Clinical wastes in the community: local authority management of clinical wastes from domestic premises

Abstract

Background: The increasing numbers of patients receiving often complex home-based health care, and the growing number of insulin-dependent diabetic, home haemodialysis and continuous ambulatory peritoneal dialysis patients, contributes to the substantial volumes of clinical waste generated from domestic premises. Arrangements for the collection and safe disposal of these potentially hazardous wastes, generally managed by local authorities, may be inadequate and, in part, unsafe.

Methods: This study audited the websites of the 526 local authorities in England, Wales, Scotland and Northern Ireland. Websites were scrutinized for information concerning clinical waste collections from domestic premises, the limits and constraints on this service, service accessibility, the practical arrangements for collection of wastes, and the health and safety issues of clinical waste management for patients who manage their own care in the community.

Results: Two hundred and sixty-two of 526 (50%) local authorities provided information on their websites concerning the collection of clinical wastes from domestic premises. Others referred patients to a district or county council, to another agency or to private contractors (n=72), while the remainder provided an in-house collection service. Weekly collections were most common, although several local authorities offered additional flexibility depending on need. Limits on the minimum or maximum volumes of waste to be collected, or on the types of clinical wastes accepted for disposal, do not support domicillary health care and create an additional burden for patients and their carers. Of particular concern was the health and safety implication of instructions to place potentially hazardous clinical wastes in a freely accessible location outside the home, at the doorstep or on the footpath, as early as 4 am on the day of collection or the night before collection.

Conclusions: The arrangements for local authority clinical waste collections from domestic premises are, in part, inadequate and may be unsafe. The arrangements do not properly support domicillary patients or their carers.