2. Introduction.
Definition.
Rules and laws
Color coding
WHO Classification
Purpose of management.
Wastes in clinics
Handling and storage.
On-site treatment.
Treatment off-site.
Contingency planning
Public relations.
Summary and Conclusion.
References.
CONTENTS
3. Definition
According to Bio-Medical Waste (Management
and Handling) Rules, 1998 of India,
Bio-medical waste - “means any waste, which is
generated during the diagnosis, treatment or
immunization of human beings or animals or in research
activities pertaining thereto or in the production or
testing of biologicals.”
This also includes 10 categories as mentioned in
schedule I, categories of Bio-Medical Waste in India
4. As per the law it has two schedules
namely:
Schedule-1:Cateogaries of Bio-medical
waste.
Schedule-2:Color coding and type of
containers for the waste.
5. CATEGORIES OF BIO- MEDICAL WASTE IN INDIA AS PER
SCHEDULE-1
1. Category No.1 Human Anatomical waste
2. Category No.2 Animal Waste
3. Category No.3 Microbiology and Biotechnology Waste
4. Category No.4 Waste sharps
5. Category No.5 Discarded medicines and Cytotoxic drugs
6. Category No.6 Solid waste Items contaminated with blood, and fluids
7. Category No.7 Solid waste i.e wastes generated from disposable items
such as tubings, catheters, intravenous sets etc
8. Category No.8 Liquid waste i.e waste generated from laboratory and
washing, cleaning, housekeeping and disinfecting activities)
9. Category No.9 Incineration ash
10. Category No.10 chemicals used in disinfection , as insecticides etc
6. Color coding and type of container for disposal of biomedical
wastes-Schedule 2
Color
coding
Type of Bag Waste Treatment option as
per Schedule- 2
Yellow Plastic Bag Cat. 1, 2, 3, &
6
Incineration/deep
burial
Red Disinfected container/
plastic bag.
Cat. 3, 6 & 7 Autoclaving/
microwaving/Chemical
Treatment.
Blue/Whit
e
translucen
t
Plastic bag/
punctureproof
container
Cat. 4&7 Autoclaving/
microwaving /chemical
treatment and
destruction/ shredding.
Black Plastic bag Cat. 5,9 and
Cat. 10 (solid)
Disposal in secured
landfill
9. In exercise of the powers conferred by section 6, 8 and
25 of
the Environment (protection) act, 1986 the central
government,om 2nd
June notified the rules for the
management and handling of bio-medical waste. These
rules are called the Bio-Medical Waste (Management and
Handling) (Second Amendment) Rules, 2000.
These rules apply to all persons who generate, collect,
receive, store, transport, treat, dispose, or handle bio
medical waste in any form.
The Bio-medical Waste (Management rules,2000.alnd Handling) (Second
Amendment) R
11. •All waste from dental offices can be divided into two basic
categories: Regulated and Non-regulated.
• Regulated waste, according to OSHA definition, is liquid or
semi liquid blood or other potentially infectious materials and
items that would release blood or other potentially infectious
materials if compressed.
•Regulated waste must be placed into appropriately designed
containers, usually red biohazard bags or sharps boxes.
•Ideally, segregation should occur as close as possible to the
point of origin.
•The person disposing of an item should know best which type
of container to select.
12. Other potentially infectious materials are body fluids that are
visibly contaminated by blood.
Infectious/hazardous waste is also included under
Regulated Waste because certain segregation, storage, and
disposal procedures must be followed.
While this waste is in the dental office and a potential hazard
to the employees, it is covered by OSHA regulations.
Infectious waste is a small subset (estimated to be 3% in
hospitals and 1-2% in dental offices) of the total waste to be
discarded. Infectious waste is the part of medical/dental
waste For e.g., contaminated sharps, teeth, pathological
waste and blood soaked items. Also known as hazardous
waste.
13. Non-Hazardous waste
Disposable paper towels, paper mixing pads, disposable
covers of operating surfaces.
Should be discarded in separate covered containers made
of durable material such as plastic or metal receptacles.
For ease in handling, the receptacles should be lined with
plastic bags.
15. • Government hospitals
• Nursing homes
• Private hospitals
• Physician's office/clinics
• Dentist's office/clinics
• Dispensaries
• Primary health centers
• Medical research and training
establishments
17. The primary purpose is :
• To reduce the likelihood of infection to staff and
the general public contacting a disease or injury
from biomedical waste.
• To reduce any injury from the sharps.
• To reduce exposure to various radioactive or
chemical wastes.
• To educate the public, and the concerned
authorities about the real and perceived health risk
associated with the management of biomedical
waste.
21. Wastes in DENTAL CLINICS:
Chemicals used like etchants and monomers, X-ray
processing solutions&cleaning solutions.
Solid wastes like Plaster of paris,Dental stone,Die stone etc
Impressions drenched in saliva and/or blood.
Contaminated needles and scalpel blades.
Diamond points,burs ,instruments,broken glassware.
Base metal debris and mercury from amalgam restorations.
Dental waxes.
Cotton
Liquid waste containing toxic substances flushed down a
drain or sink to sewers.
.
31. Cradle to Grave Aspect
• Segregation (Separation)
• Identification
• Collection
• Storage
• Transport
• Measurement
• Treatment
• Disposal
• Training, Health and safety records of the workers
32. •The majority of soiled items are not regulated waste. For
example, used gloves, masks, and gowns are not considered
regulated dental waste and thus can be added to the regular
trash.
•The same is true for environmental barriers (e.g., plastic bags or
sheets and aluminum foil) used to cover equipment during
treatment.
33. HANDLING AND STORAGE
Safe handling of regulated waste is essential.
Written procedures will help in this process. Involved
personnel must be informed of the possible health hazards
present and trained in appropriate handling, storage, and
disposal methods.
Stored regulated waste must be placed into labeled or
color-coded bags or containers. Usually such items are red and
have biohazard symbols attached.
37. The receptacles should be covered with properly fitted lid
that can be opened with a foot pedal. Keeping the lid closed
prevents air movement, as well as the spreading of
contaminants.
Waste receptacles should be lined with sturdy plastic bags
that can be removed without touching the interior of the
liner. Double-bagging of liners may also be recommended
to eliminate accidental exposure should one of the bags rip
or tear.
Ideally, regulated waste should be stored as soon as
possible with a minimum of transport.
38.
39. Maintaining bag and container integrity is vital and overfilling
must be avoided.
Regulated waste must be stored in a properly ventilated,
secured area that cannot be readily seen by patients.
Generally, waste should not be stored for more than 30
days.
Waste containers must be designed to prevent the
development of offensive odors.
Waste is discarded in a leak - resistant package that is
impervious to moisture.
The bag is sealed to prevent leakage during transportation to
the final dumpsite.
40. If hazardous waste is shipped, store the containers in an
exclusive refrigerator to maintain the integrity of the contents
and to control odor until the pick-up date.
Sink traps and evacuation lines should be thoroughly rinsed
at least daily.
Passage of an effective, environmentally compatible
disinfectant or evacuation cleaner (low sudzing) through the
system would help. A final water rinse should follow.
42. OSHA HOUSEKEEPING REQUIREMENTS
The housekeeping section of the OSHA Bloodborne
Pathogens Standard includes provisions for handling :
Contaminated sharps and instruments
Spills
Broken contaminated glassware
Regulated waste.
43. Sharps
The term sharps refers to any sharp or pointed object
that can penetrate the skin or oral mucosa. In dentistry,
the most common types of sharps are:
Needles
Scalpel blades and disposable scalpels
Exposed ends of dental arch wires
Broken glass
Burs and endodontic instruments
47. The OSHA Bloodborne Pathogens Standard contains specific
guidelines concerning sharps containers:
Sharps containers must be closeable, leak-proof, puncture-
resistant items labeled with a biohazard symbol or color-coded
red to identify it as a hazard.
They should be capable of maintaining their impermeability
during storage, transport, treatment, and disposal. This will
help prevent occupational exposure to container contents.
Sharps should be quickly placed into sharps containers after
use. They must be placed into acceptable containers as close
as practically possible to their point of use.
48.
49. Sharp items should be considered as potentially infectious
materials and thus handled with extraordinary care to prevent
accidental injuries.
Contaminated sharps are never touched with bare hands,
but by wearing appropriate gloves or by using transfer
forceps.
Sharp containers should be replaced routinely before they
are over filled.
50. Discarding used needle.
Of special concern among contaminated sharps are used
needles. The CDC estimates that healthcare workers sustain
nearly 600,000 percutaneous injuries annually involving
contaminated sharps. In response to a continuing concern of
exposure and the development of technological advances that
increase employee protection, the US Congress passed the
Needlestick Safety and Prevention Act in 2000. Enforcement
of the new provisions in the standard began on July 17, 2001.
51. Proper handling of sharps is essential because personal
protective barriers, such as gloves, will not prevent all
needlestick accidents. To minimize the potential for
exposures, needles should not be recapped, bent, or broken
by hand.
Instead a “hands-free” or a “one-hand” technique must be
used.
The hands free technique involves the use of a cap
holder, which allows the slipping of the needle into it without
touching it.
52.
53.
54. In a one-hand technique, the needle guard is placed on a
tray, and the used needle is wiggled into the cover. Once
the end of the needle is covered, it may be safely brought in
to position.
58. Recommendations Procedures for Sterilization of Sharps
Containers in Steam Autoclaves
1. 1. Use only containers approved for the collection and storage of sharps and
which are autoclavable.
2. 2. Biologically monitor the autoclave used on a regular basis (e.g., weekly).
3. 3. Consider the following procedural recommendations:
4. a. Fill containers no more than ¾ full
5. b. Leave container vents open
6. c. Place the containers in an upright position in the autoclave chamber
7. d. Process containers for 60 minutes (e.g., two regular length cycles, unless a
single longer cycle can be used)
8. e. Remove containers after processing and allow them to cool
9. f. Carefully close container vents
10. g. Label and dispose of containers according to local governmental regulations
59. Infectious material spills.
Spilled or dropped potentially infectious materials such as
gauze saturated with blood, must be cleaned up immediately.
Utility gloves and protective barrier clothing are worn.
The area of spillage is wetted with a suitable disinfectant
such as 1:10 sodium hypochlorite solution.
60. Use a large pad of paper towels so that the gloves do not
contact the liquid. Discard the towels after use.
Apply the disinfectant again. Leave the area wet for 10 mins
and then dry it with fresh paper towels.
Remove gloves carefully to avoid touching the contaminated
outside, and wash hands immediately. Wash, dry and autoclave
gloves after use if required.
61. Broken glass.
If contaminated broken glass or something sharp drops, do not
pick it up with the hands. Instead use tongs, forceps, or a
dustpan and brush.
Discard, clean and disinfect, or sterilize items used for this
purpose.
Broken glass or dropped sharps are discarded in the sharps
container.
After the sharp material has been removed, disinfect the area
as after a spill.
62. Discarding local anesthetic cartridges.
If the glass anesthetic cartridge is broken, pick up the
broken glass as previously described and discard the broken
glass with the sharps.
If the glass anesthetic cartridge is not broken and not visibly
contaminated with blood, discard it with other nonhazardous
waste.
If the glass anesthetic cartridge is visibly contaminated with
blood, discard it with regulated waste.
63. PATIENT’S IMPRESSIONS
Medical lab specimens, such as biopsy samples of
suspected oral cancerous lesions, to be transported
outside of the office for evaluation must be placed in
leakproof bags and labeled appropriately.
Dental impressions must also be placed in leakproof bags
and labeled appropriately.
64.
65. Contaminated laundry
The dental personnel should either use disposable
uniforms or make arrangements for laundering or
professional cleaning of protective clothing.
Clothing dispatched to a commercial laundry should be
packed in red laundry bags, clearly labeled with a
biohazard symbol.
66. Contaminated laundry
The dental personnel should either use disposable
uniforms or make arrangements for laundering or
professional cleaning of protective clothing.
Clothing dispatched to a commercial laundry should be
packed in red laundry bags, clearly labeled with a
biohazard symbol.
67. Amalgam disposal.
Three aspects of amalgam waste may be considered.
Amalgam scrap.
Other waste contaminated with amalgam.
Amalgam in waste water.
Amalgam scrap: Is stored under radiographic fixer solution
in a covered container. Should be recovered and recycled
whenever possible. It is considered as hazardous waste with
chances of mercury leaching out of amalgam scrap. Hence
they should be disposed off as required for that of a regulated
waste and as per local regulations. It should not be disposed
with waste that would be eventually incinerated since
amalgam decomposes on heating.
68.
69. Management of mercury spills.
Never use a vacuum cleaner, broom or paintbrush or
household cleaning products like ammonia or chlorine.
Never allow mercury to go down the drain.
In case the shoes are contaminated with the spilt mercury,
the person is asked not to walk around or leave the spill area
until the contaminants are removed.
Sprinkling of sulfur powder on mercury spills has shown to
be ineffective and inadequate to control the problem,
because of the slow reaction.
70. Mercury spills are cleaned up properly by using trap bottle,
tapes, or fresh mixes of amalgam to pick up droplets, or use
commercial clean up kits.
If the floor carpeting in the operatory gets contaminated with
mercury, removal of the carpeting may be the only effective
way to ensure decontamination. Chemical decontamination of
the carpeting may be ineffective since mercury might seep
through the carpet and remain inaccessible to the
decontaminant.
71. Managing silver and lead waste.
Silver in used radiographic fixer solutions
Use of an in-office silver recovery unit to remover silver
from used fixer solutions and recycle the used cartridge.
Send used fixer solution to a silver reclaiming facility.
Send it to a medical radiology lab or a commercial
photographic processing lab, on agreement.
Lead foil in intraoral radiograph film packets.
Should be collected and recycled through a licensed
facility.
The same would apply to lead aprons and lead collars.
72. ON-SITE TREATMENT
•Many areas allow in-house treatment of regulated
medical/dental waste. An easy and effective procedure is
sterilization by moist heat (autoclaving).
• Dry heat ovens should not be used. Of course, the
performance of the sterilizer must be biologically monitored
regularly.
•Where allowed, sharps containers can be sterilized in-
house. The open containers should be placed into the
sterilizer in an upright position.
74. AUTOCLAVE
• It’s a low heat thermal process using steam to
come in contact with the surfaces or the
instruments.
• Temperature-121 C
• Time-30-60 Minutes
• Pressure-30psi
• USE:Reusable instruments mostly
75. In-house treated regulated waste items can then be added to
the non-regulated office waste. These items should be labeled
as “treated” or with other information as required by local laws.
Pathologic waste is considered to be potentially infectious and
must be regulated.
Teeth without amalgam restorations and other tissues can be
placed directly into a biohazard bag or a sharps container.
Where allowed, the waste can then be sterilized.
Teeth with amalgams could release mercury vapor during
sterilization, thus, they should be neutralized through
disinfection (ideally, immersion for 30 minutes in a fresh solution
of a tuberculocidal disinfectant held within a sealed container).
Treated teeth can then be rinsed with water and are ready for
disposal.
76. Items heavily soiled (even saturated) with blood/saliva can
be placed into a sharps container. However, it may be easier
to store them in small biohazard bags until treated.
Used anesthetic carpules should also be placed into sharps
containers.
.
78. • TREATMENT OFF-SITE
• Some areas may require regulated waste be
removed, neutralized, and disposed of by a
commercial waste hauling service,
regulated by the local government
79. Incinerators
• Comes from a Greek word ..Meaning “BURN
TO ASHES”
• No universal incinerator exists
• It must be specifically selected, designed , and
built to meet the needs of the individual Hospital
• Design depends upon type of waste , calorific
value ,quantities and volume of waste
80. TYPES OF INCINERATORS
Three basic kinds of incineration technology
are of interest for treating health-care waste:
81. (a) Double-chamber Pyrolytic incinerators
which may be especially designed to burn
infectious health-care waste;
82. (b) Single-chamber furnaces with static grate,
which should be used only if pyrolytic
incinerators are not affordable
83. Rotary kiln: A Rotary kiln is a
pyro processing device used to raise
materials to a high temperature in a
continuous process.
84. Waste types to be incinerated are:
1)Blood and Blood products
2)Any waste which had a contact with
saliva/blood –cotton swabs
3)Specimens like impressions.
85. Waste types not to be incinerated are :
(a) pressurized gas containers;
(b) large amount of reactive chemical
wastes;
(c) silver salts and photographic or
radiographic wastes;
86. (d) Halogenated plastics such as PVC;
(e) waste with high mercury or cadmium
content, such as broken thermometers, used
batteries, and lead-lined wooden panels; and
(f) sealed ampules or ampules containing heavy
metals .
87. Final disposal
Chemical decontamination can be carried out in a special
decontamination tank with drainage facilities and also a chain
and pulley block for loading/introducing operations of the large
buckets in which the waste are placed for decontamination.
Disposal of incinerator ash
The ash generated by the incinerator can be disposed of in an
Engineered Band fill which is chemically treated to prevent
seepage of metal into the earth. The ash generated by
incineration will contain mercury, arsenic, lead and cadmium all
heavy metals harmful to the human body.
89. • Chemical disinfection is defined as process
by which most of the pathogenic organisms
from any animal surface or material is
killed
• Eg.Infectious wastes-infected sharps
• - Contaminated instruments
• -Contaminated Burs
• -Patient’s impressions
• However, solid wastes including
microbiological cultures, sharps etc. may
also be disinfected chemically with certain
limitations.
94. MUNICIPAL DISPOSAL SITES:
If a municipality or any authority genuinely
lacks the means to treat waste disposal, the use
of a land fill has to be regarded acceptable
disposal route.
95. There are three types
• Open dumps
• Sanitary landfills
• Deep Burial.
96. Open dumps
• The waste is disposed off
somewhere in the open
areas of non-civilised or
minimally populated areas
so that there is no or less
conatct of the
public.Health-care should
not be deposited on or
around open dumps.
• The risk of either people or
animals coming into contact
with infectious pathogens is
98. LANDFILLING
• It is used for disposal of biomedical waste
after treatment in incinerator.
• The land is dug as per the waste quantity
but then covered with 0.5 metres of a
suitable cover material so that access is
minimised.
• It should not be close to any water source.
100. Sanitary landfills are designed to have at least
advantages over open dumps :
• Geological isolation of from the environment,
• Appropriate engineering preparation before the
site is ready to accept waste,
• Staff present on control operations, and
• Organized deposit and daily coverage of waste.
103. 1) Gypsum recycling especially when it is
released on large scale especially on industrial
level
2)Landfill in a separate cell so that the
liberation of odorous and toxic hydrogen
sulphise is minimised.
104. DEEP BURIAL
• A pit is dug about 2 metres deep,half –filled
with waste,then covered with 10-50cm of
soil.
• It gets decomposed within a duration of 4-6
months of time.
• It should be impermeable.
• It should have no access to animals.
• It should not be prone to flood or erosions.
108. Handling and Storage
• To be kept away from fire sources
• Store this product in a clean,dry and well
ventilated area
• Keep this product away from heat and direct
sunlight.
• Must be stored far from oxiding agents,acids,bases
or polymer initiators.
• Do not store for long periods.
• Storage temperature must be lower than 15◦C
110. Personal protective clothing (PPC)
1.Gloves
a. Disposable vinyl gloves in all patient care areas
b. Latex surgical gloves for operative procedures
c. Heavy duty thick rubber gloves for waste handlers
especially the nitrile gloves.
2.Masks: Simple, reusable plastic masks to protect
health care workers from splashes
3.Aprons : Full sleeved, knee length cotton aprons
must be worn at all times.
117. General
• Hand washing facility : Soap and water should
be available at all times.
• Drinking water: Safe drinking water must be
available for waste handlers working near
boilers to prevent dehydration.
• Immunization : Tetanus, Hepatitis B.
• Maintenance of health records.
120. CONTINGENCY PLANNING
It is best if offices prepare sets of written procedures
concerning their regulated waste. Such prepared programs
should always list the person or persons responsible in the
event of an emergency.
The success of any safety program is highly dependent on
proper employee training and employer monitoring. All
office personnel must be well versed in the handling,
storage, treatment, and disposal of regulated medical waste.
121. PUBLIC RELATIONS
A good portion of the population has an aversion to blood
(liquid or dried) and medical/dental sharps, especially
needles. Such anxiety also can exist among those charged
to collect, haul, and dispose of waste.
It would be best if properly treated and labeled regulated
waste containers were placed within some other type of
container (e.g., cardboard boxes) that can more readily
conceal the actual contents. This is an example of “out-of-
sight…out-of-mind.”
122. SUMMARY
Proper handling, neutralization, and disposal of regulated
dental waste are important elements of every dental office’s
infection control program. Correct procedures will help protect
office employees and patients, contract workers, and the local
community. An effective program is based on planning, which
includes a firm understanding of the regulations that apply in
their location. All office personnel must be knowledgeable as
to the correct procedures and the appropriate equipment. .
123. Dental Color coding
i
Yellow Bin Red Bin Blue Bin Black Bin
Solid wastes
contaminated
with
bloood/saliva
e.g.cotton
rolls,gauzes,gl
oves,masks,li
nen
dressings,bed
dings etc
Solid wastes
highly
contaminated
with
blood/saliva.e.
g.cotton rolls
Disposable
instruments,su
ction tips,any
tubings.
impressions.
Sharps
Used syringes
Dental wires
Scalpel blades
Endodontic
files
Burs
IV sets
Extracted
teeth
Anaesthtic
carpules.
Extracted
teeth
Discarded
medicines.
Chemical
wastes
Acylic,etchant
s etc
Discarded
ZnOE paste
etc
Gypsum
products
125. From a waste management point of view,
the three
Rs – ‘Reduce, Reuse, Recycle’
– They offer a simplified view of the types
of action we must take. They are in order
of priority and are often referred to as the
‘WASTE MINIMISATION
HIERARCHY’
126.
127. 1.‘Reduce’ means to use less in the
first place, for example being waste
conscious as a consumer(considering
what you buy and not wasting it).
Achieved by
• Following good operating procedures
• Material substitution
• Improved inventory and centralized
purchasing
128. 2.‘Reuse’ means to use the same item more than
once in its original form. For example, choosing
reusable rather than disposable items, and
finding alternative uses for items no longer
needed for their original use.
Eg: OT Kits containing gowns ,mask, caps, shoe
covers, bed sheet can be reused if made of
cotton and this can be easily washed and
autoclaved
129. 3.‘Recycle’ means to reprocess used products into
either the same product or a different one.
• In most cases, manufacturing from recycled materials
requires less energy.
• Eg: Reclamation of solvents for reuse(Eg Xylene)
• Recycling of Containers
• Recyling of materials such as photographic film and
silver from processing chemicals.
130. Let the wastes of
“ the sick ”
not contaminate the lives of
“ the healthy “
131. REFERENCES.
Council on dental materials and devices, Council on dental
therapeutics; Infection control in dental office; JADA 97;4:673-
677,Oct1978.
Council on dental materials instruments and equipments,
Council on dental therapeutics and practice;Infection control
recommendations for the dental office and the dental
laboratory ; JADA: 116;Feb1988.
Recommended clinical guidelines for infection control in dental
education institutions: Journal of Dental Education;55:9;1991.
States act to regulate medical waste:JADA;122:Sep1991.
P.L. Fan, Dorthe Arenholt-Bindslev;Environmental issues in
dentistry- mercury;International Dental Journal: 47;2:1997.
Nairn H.F.Wilson,EdwardG.Bellinger;Dental practice and the
enviornment,International Dental Journal:48:3;161-166,1998.
132. Amalgam in dental office wastewater,JADA: 133;585-
588;May2002.
ADA Council on scientific affairs Managing silver and lead
waste in dental offices,,JADA,134:1095-1096;Aug2003.
KEVIN. R. MCMANUS,P.L.FAN:Purchasing , installing and
operating amalgam separators- Practical issues;JADA;134,1054-
1065:Aug2003.
ADA Council on scientific affairs Dental mercury hygiene
recommendations , :JADA;134,1498-1499;Nov2003.
HAZEL. O. TORRES et al : Modern dental assisting 5th
edition .
Clifford.M. Sturdevant et al :The art and science of
Operative dentistry 3rd
edition .
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