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WASTE MANAGEMENTIN

DENTISTRY

Dr. Rajeev Kashyap

B.Sc,B.D.S., M.Sc(DPH)UK

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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.

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CATEGORIES OF WASTE

Discarded sharps Laboratory and associated waste Human tissue including solutions containing blood Cytotoxic waste Pharmaceutical waste Chemical waste Radiation waste General waste

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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

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Waste Management in Dental Office

Regulated by Different Governing Bodies Federal Provincial Local

for infection control, hazardous materials handling, safety and waste disposal issues.

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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

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Occupational Health and safety Administration

Regulations concerning Blood borne pathogens Hazardous materials Safe use of chemicals

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Environmental Protection Agency.

Regulates Workplace exposure level of chemicals. Heat Radiation Discharge of waste materials Requirements concerning sterilization,

disinfections and waste management

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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

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American Dental Association

Indicate that staff are knowledgeable about the rules about waste management

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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

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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

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INFECTIOUS WASTE

Bulk blood or blood products Pathology waste Sharps Saliva(CDC consider it to be infectious

because it is often tainted with blood during treatment.)

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BLOOD

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

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PATHOGENIC WASTE

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.

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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.

Collect 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.

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Dental Amalgam

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.

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ADA Best Management Practices for Amalgam Waste

DO Do use precapsulated alloys and stock a variety of

capsule sizes Do recycle used disposable amalgam capsules Do salvage, store and recycle non-contact amalgam (scrap 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

their contents. 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 use bulk mercury Don’t put used disposable amalgam capsules in biohazard containers, infectious waste containers (red bags) or regular garbage. Don’t put non-contact amalgam waste in biohazard containers, infectious waste containers (red bags) or regular garbage Don’t put contact amalgam waste in biohazard containers, infectious waste containers (red bags) or regular garbage Don’t rinse devices containing amalgam over drains or sinks 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

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Never dispose of scrap amalgam in the sharps container, red biohazard bag or the trash.

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SHARPS

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.

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SHARPS

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.

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SHARPS

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SHARPS CONTAINERS

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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

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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.

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CONTAMINATED LAUNDRY

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.

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ENVIORNMENT PROTECTION

Environment Protection Agency approve the Haulers

Waste disposed off illegally Dental Practice is held responsible

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Reference

“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.

American Dental Council Guidelines. Handling Dental Waste

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Any Questions