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Posted By tony sage
Hi all - have a question related to health-care professionals(chiropodists)visiting clients in their houses. Controlled waste regs indicate what is clinical (bandages, syringes etc) - waste to be routed via a licensee, but some leave waste there stating their car insurance won't allow waste transport (syringes are taken though) so some "clinical" waste left to go with domestic waste - forbidden by councils. Anecdotal stories indicate some district nurses leave bandages as domestic. Seems like toenail clippings(yuk)are left as domestic. Anybody come across this "seemingly" grey area? Thanks Tony
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Posted By Robert K Lewis
Actually it is forbidden by law not the LAs etc. To carry any waste the carrier must be appropriately licensed and the waste has to be carried in the vehicles of the carrier. Company cars could fulfill this requirement but not privately owned vehicles. When it comes to waste such as this produced in domestic properties it is often simpler to allow the domestic waste exemptions to apply and allow the householder to dispose of the waste.
It is all part of the Duty of Care regs and Hazardous Waste regs.
Bob
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Posted By Ian Blenkharn
The types of [generally] low grade waste produced and the volumes involved would be way below that which would give concern.
With the exception of syringes as stated (actually it is the needle that presents the risk!) the rest can reasonably be properly wrapped in newspaper and placed into domestic waste.
Common sense needs to prevail. We all place items into domestic waste that *could*, but isn't, caegorised as clinical waste. That is acceptable to, and properly accepted by the various regulators.
Ian Blenkharn
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Posted By tony sage
Thanks for your replies. Interesting what the local authorities actually have in their arrangements - I'll need to look up "exemptions". Sounds like the regulation says clearly no clinical waste but the practice is different. Chiropodists use private cars for their business which may also muddy the waters - they seem not to object to carrying a sharps box around (again if they told their car insurers - would that be prohibited?). A blood soaked bandage produced outside a visit - we would all chuck in the black bag - but when produced from a visit - is it still classed as arising from a domestic undertaking by the client or a work undertaking by the chiropodist? If guidelines are to be given on what basis? The practices employed - sharps taken away and bandages in domestic seems the best duty of care/risk option - but would this advice hold up in court? - any other thoughts - keep'em coming - this job has no sole! eh ha ha
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Posted By Ian Blenkharn
There is no test case but common sense should prevail and thinks like this would never come to the Courts.
The smallest available sharps bins should be used - a car crammed with several oversized and filled sharps bins would not be reasonable, but nor would it be reasonable to prohibit a diabetic from travelling with their needles and syringes and a bin for disposal.
Sadly current legislation is pooorly constructed "in big bites" and the practical exceptions that are needed in situations like this are not individually specified. Perhaps that is reasonable, so as not to create loopholes. The real test is practical and reasonable, and with comparison to other common events:
- safe disposal in domestic refuse [small amounts of soft waste wrapped in paper]
- comparison with the fate of similar wastes from domestic activities that are legitimate in the domestic waste stream, too small in volume but occuring quite often and impossible to legislate
- diabetics legitimately transporting their own supplies
- risk assessment
- reasonable cost
Added to this would be the realities of being caught and the probability that any regulator would waste public money on taking maters to Court, or tha the Court would no use a commonsense test and reject such a case.
To put this in context, some estimates of clinical waste volumes suggest that those from domestic sources that end up in the domestic waste stream can account for up to 30% of the naional totals - mainly the occasional out-of-date medicine, simple wound dressing or adhesive plaster etc. Add to this the non-medical use of needles that is actually quite common in the home and for which no constraints are placed on disposal, and the "problems" faced by community chiropodists fades away into insignificance.
Ian
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Posted By Robert K Lewis
I think also that sharps are not the issue people tend to believe. In the domestic situation the single use syringe with attached needle can be made safe with the purpose made Needle Cutter that many diabetics or others with regular injection needs use. Perhaps each patient should have one - they are then safe for domestic disposal as the cut needle is stored inside the unit and it it discarded when full. Even separate needles can be cut off using one of these cutters.
The amount of clinical waste produced per visit tends to be relatively small and there is no reason that I can think of for practitioners to carry the waste back to any form of base.
The problem for carrying in cars is that several patients will be visited each day and the local amount in the car could then become significant. Ian is right in principle that the courts may not want to act in trivial cases BUT if one views this in terms of an individual doctors practice with 2 or 3 nurses plus others then the EA might want to take action against the practice in order to send out a message.
Bob
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