Angel, Katherine. (2009) The precautions of clinical waste: disposable medical sharps in the United Kingdom. BioSocieties, Vol.4 (No.2-3). pp. 183-205. ISSN 1745-8552

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Abstract

This article deals with recent changes in UK guidance on clinical waste, in particular a shift to disposable, single-use instruments and sharps. I use interviews conducted with nurses from a GP practice and two clinical waste managers at alternative treatment and incineration sites as a springboard for reflection on the relationship between the legislation on clinical waste management and its implementation. Scrutinizing the UK guidance, European legislation and World Health Organization principles, I draw out interviewees’ concerns that the changed practices lead to an expansion of the hazardous waste category, with an increased volume going to incineration. This raises questions regarding the regulations’ environmental and health effects, and regarding the precautionary approach embedded in the regulations. Tracing the diverse reverberations of the term ‘waste’ in different points along the journeys made by sharps in particular, and locating these questions in relation to existing literature on waste, I emphasize that public health rationales for the new practices are not made clear in the guidance. I suggest that this relative silence on the subject conceals both the uncertainties regarding the necessity for these means of managing the risks of infectious waste, and the tensions between policies of precautionary public health and environmental sustainability.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Arts > History
Library of Congress Subject Headings (LCSH):	Great Britain. Dept. of Health, Medical wastes -- Law and legislation -- Great Britain, Medical wastes -- Law and legislation -- European Union countries, Hazardous wastes -- Incineration -- Great Britain, Sharps (Medical instruments) -- Great Britain
Journal or Publication Title:	BioSocieties
Publisher:	Cambridge University Press
ISSN:	1745-8552
Date:	September 2009
Volume:	Vol.4
Number:	No.2-3
Number of Pages:	23
Page Range:	pp. 183-205
Identification Number:	10.1017/S1745855209990160
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
References:	Adams, J. (2000). A Richter scale for risk? In J. Morris (Ed.), Rethinking risk and the precautionary principle. Oxford: Butterworth-Heinemann. Baldwin, R. (1996). Regulatory legitimacy in the European context: the British Health and Safety Executive. In G. Majone (Ed.), Regulating Europe, 83–105. London: Routledge. Bauman, Z. (2004). Wasted lives: Modernity and its outcasts. Oxford: Polity. British Medical Journal (2009). Environmental waste in health care. British Medical Journal, 338, 1129. Cooper, T. (2007). Challenging the ‘refuse revolution’: War, waste and the rediscovery of recycling, 1900–50. Historical Research, 81(214), 710–731. Cooper, T. (2009). Modernity and the politics of waste in Britain. In P. Warde, & S. Soerlin (Eds), Nature’s end: Reconsidering environmental history. Basingstoke: Palgrave Macmillan. Department for Environment, Food and Rural Affairs (DEFRA) (2005). Review of the Special Waste Regulations 1996 in England, Hazardous Waste (England and Wales) Regulations 2005 and the List of Wastes (England) Regulations 2005: Final Regulatory Impact Assessment. London: DEFRA. Department of Health. (2006). Health technical memorandum 07–01: Safe management of healthcare waste. London: The Stationery Office. Department of Health. (2008). Sustainable development waste, URL (accessed February 2009): http://www.dh.gov. uk/en/Managingyourorganisation/Estatesandfacilitiesmanagement/Sustainabledevelopment/DH_4119635 Douglas, M. (1995 [1966]). Purity and danger: An analysis of concepts of pollution and taboo. London: Routledge & Kegan Paul. Douglas, M., & Wildavsky, A. (1982). Risk and culture: An essay on the selection and technological and environmental dangers. Berkeley: U California Press. Environment Agency (2003a). Position statement: Waste incineration in waste management strategies, URL (accessed February 2009): http://www.environment-agency.gov.uk/research/library/position/41225.aspx Environment Agency (2003b). Waste management licensing: Technical guidance on clinical waste management facilities. Environment Agency (2005). Hazardous waste (England and Wales) regulations 2005. London: The Stationery Office. Environment Agency (n.d.). Environmental facts and figures: Waste incineration, URL (accessed February 2009): www.environment-agency.gov.uk/research/library/data/34419.aspx Fisher, S. (2005). Healthcare waste management in the UK: The challenges facing healthcare waste producers in light of changes in legislation and increased pressures to manage waste more efficiently. Waste Management, 25, 572–574. Franklin, S., & Lock., M. (2003). Remaking life and death: Towards an anthropology of the biosciences. Santa Fe, NM: School of American Research Press/Oxford: James Currey. Gandy, M. (1993). Recycling and waste: An exploration of contemporary environmental policy. Aldershot: Avebury. Gandy, M. (1994). Recycling and the politics of urban waste. London: Earthscan. Ganczak, M., & Barss, P. (2008). Nosocomial HIV infection: epidemiology and prevention, a global perspective. AIDS Reviews, 10(1), 47–61. Gille, Z. (2007). From the cult of waste to the trash heap of history: The politics of waste in socialist and postsocialist Hungary. Bloomington: Indiana UP. Hacking, I. (2003). Risk and dirt. In R.V. Ericson, & A. Doyle (Eds), Risk and morality, 22–47. Toronto: Toronto UP. Hawkins, G. (2006). The ethics of waste: How we relate to rubbish. Oxford: Rowman & Littlefield. Health Services Advisory Committee (1999). Safe disposal of clinical waste. London: The Stationery Office. Hutchins, D.C.J., & White, S.M. (2009). Coming round to recycling. British Medical Journal, 338, 609. Kahneman, D., Slovic, P., & Tversky, A. (1982). Judgement under uncertainty: Heuristics and biases Cambridge: Cambridge UP. Kaiser, B., Eagan, P.D., & Shaner, H. (2001). Solutions to health care waste: Life-cycle thinking and ‘green’ purchasing. Environmental Health Perspectives, 109(3), 205–207. Lianos, M., with M. Douglas (2000). Dangerization and the end of deviance. British Journal of Criminology, 40, 261–278. Majone, G. (1997). From the positive to the regulatory state: Causes and consequences of changes in the mode of governance. Journal of Public Policy, 17(2), 139–167. Pruess, A., Giroult, E., & P. Rushbrook (1998). Safe management of wastes from healthcare activities. Geneva: World Health Organization. Scheper-Hughes, N. (2002). Commodifying bodies. London: SAGE. Sunday Times (2009a). Hepatitis B kills 57 in lucrative Indian trade in recycled medical waste. Sunday Times, 11 March. Sunday Times (2009b). Used needles are causing a health crisis in India. Sunday Times, 22 March. Sunstein, C. (2002). Risk and reason: Safety, law, and the environment. Cambridge: Cambridge UP. Sunstein, C. (2005). Laws of fear: Beyond the precautionary principle. Cambridge: Cambridge UP. Tudor, T.L., Noonan, C.L., & Jenkin, L.E.T. (2005). Healthcare waste management: A case study from the National Health Service in Cornwall, United Kingdom. Waste Management, 25, 606–615. Waldby, C., & Mitchell, R. (2006). Tissue economies: Blood, organs and cell lines in late capitalism. London: Duke UP. World Health Organization. (2005). Safe healthcare waste management: Policy paper by the World Health Organization. Waste Management, 25, 568–569.
URI:	http://wrap.warwick.ac.uk/id/eprint/2573

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