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Monday, 2 April 2001
Page: 26166


Dr STONE (Parliamentary Secretary to the Minister for the Environment and Heritage) (5:09 PM) —Based in Cohuna, one of the towns of my electorate of Murray, there is a remarkable business that is setting standards of excellence in its waste management work. This business, led by Mr David Elliot, is called Ellwaste. Last year David Elliot brought to my attention a serious problem confronting the sector of his industry which deals with clinical wastes. Since then I have worked with the Australian and New Zealand Clinical Waste Management Industry Group—in particular the network manager, Pam Keating—in an effort to help them achieve a regulated, nationally consistent response to clinical waste management.

Sadly, as recently as 23 March at the National Environment Protection Council planning day, representatives of the states and territories again rejected an immediate response to the Commonwealth's call for action to achieve nationally consistent, regulated best practice in clinical waste management. Without a consistent and regulated approach labelling, storage, transport and disposal, occupational health and safety, education and waste minimisation continues to be at risk—a risk of seriously affronting the public's sense of decency, the protection of public health and pollution or contamination of the environment.

So what is the problem? Every day clinical and related waste is generated in hospitals, veterinary surgeries, research laboratories, dental clinics, dialysis units, drug treatment centres, ambulance services, maternity clinics, community health services, nursing homes, blood banks, pharmacies, mortuaries, laundries, brothels, tattooists, body piercing establishments and private homes—wherever patients need ongoing medication, injections and dressings. The bulk of this waste is harmless, and some of it is not. While the waste generated is much the same everywhere, each state and territory has a different definition of what constitutes a hazard or what can be included in general untreated waste. The waste definition confusion reflects the inconsistent and sometimes unsafe approach to what are most important ethical, health and environmental related issues.

To advance this debate I will use the definition of clinical waste referred to in the National guidelines for waste management in the health care industry, circulated by the National Health and Medical Research Council in 1999. Unfortunately, these guidelines have no regulatory teeth. They depend on voluntary adoption by the industry, states and territories—which, as I have said, as recently as last week failed to be greatly moved by any sense of urgency. According to the NHMRC, clinical and related waste includes any material which has the potential to be hazardous, causing sharps injury, infection, disease or public offence. Their categories include sharps, human tissue or animal waste resulting from medical or veterinary research or treatments that have the potential to cause disease.

The human tissue category of clinical waste includes visually recognisable body tissues, such as limbs, placentas, biopsy specimens and non-viable foetuses, or foetuses knowingly obtained through medical procedures, regardless of appearance. It includes material or solutions containing free-flowing blood or expressible blood. Discarded sharps include hypodermic needles, scalpel blades and intravenous sets. These may be contaminated with blood, body fluid, toxic, cytotoxic or radioactive substances.

Animal tissue or carcasses used in research includes animals used in experiments related to infection or where animals have been treated with chemicals that are known to be environmentally unsafe. Cytotoxic waste is material that may be contaminated with a cytotoxic drug, used during chemotherapy usually for cancer treatments. These toxic compounds have carcinogenic, mutagenic and teratogenic potential—that is, they can cause cancer, foetal and neonatal abnormalities. Direct contact with cytotoxics may also cause irritation to the skin, eyes, mucous membranes and ulceration and necrosis of tissue.

Pharmaceutical waste excludes the cytotoxins but includes pharmaceuticals that are over their shelf life or discarded by patients, batches in contaminated packages or waste generated during pharmaceutic manufacturing. Chemical waste can include, but is not limited to, mercury, cyanide and formalin, all of which require special disposal. These chemicals can corrode sewage pipes and even cause explosions if flushed into sewerage systems. Radioactive waste is generated by nuclear medicine, radioimmuno assay and bacteriological procedures, and it can be a solid, liquid or gaseous. General waste is the bulk of all health industry waste produced. It includes sanitary and incontinence pads, intravenous drip and other equipment which may be contaminated with other hazardous substances. And there is the problem that a single container of waste can be a jumble of sharps, bloodied bandages, infectious material and human tissue.

So clearly we have a problem. The different states and territories have different priorities and different capacities in dealing with the definition, storage, collection, labelling, transportation, tracking and monitoring of the disposal of this clinical waste. The technologies they approve differ, as well as the air emissions standards for incinerators and landfill standards. For example, Queensland, Western Australia, Northern Territory, Tasmania and remote parts of regional New South Wales allow landfill disposal of untreated clinical wastes such as bloodied bandages. Other jurisdictions do not. While high temperature incineration is approved in all jurisdictions, autoclaves are only approved in Queensland and New South Wales. Microwaving is only approved in New South Wales. Grinding and shredding with sodium hypochlorite is approved in Victoria, New South Wales and Queensland, but in Queensland they also approve of grinding and shredding with hydrogen peroxide and lime. And so it goes on.

Clearly there is some incentive for waste disposal businesses to shop around for the state with the least costly requirements for clinical waste disposal. As well, some states and territories do not have the required infrastructure, so transportation of the clinical waste across borders is essential. Given the inconsistency of definitions, labelling, storage and disposal, this transportation presents a major challenge to the industry. It is difficult for a contractor to know exactly what part of the load needs to be treated in the receiving state or territory. Since we are now also disposing of East Timor medical waste in the Northern Territory, especially that generated by United Nations facilities, we also need quarantine understandings. There is no nationally agreed set of colours or symbols to identify the waste in storage in containers or transport. This makes it extraordinarily difficult for the industry. There is no consistency as to the acceptable container and handling practices. For example, while one state has been advocating the disposal of untreated clinical waste to landfill, there are no requirements for mechanical aids on the vehicles to empty the containers safely to protect the workers.

Many health care organisations have facilities located in different states and territories. This means they must duplicate their management systems, policies and procedures, purchasing requirements and education programs. It also means that waste product is more likely to be transported for dumping in the states with the poorest air emissions standards or the cheapest landfill disposal options. This obviously increases environmental risks. It is not fair to those who live in remote and rural communities. Similar problems also exist with the Australian Dangerous Goods Code. Such problems could be ameliorated through a national approach to clinical waste management.

The NHMRC guidelines recommend that `the states and territories should negotiate detailed and consistent definitions of the terms to be used in the documentation of their waste management requirements' and that `there is a need for a national, uniform strategy for clinical and related wastes management'. We have a vehicle for overcoming the current problems. This is the national environment protection measures and they can deal with the clinical waste issue between jurisdictions and territories across the nation. A NEPM could produce benefits to all governments by reducing uncertainty about what clinical waste is and how it should be regulated. It would reduce divided opinions between government agencies within states and territories and give industry the same requirements for each jurisdiction, creating real opportunity for communities to enjoy improved and equivalent standards of protection from infection and pollution. In particular, it could better assure the sensitive disposal of all human tissue.

I strongly congratulate the industry—it has done an enormous amount of work—that deals with clinical waste disposal. It is most conscientious and most anxious to see a better system in Australia prevail. I call upon the states and territories to think much harder about the need for a national environmental protection measure to deal with clinical waste, and I certainly will continue my efforts, as Parliamentary Secretary to the Minister for the Environment and Heritage, to make sure that we very soon do address this most particular problem.