Waste management

Waste management must be a part of every practice's written exposure control plan.

Charles John Palenik, MS, PhD

Waste management must be a part of every practice's written exposure control plan. Components of the plan should include assignment of risk, types of regulated waste, isolation schemes, handling and storage, neutralization, contingency planning, and community relations.

Assignment of risk — Infectious waste is defined as waste capable of causing an infectious disease. It is also known as regulated waste (regulated by a governmental agency). Regulated waste requires that special disposal procedures be used. Except for a relatively limited number of items, dental waste can be disposed of using regular waste storage, removal, and disposal schemes.

Types of regulated waste — For dental offices, there are five types of regulated waste. These include: 1) Bulk (in liquid or semi-liquid form) blood or blood products and other potentially infectious materials, including saliva; 2) Items soaked or caked with blood/saliva; 3) Pathologic waste including exfoliated or extracted teeth; 4). Used sharps, such as injection needles and scalpel blades; and 5) Potential sharps, including used anesthetic carpules, which could contain aspirated blood and possibly break.

Isolation schemes — Regulated waste should be isolated. Regula-tions require that properly designed sharps containers or biohazard bags be employed. The OSHA Blood-borne Pathogens Standard de-scribes the criteria to be used when selecting sharps containers and biohazard bags.

Handling and storage — Dental offices should have written policies and should properly train all affected employees. Regulated waste should be stored in a secure area, and should not be kept for more than 30 days.

In almost all locations, liquid or semi-liquid blood can be evacuated into the practice's waste water system. Sink traps and evacuation lines should be rinsed daily. Using an environmentally compatible disinfectant would also be helpful.

Neutralization — Many areas allow for in-house treatment of regulated dental waste. Moist heat must be used, and sterilizers must be biologically monitored regularly. Sharps containers should be left open, no more 3/4 filled, and then processed in an upright position through two consecutive sterilization cycles. Containers are then labeled as "treated" and can be placed with the nonregulated waste. Unless quite large, biohazard bags can be treated in a single sterilization cycle. Teeth without amalgam restorations can be put into sharps containers or small biohazard bags and processed. If amalgam is present, the teeth should be immersed in a fresh tuberculocidal disinfectant solution for 30 minutes, rinsed well, and disposed of or returned to the patient.

Some locations require the hiring of a commercial waste hauling service. Others choose to pay for the convenience. Haulers must be EPA-registered, leave a receipt each collection, and send an official manifest within 30 days. Offices should determine their liability concerning the waste that has been removed.

Contingency planning — Offices should anticipate interruptions in their waste management program. It is always best if contingency plans are written and utilize those personnel trained to respond to these situations. Offices should also be ready to deal with spills, sterilizer breakdowns, and waste haulers who fail to appear.

Community relations — Many people are averse to the sight of blood and sharps. Properly treated regulated waste should be placed into some type of container, like a cardboard box. The actual contents would then be concealed.

OSAP is the leading source for dental infection control and safety information. Visit www.osap.org/resources for the latest standards and information.

Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik has authored numerous articles, book chapters and monographs, and is the co-author of the popular Infection Control and Management of Hazardous Materials for the Dental Team. He serves on the Executive Board of OSAP, dentistry's resource for infection control and safety.Questions about this article or any infection control issue may be directed to office@osap.org.

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