In 1998 NSW Health developed Waste Management Guidelines to promote continuous improvement in waste management across the public health sector. Systematic implementation of the Guidelines was impeded in 1999- 2000 by resistance from the waste industry and transport workers. Since then, NSW Health has not actively promoted waste management in public hospitals. As a consequence Area Health Services (AHSs) and hospitals have developed separate and individual responses to waste management. This has resulted in inconsistent management of waste by public hospitals, inappropriate segregation of waste and additional costs of waste disposal.