The peak body for the management of clinical and related waste in Australia, the National Biohazard Waste Industry (BWI) committee has developed guidance to help hospitals, aged, and health care providers manage COVID-19 affected materials as well as those managing waste, both within and outside these facilities.
BWI is a division of the Waste Management and Resource Recovery Association of Australia (WMRR).
In a statement to members and the media, BWI said they were seeking to offer general guidance to stakeholders. BWI recommends that organisations contact and work with their waste management providers if they have any specific questions or require further information.
Under AS 3816:2018 Management of Clinical and Related Wastes, clinical waste is defined as any waste that has the potential to cause injury, infection, or offence, arising but not limited to medical, dental, podiatry, health care services and so forth.
“At this time, we are not aware of any evidence that direct, unprotected human contact during the handling of healthcare waste has resulted in the transmission of COVID‐19, nor is COVID‐19 regarded as a Category A infectious disease (World Health Organisation, 2020),” the statement said.
According to BWI, it also understands that the WHO and some Australian health officials have, in fact, declared that clinical waste from infected patients should be treated as normal clinical waste with no additional measures. It noted that this, however, may not be a uniform stance.
“In light of the dynamic and evolving nature of the COVID‐19 situation, along with the growing body of knowledge including the significant range of unknown characteristics, such as survival on surfaces, BWI said it was prudent to suggest the adoption of additional measures.
“As governments evaluate the transmissibility and severity of COVID‐19, these additional measures aim to offer a degree of precaution and assistance to staff who will be responsible for the management of higher than normal, and potentially more hazardous clinical waste volumes generated during this time,” the statement said.
BWI said that it also hoped that additional measures would afford a greater level of protection to healthcare facility staff and waste handlers, both within and external to the facility, responsible for the management of clinical waste.
It is the recommendation of BWI that these proposed measures should be adopted alongside current PPE and other relevant practices. At a minimum, individuals handling clinical waste should wear appropriate PPE (boots, aprons, long‐sleeved gowns, thick gloves, masks, and goggles) and perform proper hand hygiene after removal of wastes.
BWI would like to reiterate the importance of all facilities continuing to work and engage with their waste management providers on these recommended additional measures:
- Implementation of double bagging of waste from patients confirmed as infected with COVID‐19. This can most easily be achieved by first lining all clinical waste Mobile Garbage Bins (MGBs) with clinical waste bin liners. By placing infected waste into a primary clinical waste bag and tying this bag up prior to disposal in the lined MGB – the bag lining the MGB must also be tied up ‐ a significant increase in protection can be achieved
- Bins or containers that have been used in isolation rooms or in close proximity to patients confirmed as infected with COVID‐19, the exterior surface should be wiped clean in accordance with WHO guidelines prior to collection
- Discreet notification and identification of any bins carrying infected waste in a discreet manner, as clearly agreed upon with your waste management provider
BWI stated that there could be an understandable reluctance to overtly label bins containing COVID‐19 waste. Therefore, this could be as simple as the addition of a simple mark or sticker as clearly agreed and documented between the facility and your waste management provider.
Additional waste types and best practice
For soiled linen, towels and incontinence aids BWI stated that it is critical to conduct hand hygiene when there is suspected or direct contact with faeces (if hands are soiled, soap and water are preferred to alcohol‐based hand rub).
In all healthcare settings, including those with suspected or confirmed COVID‐19 cases, faeces must be treated as a biohazard and handled in accordance with the current Australian Standards.
Nappies and incontinence aids, if used, should be disposed of, as they would in all situations, as infectious waste. The WHO provides guidance on the minimum requirements for soiled linen and towels that these are to be disinfected for reprocessing. Single‐use materials should be treated as infectious waste.
Implementation of measures
BWI said that these needed to be implemented as soon as practicably possible. It said that the WHO guiding document Guidance laid out in this statement was adapted from the March 3, 2020 WHO guiding document, Water, sanitation, hygiene and waste management for COVID‐19.
It also advised that the contents of the technical brief from the WHO is based on the information currently available for SARS‐CoV‐2 and the persistence of other viruses in the coronavirus family. It reflected input and advice from microbiologists and virologists, infection control experts, and those with practical knowledge about water, sanitation and hygiene (WASH) and infection prevention and control (IPC) in emergencies and disease outbreaks.