Waste Management

Auckland District ENVIRONMENTAL MANAGEMENT Infection Control
Health Board (Section 4) Manual

WASTE MANAGEMENT
Section: Environmental Management Issued by: Infection Control Co-ordinator
File: Waste Management Nov10.doc Authorised by: Chief Medical Officer
Classification: IC01/ENV/004 Date Issued: Updated November 2010
Waste Management Page: 1 of 22
Overview

Content This document covers the following topics relating to waste
management.

Topic See Page
Overview ..................................................................................... 1
Management of Waste Generation & Disposal ........................... 2
General Policy ............................................................................. 4
Waste Types Definitions .......................................................... 7
Types of Waste Containment ...................................................... 9
Waste Segregation & Recycling ............................................... 10
General Waste ........................................................................... 12
Clinical Waste ........................................................................... 14
Chemical Waste ........................................................................ 17
Cytotoxic Waste ........................................................................ 19
Pharmaceutical Waste ............................................................... 20
Radioactive Waste ..................................................................... 21

Infection Control ENVIRONMENTAL MANAGEMENT Auckland District
Manual (Section 4) Health Board
WASTE MANAGEMENT
Page: 2 of 22 Waste Management
Management of Waste Generation & Disposal

Purpose To manage waste generation and disposal throughout the
Organisation in accordance with the terms of all relevant legislation
and in a manner that meets the requirements of the New Zealand
Standard for Health Care Waste Management (NZS 4304: 2002).

Scope All areas within Auckland District Health Board.

Responsibility Individual RC Managers are responsible for ensuring that all waste
generated in their area is disposed of in line with this document.

Associated
Document
The table below indicates other documents associated with this
document.

Type Document Titles
Board Policies Body Parts - Autopsy
Body Parts - Surgical
Infection Control
Policies
Cleaning of Inpatient/Clinical Areas -
Infection Control Requirements for
Patient Isolation
Standard Precautions
Health & Safety Mercury Guidelines for Safe Use
Pharmacy Spillage of Cytotoxic Drugs

Continued on next page
WASTE MANAGEMENT
Management of Waste Generation & Disposal, Continued

Type Document Titles
Legislation Toxic Substances Regulation 1983;
amendments 1998 & 1999
Resource Management Act 1991
Hazardous Substances & New Organisms
(HSNO)Act 1996
Radiation Protection Act 1965
Radiation Protection Regulations 1982
Biosecurity Act 1993
Land Transport Rule, Dangerous Goods 2005
Land Transport Act 1998; amendment 2005
Local Authority
Reg.
Auckland Regional Council Trade Wastes
By-laws 1991
Auckland Metropolitan Drainage Act 1960
Standards NZS 8142:2000 Infection Control
NZS 4304:2002 Management of Healthcare
Waste
NZS 5433:1999 Transportation of Dangerous
Goods on Land
AS/NZS 4261:1994 Reusable containers for
the collection of sharp items used in human
and animal medical applications
SAA/SNZ HB76:2003 Dangerous Goods -
Initial Emergency Response Guide.
NZS 7603:1979 Specifications for Refuse
Bags for Local Authority Collection
Guideline OSH Guidelines for the Safe Handling of
Cytotoxic Drugs and Related Waste May 1997.

WASTE MANAGEMENT
General Policy

General Policy This document provides a broad overview of approved methods of
waste management.

Specific guidelines and training are required of all areas disposing of
waste types related to their specialty.

All human waste shall be treated in a manner that upholds the
spiritual, cultural, and physical dignity of the person from whom the
waste was generated.

All staff involved in waste management shall be trained in
accordance with the protocols in this document.

All waste generated shall be handled in such a manner that it does not
cause harm / injury to personnel or the environment.

Waste management within the Organisation will be monitored and
audited.

This document references the Standard NZS 4304:2002 Management
of Healthcare Waste which is the recommended Standard from the
Ministry of Health.

Waste Disposal
Plan
Prior to the implementation of any procedure that generates any
waste type a plan should be in place for the disposal of the waste.

Waste Reduction There will be a co-ordinated approach in the supply of goods and
subsequent disposal of associated waste.

In purchasing goods and services, due consideration will be given to
the principle of waste minimisation.

WASTE MANAGEMENT
General Policy, Continued

Containment &
Storage
Waste must be contained, properly secured and stored in an
appropriate bag/container.

It is not necessary for rubbish bag holders to have lids unless the
waste contained therein is likely to be smelly or otherwise offensive,
and/or it is impractical to change the bags at least daily.

Waste that is not adequately secured will not be collected.

All bags must be tied off at the top.

Split or leaking bags must go into another bag or placed into a fluid
bin as appropriate to contain the waste.

The bag must not be overfilled which may cause the bag to split (i.e.
fill to 2/3 capacity only).

Waste collection staff must not be endangered in any other way by
the nature or packaging of the waste.

The contractor will not collect contaminated waste that is not
appropriately packaged.

Waste shall be stored for collection in designated areas away from
public traffic, and separate from any food preparation and transport
routes, patient treatment, sterile supplies or other clean areas.
Waste may be stored in ward sluice rooms, provided sufficient space
is available so as not to compromise other functions.

Bulk storage of waste for collection shall be in designated areas that
are secure, lockable, well aerated and maintained by the contractor to
comply with NZS 4304:2002.

Transport
Movement
Any movement of waste around the organisation should maintain its
segregation to ensure subsequent safe disposal.
Any movement of waste around the organisation should maintain
the principle of keeping clean and dirty functions and goods
separate.
Any reusable hard shell containers used to collect, store or
transport waste must be cleaned as required by the contractor.

WASTE MANAGEMENT
General Policy, Continued

Contractor Waste shall be collected from designated areas and disposed of
appropriately by the contractor.

All procedures used by the contractor in fulfilling their contract must
be fully documented, and these procedures approved by Infection
Control.
All contractors employed directly or indirectly in waste
management will be required to abide by the terms of this
document, and the principles laid out in NZS4304:2002.
Any required documentation (e.g. Hazardous Substances or
Dangerous Goods Declaration) shall be completed at the point of
generation, and accompany the waste.

Legal
Requirements
Any additional requirements (licences, statutory documentation)
required by external agencies must be complied with also.

The major requirements for waste is:
Waste must be appropriately segregated and identified at the
point of generation.
Waste must be placed in containers displaying appropriate colour
code and international hazard symbol and hazardous substance
class where specified. (NZS 5433:1999).

Effluent Discharge Waste discharged to the site sewerage system (including any waste
chemicals) must comply with the Auckland Regional Council Trade
Waste Bylaw - 1991. To assist staff in making disposal decisions the
following guidelines are available on the Facilities Management
intranet website or as hard copy from Facilities Management;
Guidelines on the Discharge of Effluent to the Sewer.

WASTE MANAGEMENT
Waste Types Definitions

General Waste Waste material, which is non-hazardous, includes office or paper
waste, kitchen waste and any other household type waste. The
majority of hospital waste is classified as general waste.

Clinical Waste Human material contained or spilled accidentally, which has the
potential to cause a microbiological or pathological hazard to health.
Includes the categories of sharps, human tissues, laboratory waste
and any other category as specified by the organisation. (See Other
Clinical waste).

Heavily Contaminated: Refers to items that are heavily soiled with
blood or body fluids and would be dripping with blood or body
fluids. It also refers to an item of waste that would generally be
considered to be offensive, and is therefore unsuitable for landfill.

Sharps: objects or devices having sharp points or protuberances or
cutting edges, capable of cutting or piercing the skin.
e.g. Needles, scalpel blades, scissors, blood glucose lancets.

Human tissue waste: body tissue, organs, limbs, and any free-
flowing liquid body fluid.

Laboratory waste: a specimen or culture discarded in the course of
medical or dental practice or research, including genetically
manipulated material and imported biological material.

Animal waste: animal material which has the potential to cause a
microbiological or pathological hazard to health. Includes categories
of laboratory and animal waste resulting from medical research.

Other Clinical waste: Waste that may be offensive in odour, such as
any material or by-product of a process contaminated with infectious
agents or body fluids.

WASTE MANAGEMENT
Waste Types Definitions, Continued

Related Wastes Chemical waste: Material generated from the use of chemicals in
medical, laboratory, ancillary and disposal procedures.

Cytotoxic waste: Material which includes sharps and is, or may be
contaminated with, a cytotoxic drug during certain laboratory
procedures and during the preparation, transport or administration of
cytotoxic therapy.

Pharmaceutical waste: Material that may arise from pharmaceutical
products that have passed their recommended shelf life, discarded
pharmaceuticals due to off-specification batches or contaminated
packaging, drugs returned by patients, drugs that are no longer
required by the organisation. (Excludes disposal of pharmaceutical
drugs and their metabolic by-products excreted from patients
undergoing therapy).

Radioactive waste: Material including sharps, contaminated with a
radioisotope which arises from the medical or research use of
radionuclides, e.g. during nuclear medicine, radioimmunoassay and
microbiological procedures, and may be in solid, liquid or gaseous
form.

WASTE MANAGEMENT
Types of Waste Containment

White Plastic Bags 50-micron thick plastic bag. May have General Waste printed on
side of the bag. Suitable for non-penetrating general hospital waste.
White plastic bags are disposed of at landfill.

Brown Paper Bags Dry general waste.

Yellow Plastic Bags 50 micron thick plastic bag with biohazard symbol displayed on bag.
Suitable for waste that is heavily contaminated with body fluids but
is not liquid. Yellow plastic bags are disposed of by the contractor at
the plant site.

Fluid Bins Can be either 50L or 120L bins with biohazard symbol displayed.
These bins are for liquid waste of blood or other body fluids that
would leak out if in yellow plastic bag. The bins are lined with 170
micron yellow bags. The contractor at the plant site disposes of the
contents of the bins.

Cytotoxic Bins &
Bags
Non-reusable purple, hard shell plastic containers or
purple plastic bags labelled with the telophase symbol.
Cytotoxix waste is transported off shore for
incineration by the contractor in Australia.

Sharps Containers Yellow hard shell plastic containers containing the
universal biohazard symbol. The contractor at the
plant site disposes of the contents of the bins.

Radioactive
Containers
Non-reusable rigid container, stored and transported
upright. International ionising radiation symbol in
black.

WASTE MANAGEMENT
Waste Segregation & Recycling

Purpose To outline the procedure for segregation of waste.

To minimise/ prevent cross infection via blood or body fluid
contaminated rubbish.

Responsibility This procedure applies to all Auckland District Health Board staff
who generate waste (whether in clinical areas or not).

Segregation The process ensures the different waste categories are kept separate
at their generation point, during handling, interim storage and
transportation, prior to disposal.

Recycling Recycling of waste is to be encouraged.

Glass, plastic and cardboard is to be placed into appropriate
containers for removal by an approved contractor.

WASTE MANAGEMENT
Waste Segregation & Recycling, Continued

Procedure Follow the steps below to segregate waste.
For further information refer to the waste type section.

Is it radio-
active or cytoxic
waste?
Yes
Is it a sharp?
(e.g. needle)
No
Is it heavily
soiled with blood
or body fluid?
Yes
No
No
Is the blood and
body fluid likely to
leak?
Yes
Yes
No
Dispose of into a yellow
biohazard rubbish bag
(e.g. blood soaked swabs)
Dispose of into white
plastic/brown paper bag.
Place into a fluids bin
(e.g. full drainage bottle)
Place into a
sharps container
Dispose of into appropriately
labelled container as per Company
Waste Management policy.
ITEM

Note Normal household type glass should be disposed of into
appropriately labelled glass containers.

WASTE MANAGEMENT
General Waste

Purpose To detail the policies for collection, segregation, labeling and
disposal of various types of general waste.

Paper Waste Paper suitable for recycling is to be placed into the paper recycle
bins.

Cardboard suitable for recycling is flattened and collected by the
contractor.

Other paper and general office waste is disposed of into either white
plastic or brown paper bags for collection and is disposed of by
landfill.

Any patient or commercially sensitive papers must be either shredded
or placed into the locked blue confidential bins for Rotoclaving by
the Contractor. Shredded paper may be placed in white plastic or
brown paper bags for disposal by landfill.

Confidential
Document Bins
Access into confidential document bins for the purpose of document
retrieval must only be through the Waste contractor who will have a
key to unlock bin.
All confidential document bins must have a bin liner and padlock
attached.
No confidential documents are to be kept in open bins under
work stations or desks.

Note: No keys are to be held by any department or ward unless
authorized by commercial services of ADHB.

Recycling Co-
mingle Bins
Glass, plastic, aluminium and tin are recycled in green with yellow
lid co-mingle bins.

Glass contaminated with hazardous substances must be disposed of
according to the hazard type refer to the appropriate section in this
document.

WASTE MANAGEMENT
General Waste, Continued

Kitchen/ Food
Waste
May be placed into black plastic bags, then into designated
wheelie bins, for landfill disposal.
Food scraps may also be disposed of into a kitchen macerator and
flushed to the sewer.
Bins for collecting food waste must have lids.

Wastes from
Clinical Treatment
Areas
Household type waste generated in the clinical area is suitable for
disposal as general waste and should be placed into white plastic or
brown paper bags and disposed of in sanitary landfill.

Examples are:
Intravenous tubing (with plastic spike removed) and bags, oxygen
masks and tubing.
Metrisets, buotrols, three way taps, rubber top vials.
All intravenous plastic cannulas, epidural catheters.
Unused test tubes, empty syringes (no needles) from the
needleless system.
Empty 10 ml, 20 ml, 50 ml and 250 ml bottles (Radiology).
Drainage collectors which have been emptied of contents e.g.
haemovacs, colostomy equipment, urinary bags, and minivacs.
Catheters e.g urinary, suction, rectal and naso-gastric.
Disposable sheeting e.g burns sheeting, plastic sheeting;
continence products, disposable nappies and sanitary pads.
Disposable scopes e.g sigmoidoscopes, speculums.
Used dressings, swabs, gauze etc and material from dressing
packs.
Specimen containers, used and emptied.
Used tissues, emptied sputum mugs, emptied vomit bowls.
Disposable gloves, masks, gowns and plastic aprons.
Disposable airways, bacterial viral filters, oral/pharyngeal suction
catheters and endotracheal tubes.
Underwater seal drainage tubing.
Tinfoil containers.
Plaster of Paris casts.
Glass if unsuitable for recycling.
Broken glass, light bulbs, broken suction bottles (wrapped in
newspaper).

WASTE MANAGEMENT
Clinical Waste

Purpose To detail the policies for collection, segregation, labeling and
disposal of the various types of clinical waste.

Disposal of Clinical
Waste
There are several methods for processing/disposing of clinical waste,
e.g. incineration, compaction. Any contractor appointed to collect
and dispose of ADHB waste must operate a safe, effective operation
that meets all relevant standards, codes, legislation, local authority
regulations, and does not pose any hazard to the general public, to
ADHB staff, patients, or visitors, or to the environment.

In addition, the Infection Control Service must approve any such
disposal process. The Infection Control Service is responsible for
monitoring and auditing the contractor to ensure such ongoing
compliance.

Paper, plastic or other materials which are contaminated with body
fluids or other biohazardous material that are not likely to leak out
should be placed into yellow plastic bags for collection by the
contractor for disposal.
Bags must be securely closed before collection.
Do not place liquid waste into bags - use the fluid bins as above.
Yellow bags be at least 50 microns thick.

Sharps Must be disposed of into dedicated puncture resistant sharps
containers which comply with AS/NZS4261: 1997 and which have
been approved by Infection Control.

Sharps containers must be correctly assembled.

Sharps containers must not be overfilled and be closed properly to
avoid spills or protrusion of sharps. Do not fill past the 2/3 mark or
designated fill line.

Sharps containers are collected and disposed of by the contractor.

Do not place sharps into plastic or paper bags as this creates a hazard.

WASTE MANAGEMENT
Clinical Waste, Continued

Human Body Fluid/
Tissue Waste
Any bag, tube or vessel containing a body fluid is to be placed into
the dedicated yellow fluid bins. The bags are filled to 2/3 full then
closed using a tie and the bins lid replaced tightly to secure the
contents. The contractor collects the contents of these bins for
disposal.

A yellow plastic rubbish bag is to be used to contain any waste that is
heavily contaminated with body fluids which are not free-flowing
liquids. This is filled 2/3 full and tied off.

Tissues fixed in a solution of 10% Formalin, prior to collection for
disposal, are drained and placed in the fluid bins which are labelled
Biohazard as supplied by the contractor. The bags are filled to 2/3
full then closed using a tie or tie-wire apparatus and the bins lid
replaced tightly to secure the contents.

The Auckland City Mortuary staff organises the disposal of limbs by
the School of Medicines contractor. The limbs are placed inside a
120 micron yellow plastic bag which is then placed in a multi-walled
brown paper bag and sealed by taping. Sharp edges such as bone, are
padded to prevent perforation of the packaging. A form, Mortuary
Department Request from Main Building Operating Rooms
(detailing method of disposal and patient identification) which has
been completed and signed by the nurse in the operating room, is
attached to the package.

Some human tissues including complete organs, foetal tissue and
placentas, are transported by Funeral Director and disposed of at
Mangere Crematorium, or collected by the patient or family/whanau
members on request. A Mortuary Department request form shall be
completed and signed in each instance. Where human tissue is kept
by the ADHB, it shall be managed according to Body Parts Policy
and disposed of in a manner in accordance with relevant Standards
and Policies.

WASTE MANAGEMENT
Clinical Waste, Continued

Laboratory Waste Some laboratory waste may require pre-treatment before disposal,
e.g. all waste from the TB laboratory is autoclaved before disposal.

All other laboratory waste is collected and segregated as per the
sharps and other clinical wastes sections.

Some laboratory waste is classified also under Related wastes. Refer
to that section for details (e.g. chemical, cytotoxic, pharmaceutical,
radioactive).

Isolation Room
Waste
In general all isolation room waste is placed in white rubbish bags,
unless waste is heavily soiled with blood and body fluid.

In rare cases of extremely infectious diseases, e.g. Ebola or Lassa
fever, special precautions are required. In the unlikely event of such
an occurrence at ADHB, contact Infection Control or Infectious
Diseases for further guidance.

Animal Waste Is to be placed into yellow biohazard bags and collected by the
contractor for disposal.

Bags must be securely closed before collection.

Do not place liquid waste into bags. If liquid waste is likely, a fluid
bin will be required.

WASTE MANAGEMENT
Chemical Waste

Purpose To detail the policies for the collection, segregation, labeling and
disposal of the various types of chemical waste.

Chemical Waste Compliance with all laws, regulations and by-laws is mandatory.
Refer to Transport of Dangerous Goods on Land: 2005; Land
Transport Rule 45001: 2005, Dangerous Goods: 2005.

Prior to the use of any hazardous chemical a plan should be in place
for its disposal, including by-products. Managers of areas generating
such waste are responsible for providing training in the safe
handling, storage and disposal of the products, ensuring written
procedures are documented, followed and updated records of reviews
of procedures and training are maintained.

Different wastes should not be mixed and precise labeling is
obligatory. Waste shall be placed in containers displaying the
appropriate waste category colour code, international hazard symbol
and, where specified, the hazardous substance class. (NZS
4304:2002).

In storing solvents, containers must have a minimum of 8mm air
space left for expansion. Solvents must be collected in glass bottles,
or empty 20 litre drums in which solvents provided by the supplier
were purchased. An accurate inventory should be kept of types and
quantities of chemicals held for disposal.

Spontaneously flammable materials, (e.g., solvents, oxidising
materials, some acids when mixed with organic material, rags soaked
in paint or oil) must be handled with great care and never deposited
in the normal waste bins.

Legislative requirements for documentation must be met.

Particular care must be taken to maintain secure storage with no
unauthorised access possible.

WASTE MANAGEMENT
Chemical Waste, Continued

Chemical Waste
continued
Storage must be in an appropriate area (e.g. flammables cupboard,
dangerous goods store) away from incompatible chemicals.
Appropriate emergency equipment according to current regulations
must be provided.

Quarterly audits of Dangerous Goods Storage areas is to be arranged
in accordance with NZS 5433:1999 Transport of Dangerous Goods
on Land.

Depending on the substance, it is collected into hard shell containers
by the contractor for incineration or landfill (depending on
regulations and quantities); or, some substances may be flushed
down the sink or sluice with appropriate volumes of water and pre-
treatment where indicated.

WASTE MANAGEMENT
Cytotoxic Waste

disposal of the various types of cytotoxic waste.

Cytotoxic Waste All procedures for the handling of cytotoxic waste must comply with
the Guidelines for the Safe Handling of Cytotoxic Drugs and Related
Wastes, 1997; Pharmacy: Spillage of Cytotoxic Drugs: June 2003,
NZS4303:2002 Management of Healthcare Waste and NZS
5433:1999 Transport of Dangerous Goods on Land.

Cytotoxic waste shall only be collected and handled by personnel
trained in handling such substances. Managers of areas generating
such waste are responsible for providing training in the safe
handling, storage, management of spills and disposal, and ensuring
written procedures are documented and followed and updated records
of reviews of procedures and training are maintained.

Containers for cytotoxic material shall be sealed and labeled prior to
leaving the workroom or laboratory.

Cytotoxic waste mixed with other waste (e.g. blood and other body
fluids) shall be treated as cytotoxic waste.

Low concentration cytotoxic waste from patients being treated with
cytotoxic preparations should be flushed to the sewer system.

Sharps are collected into dedicated cytotoxic sharp containers. These
are disposed of by the contractor.

Other cytotoxic waste generated is collected, securely closed, and
collected by the contractor for incineration. Yellow bags with a
telophase sticker attached are acceptable if purple bags are not
available.

Cytotoxic waste is disposed of and incinerated off shore in Australia
by the contractor

Do not place cytotoxic waste into white plastic or brown paper bags.

WASTE MANAGEMENT
Pharmaceutical Waste

disposal of the various types of pharmaceutical waste.

Pharmaceutical
Waste
All practices in relation to pharmaceutical waste must comply with
policies outlined in ADHB Pharmacy Policy Manual.

Must be contained in appropriate hard shell containers, and the
contents clearly identified.

Return to Pharmacy, who will sort and dispose of.

Disposal of Controlled Drugs shall be by two pharmacists in
accordance with current guidelines, and an accurate record kept.

Pharmaceutical suppliers must provide either appropriate disposal
information for their products, or agree to accept their products back
when no longer required.

All trial medication not dispensed by Pharmacy staff must be
collected and disposed of by the supplier or pharmaceutical firm.

May be collected for incineration by the contractor or flushed into the
sewer, depending on the substance and relevant laws, by-laws and
other regulations.

Expired or waste vaccines should be inactivated before disposal by
heat or autoclaving, or alternatively be disposed of by high
temperature incineration.

Where pharmaceutical products are utilised in areas other than
pharmacies (e.g. laboratories), then the same policies above shall
apply.

WASTE MANAGEMENT
Radioactive Waste

disposal of the various types of radioactive waste.

Radioactive Waste The handling and disposal of radioactive waste must meet the
requirements of Radiation Protection Act 1965 and Radiation
Protection Regulations 1982, Biosecurity Act 1993, Toxic
Substances Regulation 1983, the National Radiation Laboratory
(NRL) and the Code of Safe Practice for the use of Unsealed
Radioactive Materials, 1996.
Staff responsible for areas generating radioactive waste shall be
licensed by the National Radiation Laboratory.
The licensee shall be a suitably qualified person licensed to use
radioactive material or irradiating apparatus under the Radiation
Protection Act 1965 and the Radiation Protection Regulations
1982.
Licensees of areas generating such waste are responsible for
providing training in the safe handling, storage and disposal, and
ensuring that written procedures are documented and updated All
radioactive waste containers shall be clearly identified with a
radiation symbol.
Waste is to be collected into suitable containers, (e.g. non-
reusable rigid containers).
Areas dedicated to store radioactive waste shall be secure at all
times and display the black ionising radiation symbol.
The licensee is responsible for determining when radioactive
waste is at a level acceptable for disposal.
When practicable, radioactive material should be securely stored,
until the residual activity has been calculated to be reduced, to a
level allowable for disposal. The waste is then disposed of as per
other waste - i.e. biohazardous into yellow bags for Rotoclaving;
non-hazardous liquid into sewer; non-hazardous solids into white
plastic or brown paper bags and to the landfill. Any reference to
radiation is to be removed prior to landfill disposal. If not
practicable to store until safely decayed, consult the NRL for
advice.

WASTE MANAGEMENT
Radioactive Waste, Continued

Radioactive Waste,
continued
Radioactive sources must be packaged and couriered to the
disposal or reuse agency.
Legislation requires that radioactive waste, when transported on
land, shall carry a Dangerous Goods declaration. (Refer to NZS
5433:1999).
Where the radioactivity levels are below the limits specified in
the NRL Code of Safe Practice, the waste may be disposed of as
Clinical waste.

Waste Management

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Health Board (Section 4) Manual

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