Hospitals rely on non-statutory guidelines

Neither the Blackrock Clinic nor the Mater Hospital have been able to explain how potentially hazardous clinical waste with their name-tags on it ended up in illegal dumps in Co Wicklow. Both institutions, however, have pledged to tighten their procedures in dealing with waste.

There is no statutory definition of what constitutes "healthcare risk waste". Hospitals must rely on a set of non-statutory guidelines issued by the Department of Health in October 1999 and currently being revised, according to a Department spokesman.

In the past, many hospitals disposed of their waste - including swabs, syringes, human tissue, blood and amputated limbs - by incinerating it on-site, often using primitive facilities. For environmental reasons, including localised air pollution, these were all closed down in 1994.

Subsequently, Ireland exported its healthcare risk waste for disposal in England and then to Belgium and the Netherlands. However, the EU takes a dim view of the export of waste and requires member-states to dispose of or treat the waste they generate domestically if at all possible.

To comply with EU requirements, and as part of the peace process here, the health authorities on both sides of the Border devised a common strategy for the treatment of healthcare risk waste and advertised for tenders from competent waste-management companies.

In 1998, a contract was awarded to Sterile Technologies Ireland Ltd (STI) to collect, treat and dispose of some 8,000 tonnes of such waste annually in its two plants - one located on the Western Industrial Estate in Dublin and the other in Antrim - at a cost of £450 (€571) per tonne.

STI supplies all of the major hospitals with 50-kg yellow wheelie bins, bar-coded for traceability, into which most categories of healthcare risk waste are deposited in cable-tied yellow bags.

These are collected daily and brought to one or other of the company's plants.

Each bin is first scanned so STI knows who owns it and weighed so the company knows what to charge. It is then tipped into a steam sterilising machine, where it is shredded and sterilised for 80 minutes, emerging "cleaner than domestic waste", according to STI.

By that stage, it has been broken down into "a sort of confetti", as the company's managing director, Des Rogers, describes it. This treated waste is then taken to landfill for final disposal. "What we operate is a trackable, traceable system. Anyone can come and look at it", he says.

There are some elements of healthcare risk waste that STI does not treat, specifically out-of-date pharmaceuticals and "recognisable anatomical waste" (i.e. body parts); these "special fractions", amounting to 2 per cent of the total, are exported to Belgium for incineration.

STI, which has a turnover of £5 million a year, treats about 90 per cent of all hospital waste in the Republic and Northern Ireland. Another company, Dublin-based Ecosafe Ltd, treats the remainder for clients such as Mount Carmel and the Mater Private, using similar technology.

Precisely what goes into the yellow bags is determined by each hospital's infection-control officer, based on his or her interpretation of the Department of Health's guidelines, and all staff are instructed accordingly.

Ordinary non-risk hospital waste goes direct to landfill.

Four years ago, workers at Fingal County Council's Baleally landfill refused to accept ordinary waste from hospitals in black plastic bags after finding that some contained clinical waste. As a result, all ordinary waste from hospitals must be presented in transparent bags.

"The fundamentals are that each hospital makes the call about what goes into which bag", as one waste-management expert puts it. "Some of them may be cutting corners to save money because treating healthcare risk waste properly is much more expensive than landfill".

The Mater Hospital has said it was "appalled and horrified" that some of its clinical waste was discovered on an illegal dump in Co Wicklow.

The Blackrock Clinic, one of the most expensive private healthcare facilities in the State, was equally shocked at being implicated.

Asked how it could happen, Mr Brian Harty, the clinic's chief executive, said the segregation of clinical and non-clinical waste was "not a simple exercise". The classification was complex and involved going through 19 pages of documentation in the Department of Health's guidelines.

"It would appear that a small quantity of clinical waste found its way into non-clinical waste bags", Mr Harty said. "Since then, all staff have been made aware of the correct procedures for disposal and all documents are being shredded to protect patient confidentiality".

Asked if the clinic felt it had an obligation to ensure that the waste it generated was properly disposed of, he said: "We weren't just using anybody. Dublin Waste the company which was removing non-clinical waste from the premises was licensed by the EPA for the disposal of that waste".

Following Dublin Waste's conviction on seven charges under the 1996 Waste Management Act, Mr Harty said the Blackrock Clinic was reviewing its contract with this company. The Mater Hospital has already discontinued its arrangements with Dublin Waste.

Section 32 of the 1996 Act places an onus on everyone who generates waste not to hold, recover or dispose of it "in a manner that causes or is likely to cause environmental pollution". What this means is that the holder of waste at any given time is responsible for looking after it.

Thus, when a hospital passes waste to a contractor it becomes the contractor's responsibility. Asked if the Blackrock Clinic felt any moral responsibility, Mr Harty said: "We would wish to apologise to people of Wicklow who have been inconvenienced by this lapse."

Ireland's leading waste expert, P.J. Rudden, of consultant engineers MC O'Sullivan, called for a major effort to enforce the existing regulations. "This needs to be done very quickly to protect the integrity of waste management plans. It is a question of trust."