The differences between offensive and clinical waste.

Offensive and clinical waste in healthcare waste management must be separated to minimise the risks of personal harm and negative environmental impact.

In Health Technical Memorandum 07-01, the clinical waste colour code delegates highly infectious material to yellow containers, known infectious items to orange, and offensive waste or non-infectious to yellow and black (tiger stripe) bags. 

Whilst lines may seem blurred at first glance, there are definitions of each waste type that allow for simple segregation in healthcare.

What is clinical waste?

It’s important to first begin with the definition of clinical waste. The Controlled Waste (England and Wales) Regulations 2012 states clinical waste is generated from a healthcare activity that:

Contains viable microorganisms or their toxins which are known or reliably believed to cause disease in humans or other living organisms

• Contains or is contaminated with a medicine that contains a biologically active pharmaceutical agent
• Is a sharp, bodily fluid or other biological material (including human and animal tissue) containing or contaminated with a dangerous substance

In healthcare environments, clinical waste may be produced through day-to-day care. These items can be identified when working with patients who are ill and when delivering high-quality aid.

The use of a yellow or orange container will depend on the properties of the clinical waste item. Highly infectious material (yellow containers) could present an infectious hazard and medicinal or chemical contamination risks. This could include an IV bag or a pharmaceutically contaminated sharp.

• On the other hand, a known infectious item (orange containers) will have a confidently suspected risk of infection, but will not present any other hazard. This could therefore include an infectious wound dressing or a contaminated swab. 

Anatomical waste (signified by red in the waste colour code), cytotoxic and cytostatic waste (purple), and pharmaceutical waste (blue), are all clinical waste items.

Whilst yellow and black bags are part of the same colour code, they ultimately store non-clinical waste.

What is offensive waste?

Offensive waste should account for approximately 60% of NHS waste according to the NHS clinical waste strategy that was laid out in 2023. This means that a large proportion of the waste produced throughout general and dental healthcare could fall into this category.  But how is it different to clinical waste?

Offensive waste is waste that:

• Is not clinical waste
• Is not infectious – but may still contain body fluids, secretions or excretions
• Is non-hazardous¹

The material in this category is given the name “offensive” waste as it will commonly be unpleasant in odour and appearance. This isn’t a steadfast rule, as used PPE and gloves will still come under the offensive waste stream even if bodily fluids aren’t present, for example.

Sharps are never considered offensive waste, and should not be placed in a tiger-striped bag or any waste bag as a given. They should instead be placed in an appropriate sharps bin.

The differentiation between clinical and offensive waste is subtle but clinicians should follow the rule that if there is no good reason to believe an item is hazardous, it should be considered offensive waste. A hazardous property may include an item being infectious, chemically/pharmaceutically/cytotoxically contaminated or radioactive.

Choose colour coding posters

Healthcare providers can keep handy reminders on display relevant to each point of care so they and their colleagues are aware of their waste management responsibilities.

Initial Medical, the expert waste management service, has a range of useful colour coding posters available for free download.  These detail what items are placed in offensive waste containers, and others that should be designated as clinical waste.