Dealing with Covid-19 PPE waste – the next big question for the NHS

by Graham Flynn, April 17, 2020

Also published in The Parliamentary Review

The most pertinent and repeated question that we’ve received in recent days is ‘how should we manage clinical waste in relation to Covid-19 crisis?’ So says Graham Flynn, Director of technology based clinical waste management company Anenta.

This question has become particularly acute following the rapid and heroic establishment of Clinical Decision Units, Covid-19 testing sites and Nightingale Hospitals. Up and down the country, plans are being rolled out to set up centres to deal with individuals and patients affected by the pandemic. From the most senior management tiers of NHS England to NHS Trusts, NHS Property Service and CCGs, all are asking the same question: ‘how should clinical waste generated by coronavirus be disposed of safely?’

Paradoxically, the amount of clinical waste is actually decreasing. GPs are not seeing patients in any great volume, so the overall amount of clinical waste is falling. But, the quantity of PPE used in Covid-19 testing centres and hospitals is rising dramatically.

Traditionally classified as offensive waste, if not contaminated with bodily fluid or infectious substances, PPE would typically be disposed of through the offensive waste stream, which is either landfilled or sent to waste to energy facilities (WTE). However, with the onset of the Covid-19 pandemic, all gloves, gowns, face protectors and other forms of PPE are now being treated as Cat B clinical waste.

As such, all PPE waste - alongside waste related to possible or confirmed cases of Covid-19 -needs to be placed in orange collection bags, which should be sealed with a swan neck and cable tie.

Doing this correctly removes the need for double bagging, as the swan neck and cable tie method prevents air escaping from bags when they are moved or collected. Failure to do this correctly, or the practice of simply tying knots in orange bags, could lead to the potential spread of infection, as trapped air can be expelled from poorly sealed bags.

It is for this reason that we recommend double bagging where poor management practices are identified, as double bagging when knots are applied reduces the risk of any infection escaping Double bagging also diminishes the chance of contamination from the exterior of the original bag being passed on, protecting the safety of all those involved with the storage, collection and processing of clinical waste.

However, with concerns mounting over the potential shortage of orange Cat-B bags, our updated recommendation as of 17th April 2020 - which has been shared with the NHS’ National Waste Teams working on clinical waste management - is to ensure that all staff responsible for disposing of PPE into the Cat B waste stream, are trained to adopt the swan neck and cable tie solution. This enhances the protection of all from the potential transmission of Covid-19, while reducing the number of orange bags being used.

Once correctly tied, all bags should be stored safely in carts that are tagged with the appropriate clinical waste consignment - in line with latest guidance here - ready for collection and disposal, preferably through ‘alternative treatment’ to destroy the virus or, where appropriate, via incineration.

Given that ‘alternatively treated’ PPE can be used for energy generation, this is by far the favoured option. Just as well too, as this is a disposal method that has yet to hit capacity. As such, there are no major barriers to the waste treatment of PPE, meaning that materials can be processed quickly and effectively.

The only limiting factors are the effective implementation of logistics for the collection of PPE materials and clinical waste, and the need to ensure that costs do not balloon as demand rises.

Over the past two years, the price per tonne for the treatment and disposal of clinical waste via incineration has increased from £650 per tonne to £1,500 per tonne. As demand rises then so too could prices, even for ‘alternative’ waste treatment as the market responds to a growth opportunity; it’s important to remember that some incinerator operators also have ‘alternative treatment’ facilities and may be tempted to ratchet pricing accordingly.

This is where NHS authorities and sites need to take great care to ensure that they are working with reputable companies who choose to keep their costs in check, supporting the NHS at this testing time; not profiteering from it.

Now, more than ever, protecting the NHS’ bottom line has a vital role to play in protecting the front line: the heroes and heroines that are looking after the health and wellbeing of the nation.

This is where we hope to play our part in helping the NHS tackle the challenges of Covid-19 by enabling it to specify and put into place appropriate waste management contracts and services that will serve the NHS to best effect.

By realising the benefits and savings that are possible through Anenta’s proprietary online total waste management platform, we aim to serve the nation by supporting the NHS. Through the empowerment of all stakeholders - creating and maintaining trust between the customer and service provider - we enable the delivery not only of correctly specified contracts and services, but best value and stable prices, freeing up more money for the front-line.

It’s how, over the past four years, Anenta has saved the NHS over £3.2m on existing contracts across more than 30 CCGs for GP activity and NHS England Pharmacies in London and the South East – a figure that’s set to increase dramatically through the implementation of transparency, contract control and accountability delivered by Anenta’s management platform and expertise.

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