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Best management practices for hazardous dental waste
disposal
RAJARAM NAIK *
SURESHCHANDRA B. *
SRINIDHI HEGDE **
AFTAB DAMDA **
MEETA MALIK ***
* Professor, * * Reader, * * * Post Graduate Student. Department of Conservati ve Denti stry & Endodonti cs, A.J. Insti tute of Dental Sci ences, Mangal ore.
Government of India under its gazetted
notification from the Ministry of Environment and
Forests informed to all concerned that no one can
dispose any kind of waste, general or bio-medical
waste in the open. Disposal of harmful waste
produced by dentists and clinics can pollute the
environment. Dental biomedical waste disposal in
the road side bins can infect the municipal waste
collectors if they are not properly protected. In view
of this most nations have introduced best
management practices for hazardous dental waste
disposal.
Bio-medical waste is generated during the
diagnosis, treatment or immunization of human
beings or animals or in research activities. It may
include wastes like sharps, soiled waste,
disposables, anatomical waste cultures, discarded
medicines, chemical wastes etc. This waste is
potentially hazardous, the main hazard being
infection, and may pose a serious threat to human
health if management is indiscriminate and
unscientific.Proper collection and segregation of
biomedical waste are important.
At the same time, the quantity of waste
generated is equally important. A lesser amount of
biomedical waste means a lesser burden on waste
disposal work, cost-saving and a more efficient
waste disposal system.
The surveys carried out by the Central Board
and various other agencies indicated that the health
care establishments in India were not given due
attention to their waste management. It did not form
an integral part of their health care program. The
negligence on the part of the health care
establishment was reflected in various articles in
the newspapers and a public interest litigation in
the Supreme Court. Realizing the gravity of the
ABSTRACT
Proper handling, treatment and disposal of biomedical wastes are important elements of health care office infection
control programme. Properly designed and applied, waste management can be a relatively effective and an
efficient compliance-related practice. Some waste from healthcare facilities, however, is contaminated. If not
disposed of properly, contaminated wastes may carry microorganisms that can infect the people who come in
contact with the waste as well as the community at large.
Keywords: Waste Management, Hazardous Waste, Infection Control.
Review Article
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issue, the Central Board took up the matter, in right
earnest, with the Ministry of Environment and
Forests. This led to the notification of Bio-medical
waste (Handling and management) Rules, 1998.
Now that there is legal binding on the health care
establishments, the state government is slowly
streamlining the process of waste segregation,
collection, treatment and disposal.
POLICIES AND PROCEDURES:
(a). Strategies for minimizing the quantities of
biomedical waste generated and disposed of;
(b). Methods of segregating, packaging,
labelling, moving, storing, treating, and transporting
the various waste types. (Both on- and off-site, as
appropriate);
(c). Methods for keeping records of the
quantities of biomedical waste generated, treated,
and disposed of;
(d). A list of all regulations and legislation
concerning biomedical waste that are applicable
in the facilitys jurisdiction.
(e). A list of those responsible for managing
biomedical waste in the event of an accident or
spill; and
(f). Provision for regular, ongoing staff
instruction about proper handling and potential
hazards of biomedical waste.
Certain basic elements must be embodied in
any biomedical waste management program to
ensure that biomedical waste is handled and
disposed off safely and efficiently.
COLOUR AND TYPE OF CONTAINER FOR DISPOSAL OF BIO-MEDICAL WASTES
Colour Coding
Yellow
Red
Blue / White
Translucent
Black
Type of Container
Plastic Bag
Disinfected Container /
Plastic Bag
Plastic Bag / Puncture Proof
Container
Plastic Bag
Waste
Cat. 1, Cat. 2, Cat. 3,
Cat. 6
Cat. 3, Cat. 6, and Cat. 7
Cat. 4 and Cat. 7
Cat. 5 and Cat. 9, Cat.
10 (Solid)
Incineration / deep burial
Autoclaving / Microwaving
Chemical Treatment
Autoclaving / Microwaving
Chemical Treatment and
Destruction / Shredding
Disposal in Secured Landfill
A. NON-ANATOMICAL WASTES (BLOOD
SOAKED MATERIALS)
All biomedical wastes must be colour coded
and marked with the Workplace Hazardous
Material Information System (WHMIS) biohazard
symbol. Biomedical wastes can only be transported
by a company with proper certification. Biomedical
wastes are also occupational health and safety
concerns for those who come in contact with them.
Non-dripping gauze and extracted teeth are not
considered biomedical; however teeth with
amalgam restorations cannot be placed in the
incinerator for disposal.
BEST MANAGEMENT PRACTICE (BMP)
Use a yellow biomedical waste bag to collect
the non-anatomical wastes and then double bag
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the waste, label the bag with a biohazard symbol.
Keep refrigerated if onsite for more than 4 days.
Once accumulated, contact a certified biomedical
waste carrier for disposal. These bags are available
from your biomedical waste carrier and your dental
equipment supplier.
Never throw blood soaked materials into the
regular garbage or into the compost waste and never
place them in the sharps container.
NON-ANATOMICAL WASTES
All sharps must be disposed using the
appropriate guidelines. Proper disposal will
minimize possible puncture wounds on other
workers handling these wastes such as cleaners and
waste carriers.
BEST MANAGEMENT PRACTICE (BMP)
Collect sharps in a red or yellow puncture
resistant container with a lid that cannot be
removed. The sharps container should be properly
labelled with biohazard symbol. Once container
is full, the biomedical waste should be disposed
by contacting a certified biomedical waste carrier.
Never throw sharps in a regular garbage bag
and never place other biomedical wastes materials
in this container. Do not fill over -full to prevent
injury.
Do not dispose the syringes and needles as it
is. Always cut the needle with a needle cutter and
dispose it otherwise the rag pickers are likely to
pick up these syringes and needles and it gets re-
circulated into the main stream.
NEEDLE DISPOSAL
The waste containers are designed for proper
disposal of used needles. Containers are
environmentally safe. When burned properly at a
waste disposal facility, containers emit only carbon
dioxide and water.
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MERCURY CONTAINING WASTES
ELEMENTAL MERCURY WASTE
MANAGEMENT OPTIONS
BEST MANAGEMENT PRACTICE (BMP)
Store unused elemental mercury in a tightly
sealed, break resistant container and label those
container properly; Hazardous Waste: Elemental
Mercury
Contact a certified waste carrier for recycling
or disposal. Most cities in India have certified waste
collectors approved by the pollution board of India
Use a mercury spill kit if you have a spill of
elemental mercury.
MERCURY SPILL KIT
React unused elemental mercury with silver
alloy to form scrap amalgam. Never transport
elemental mercury yourself nor place it in the
garbage. Elemental mercury should never be
washed down the drain.
It is often simpler and more cost effective to
reduce or eliminate the generation of waste at the
source so that the liability is never created.
MERCURY CONTAINING WASTES
SCRAP AMALGAM
WASTE MANAGEMENT OPTIONS
Some of the metals in amalgam are hazardous
to the environment. The provincial regulations in
most nations prohibit the release of these wastes
(mercury and silver) into the regular waste stream
and further restrictions apply to these metals in the
sewer systems. It is important for dentists to
minimize the release of these wastes from the dental
office.
Scrap Amalgam Best Management Practice
(BMP)
Use a Sponge type MercontainerTM to store
the scrap amalgam. Empty amalgam capsules are
non-hazardous and can be disposed in the garbage.
Use an ISO 11143 compliant amalgam
separator on the suction lines to remove over 95%
of the contact amalgam prior to entering the sewer
system.
Use disposable suction traps on your dental
units and change them weekly. Use gloves, mask,
and glasses when cleaning the suction traps. Place
the used disposable trap into a properly labelled
container of MerconvapTM solution for proper
disposal. Once full, contact a certified waste carrier
for recycling or disposal.
GOOD MANAGEMENT PRACTICE (GMP)
Use a properly labelled container with
mercury vapour suppressant such as fixer or
MerconvapTM solution to submerse the amalgam
particles. Make sure the container is labelled
Hazardous Waste: Scrap Amalgam. Mix only as
much amalgam as is immediately required using
premeasured capsules. Manually remove large
pieces of amalgam which are produced when
removing old fillings and place them in a contact
amalgam container.Consider using amalgam
substitutes in cases where they are appropriate
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(clinically equal or superior to amalgam), ethical
and economically feasible.
Use gloves, mask, and glasses when removing
the non-disposable traps from the suction line.
Remove all visible amalgam by tapping the
trap into a MercontainerTM. Never dispose scrap
amalgam in the garbage and never wash it down
the drain.
Do not place scrap amalgam in the sharps
container and never rinse the traps and filters in
the sink as amalgam particles will discharge into
the sewer.
Do not throw disposable traps that contain
amalgam particles into the garbage
Do not place extracted teeth with amalgam
fillings in the regular garbage. It should be disposed
of in the Scrap Amalgam container to avoid
incineration
Do not suction up unused particles of
amalgam, instead place them in a mercury vapour
suppressant container
AMALGAM SEPARATION
The basic types of amalgam separation
technologies are the sedimentation units which
reduce the speed of the downflow of water with
baffles or tanks to allow amalgam particles to settle.
Centrifuge units spin the water out to the sides of
the unit. These units offer good amalgam removal
but cause some foaming with American vacuum
systems. Ion Exchange units use polymers to capture
small particles; these are often used in series with
sedimentation units. Other wastewater treatment
technologies such as electrolysis and chemical
additions have been adapted for dental
applications.
ISO Certified Amalgam Separator
Safe and effective management of waste is not
only a legal necessity but also a social responsibility.
Lack of concern, motivation, awareness and cost
factor are some of the problems faced in the proper
hospital waste management. Proper surveys of
waste management procedures in dental practices
are needed. Clearly there is a need for education
as to the hazards associated with improper waste
BEST MANAGEMENT PRACTICESFOR HAZARDOUSDENTAL WASTE DISPOSAL
Personal Protective Equipment
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disposal. Lack of apathy to the concept of waste
management is a major stymie to the practice of
waste disposal. An effective communication
strategy is imperative keeping in view the low
awareness level among different category of staff
in the health care establishments regarding
biomedical waste management.
Hence, health care providers should always
try to reduce the waste generation in day-to-day
work in the clinic or at the hospital.
References:
1. Thomas Barron. Mercury in our Environment. CDA Journal
2004;32(7)556-563.
2. Richard T. Kao, Scott Dault, Teresa Pichay Understanding
the Mercury Reduction Issue: The Impact of Mercury on the
Environment and Human Health. CDA Journal
2004;32(7)574-579.
3. Michael W. Davis. A Review of the ADA Mercury Hygiene
recommendations. Dent Today 2003.22:86-91.
4. Thomas W. Clarkson,Laszlo Magos, Gary J. Myers. The
Toxicology of Mercury-Current Exposures and Clinical
Manifestations. N Engl J Med 2003;349:1731-1737.
5. ADA Council Of Scientific Affairs. Dental Mercury Hygiene
recommendations. JADA 2003;134:1498-1499.
6. Mc Manus KR, Fan P L, et al. Purchasing installing and
operating dental amalgam separators : Practical issues. J Am
Dent Assoc . 2003 August ; 134(8) : 1054-65.
7. Leggat PA, Chowanadisai S, et al. Occupational hygiene
practices of dentists in Southern Thailand. Int. Dent J. 2001
Feb; 51 (1) : 6-11.
8. Guidelines for the Management of biomedical Waste in
Canada. February 1992.
RAJARAM NAIK, SURESHCHANDRA B., SRINIDHI HEGDE, AFTAB DAMDA, MEETA MALIK