WASTE MANAGEMENT IN DENTISTRY Dr. Rajeev Kashyap B.Sc,B.D.S., M.Sc(DPH)UK
WASTE MANAGEMENT DEFINITION
Waste Management is collection, transport,processing,recycling of disposal of waste material.This term usually relates to materials produced by human activity and is generally undertaken to reduce effect on health, the environment and aesthetics.
Practice of waste management may differ in developing nation to under developing nation, urban to rural area and residential to industrial setup.
CATEGORIES OF WASTE
Laboratory and associated waste
Human tissue including solutions containing blood
Containers and identification Clinical waste Clinical waste must be placed in yellow bags and containers identified with the Biohazard symbol and the words “CLINICAL WASTE” marked prominently and permanently in black. Cytotoxic waste Cytotoxic wastes require careful handling and containment. All cytotoxic waste must be placed into purple bags and containers that are identified with the cell in telophase symbol and the wording “CYTOTOXIC WASTE” in white. Radioactive waste Radioactive waste must be placed into red bags and containers that are marked with the radiation warning symbol and the words “RADIOACTIVE WASTE” in black. The Radiation
Waste Management in Dental Office
Regulated by Different Governing Bodies
for infection control, hazardous materials handling, safety and waste disposal issues.
Understanding Waste Management in Dental Clinic
Clinical Personal must be trained to handle waste.
Trainings provided by Different organizations under guidelines of OSHA, CDC, ADA and Environment Protection agencies
Occupational Health and safety Administration
Blood borne pathogens
Safe use of chemicals
Environmental Protection Agency.
Workplace exposure level of chemicals.
Discharge of waste materials
Requirements concerning sterilization, disinfections and waste management
Center For Disease Control
In Dental Practice provides
Program for waste management need to be developed
Personals dealing with waste in practice are appropriately trained
American Dental Association
Indicate that staff are knowledgeable about the rules about waste management
Types of Waste
Regulated Medical Waste ( Hospital waste and Infectious medical waste – this require special care and is nearly 3% of the total waste )
Non regulated medical waste
Types of regulated waste
Contaminated Waste: items came in contact with blood or blood products
Hazardous waste:posing a risk to human being or environment
Infectious waste:capable of causing an infectious disease
Medical waste:any solid waste that is generated in the diagnosis treatment or immunization
Regulated waste :needs special handling and disposal
Toxic waste:having a poisonous effect
Bulk blood or blood products
Saliva(CDC consider it to be infectious because it is often tainted with blood during treatment.)
Blood mixed with saliva and other fluids evacuated in the dental office as waste water system.
Rinse sink traps and evacuation lines daily with disinfected solution
Carefully pour blood, suction fluids into the drain connected to the sewer system(meeting local regulatory guidelines)in an acceptable method
Teeth and other tissues
Potentially infectious there disposal should be in a color labeled container (many areas allow in house neutralization of such items)
Disposal of treated tooth and other tissue are as to the local guidelines
Pathologic waste is hidden from public and its disposal is in a secured and receptable.
ANATOMICAL WASTE (HUMAN TISSUE)
Human tissue waste generation is normally limited to oral surgeons and periodontists for example in the course of harvesting of human tissue for treatment.
C ollect human tissue in red liners that are marked with a universal biohazard symbol.
Store anatomical waste in an enclosed storage area that is locked and separated from other supply areas. Anatomical waste should be stored at a temperature at or below 4 degrees centigrade. The storage area must be marked as Biomedical Waste Storage Area and must display the universal symbol.
Once accumulated contact an approved biomedical waste carrier for disposal.
Amalgam restored teeth can be disinfected before disposal with sterilizing chemical for 30 minutes and should rinse treated teeth well. Teeth with amalgam restoration must not be heat sterilized to avoid the possibility of mercury vapor release during the sterilization procedure.
Extracted teeth should not ordinarily be returned to patients, however, the new CDC guideline allows extracted teeth to be returned to the patient. It should be soaked first in sodium hypochlorite for 10 minutes before returning to the patient.
ADA Best Management Practices for Amalgam Waste
Do use precapsulated alloys and stock a variety of
Do recycle used disposable amalgam capsules
Do salvage, store and recycle non-contact amalgam
Do salvage (contact) amalgam pieces from restorations
after removal and recycle the amalgam waste
Do use chair-side traps, vacuum pump filters and
amalgam separators to retain amalgam and recycle
Do recycle teeth that contain amalgam restorations.
Do manage amalgam waste through recycling as
much as possible
( Note: Ask your recycler whether or not extracted
teeth with amalgam restorations require disinfection.)
Don’t dispose of extracted teeth that contain amalgam
restorations in biohazard containers, infectious
waste containers (red bags), sharps containers
or regular garbage
Don’t flush amalgam waste down the drain or toilet
Never dispose of scrap amalgam in the sharps container, red biohazard bag or the trash. 5
Sharps waste is in the form of medical waste in the form of devices or objects used to puncture or lacerate the skin.
Sharps waste is designated as biohazard and is to be carefully handled.
Contaminated sharps are capable of transmitting the disease from injection needles, orthodontic bands,burs, scalpel blades, sutures, instruments and broken glass.
Sterilization of sharp containers
Use labeled and specified container
Spore test the sterilizer.
Label the disposable containers as to local regulations.
Keep containers in upright position.
Process containers for 40- 60 minutes.
Leave containers vent open.
Handling of Sharps
Needles should not be bend, break, or manipulated for the avoidance of accidents in clinic
Protective cap holdings devices capping sheath by scoop technique
Size of sharp container also influence overall efficacy of sterilization
X-RAY FIXER AND DEVELOPER
Separate fixer and developer solutions in the container provided by the approved waste carrier and supplier.
Label the container.
Once the container is full contact appropriate waste carrier for disposal.
Contaminated laundry is to be placed and transported in bags containers that are color coded or labeled with a biohazard symbol..
If the contaminated laundry is sent off site for cleaning, it must be placed in bags or containers that are color coded or labeled with a biohazard symbol, unless the laundry uses universal precautions in handling all soiled laundry.
Environment Protection Agency approve the Haulers
Waste disposed off illegally Dental Practice is held responsible
“ Infection Control & Management of Hazardous Materials for Dental Team” Chris H.Miller,Charles John Palenik.
“ National Guidelines for waste management in health care industry” Govt. of Australia Guide lines.