Healthcare Waste: Difference between revisions

(27 intermediate revisions by 3 users not shown)

Line 3:

[[File:Healthcare waste pic.jpg|280px|left|Picture of Healthcare Waste packaging from Herefordshire CGC report]]__TOC__

==Macro Tonnage==

The macro-level data reported for 2020 by [[DEFRA]]<ref>[https://www.gov.uk/government/statistics/uk-waste-data UK Statistics on Waste July 2020 update]</ref> for tonnage arisings is summarised in the figure below, with a total of 355kt tonnes of Healthcare Waste (and some associated biological waste) arising in the UK, the large majority of which came from the service sector :

==Clinical Waste==

[[File:Helathcare tonnage 2020.png|1000px|center]]

==Overview==

===Clinical Waste===

'''Clinical Waste''' is [[Healthcare Waste]] that:

*contains viable micro-organisms or their toxins which are known or reliably believed to cause disease in humans or other living organisms

Line 14:

Line 18:

*is waste of a similar nature from a non-healthcare activity

==Offensive Waste==

===Offensive Waste===

'''Offensive Waste''' is:

'''Offensive Waste''' is non-infectious waste which is unpleasant and may cause offence to those coming into contact with it. It includes<ref name="Net">[https://www.netregs.org.uk/environmental-topics/waste/managing-waste-materials/offensive-waste/ NetRegs]</ref>:

*is not ~~clinical~~ waste

*outer dressings and protective clothing e.g. masks, gowns and gloves that are not contaminated with body fluids

*~~contains body fluids, secretions or excretions~~

*hygiene waste and sanitary protection e.g. nappies and incontinence pads

*falls within [[EWC]] waste codes [[EWCChap18 | 18 01 04]], [[EWCChap18 | 18 02 03]] or [[EWCChap20 | 20 01 99]]

*autoclaved laboratory waste.

*falls within [[EWC]] waste codes [[EWCChap18 | 18 01 04]], [[EWCChap18 | 18 02 03]] or [[EWCChap20 | 20 01 99]].

==Management of Healthcare Waste==

Offensive waste does not include <ref name="Net" />:

The management of Healthcare Wastes is set out in '''Healthcare Technical Memorandum 07-01 - Safe Management of Healthcare Waste'''<ref name=''Tech1''>[https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/167976/HTM_07-01_Final.pdf Link to pdf document]</ref> ~~Which~~ replaced the Safe Management of Healthcare Waste in 2013 <ref>Published in 2006, this removed the clinical waste classification system categorising into 5 types; A to E</ref>. Management of Healthcare Waste for regulated facilities with an environmental permit is the subject of guidance issued in ~~June~~ 2020 <ref>[https://www.gov.uk/guidance/healthcare-waste-appropriate-measures-for-permitted-facilities Healthcare Waste:Appropriate Measures for Permitted Facilities]</ref> by the [[EA]] which sets out appropriate measures in the following sections:

*sharps

*anatomical waste e.g.body parts, organs or blood

*chemicals, medicines

*dental amalgam

*any waste that is infectious (i.e. a clinical waste)

===Management of Healthcare Waste===

The management of Healthcare Wastes is set out in '''Healthcare Technical Memorandum 07-01 - Safe Management of Healthcare Waste'''<ref name='Tech1'>[https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/167976/HTM_07-01_Final.pdf Link to pdf document]</ref> which replaced the Safe Management of Healthcare Waste in 2013 <ref>Published in 2006, this removed the clinical waste classification system categorising into 5 types; A to E</ref>. Management of Healthcare Waste for regulated facilities with an environmental permit is the subject of guidance issued in July 2020 <ref>[https://www.gov.uk/guidance/healthcare-waste-appropriate-measures-for-permitted-facilities Healthcare Waste:Appropriate Measures for Permitted Facilities]</ref> by the [[EA]] which sets out appropriate measures in the following sections:

* When appropriate measures apply

Line 34:

Line 46:

* Process efficiency appropriate measures

==Healthcare Waste - Packaging Colour and Appropriate Waste Management==

==Categories of Healthcare Waste (Packaging Colour and Appropriate Waste Management)==

The types of [[Healthcare Waste]] are grouped and designated by packaging colour set out in the table below (can be bag colour or lid colour)<ref>[https://assets.publishing.service.gov.uk/media/5f05a7fae90e0712d0206e88/Types_of_healthcare_waste_table.pdf Types of Healthcare Waste]</ref> <ref name =''Tech1''/>:

The types of [[Healthcare Waste]] are grouped and designated by packaging colour set out in the table below (can be bag colour or lid colour)<ref>[https://assets.publishing.service.gov.uk/media/5f05a7fae90e0712d0206e88/Types_of_healthcare_waste_table.pdf Types of Healthcare Waste]</ref> <ref name ='Tech1'/>:

{| class="wikitable"

Line 41:

Line 53:

!colspan="3"| Colour of Packaging: Orange

|-

|Appropriate healthcare waste management activities||Storage, '''alternative treatment or ~~incineration~~'''

|Appropriate healthcare waste management activities||Storage, '''alternative treatment or [[Incineration]]'''

|-

|rowspan=5|Waste types and List of Waste (LoW) code(s)||rowspan=5|'''Infectious waste''', not contaminated with chemicals or medicines

Line 55:

Line 67:

! colspan="3"|Colour of Packaging: Yellow

|-

|Appropriate healthcare waste management activities||Storage and '''~~incineration~~'''

|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''

|-

|rowspan=6|Waste types and List of Waste (LoW) code(s)||rowspan=3|'''Infectious waste''', contaminated with chemicals:

Line 71:

Line 83:

! colspan="3"|Colour of Packaging: Red

|-

|Appropriate healthcare waste management activities||Storage and '''~~incineration~~'''

|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''

|-

|rowspan=12|Waste types and List of Waste (LoW) code(s)||rowspan=3|Infectious '''anatomical waste''', chemically preserved:

Line 99:

Line 111:

! colspan="7"|Colour of Packaging: Purple

|-

|Appropriate healthcare waste management activities||Storage and '''~~incineration~~'''

|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''

|-

|rowspan=6|Waste types and List of Waste (LoW) code(s)||rowspan=3|'''Cytotoxic and cytostatic''' medicines:

Line 115:

Line 127:

! colspan="3"|Colour of Packaging: Blue

|-

|Appropriate healthcare waste management activities||Storage and '''~~incineration~~'''

|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''

|-

|Waste types and List of Waste (LoW) code(s)||Other '''waste medicines''', excluding cytotoxic and cytostatic medicines||[[EWCChap18|18 01 09]], [[EWCChap18|18 02 08]] or [[EWCChap20|20 01 32]]

Line 121:

Line 133:

! colspan="3"|Colour of Packaging: Black and Yellow ('tiger bags')

|-

|Appropriate healthcare waste management activities||Storage, '''~~incineration~~ or ~~landfill~~'''. Compaction, where specifically permitted.

|Appropriate healthcare waste management activities||Storage, '''[[Incineration]]''' or '''[[Landfill]]'''. Compaction, where specifically permitted.

|-

|rowspan=4|Waste types and List of Waste (LoW) code(s)||rowspan=3|Non-infectious '''offensive waste''':

Line 133:

Line 145:

! colspan="3"|Colour of Packaging: Not Specified

|-

|Appropriate healthcare waste management activities||Storage, '''~~incineration~~ or ~~landfill~~'''. Compaction, where specifically permitted.

|Appropriate healthcare waste management activities||Storage, '''[[Incineration]]''' or '''[[Landfill]]'''. Compaction, where specifically permitted.

|-

|rowspan=4|Waste types and List of Waste (LoW) code(s)||rowspan=3|Non-infectious '''offensive waste''':

Line 144:

Line 156:

|}

==Treatment of Healthcare Waste==

==Treatment and Disposal of Healthcare Waste==

With regard to the table above, it can be seen that there are options for '''incineration''' and '''alternative treatment'''. ~~With regard~~ to ~~any~~ treatment ~~process, it~~ must demonstrate that Healthcare Waste is 'rendered safe'. 'Rendered safe' means:

With regard to the table above, it can be seen that there are options for '''incineration''' and '''alternative treatment''' and in some specific cases [[landfill]] is acceptable.

===Incineration===

For [[incineration]], Healthcare Waste will normally be incinerated in [[High Temperature and Clinical Waste Incineration]]. The graph below shows the trend for different types of incineration of Healthcare Waste, plus the small amount that was exported for [[R1]] incineration. Some [[Residual Waste EFW]] incinerators are able to dispose of specific Clinical Waste streams, and as a result of the COVID-19 pandemic the [[EA]] published a Regulatory Position Statement (RPS C23) clarifying the circumstances where COVID-19 waste could be [[Incineration|incinerated]] with Municipal Waste Waste ([[MSW]]) until July 2021. <ref>[https://www.gov.uk/government/publications/incinerating-specified-healthcare-wastes-at-a-municipal-waste-incinerator-rps-c23/incinerating-specified-healthcare-wastes-at-a-municipal-waste-incinerator-rps-c23#conditions-you-must-comply-with RPS C23]</ref>

===Alternative Treatment===

There are several types of Alternative Treatments (AT) available for the treatment of [[Healthcare Waste]] all of which must demonstrate that the [[Healthcare Waste]] is 'rendered safe'<ref name='Tech1'/>. 'Rendered safe' means:

* demonstrates the ability to reduce the number of infectious organisms present in the waste to a level at which no additional precautions are needed to protect workers or the public against infection from the waste;

* destroys anatomical waste such that it is no longer generally recognisable;

* renders all ~~'''~~Clinical Waste~~'''~~ (including any equipment and sharps) unusable and unrecognisable as ~~'''~~Clinical Waste~~'''~~;

* renders all Clinical Waste (including any equipment and sharps) unusable and unrecognisable as Clinical Waste;

* destroys the component chemicals of chemical or medicinal and medicinally-contaminated waste.

Line 155:

Line 173:

* [[Microwaves]]

* [[Irradiation]]

* [[Chemical ~~Treatment~~]]

* [[Chemical Disinfection]]

* [[Dry Heat]]

* [[~~Physical/~~Mechanical Treatment]]

* [[Thermal Disinfection]]

Mechanical Treatment is also available as a pre-treatment option for any of the AT's outlined above. By pulverising, shredding, crushing etc the [[Healthcare Waste|waste]] this results in a reduction of the volume of the [[Healthcare Waste|waste]] by 60% plus although it does not kill any pathogens, microorganisms or disinfect equipment<ref>[https://www.malsparo.com/treat2.htm Malsparo]</ref>.

==NHS Management of Healthcare Waste [[ERIC]]==

The [[wikipedia:National Health Service| NHS]] report their management of Healthcare Waste via the Estates Returns Information Collection ('''[[ERIC]]''') dataset<ref>https://digital.nhs.uk/data-and-information/publications/statistical/estates-returns-information-collection</ref> which gives a break down the tonnage, management approach, and associated cost of waste - including Healthcare/Clinical Waste. The figure below for the ERIC data over the last four years shows a downward trend for Healthcare Waste going to incineration<ref>The data for 2017 and 2018 is on a different basis within ERIC and represents the total waste sent for incineration, leading to an exaggeration of the drop in incineration in the figure</ref><ref>For the data for 2020/21 the figure produced by Monksleigh adjusts the ERIC data for 4 NHS Trusts that appear to have reported in kg rather than tonnes. This is the subject of a review by NHS Digital as it also impacts the Clinical Waste tonnage treated as a whole by the NHS estate</ref> (against a backdrop of increasing tonnage overall, notwithstanding the impacts of the [[wikipedia: COVID-19|pandemic]], this means increasing tonnage has gone to treatment). The figure also shows that the proportion of waste incinerated from the [[wikipedia:National Health Service| NHS]] has dropped relative to the total Healthcare Waste incinerated - reflecting that non-NHS facilities (such as private hospitals, care homes etc)<ref>https://digital.nhs.uk/services/organisation-data-service/file-downloads/non-nhs-organisations</ref> have relied more heavily on incineration than treatment for the management of their waste over recent years.

==References==

@@ Line 3: / Line 3: @@
 [[File:Healthcare waste pic.jpg|280px|left|Picture of Healthcare Waste packaging from Herefordshire CGC report]]__TOC__
 <br clear='left'/>
+==Macro Tonnage==
+The macro-level data reported for 2020 by [[DEFRA]]<ref>[https://www.gov.uk/government/statistics/uk-waste-data UK Statistics on Waste July 2020 update]</ref> for tonnage arisings is summarised in the figure below, with a total of 355kt tonnes of Healthcare Waste (and some associated biological waste) arising in the UK, the large majority of which came from the service sector :
-==Clinical Waste==
+[[File:Helathcare tonnage 2020.png|1000px|center]]
+==Overview==
+===Clinical Waste===
 '''Clinical Waste''' is [[Healthcare Waste]] that:
 *contains viable micro-organisms or their toxins which are known or reliably believed to cause disease in humans or other living organisms
@@ Line 14: / Line 18: @@
 *is waste of a similar nature from a non-healthcare activity
-==Offensive Waste==
+===Offensive Waste===
-'''Offensive Waste''' is:
+'''Offensive Waste''' is non-infectious waste which is unpleasant and may cause offence to those coming into contact with it. It includes<ref name="Net">[https://www.netregs.org.uk/environmental-topics/waste/managing-waste-materials/offensive-waste/ NetRegs]</ref>:
-*is not clinical waste
+*outer dressings and protective clothing e.g. masks, gowns and gloves that are not contaminated with body fluids
-*contains body fluids, secretions or excretions
+*hygiene waste and sanitary protection e.g. nappies and incontinence pads
-*falls within [[EWC]] waste codes [[EWCChap18 | 18 01 04]], [[EWCChap18 | 18 02 03]] or [[EWCChap20 | 20 01 99]]
+*autoclaved laboratory waste.
+*falls within [[EWC]] waste codes [[EWCChap18 | 18 01 04]], [[EWCChap18 | 18 02 03]] or [[EWCChap20 | 20 01 99]].
-==Management of Healthcare Waste==
+Offensive waste does not include <ref name="Net" />:
-The management of Healthcare Wastes is set out in '''Healthcare Technical Memorandum 07-01 - Safe Management of Healthcare Waste'''<ref name=''Tech1''>[https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/167976/HTM_07-01_Final.pdf Link to pdf document]</ref> Which replaced the Safe Management of Healthcare Waste in 2013 <ref>Published in 2006, this removed the clinical waste classification system categorising into 5 types; A to E</ref>. Management of Healthcare Waste for regulated facilities with an environmental permit is the subject of guidance issued in June 2020 <ref>[https://www.gov.uk/guidance/healthcare-waste-appropriate-measures-for-permitted-facilities Healthcare Waste:Appropriate Measures for Permitted Facilities]</ref> by the [[EA]] which sets out appropriate measures in the following sections:
+*sharps
+*anatomical waste e.g.body parts, organs or blood
+*chemicals, medicines
+*dental amalgam
+*any waste that is infectious (i.e. a clinical waste)
+===Management of Healthcare Waste===
+The management of Healthcare Wastes is set out in '''Healthcare Technical Memorandum 07-01 - Safe Management of Healthcare Waste'''<ref name='Tech1'>[https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/167976/HTM_07-01_Final.pdf Link to pdf document]</ref> which replaced the Safe Management of Healthcare Waste in 2013 <ref>Published in 2006, this removed the clinical waste classification system categorising into 5 types; A to E</ref>. Management of Healthcare Waste for regulated facilities with an environmental permit is the subject of guidance issued in July 2020 <ref>[https://www.gov.uk/guidance/healthcare-waste-appropriate-measures-for-permitted-facilities Healthcare Waste:Appropriate Measures for Permitted Facilities]</ref> by the [[EA]] which sets out appropriate measures in the following sections:
 * When appropriate measures apply
@@ Line 34: / Line 46: @@
 * Process efficiency appropriate measures
-==Healthcare Waste - Packaging Colour and Appropriate Waste Management==
+==Categories of Healthcare Waste (Packaging Colour and Appropriate Waste Management)==
-The types of [[Healthcare Waste]] are grouped and designated by packaging colour set out in the table below (can be bag colour or lid colour)<ref>[https://assets.publishing.service.gov.uk/media/5f05a7fae90e0712d0206e88/Types_of_healthcare_waste_table.pdf Types of Healthcare Waste]</ref> <ref name =''Tech1''/>:
+The types of [[Healthcare Waste]] are grouped and designated by packaging colour set out in the table below (can be bag colour or lid colour)<ref>[https://assets.publishing.service.gov.uk/media/5f05a7fae90e0712d0206e88/Types_of_healthcare_waste_table.pdf Types of Healthcare Waste]</ref> <ref name ='Tech1'/>:
 {| class="wikitable"
@@ Line 41: / Line 53: @@
 !colspan="3"| Colour of Packaging: Orange
 |-
-|Appropriate healthcare waste management activities||Storage, '''alternative treatment or incineration'''
+|Appropriate healthcare waste management activities||Storage, '''alternative treatment or [[Incineration]]'''
 |-
 |rowspan=5|Waste types and List of Waste (LoW) code(s)||rowspan=5|'''Infectious waste''', not contaminated with chemicals or medicines
@@ Line 55: / Line 67: @@
 ! colspan="3"|Colour of Packaging: Yellow
 |-
-|Appropriate healthcare waste management activities||Storage and '''incineration'''
+|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''
 |-
 |rowspan=6|Waste types and List of Waste (LoW) code(s)||rowspan=3|'''Infectious waste''', contaminated with chemicals:
@@ Line 71: / Line 83: @@
 ! colspan="3"|Colour of Packaging: Red
 |-
-|Appropriate healthcare waste management activities||Storage and '''incineration'''
+|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''
 |-
 |rowspan=12|Waste types and List of Waste (LoW) code(s)||rowspan=3|Infectious '''anatomical waste''', chemically preserved:
@@ Line 99: / Line 111: @@
 ! colspan="7"|Colour of Packaging: Purple
 |-
-|Appropriate healthcare waste management activities||Storage and '''incineration'''
+|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''
 |-
 |rowspan=6|Waste types and List of Waste (LoW) code(s)||rowspan=3|'''Cytotoxic and cytostatic''' medicines:
@@ Line 115: / Line 127: @@
 ! colspan="3"|Colour of Packaging: Blue
 |-
-|Appropriate healthcare waste management activities||Storage and '''incineration'''
+|Appropriate healthcare waste management activities||Storage and '''[[Incineration]]'''
 |-
 |Waste types and List of Waste (LoW) code(s)||Other '''waste medicines''', excluding cytotoxic and cytostatic medicines||[[EWCChap18|18 01 09]], [[EWCChap18|18 02 08]] or [[EWCChap20|20 01 32]]
@@ Line 121: / Line 133: @@
 ! colspan="3"|Colour of Packaging: Black and Yellow ('tiger bags')
 |-
-|Appropriate healthcare waste management activities||Storage, '''incineration or landfill'''. Compaction, where specifically permitted.
+|Appropriate healthcare waste management activities||Storage, '''[[Incineration]]''' or '''[[Landfill]]'''. Compaction, where specifically permitted.
 |-
 |rowspan=4|Waste types and List of Waste (LoW) code(s)||rowspan=3|Non-infectious '''offensive waste''':
@@ Line 133: / Line 145: @@
 ! colspan="3"|Colour of Packaging: Not Specified
 |-
-|Appropriate healthcare waste management activities||Storage, '''incineration or landfill'''. Compaction, where specifically permitted.
+|Appropriate healthcare waste management activities||Storage, '''[[Incineration]]''' or '''[[Landfill]]'''. Compaction, where specifically permitted.
 |-
 |rowspan=4|Waste types and List of Waste (LoW) code(s)||rowspan=3|Non-infectious '''offensive waste''':
@@ Line 144: / Line 156: @@
 |}
-==Treatment of Healthcare Waste==
+==Treatment and Disposal of Healthcare Waste==
-With regard to the table above, it can be seen that there are options for '''incineration''' and '''alternative treatment'''. With regard to any treatment process, it must demonstrate that Healthcare Waste is 'rendered safe'. 'Rendered safe' means:
+With regard to the table above, it can be seen that there are options for '''incineration''' and '''alternative treatment''' and in some specific cases [[landfill]] is acceptable.
+===Incineration===
+For [[incineration]], Healthcare Waste will normally be incinerated in [[High Temperature and Clinical Waste Incineration]]. The graph below shows the trend for different types of incineration of Healthcare Waste, plus the small amount that was exported for [[R1]] incineration. Some [[Residual Waste EFW]] incinerators are able to dispose of specific Clinical Waste streams, and as a result of the COVID-19 pandemic the [[EA]] published a Regulatory Position Statement (RPS C23) clarifying the circumstances where COVID-19 waste could be [[Incineration|incinerated]] with Municipal Waste Waste ([[MSW]]) until July 2021. <ref>[https://www.gov.uk/government/publications/incinerating-specified-healthcare-wastes-at-a-municipal-waste-incinerator-rps-c23/incinerating-specified-healthcare-wastes-at-a-municipal-waste-incinerator-rps-c23#conditions-you-must-comply-with RPS C23]</ref>
+[[File:Clinical Waste Incineration Graph.png|600px|center|Graph of Clinical Waste to Incineration all rights reserved Monksleigh]]
+===Alternative Treatment===
+There are several types of Alternative Treatments (AT) available for the treatment of [[Healthcare Waste]] all of which must demonstrate that the [[Healthcare Waste]] is 'rendered safe'<ref name='Tech1'/>. 'Rendered safe' means:
 * demonstrates the ability to reduce the number of infectious organisms present in the waste to a level at which no additional precautions are needed to protect workers or the public against infection from the waste;
 * destroys anatomical waste such that it is no longer generally recognisable;
-* renders all '''Clinical Waste''' (including any equipment and sharps) unusable and unrecognisable as '''Clinical Waste''';
+* renders all Clinical Waste (including any equipment and sharps) unusable and unrecognisable as Clinical Waste;
 * destroys the component chemicals of chemical or medicinal and medicinally-contaminated waste.
@@ Line 155: / Line 173: @@
 * [[Microwaves]]
 * [[Irradiation]]
-* [[Chemical Treatment]]
+* [[Chemical Disinfection]]
 * [[Dry Heat]]
-* [[Physical/Mechanical Treatment]]
+* [[Thermal Disinfection]]
+Mechanical Treatment is also available as a pre-treatment option for any of the AT's outlined above. By pulverising, shredding, crushing etc the [[Healthcare Waste|waste]] this results in a reduction of the volume of the [[Healthcare Waste|waste]] by 60% plus although it does not kill any pathogens, microorganisms or disinfect equipment<ref>[https://www.malsparo.com/treat2.htm Malsparo]</ref>.
+==NHS Management of Healthcare Waste [[ERIC]]==
+The [[wikipedia:National Health Service| NHS]] report their management of Healthcare Waste via the Estates Returns Information Collection ('''[[ERIC]]''') dataset<ref>https://digital.nhs.uk/data-and-information/publications/statistical/estates-returns-information-collection</ref> which gives a break down the tonnage, management approach, and associated cost of waste - including Healthcare/Clinical Waste. The figure below for the ERIC data over the last four years shows a downward trend for Healthcare Waste going to incineration<ref>The data for 2017 and 2018 is on a different basis within ERIC and represents the total waste sent for incineration, leading to an exaggeration of the drop in incineration in the figure</ref><ref>For the data for 2020/21 the figure produced by Monksleigh adjusts the ERIC data for 4 NHS Trusts that appear to have reported in kg rather than tonnes. This is the subject of a review by NHS Digital as it also impacts the Clinical Waste tonnage treated as a whole by the NHS estate</ref> (against a backdrop of increasing tonnage overall, notwithstanding the impacts of the [[wikipedia: COVID-19|pandemic]], this means increasing tonnage has gone to treatment). The figure also shows that the proportion of waste incinerated from the [[wikipedia:National Health Service| NHS]] has dropped relative to the total Healthcare Waste incinerated - reflecting that non-NHS facilities (such as private hospitals, care homes etc)<ref>https://digital.nhs.uk/services/organisation-data-service/file-downloads/non-nhs-organisations</ref> have relied more heavily on incineration than treatment for the management of their waste over recent years.
+[[File:NHS Tonnage Incinerated vs Total.png|500px|center|NHS Clinical Waste Incinerated vs total Clinical Waste Incinerated - all rights reserved Monksleigh Ltd]]
 ==References==
 <references />