Potential compromise of hospital hygiene by clinical waste carts.

Bulk waste storage carts are common in hospitals and undoubtedly assist in the day-to-day management of clinical wastes. They are used for the transport and interim storage of primary clinical waste containers and are often located close to or within hospital buildings to receive such wastes from clinical departments. Examination of a random selection of bulk clinical waste carts at nine acute hospitals across Greater London revealed external soiling in all of 23 carts. Eight of 13 carts were also soiled on the inner surfaces, with evidence of bloodstains and free fluids in the base of five carts. Staphylococcus aureus and enterococci were recovered in low numbers from the lids (N=7) and wheels (N=10) of carts and Escherichia coli, Enterobacter spp. and Pseudomonas aeruginosa were recovered from the wheels of a further five carts. Two carts were heavily contaminated with Aspergillus spp. Pathogens originating from clinical wastes may be transferred from contaminated bulk waste carts to the wider hospital environment. It may be advisable to keep bulk carts outside clinical areas, and preferably outside all hospital buildings. This becomes particularly important in circumstances where carts supplied by contractors are not dedicated to a single hospital or National Health Service trust.