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Carriage of clinical waste

Guidance for enforcement officers

Introduction

Standards of compliance with CDG Regulations and ADR are very variable when it comes to the carriage of clinical waste. These notes are intended to summarise the key issues that are likely to be found at on-the-road inspections. There is also information about the links between carriage and waste legislation.

Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations and ADR

As with other dangerous goods, CDG Regulations refer to the requirements of ADR but, for historical reasons, there are a number of misunderstandings relating to clinical waste that may affect how an enforcement officer deals with apparent breaches. For convenience the main relevant ADR text is reproduced at annex 1.

Clinical waste can be carried in bulk or in packages, and vehicles can carry in both formats.

Carriage of packaged goods

Loads may comprise any combination of boxes and bins generally described as "rigid packagings". They need to be UN marked, and labelled properly. This is the simplest form of carriage and a summary of the requirements may be found at annex 2 below.

Sometimes packages of other healthcare waste may be carried. Waste medicines such as UN 1851, 3248, 3249 come into this category

Rigid packagings

Include "sharps boxes", some examples are given below.


examples of sharps boxes

Typical UN code marking starts with:


Other boxes with firmly closing lids, eg

boxes for clinical waste with firmly closed lids

Typical UN marking begins 4H2/Y


Large packaging ("wheelie bins"). Should be used with the waste contained in a UN certified plastic bag which in turn is placed in the bin

wheelie bins for clinical waste

Typical UN marking will start:

  • for plastic 50H/Y/mm yy
  • for steel 50A/Y/mm yy

mm yy = month and year of manufacture


Typical package problems

The large packaging ("wheelie bin") is sometimes not well maintained or is over-filled.

over filled clinical waste wheelie bins

Both these situations are unacceptable and are in Risk Category 1.  An immediate PN would be appropriate, and the consignor or carrier should be required to make good the packaging before the vehicle is allowed on its way. Remedial action will need to be carried out in a place and in a manner that does not create risk to others.  A deferred PN should be considered if it is thought that greater risk arises from immediate remedial action.  In any event prosecution of the carrier and/or the consignor should be considered with appropriate evidence (including photographs) collected at the time.

ADR 5.2.2.1.7 requires large packagings to be labelled ("hazard diamonds" and UN Number) on two opposite sides. This is sometimes a problem as markings may be damaged or defaced.


Bulk carriage

Bulk carriage of clinical waste will usually be in the form of yellow or orange bags loosely loaded into the back of a van or lorry.

Plastic film bags

Bags are not "packages" in their own right. They may be used in conjunction with a bin (which then forms a package), but if loosely loaded in to the load compartment of a vehicle they comprise "carriage in bulk".

plastic clinical waste bag

Example of a clinical waste bag and its markings.  They are usually yellow or orange.

Typical marking will begin 5H4/Y * /S

* max weight of bag in kg


Judging whether bags are "genuine" is not possible at the roadside. If they are properly marked, they should be accepted as compliant. There is a subtle additional point contained in ADR at 7.3.2.6.2(c) (annex 1) but for the present it is not easy to tell whether bags meet that standard. From January 2009 manufacturers are expected by DfT /VCA to mark bags to state whether they meet that standard or not. This is not an ADR requirement. Concerns about bag quality should be referred to HSE HID CI 4B for follow up. Some information is available on the VCA website.

Driver training

For carriage in bulk the driver has to be ADR trained at least for class 6.2 in the "other than tanks" column of the certificate. There is no "small load" exemption for bulk carriage.

General training under ADR 1.3 is also required

It is reasonable to assume that the vehicle is carrying clinical waste if the load includes bags or rigid boxes (sharps containers) which are marked with

See also "Action" below.

If the driver seems unsure about what he is carrying or the hazards it presents this should be followed up.

Vehicle equipment

If carrying only infectious substances (usually the case) the vehicle needs to carry a minimum of one 2 kg dry powder fire extinguisher, regardless of vehicle size or load quantity. DfT has agreed a derogation so that this is not applied to health care workers carrying small quantities of waste from patients' homes etc.

The usual other equipment specified in ADR 8.1.5 should be carried. Changes to the Instructions in Writing provisions now mean that "eye rinsing liquid" has to be carried. There is no need for a shovel, a drain seal or a "collecting container"

A summary of the requirements may be found at Annex 2.

Used medical devices

this term covers items such as used surgical instruments which are frequently carried from hospitals to specialist cleaning and sterilisation facilities. They have traditionally been treated as "clinical waste" but present particular difficulties in the context of ADR.

A "multilateral agreement", so far signed by Germany and the United Kingdom exempts the carriage of "medical devices" from the terms of ADR subject to certain conditions. The text of the agreement can be found at UNECE - Multilateral agreement M232

Documentation

Transport documents must be carried for any size of bulk load. In practice the relevant information may be included in a waste transfer note. This is discussed in the CDG manual under "Common problems - waste".

A specimen Consignment Note is shown at Annex 3 .

The vehicle and its load compartment

Carriage in bulk is permitted

  1. in accordance with the conditions of special provision VV 11, or
  2. in an approved "BK2" container. "Container" includes the load compartment of a van or lorry

DfT has not approved any BK2 containers. It follows that in GB carriage in bulk has to be under the terms of VV 11.  VV11 sets a standard but does not prescribe how that is to be achieved.

The conditions set out in 7.3.2.6.2 apply to carriage under the BK2 provisions. Those conditions largely replicate the conditions set out in the (now withdrawn) HSE Certificate of Exemption No 1 of 2002. The Trade Association (SMDSA) supported these conditions at the time, with the exception of 7.3.2.6.2(c) which refers to tear and impact resistance of bags, which is a more recent addition to ADR.

Accordingly HSE guidance is that VV11 is satisfied if the conditions in 7.3.2.6.2 (other than sub-para (c)) are satisfied. For the present enforcement officers need only check that the bags are marked with UN packaging certification marks. This should be done by a simple visual check of the load only. Example shown above.

Basic standards of the load compartment

Note that by the definition of "bulk container" (ADR 1.2.1) the load compartment of a vehicle is deemed to be a bulk container.

ADR 7.3.2.6.2 (b) "Closed bulk containers and their openings shall be leakproof by design. These bulk containers shall have non porous interior surfaces and shall be free from cracks or other features which could damage packagings inside, impede disinfection or permit inadvertent release"

Commercial vans will not generally meet the leakproof criterion and this can be an issue where vehicles are hired for short term service.

The end to be achieved is that leaks from bags that may be damaged will not readily escape from the load compartment during carriage. The other criteria in 7.3.2.6.2 must be met and this should ensure that the risk of leakage is minimal.

Examples of how "leakproof by design" might be achieved include

Note that the interior of the compartment has to meet other criteria. It must be non-porous, free from cracks and other features that could damage the packagings (e.g. the bags), or that would impede disinfection. Again, these would mitigate against the use of an ordinary "Luton bodied", or similar, van.

7.3.2.6.2 (g) Where rigid packagings (such as sharps boxes or "wheelie bins") are carried with bags, arrangements have to be made to ensure that the bags cannot be damaged.

7.3.2.6.2 (h) "Bags should not be so compressed that they "are rendered no longer leakproof".


Typical problems

Some common findings with commentary are illustrated below.

over loaded clinical waste van

No lining in an ordinary van or larger trailer.

Fittings of various sorts can damage the bags and whether the van can be properly cleaned is an issue.

Rigid packagings mixed with bags

clinical waste van with plywood lining

Plywood lining. This is not "non-porous"

gap in clinical waste van bodywork

Load compartment not "leakproof". Gap in bodywork at corner near roller shutter door


Segregation of packages and bulk items

One of the most important parts of ADR 7.3.2.6.2 is the rule about the segregation of packages and bags to ensure that the bags do not get damaged and release their contents. It is quite common for bags and rigid packagings to be carried together, as shown above. This does not meet the conditions of 7.3.2.6.2(g)

In the next example the carrier has provided a partition to separate the bags from the rigid packages, but there are other concerns. See 7.3.2.6.2(b)

clinical waste van with side rails

Not "specially equipped". Side rails could damage bags


Some other problems

Some vehicles cannot easily be fitted with orange plates and placarding. 

plain orange plate in windscreen of clinical waste van

Plain orange plate at the front is in the windscreen

rear orange plate of clinical waste van

Although carrying in bulk, only the plain rear orange plate is displayed (should have "bulk" placards etc)

This can arise when vehicles are hired, but not always. Sometimes vans normally used for collecting "non DG" waste are used for clinical waste and similar problems will be found.


Breaches of CDG

Apart from routine mistakes and lack of knowledge, it has become apparent that some problems arise when packaged clinical waste (typically bags inside "wheelie" bins) is taken to a "transfer station". The bags may then be taken out of the bins and transferred as bulk in much larger vehicles to the comparatively few incinerators and other facilities licensed to dispose of clinical waste. This secondary transfer may be in breach of many aspects of CDG Regulations. For example, the vehicle may be unmarked (or not marked for bulk carriage), the driver untrained, and the vehicle (load compartment) unsuitable.

In some cases there may be leakage from bags and in turn from the vehicle. Officers should avoid contact with any such fluids and as far as possible ensure the vehicle is moved to a safe place pending completion of the inspection. In these cases it may be necessary to ensure the vehicle is subsequently moved to the nearest proper disposal site. See "deferring a PN" below.

It is also possible that the waste documents will have been altered. There is more information on waste legislation below.

Action

Breaches of CDG Regulations should be dealt with on their merits as usual. In the event that the transport documentation appears to be incomplete or inaccurate, the driver should be questioned and the load inspected. This should be sufficient to support the officer's opinion that relevant dangerous goods are being carried for the purposes of a Prohibition Notice. Photographs of the load, showing bag markings, should be taken if possible.

To enable legal proceedings to be considered later, it is important to collect other evidence including a witness statement from the driver and details of the transport documentation. Waste transfer notes have unique numbers which should be noted. If facilities permit, copies should be taken and cross-referenced in the statement from the driver. Otherwise, it may be possible to photograph the document(s). Photographs should be evidenced by the officer concerned.

Legal advice is that documents provided and carried in order to comply with CDG Regulations are evidence that the vehicle is carrying the type and quantities of dangerous goods stated. As always, officers should seek other evidence such as photographs of the vehicle markings and/or package labels, and "instructions in writing" and link these to a statement taken from the driver and to the officer's statement.

In some cases there may be no documentation (or the documents give no indication that the goods are dangerous for carriage) and/ or the driver claims that the goods are not clinical waste. If the load includes filled UN 3291 bags it should be regarded as clinical waste for the purposes of supporting the officer's "opinion" in connection with the issue of a Prohibition Notice. Again the officer should seek whatever supporting evidence may be available, including journey details.

Deferring a PN

Where an immediate PN is otherwise justified it may be safer to defer the PN to allow the load to be taken to the nearest disposal site regardless of the original destination.

Waste legislation

It is a principle of waste legislation that controlled waste is "traceable". Bulking up such loads will almost certainly break that chain. In turn a new consignment is created and this is where the description of the waste may change. For example loads of large packages (wheelie bins) which contain UN 3291 plastic bags may be "bulked up" at a transfer station for onward movement for final disposal. It may then be "reclassified" so that it does not have to go to an incinerator or treated as dangerous for carriage.

European waste classification (EWC) codes

Waste has to be classified and properly documented.

"Yellow (or orange) bag" clinical waste is EWC 18 01 03 and of course class 6.2 UN 3291. Normally there should be no objection to the use of the waste documentation as a "transport document" as long as the relevant "carriage" information is included. The specimen waste consignment note at annex 3 includes provision for carriage information

Under current NHS guidelines, yellow UN bags are used for wastes that must go to incineration, and orange UN bags may be disposed of in alternative ways (but they could also go to incineration).

Related types of waste are "Offensive/hygiene waste" for which the EWC is 18 01 04. This is typically in a yellow bag with a broad black stripe and will not be marked with the UN numbers and symbols.

tiger bag

So-called "tiger bag" for (offensive/ hygiene waste)

This type of waste does not have to go to an incinerator or autoclave and is not classified as "dangerous for carriage"

If "proper" clinical waste bags are found in a load consigned as EWC 18 01 04 details should be taken and forwarded to the EA or SEPA as appropriate. The easiest way to do this is to copy or photograph the documents and forward the information to EA / SEPA with basic information about the stop:

In these circumstances, CDG action should be taken as outlined above and appropriate to the evident breaches.

The full health service approach to waste may be found on the DoH web site    Chapters 7 and 8 are the most relevant in this context.

Updated 2011-06-12