EWC chapter 18: healthcare and clinical waste codes explained
Last updated 7 September 2026
In short
EWC chapter 18 covers wastes from human or animal healthcare and related research in 16 six-digit codes across 2 subcategories (18 01 and 18 02), of which 7 are hazardous (marked with an asterisk). The most commonly encountered hazardous codes are 18 01 03* (wastes requiring infection-prevention measures), 18 01 08* (cytotoxic and cytostatic medicines) and 18 01 10* (dental amalgam waste).
Healthcare and clinical waste is one of the most tightly regulated waste streams in the UK. Getting the EWC code right determines whether you need a standard waste transfer note or a hazardous waste consignment note — and which carrier you can use. This guide explains all 16 EWC chapter 18 codes, which are hazardous, and what records the law requires.
What is EWC chapter 18?
The chapter divides into two subcategories: 18 01 for wastes from natal care, diagnosis, treatment or prevention of disease in humans, and 18 02 for research, diagnosis, treatment or prevention of disease involving animals. Both follow the same structure — parallel codes for sharps, infectious waste, chemicals, cytotoxic medicines and, in the human subcategory, dental amalgam.
Chapter 18 waste arises in GP surgeries, hospitals, dental practices, care homes, veterinary practices, pharmacies, and any research institution handling biological material. The EWC code on the waste transfer note or consignment note must correctly reflect the actual nature of the waste, not simply the setting in which it was produced.
What are the EWC 18 01 codes for human healthcare waste?
| EWC code | Description | Hazardous? |
|---|---|---|
| 18 01 01 | Sharps (except 18 01 03) | No |
| 18 01 02 | Body parts and organs including blood bags and blood preserves (except 18 01 03) | No |
| 18 01 03 * | Wastes whose collection and disposal is subject to special requirements in order to prevent infection | Yes |
| 18 01 04 | Wastes whose collection and disposal is not subject to special requirements in order to prevent infection (for example dressings, plaster casts, linen, disposable clothing, diapers) | No |
| 18 01 06 * | Chemicals consisting of or containing hazardous substances | Yes |
| 18 01 07 | Chemicals other than those mentioned in 18 01 06 | No |
| 18 01 08 * | Cytotoxic and cytostatic medicines | Yes |
| 18 01 09 | Medicines other than those mentioned in 18 01 08 | No |
| 18 01 10 * | Amalgam waste from dental care | Yes |
What are the EWC 18 02 codes for animal healthcare and research waste?
| EWC code | Description | Hazardous? |
|---|---|---|
| 18 02 01 | Sharps (except 18 02 02) | No |
| 18 02 02 * | Wastes whose collection and disposal is subject to special requirements in order to prevent infection | Yes |
| 18 02 03 | Wastes whose collection and disposal is not subject to special requirements in order to prevent infection | No |
| 18 02 05 * | Chemicals consisting of or containing hazardous substances | Yes |
| 18 02 06 | Chemicals other than those mentioned in 18 02 05 | No |
| 18 02 07 * | Cytotoxic and cytostatic medicines | Yes |
| 18 02 08 | Medicines other than those mentioned in 18 02 07 | No |
Which EWC chapter 18 codes are hazardous?
Seven of the 16 EWC chapter 18 codes are hazardous (marked *). Any waste carrying an asterisked code must travel on a hazardous waste consignment note, not a standard waste transfer note, and records must be kept for at least 3 years.
Hazardous waste also requires a carrier registered for hazardous waste collection. A waste carrier registered only for non-hazardous waste cannot legally collect 18 01 03* or the other asterisked codes. Using an unchecked carrier is a breach of the s.34 duty of care regardless of which EWC code appears on the paperwork.
What is the difference between 18 01 03* and 18 01 04?
In practice, 18 01 03* is the correct code for:
- Items visibly contaminated with blood or body fluids (swabs, dressings from infected wounds, soiled incontinence pads where infection is present)
- Waste from patients in isolation (where an infectious disease is being managed)
- Sharps that have contacted a patient — though these can also be assessed case by case; if there is no infection risk, 18 01 01 may apply
- Microbiological cultures and other laboratory waste with infection risk
Code 18 01 04 applies to items that come from a healthcare setting but carry no infection risk — clean aprons, unopened gloves, plaster casts, and routine dressings from patients without infectious conditions. These are often described as "offensive waste" or "hygiene waste" in the industry, though the EWC does not use those terms.
What records are required for clinical and healthcare waste?
- Waste transfer note (non-hazardous): covers codes without an asterisk, such as 18 01 01, 18 01 04, 18 01 07, 18 01 09, 18 02 01, 18 02 03, 18 02 06 and 18 02 08. Both producer and carrier keep a copy for at least 2 years.
- Hazardous waste consignment note: required for all asterisked codes. Producers, carriers and receiving sites all keep copies for at least 3 years.
- Carrier registration: the carrier must be registered as a waste carrier. For hazardous codes, confirm they are authorised to carry hazardous waste before handing over any load.
- Digital Waste Tracking (receivers): permitted sites accepting chapter 18 waste must record a Receipt of Waste in DEFRA's Digital Waste Tracking service from October 2026 (January 2027 in Scotland). Carriers come into scope from October 2027.
This guide is general information about EWC chapter 18 waste codes and is not legal advice. Healthcare waste is also governed by additional legislation — including the Hazardous Waste (England and Wales) Regulations 2005 and their devolved equivalents — and you should check your specific obligations against the primary sources below and, if in doubt, your environmental regulator.
Frequently asked questions
- What is EWC chapter 18?
- EWC chapter 18 covers wastes from human or animal healthcare and related research (except kitchen and restaurant wastes not arising from immediate health care). It contains 16 six-digit codes across 2 subcategories — 18 01 for human healthcare and 18 02 for animal healthcare and research — of which 7 are hazardous (marked with an asterisk *).
- Which EWC chapter 18 codes are hazardous?
- Seven of the 16 chapter 18 codes are hazardous: 18 01 03* (potentially infectious clinical waste), 18 01 06* (chemicals containing hazardous substances), 18 01 08* (cytotoxic and cytostatic medicines), 18 01 10* (dental amalgam), and from the animal healthcare subcategory: 18 02 02* (potentially infectious waste), 18 02 05* (chemicals containing hazardous substances) and 18 02 07* (cytotoxic and cytostatic medicines). Hazardous waste must travel with a consignment note, not a standard waste transfer note.
- What is the difference between 18 01 03* and 18 01 04?
- The dividing line is infection risk. Code 18 01 03* applies to waste whose collection and disposal requires special measures to prevent infection — for example items contaminated with blood or body fluids, or waste from isolation wards. Code 18 01 04 covers waste that presents no infection risk, such as clean dressings, plaster casts or disposable clothing from non-infectious patients.
- Do sharps require a hazardous waste consignment note?
- Not automatically. Sharps that have not contacted infectious material are classified as 18 01 01 (non-hazardous) and travel on a standard waste transfer note. Sharps from patients where infection could be transmitted should be classified as 18 01 03* (hazardous) and require a consignment note. Always classify based on actual infection risk, not the container type.
- How long must healthcare providers keep clinical waste records?
- Non-hazardous healthcare waste must be documented on a waste transfer note and kept for at least 2 years. Hazardous healthcare waste must be documented on a hazardous waste consignment note and kept for at least 3 years. Both the producer and the carrier must retain their copies and produce them if the regulator asks.
Related guides
This guide is general information from ComplyWaste, not legal advice. Always check the primary sources for your situation.