Skill List > Safe disposal of waste, sharps, linen and equipment
Clinical Alert
Elsevier Clinical Skills covers the principles of this procedure. You must follow local policies and procedures regarding technique, equipment used and documentation.
Authors:
Written by: K. Rawlings-Anderson BA (Hons), MSc (Nursing), DipNEd, RN;  J. Hunter BSc (Hons), MA, PG Cert, RN 
Domestic waste should be disposed of in a black bin bag
Infectious, often called clinical, waste is disposed of in a yellow or orange bag
Offensive waste should be disposed of in a yellow bin bag with a black stripe (tiger bag). Note: manufacturer colours may vary.
Learning Objective
After reading the skill overview, following up some of the references/web sites and completing the self-test quiz you should be ready to be assessed in practice in the skill of disposal of waste and cleaning equipment.

Introduction

The safe management of healthcare waste is the responsibility of every healthcare professional (RCN 2014) and is an essential part of ensuring that healthcare activities do not pose a risk or potential risk of infection (DH 2013). The Department of Health (DH 2013) advise that healthcare organisations should consider public safety, waste minimisation, and waste-derived carbon impact when developing waste management policies. Current hospital waste disposal policy may differ between organisations or NHS Trusts as contemporary waste disposal streams are based on a colour-coding system that is recommended but not mandated.  

Healthcare waste can be produced in hospitals or in a person’s own home. Waste items that cause harm to the environment or human health may be classified as hazardous waste (RCN 2014).

The Royal College of Nursing (RCN 2018) suggests that nurses have a significant role to play in improving waste segregation and management. They are ideally placed to minimise unwarranted variations in waste management and associated financial costs.

The DH have recommended a colour-coding system for the identification, segregation and disposal of waste. This is intended to ensure appropriate management of different waste streams. The following healthcare waste types are included in the DH guidance (2013):

  • Infectious waste

  • Anatomical waste

  • Medicinal waste 

  • Cytotoxic and cytostatic waste

  • Sharps contaminated with cytotoxic and cytostatic waste

  • Sharps contaminated with other medicinal waste products

  • Sharps which are potentially infectious

  • Offensive/hygiene waste

  • Domestic waste

  • Amalgam waste

  • Chemical waste

  • Radioactive waste

  • Large equipment and mattresses

  • Implanted/infectious medical devices.

All institutions should have a written policy on waste segregation and disposal, which provides guidance on all aspects, including special waste, like pharmaceuticals and cytotoxic waste, segregation of waste, and audits. This should include the colour coding of bags/receptacles used for each type of waste. 

Nurses should ensure that they perform appropriate hand hygiene practices and wear relevant personal protective equipment when dealing with disposal of waste , sharps, linen and equipment. 
See: ECS Hand washing, ECS Use of alcohol-based hand rub and ECS Use of apron and non-sterile gloves

In general, nurses in non-specialist areas deal with four main categories of waste, which are detailed in Table 1.

Table 1 Categories of waste (DH 2013)

Type of waste

Colour

Notes

Examples 

Infectious waste (commonly called clinical waste)

Orange Waste contaminated with bodily fluids which poses a potential infection risk Dressings, personal protective equipment such as gloves/aprons
Yellow Waste contaminated with infected bodily fluids and chemicals.  This waste is incinerated

Chemically contaminated samples and diagnostic kits such as laboratory equipment

Offensive waste Yellow with black stripe (Tiger bag)
Offensive or hygiene waste classified as non-hazardous as it is  not considered to pose an infection risk Incontinence pads, catheter bags, stoma bags, blood contaminated items from screened community

Domestic waste

Black Items you would find in normal household waste. NB. Some organisations may use additional bins for recycling purposes Food, food wrappers and newspapers

Sharps

Yellow with orange lid Non-medicinally contaminated  Lancets for blood glucose monitoring, stitch cutters, shaving razors
 Yellow with yellow lid
Medicinally contaminated. These are the ones most commonly used in practice   Syringes, needles, ampules  used in the administration of medication 

Sharps

Many healthcare procedures involve the use of needles or other devices capable of puncturing the skin, such as scalpels, lancets, etc., which are collectively referred to as ‘sharps’. An injury from a needle or other device contaminated with blood or other body fluids poses a high risk to healthcare workers and so special care must be taken when using and disposing of sharps (Blenkharn 2014). All sharps must be discarded into special yellow sharps bins, which are rigid, puncture resistant and leak proof. They have a special opening that is designed to allow sharps to be dropped easily into the container, but will not allow items to spill out should the container topple over. Sharps bins once closed, cannot be reopened.

The RCN (2017) identify several points for best practice in relation to the safe handling and disposal of sharps (Table 2). The safe disposal of needles and other sharps is always the responsibility of the person who used them; they should never be left for anyone else to clear away. 

  • Policies should be in place to enable safe disposal and transport of used sharps in community settings
  • Reporting procedures and policies related to sharps injuries should be in place
  • Means of safe disposal of sharps are established for all procedures

Table 2 RCN Guidance on Sharps Safety (2017)

Practice

 
  • Handling of sharps is kept to a minimum
  • Syringes and needles are disposed of as a single unit
  • Needles are never re-sheathed
  • Needles are not broken or bent before disposal
  • Staff are trained in the safe use of sharps
  • Staff comply with local sharps or inoculation injury policy
 Sharps containers  
  • Available at point of use, are at eye level and within arm’s reach
  • Are not filled to more than two-thirds
  • Should be signed on assembly and disposal
  • Should be stored away from the public and out of reach of children
 Policies  
  • Policies should be in place to enable safe disposal and transport of used sharps in community settings
  • Reporting procedures and policies related to sharps injuries should be in place
  • Means of safe disposal of sharps are established for all procedures

Linen

Clean linen should be stored in a designated area and preferably enclosed e.g. a designated linen cupboard or room. Clean linen that is not fit for purpose e.g. frayed, ripped or stained should be disposed of according to hospital policy.  When making beds or coming into contact with used linen, staff should wear appropriate personal protective equipment following risk assessment. The minimum requirement would be to wear an apron.  All used linen should be categorised to ensure that all healthcare staff are protected from potential contamination (DH 2016).

There are two types of linen bags used in healthcare settings. Impermeable bags are used for all linen and do not allow any fluid to leak or pass through during use. Water-soluble bags (which may be referred to as alginate bags) or impermeable bags with a water-soluble seam, dissolve or break apart when in a washing machine. These avoid laundry staff from coming into contact with fouled or infectious linen. Linen classifications are outlined in Table 3.

Table 3 Classification of linen (DH 2016)

Type 

Description

Disposal

Used (soiled and fouled linen)

All used linen, it may be contaminated with body fluids or blood. Any linen from known or suspected infectious patients must not be included in this classification Place linen in an impermeable bag. These are usually white or clear plastic
Infectious linen All used linen from patients with diarrhoea; or linen contaminated with body fluids or blood from patients with blood-borne viruses or other known infectious diseases e.g. shingles or measles.  NB. Heavily fouled or contaminated linen from non-infectious patients should be treated as infectious linen Seal in a water soluble bag (usually red) and place in an impermeable bag immediately after linen is removed from the bed.
Water soluble bags are also recommended for heavily fouled linen

General equipment

Nurses should be aware that equipment is categorised as single use e.g. urinary catheter; single patient use, e.g. nebuliser; or communal use, e.g. commodes; pulse oximeters and intravenous infusion stands.  Single use equipment must be disposed of immediately after use, whereas single patient use equipment should be cleaned and stored between uses and may only be used for one patient. Communal equipment should be cleaned and labelled between patients. Frequency and methods of decontamination are dictated by Trust policy. Staff must adhere to Trust policies to ensure safe practice and to reduce contamination of patients and staff.
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