.

To achieve this outcome, the department is committed to ensuring available resources are used efficiently for future generations, according to the department’s 2018-20 Waste Reduction and Recycling Plan.

To attain desired sustainability, the department has repurposed the waste hierarchy to highlight the importance of waste reduction and recycling within hospitals.

Brisbane’s Metro North Hospital and Health Services Environment and Waste Manager Gregg Butler, who has worked in the health sector for over 40 years, is at the forefront of rethinking waste in the industry.

“Over the years, Metro North have worked to install all sorts of waste management initiatives throughout our facilities,” Gregg says.

Metro North initiatives include the “Know Which Bin To Throw It In” campaign, which educates staff on correct waste segregation and the tube terminator, a machine that destroys lightbulbs to reduce the impact of mercury in landfill.

“The money we save through recycling and waste reduction initiatives allows us to buy new equipment such as hospital beds, which is beneficial for the community,” Gregg says.

While the waste hierarchy privileges avoidance and reduction, hospitals by their very nature generate a significant amount of waste that cannot be recycled.

“Recycling what we can is important, but a lot of hospital waste is hazardous and needs to be disposed of responsibly, namely clinical waste,” Gregg says.

Clinical waste is an unavoidable waste stream with limited diversion and processing methods. It is generally defined as any waste with the potential to cause disease, including discarded sharps, human tissue and laboratory waste.

Standard Australian destruction practices fall largely into two camps, autoclave and incineration.

“I don’t like treating clinical waste though autoclave because as far as I’m concerned, it doesn’t get rid of the pathogens and some of the needle and blood products,” Gregg says.

“Ace Waste are the only ones with incinerators in Queensland, and in my personal opinion, incineration is the way to go.”

To process its clinical waste, Metro North work closely with family owned medical waste disposal company Ace Waste.

Ace Waste was founded in 1987 in response to the need for a professional clinical waste collection and disposal service. The company provides hospitals, healthcare facilities and other businesses with safe waste collection, storage and disposal services.

Additionally, Ace Waste offers secure transportation and high temperature incineration at their Brisbane treatment facility, located at Willawong.

“Metro North have had a relationship with Ace Waste since they were established in the late 80s,” Gregg says.

“We choose to work with Ace Waste specifically because they incinerate, which I consider the most appropriate disposal method for clinical and related toxic waste.”

According to Gregg, when medical waste regulations came into effect in 1994, Ace Waste were already compliant.

As per the Queensland Government’s clinical and related waste policy, hospital waste must be handled, stored, and transported appropriately to minimise the potential for contact. Additionally, prior to disposal at landfill, all clinical waste must be treated.

While incineration renders the waste unrecognisable, the bi- product in the form of residual ash still requires disposal at a regulated waste disposal facility, which Ace Waste facilitates.

“They can handle anything clinically related as far as regulations go, blood products, cytotoxic waste, chemical waste,” Gregg says.

“They take roughly 80 to 90,000 kilograms from Metro North every month, which is substantial, and they have the know how and capacity to dispose of it safely and efficiently.”

The Ace Waste incineration process involves loading waste into a primary chamber and incinerating it at temperatures between 1000 °C and 1150 °C. The exhaust gas from the secondary chamber is then cooled, before being passed through the air pollution control plant.

The process guarantees the complete destruction of infectious waste materials and ensures pathogens and toxic disease are unable to be released into the ground or atmosphere.

“At those temperatures there is no residue what so ever, which means contaminants won’t turn up in landfill,” Gregg says.

“Additionally, high temperature Incineration converts plastic into energy and is a great substitute for fossil fuels.”

According to Gregg, thermal degradation is a gasification process in essence.

“Not only are volatile plastics used as alternate fuel, the resultant heat destroys pathogens and pharmaceuticals and converts it into carbon dioxide and water,” he says.

Queensland regulations also require clinical waste to be effectively segregated into categories such as chemical waste, human tissue waste and pharmaceutical waste.

“Ace Waste provide appropriate storage bins, which lets staff easily sort waste at the point of disposal,” Gregg says.

“The service has always been A plus with Ace Waste, hence the contracts being renewed over and over again.”

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