FEATURE CORE CPD: Disposing of clinical ONE HOUR and dental waste By Rebecca Allen1
ental professionals Defining different types of waste Amalgam waste is waste consisting are under increasing Clinical waste is defined as ‘any waste which of amalgam in any form and includes pressure to understand consists wholly or partly of human or animal all other materials contaminated with and adhere to clinical tissue, blood or other body fluids, excretions, amalgam. Amalgam waste is hazardous waste regulations. Proper drugs or other pharmaceutical products, due to the potential of harm to humans management and disposal swabs or dressings, syringes, needles or other and the environment caused by mercury. Dof clinical waste is vital and there is strict sharp instruments’. This type of waste may Any amalgam waste should be placed in a legislation in place to prevent harm being prove hazardous to any person coming into specialist dental container, with a mercury caused to the environment and to contact with it unless it is rendered safe. suppressant, to prevent the risk of harm to human health. Waste is defined as ‘hazardous’ when the your dental team from the mercury vapours. To dispel some of the misconceptions waste itself or the material or substances In addition all dental practices should have around clinical waste and to enable it contains are harmful to humans or the an amalgam separator installed to capture any organisations to clearly verify if they need environment. The other main waste stream amalgam particulates in waste water. These to take further steps to become compliant is known as offensive waste, which primarily should be fitted both to the dental chair and with all regulations, this article outlines contains waste that is considered unpleasant dirty sink. the considerations dental businesses must due to its appearance and smell, for instance Other hazardous waste streams typically undertake when disposing of both clinical incontinence waste. found in dental practices are fixer and and dental waste safely. Fig. 8 Yellow lidded developer from X-ray machines. These must sharps not be mixed prior to disposal and must be sent for disposal via recycling. As well as this, dental study moulds contain gypsum which, when landfilled with biodegradable waste, can produce hydrogen sulphide gas. Hydrogen sulphide gas is highly toxic and malodorous. In accordance with the Environment Permitting (England and Wales) Regulations 2010, gypsum has been banned from normal landfill (containing biodegradable waste) and must go into a separate cell for high sulphate waste.
Healthcare waste legislation There are many controls in place to ensure that clinical waste is managed safely and disposed of in a way that ensures human health and the environment remain free from harm. These controls are listed under
1 Category Manager, Initial Medical. Rebecca has worked in the Healthcare sector for the past 13 years and was a Research Chemist with Bayer Cropscience prior to joining Rentokil Initial in 2003. She keeps up to date on all developments within the clinical waste management industry and is an active member of the CIWM, SMDSA and BDIA.
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the Environment Protection Act 1990, where Waste pre-acceptance: it states that it is ‘unlawful to deposit, recover The Environment Agency has imposed a or dispose of controlled (including clinical) legal requirement in Environmental Permits Fig. 1 Yellow - Infectious waste without a waste management licence, for disposal sites to ensure that producers waste for or in a way that causes pollution of the carry out audits of their waste before it can be disposal by incineration environment or harm to human health’. legally accepted and disposed of. These are All clinical waste handling and disposal known as ‘pre-acceptance audits’. Producers procedures must comply with the will also be required to periodically re-audit following regulations: sites in the future. ■ The Environmental Protection Act 1990 To ensure your waste is suitable for any Fig. 2 (including the Duty of Care Regulations) chosen method of disposal, all your waste Orange – ■ The Controlled Waste Regulations 2012 streams must be audited, documented and Infectious ■ The Hazardous Waste Directive 2011 this information relayed to your final disposal waste for disposal by ■ The Carriage of Dangerous site. Failure to do this may leave you in breach treatment Goods Regulations. of your duty of care responsibilities, which or incineration can lead to prosecution and unlimited fines. The statutory ‘Duty of Care’ applies to everyone involved in the waste management Colour coding industry. It states that as a producer of any It is essential to segregate clinical and dental controlled waste it is your responsibility to at the point of production following the Safe Fig. 3 Yellow/ Black (Tiger) ensure correct and proper management of the Management of Healthcare Waste guidance – Offensive/ controlled waste your business produces. issued by The Department of Health.1 By using hygiene The main principles of ‘Duty of Care’ are the national colour coding system detailed you waste for disposal by about documenting the transfer of waste and can easily identify and segregate your waste, deep landfill ensuring that your waste is handled correctly and help to drive waste minimisation and best by waste carriers (eg are you using a registered practice within the industry. carrier of waste? Are they are taking waste to Proper segregation of different types of suitably licensed/permitted sites?). You should waste is critical to safe management. The only use a contractor who can provide proof mixing of waste streams is prohibited by law Fig. 4 Blue of compliance with the legislation. in England and Wales, and best practice in – Medicinal Scotland and Northern Ireland. It also helps waste for The importance of your waste support waste minimisation and reduces the disposal by incineration transfer paperwork risk of exposure and injury to your staff. Waste Transfer Notes: All containers used for the disposal of For all transfers of waste appropriate clinical waste must be labelled in accordance documentation must be provided. For non- with the details of the legal requirements hazardous waste this is usually in the form for transporting and packaging waste. Your Fig. 5 Purple of a waste transfer note. You will be provided container labels should clearly identify – containing with an annual waste transfer note covering the waste types present within, and should cytotoxic or all transfers of non-hazardous waste for a be signed by the producer ready for cytostatic waste for 12-month period. When you receive this onward disposal. disposal by documentation you must check this for incineration accuracy purposes and the return slip must Identifying your waste streams be returned to your waste contractor for full Yellow - Infectious waste for disposal by traceability. incineration (Fig. 1) Orange – Infectious waste for disposal by Hazardous (England and Wales) treatment or incineration (Fig. 2) Fig. 6 Red – or Special (Scotland) Waste Yellow/Black (Tiger) – Offensive/hygiene Anatomical Consignment Note: waste for disposal by deep landfill (Fig. 3) waste for disposal by All consignments of hazardous (special) waste Blue – Medicinal waste for disposal by incineration must be accompanied by a hazardous or incineration (Fig. 4) special waste consignment note. Purple – containing cytotoxic or cytostatic This will include: waste for disposal by incineration (Fig. 5) ■ All site addresses and personnel involved Red – Anatomical waste for disposal by with the waste transfer incineration (Fig. 6) ■ A full description of waste type, including White – Amalgam waste for recycling (Fig. 7) Fig. 7 White required shipping terms – Amalgam ■ Correct European Waste Catalogue (EWC) Safe management of sharps waste waste for code for each waste stream to prevent needlestick injuries recycling ■ A required copy for you to store on Under the new Health and Safety (Sharps your premises. Instruments in Healthcare) Regulations 2013,2 www.nature.com/BDJTeam BDJ Team 20 FEATURE
Yellow lidded sharps (Fig. 8) 4) Will your waste be fully traceable from Yellow lidded: sharps that are contaminated point of product through to end disposal? with medicines (excluding cytotoxic 5) Do all the products supplied to you meet or cytostatic medicines) for legal requirements, such as UN approval disposal by incineration. for your sharps containers? 6) Will the supply of products be free of Orange lidded sharps charge or are they an additional cost? (Fig. 9) 7) Will your waste be fully segregated on-site Orange lidded: sharps that are not and during transportation to meet the contaminated with medicines for current regulations? disposal by treatment 8) Can the clinical waste management or incineration. company guarantee your service delivery will happen on time, every time? Blue lidded sharps (Fig. 10) 9) Has the service been tailored to Blue lidded: waste medicines, such your requirements? as used and unused LA cartridges 10)Are there any hidden charges? for disposal by incineration. 1. This has been superseded by the following The guide above should provide an publication. Department of Health. overview of how to effectively dispose Environment and sustainability. Health of your clinical waste to avoid compliance Technical Memorandum 07-01: Safe Fig. 9 Orange lidded sharps issues, and more importantly, harm to other management of healthcare waste. 20 people and the environment. If you have any March 2013. Available at: www.gov.uk/ healthcare facilities need to assess the risk further questions about safely disposing of government/uploads/system/uploads/ of exposure to blood-borne infections from clinical waste, contact an expert company, attachment_data/file/167976/HTM_07- sharps injuries, identify how to eliminate this who provide tailored advice according to your 01_Final.pdf (accessed 4 April 2014). and where exposure cannot be eliminated, business needs. 2. Health and Safety Executive. Health and put into place extensive prevention methods. Safety (Sharp Instruments in Healthcare) The new legislation also requires a framework Choosing a clinical waste Regulations 2013. Guidance for employers for the occurrence of a sharps injury. The management company and employees. 2013. Available at: www. directive is supported by a local, national The first and most important thing to check is hse.gov.uk/pubns/hsis7.htm (accessed 4 and European-wide reporting system and that you are using a Registered Waste Carrier; April 2014). employers need to revise their reporting you can do this by asking to see a copy of procedures with health and their licences. Following this, the Top 10 safety representatives. Things you need to look out for are: Initial Medical is an expert in Key tips to make sure you comply with the 1) Is the waste carrier licensed to take away healthcare waste management, new regulations: the types of waste you are producing? providing a complete collection, ■ Implement safe procedures for using and 2) Are the service technicians that will be disposal and recycling service for disposing of sharp medical instruments collecting your waste ADR licensed? This hazardous and non-hazardous waste and contaminated waste is essential when transporting dangerous and offensive waste produced by ■ Eliminate the unnecessary use of sharps goods such as clinical waste businesses and organisations within by implementing changes in practice 3) Will you receive all the compulsory the UK. Initial Medical’s healthcare and through providing medical devices waste documentation to cover your incorporating safety-engineered waste transfers? waste services ensure that all of protection mechanisms your waste is stringently handled in ■ Provide sharps disposal equipment as close compliance with legislation and in as possible to the assessed areas where accordance with Safe Management sharps are being used or found of Healthcare Waste V2 best practice ■ Ban the practice of recapping guidelines, providing you with the ■ Use personal protective equipment peace of mind that you are adhering ■ Train your practice staff on the correct to current legislation. Visit www. use of sharps devices and the disposal of initalmedical.co.uk or call 0870 sharps waste. 850 4045.
It is essential that your sharps are segregated and disposed of correctly based on their medical contamination. The lid colour of Look out for core CPD on MEDICAL the receptacle relates to how the waste should EMERGENCIES in the May 2014 BDJ Team! be treated and disposed of. Consider the following in your Fig. 10 Blue lidded sharps dental practice: bdjteam201438
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