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Healthcare (including clinical) Waste

Healthcare waste is generated from healthcare practices, or produced by healthcare workers in the community. Healthcare waste is a broad classification and includes clinical waste. Healthcare waste contains a number of special waste streams.

The Special Waste Regulations 2004 (as amended) [1] outlines the segregation and movement of special waste in Scotland from the point of production to the final point of disposal or recovery.

Gypsum (Calcium Sulphate) Waste

Gypsum waste is prohibited from entering normal landfill. There is a risk of hydrogen sulphide gas generation if calcium sulphate (found in gypsum) is disposed of in normal (biodegradable) landfill [2].

Segregate and store non-contaminated gypsum material, in appropriately labelled container and send for recycling or specifically designed landfill.

Dispose of study models and casts contaminated with potentially infectious materials in the yellow waste stream.

Note: Yellow waste is incinerated at a minimum of 850℃. Incineration at 850℃ destroys (physical and chemical breakdown) gypsum. The bottom ash resulting from the incineration process does not contain gypsum and is suitable for landfill.

Orange Stream

Orange waste is categorised as infectious special (hazardous) waste. Orange waste is shredded to be unrecognisable and then heat treated to render it safe prior to final disposal in landfill.

BiohazardStore the following low-risk healthcare waste in orange bags labelled with the black biohazard symbol:

  • disposable PPE (e.g. gloves, aprons, masks);
  • dressings and swabs;
  • cotton wool rolls and pledjets
  • contaminated detergent and alcohol wipes
  • items contaminated with infectious bodily fluids
  • items visibly contaminated with blood
  • unrecognisable tissue

Orange waste
Insert orange bags in a bin bag holder and keep at a location that will facilitate effective segregation of waste. This will also enable any spillages to be immediately visible and dealt with quickly to avoid the risk of infection.

  • If a holder with a protective front cover or a foot-operated lid is used, then a strict decontamination regime is required, as spillages might not be visible.

Do not use orange bags as sleeves in pedal bins or similar domestic containers because spillages can go unnoticed and decontamination is difficult to effect.

Ensure any liquids are made leak proof; this can be done using a self-setting compound.

Do not fill orange waste stream bags more than three quarters full, beyond fill line or exceed 4kg in weight.

To seal the orange waste bag, hold the neck of the plastic bag, twist it and then fold it to form a “swan neck”. Then, place a ratchet type clinical waste tag around the swan neck and tighten it up to achieve a secure seal.

If using Orange stream waste bins, do not fill beyond the fill line or exceed 4kg in weight.

Once sealed, label the orange stream waste to identify the source of the waste.

Secondary containers (e.g. wheelie bins) for storage and collection of orange stream waste bags, should also be fit for purpose, colour coded and appropriately labelled. The bins should be stored in a secure location, it is best practice for the bins to be lockable.

Note: All Orange stream waste products can be stored together in the same container.

Yellow Stream

Yellow steam waste is categorised as infectious special (hazardous) waste. Yellow waste is disposed of by specialist incineration at a minimum of 850℃. to render it safe, and then disposed of in landfill.

The Scottish Health Technical Note: Waste Management Guidance, Part D [3] states high risk healthcare waste should be stored in 1 or 5 litre rigid yellow containers (formerly known as sharps bins). The containers may have yellow or red lids [3]. NHS Health Protection Scotland indicate blue lidded bins are also acceptable for disposal of pharmaceutical products, including full or partially discharged syringes, vials or giving sets [5]. Your health board will provide information on bin size and lid colour.

Store the following high risk healthcare waste labelled as dental waste for Yellow stream disposal:

Yellow waste

Yellow waste

    • single-use needles;
    • disposable syringes;
    • scalpel blades;.
    • burs;
    • endodontic files;
    • matrix bands;
    • used and partly used local anaesthetic cartridges; [5]
    • extracted teeth without amalgam;
    • pharmaceuticals (including drug vials); [5]
    • contaminated metal parts or broken instruments;
    • highly infectious waste or blood.
    • potentially infectious gypsum waste (e.g. study models)
    • broken glass;
    • blood and contaminated liquids, including bags and tubes (treat with caution because of the risk of infection).

NB: As the last two listed items above are produced in very low quantities in dental surgeries (and to avoid potential mis-segregation by the introduction of an Orange stream bin container) it is acceptable to place these into a Yellow stream rigid waste container.

Ensure any liquids are made leak proof; this can be done using a self-setting compound.

Keep these bins close to the point of use.

Do not fill yellow stream containers beyond the fill line or exceed 4 kg in weight.

Once sealed, label the yellow stream container to identify the source of the waste.

Note: All Yellow Stream waste products can be stored together in the same container.

Red Stream

Amalgam wastePhotochemical wasteRed stream waste is classified as special (hazardous) waste. Red stream items cannot be disposed of by treatment or incineration and require specialist recovery and processing. Store the following healthcare waste types in separate rigid red containers with red lids, or white containers with red lids, labelled according to the particular type of waste for Red stream recovery and disposal:

Amalgam waste containers are lined with mercury-absorbing foam; separate containers are supplied for used amalgam waste and amalgam capsules);

  • Amalgam waste – Placed into 0.5, 1 or 5 litre rigid screw top rigid waste bin containing a suppressant. Clearly labelled Amalgam Waste;
  • Amalgam capsules waste. Placed into 0.5, 1 or 5 litre rigid screw top waste bin containing a suppressant. Clearly labelled Amalgam Waste – Capsules;
  • Extracted teeth with amalgam. Placed into 0.5, 1 or 5 litre rigid screw top waste bin containing a suppressant. Clearly labelled Teeth with Amalgam and Infectious Material;
  • Filters for dental aspirating systems;
  • Lead foils from X-ray film packets (collected for recycling). Placed into 5 litre rigid screw top waste bin, or (if stored in processing room) 5 litre clinical user ‘flip top’ bin. Clearly labelled lead foils.
  • Radiographic chemicals (e.g. spent developer and fixer); carefully placed into 10 litre rigid, opaque waste bin with red screw top lid. Clearly labelled with details of fluid or chemicals.

NB: use a separate container for each chemical. Further information regarding the disposal of dental-specific Red stream waste, including EWC codes for radiographic waste, can be found in SHTN3 part D [3].

Do not fill Red stream containers beyond the fill line or exceed 4 kg in weight.

Once sealed, label the Red stream container to identify the source of the waste.

Install amalgam separation units (that meet BS EN ISO 11143:2000 standards) to separate amalgam from waste water used in dental aspirating systems and dispose of as Red stream waste.

Note: Each type of Red stream waste must be stored in separate Red stream containers as the containers are sent to treatment facilities depending on the type of waste they contain.

Disposal of healthcare waste

Arrange for all special (healthcare) waste to be collected and disposed of by your NHS Board under the SEHD 2006 PCA(D)5 scheme [4]. Otherwise, a registered waste management contractor who has a licence for disposal of these specific categories of waste and a contract for this service is required.

Ensure the arrangements include a consignment note with a SEPA special waste consignment note (SWCN) and carriers schedule for each uplift, confirming the number of containers, European Waste Catalogue code and tonnage of waste.

Keep consignment notes for at least three years.

Sources of Information

  1. The Special Waste Amendment (Scotland) Regulations 2004 (as amended) legislation.gov.uk/ssi/2004/112/contents/made
  2. The Disposal in Landfills for Non-Hazardous Waste of Gypsum Wastes. Technical Guidance Note Scottish Environment Protection Agency ( SEPA) (2009) https://www.sepa.org.uk/media/28998/technical-guidance-note-disposal-of-gypsum-in-landfills. (PDF)
  3. Scottish Health Technical Note 3 (SHTN3) NHSScotland waste management guidance: Part D Guidance and example text for waste management Health Facilities Scotland Version 6.0 (2015) http://www.hfs.scot.nhs.uk/publications-/guidance-publications/
  4. Notification of Revised Board Responsibilities for the Management and Funding of Dental Clinical and Special Wastes. PCA(D)5. Directorate of Primary Care and Community Care. Scottish Executive Health Department (May 2006)(www.sehd.scot.nhs.uk/pca/PCA2006(D)05. (PDF))
  5. Standard Infection Control Precautions Literature Review: Safe Disposal of Waste (2020) NHS Health Protection Scotland www.nipcm.hps.scot.nhs.uk/media/1626/2020-07-sicp-lr-waste-v4.pdf

Further  information

NHSScotland Waste Prevention and Reuse Guide

NHSScotland Waste Management Guidance ( SHTN 03-01) ( version 7)