19.. HOSPITAL WASTE MANAGEMENT dentistry

hospital waste management

1. DENTAL HOSPITAL WASTE MANAGEMENT DR DIVYA JOSHI

2. Contents Introduction Definition Guidelines and Rules C ategories of persons exposed to risk of infection Classification of biomedical waste N eed for biomedical waste Steps To Segregate Waste D isposal of solid waste D ental aspect of waste disposal Biomedical waste management rules Conclusion References 2

3. INTRODUCTION Hospitals are known to serve the ill persons, at the same time they also produce filth and garbage, which has adverse effects on human body and environment. Health care waste considered as a reservoir of pathogenic microorganisms, If not managed properly, it can cause potential health hazards to human beings by way of diseases like, AIDS, Hepatitis B etc The dentist generate 3% of total medical waste estimated by US medical waste tracking system . Management of healthcare waste is an integral part of infection control and hygiene programs in healthcare settings Singh H, Bhaskar DJ, Dalai DR, Rehman R, Khan M. Dental Biomedical Waste Management. Int J Sci Stud. 2014;2(4):66-68 3

4. Biomedical Waste “Any waste, which is generated during diagnosis, treatment or immunization of human beings or animals, or in research activities in pertaining thereto or in the production or testing of biologicals .” 4 Park's Textbook of Preventive and Social Medicine

5. Biomedical Waste management rules The Ministry of Environment and Forests, Government of India notified the Bio-Medical Waste (Management and Handling) Rules on 27th July 1998 under the provisions of Environment (Protection) Act, 1986 . These Rules apply to all persons, who generate, collect, receive, transport, treat, dispose or handle biomedical waste in any form. It consists of six schedules: Schedule I: Categories of Bio-Medical Waste Schedule II : Color Coding and Type of Container for Disposal of Bio-Medical Wastes Schedule III : Label for Bio-Medical Waste Containers/Bags Schedule IV : Label for Transport of Bio-Medical Waste Containers/Bags Schedule-V : Standards for Treatment and Disposal Of Bio-Medical Wastes Schedule-VI: For Waste Treatment Facilities like Incinerator/ Autoclave/ Microwave System BIO-MEDICAL WASTE (MANAGEMENTAND HANDLING) RULES, 1998

6. The biomedical waste management policy followed nowadays is as per the Biomedical Waste Management Rules 2016 , notified by the Ministry of Environment, Forest and Climate Change, Government of India as per the gazette notification dated 28 th  March 2016. 1998 Schedule I: Categories of Bio-Medical Waste Schedule II : Colour Coding and Type of Container for Disposal of Bio-Medical Wastes Schedule III : Label for Bio-Medical Waste Containers/Bags Schedule IV : Label for Transport of Bio-Medical Waste Containers/Bags Schedule-V : Standards for Treatment and Disposal Of Bio-Medical Wastes Schedule-VI: For Waste Treatment Facilities like Incinerator/ Autoclave/ Microwave System 2016 Schedule I Schedule IV Schedule II Schedule IlI BIO-MEDICAL WASTE (MANAGEMENTAND HANDLING) RULES, 1998/ 2016

7. An identification and separation system for infectious materials and their containers should be adopted. Categories should include: 1. Non-contaminated (non-infectious) waste that can be reused or recycled or disposed of as general, “household” waste 2. Contaminated (infectious) “sharps” – hypodermic needles, scalpels, knives and broken glass; these should always be collected in puncture-proof containers fitted with covers and treated as infectious 3. Contaminated material for decontamination by autoclaving and thereafter washing and reuse or recycling 4. Contaminated material for autoclaving and disposal 5. Contaminated material for direct incineration According to WHO laboratory safety rules WHO Laboratory biosafety manual Third edition

8. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) Categories of Regulated Medical Waste Disposal Plan for Regulated Medical Wastes Handling, Transporting, and Storing Regulated Medical Wastes Treatment and Disposal of Regulated Medical Wastes Special Precautions for Wastes Generated During Care of Patients with Rare Diseases microbiology laboratory wastes [e.g., cultures and stocks of microorganisms]; • bulk blood, blood products, blood, and bloody body fluid specimens; • * pathology and anatomy waste; and • * sharps Develop a plan for the collection, handling, predisposal treatment, and terminal disposal of regulated medical wastes Inform personnel involved in the handling and disposal of potentially infective waste of the possible health and safety hazards; ensure that they are trained in appropriate handling and disposal methods Treat regulated medical wastes by using a method (e.g., steam sterilization, incineration,or an alternative treatment technology) approved by the appropriate authority Decontaminate the blood born waste Incineration of medical infectious waste Guidelines for Environmental Infection Control in Health-Care Facilities updated on 2019

9. OSHA and CDC guidelines Prescribe disposable or single use needles Contaminated reusable sharp instruments must not be stored in a manner to reach employees hands Ensure that the employees currently use and discard PPE(personal protection equipment's) Contaminated sharps or regulated wastes to be discarded in hard walled containers Contaminated equipment's that require service must first be decontaminated and a biohazard label must be placed. Place reusable contaminated sharp instruments into a basket in a hard walled container Chris miller, infection control and management 5 th edition 2003 9

10. CATEGORIES OF PERSONS EXPOSED TO RISK OF INFECTION Safe management of wastes from health-care activities 2nd edition WHO

11. Classification of biomedical waste Management Safe management of wastes from health-care activities 2nd edition WHO 11

12. Category Type of waste Example Category 1 Human anatomical waste Tissue , Organs , Body parts Category 2 Animal waste Generated during research/experimentation, from veterinary hospitals Category 3 Microbiology and biotechnology waste Laboratory culture, microorganism, human and animal cell culture , toxins. Category 4 Waste sharps Hypodermic needles, syringe, scalpel, broken glass Category 5 Discarded medicine and cytotoxic drugs X rays , cancer and chemotherapy Category 6 Soiled waste Dressing, bandages, plaster casts, material contaminated with blood Category 7 Solid waste Items disposed other than sharps Category 8 Liquid waste Generated from any infected areas Category 9 Incineration waste Ash from incineration of biomedical waste Category 10 Chemical waste Chemicals used in production of biological, chemicals used in disinfecting, as insecticides, etc. Classification As Per Ministry Of Environment And Forests Park's Textbook of Preventive and Social Medicine

13. Color Coding and Type of Container for Disposal of Bio-Medical Wastes Park's Textbook of Preventive and Social Medicine Note: Cat 8,10 do not require containers or bags

14. General waste Human anatomical waste , Chemo-drugs, Soiled waste Expired or Discarded Medicines, soiled linen Contaminated Plastic Waste (Recyclable) Waste sharps including Metals Glassware: Broken or discarded and Contaminated glass including medicine vials and ampoules Medical Waste Park K. Park’s Textbook of Preventive and social medicine. 24th edition 14

15. Label for Bio-Medical Waste Containers/Bags Park K. Park’s Textbook of Preventive and social medicine. 24th edition

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17. Classification Of Waste WHO Classification General waste 17 General waste , also known as residual or mixed waste , includes all the waste other than biomedical waste and which has not been in contact with any hazardous or infectious, chemical or biological secretions and does not include any waste sharps. . Veena Benakatti , Hema Kanathila ,BIOMEDICAL WASTE MANAGEMENT IN DENTAL OFFICE-A review world journal of advance healthcare research 2018 , 2;177-181

18. Pathological waste 18 Pathological waste   are identifiable parts of human bodies like excised human tissues, tumours, extracted teeth. A yellow biomedical waste bag is used to collect the pathological waste . Veena Benakatti , Hema Kanathila ,BIOMEDICAL WASTE MANAGEMENT IN DENTAL OFFICE-A review world journal of advance healthcare research 2018 , 2;177-181

19. Infectious waste 19 Infectious waste They include any material contaminated with blood or other body fluids containing pathogenic microorganisms, cultures and stocks of infectious agents . Wastes like cotton, gauze, suction tips, gloves , mask, suture materials, tissue swabs and dental impressions must also be placed in leak-proof bags and labelled appropriately Veena Benakatti , Hema Kanathila ,BIOMEDICAL WASTE MANAGEMENT IN DENTAL OFFICE-A review world journal of advance healthcare research 2018 , 2;177-181

20. SHARPS 20 SHARPS WASTE   They include any item having corners, edges, or projections capable of cutting or piercing the skin. The sharp waste in dentistry includes needles, syringes, scalpels, drills, blades, endodontic files, burs and orthodontic wires . OSHA has given specific guidelines related to sharps containers 1. Sharps containers must be closable, leak-proof, and puncture-resistant . Items are labelled with a biohazard symbol or color-coded red to identify it as a hazard. 2. They should be capable of maintaining their impermeability during storage, transport, treatment, and disposal. 3. Sharps should be quickly placed into sharps containers after use. 4.Sharp containers should be replaced routinely before they get over filled Veena Benakatti , Hema Kanathila ,BIOMEDICAL WASTE MANAGEMENT IN DENTAL OFFICE-A review world journal of advance healthcare research 2018 , 2;177-181

21. Chemical waste 21 Step 1 : DEFINITION OF CHEMICAL WASTE Step 2 : SELECTING A CONTAINER For bulk solvent and aqueous liquid waste streams use a Low Density Polyethylene container is used. These containers are compatible with most chemical wastes. Do not use glass, plastic-coated glass or other re-used reagent chemical bottles to store or accumulate bulk liquid chemical waste. Do not use containers that are old, dented, damaged, leaking or cracked. The container must be able to be capped, sealed or closed. The container must be compatible with the waste streams that will be placed in it. Step 3 : LABELING CHEMICAL WASTE Step 4 : ADDING WASTE TO THE CONTAINER Step 5 : STORING OF WASTE Step 6 : INSPECTING WASTE ACCUMULATION AREA Step 7 : CHEMICAL WASTE DISPOSAL Veena Benakatti , Hema Kanathila ,BIOMEDICAL WASTE MANAGEMENT IN DENTAL OFFICE-A review world journal of advance healthcare research 2018 , 2;177-181

22. Radioactive waste 22 Contains radioactive material . Cytotoxic waste includes substances with teratogenic, mutagenic or carcinogenic properties. Whereas, radioactive waste include radioactive material and residues of toxic metals (chromium, copper, lead, mercury, nickel, silver and zinc are the most common Veena Benakatti , Hema Kanathila ,BIOMEDICAL WASTE MANAGEMENT IN DENTAL OFFICE-A review world journal of advance healthcare research 2018 , 2;177-181

23. PHARMACEUTICAL WASTES 23 Pharmaceutical waste include anesthetics, sedatives, antibiotics and analgesics. Wastes comprising of outdated , contaminated and discarded medicines should be collected in a yellow colored container Veena Benakatti , Hema Kanathila ,BIOMEDICAL WASTE MANAGEMENT IN DENTAL OFFICE-A review world journal of advance healthcare research 2018 , 2;177-181

24. Pressurized containers 24 Pressurized Containers include: Gas cylinders Gas cartridges Aerosol cans Collection and disposal of aerosol containers may be collected with general waste once they are completely empty. Aerosol containers shouldn’t be burnt or incinerated. Park K. Park’s Textbool of Preventive and social medicine. 24th edition

25. Need for biomedical waste management The hospital waste, in addition to the risk for patients and personnel who handle these wastes poses a threat to public health and environment Nosocomial infection to patients from poor waste management control Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash . Drugs that are dispensed of are repacked and sold off from unexpected buyers Park's Textbook of Preventive and Social Medicine nosocomial infection also known as hospital acquired infection is defined as infection acquired by a patient during hospital care which was not present or incubating at the time of admission. this includes infection acquired in the hospital but appearing after discharge (48hrs of discharge)

26. 26 Sources of Nosocomial Infections : Common Nosocomial Infections : Preventing nosocomial infection: Hand washing as often as possible, use alcohol hand wash, removing jewellery before washing. Stethoscope : cleaning with an alcohol swab daily Gloves :supplement rather than replace hand wash Mask : routine use White coat: enforced use in clinical unit, changing of the coat Park's Textbook of Preventive and Social Medicine

27. Hazards Of Improper Waste Disposal Injuries from sharps to all categories of hospital personnel and waste handlers. 27 ONE SCOOP TECHNIQUE Leave the needle cap on the surface and guide the tip of the used needle tip into it using only one hand. Lift the needle and syringe vertically and, once the tip is covered, use the other hand to fix the cap into place Chris miller, infection control and management 5 th edition 2003

28. Characteristics Of Waste Storage & Disposal Made up of hard plastic Size of containers depends on quantum of waste Secure lid Puncture proof Inner surfaces should be smooth and rounded 28 Park K. Park’s Textbook of Preventive and social medicine. 24th edition

29. Plastic polyethylene bags should have.. Should be made of low density polythene of 55 microns or high density polythene of 25 microns “Biohazard” label on it. Made of non chlorinated plastics . 29 Containers for sharps should be … Sturdy , puncture proof container Should have secure lid Appropriate disinfectants like polar bleach Should have a handle Park K. Park’s Textbook of Preventive and social medicine. 24th edition

30. Radioactive waste storage containers should be ... Made up of hard plastic Puncture proof and leak proof Should be kept in proper area The name of radioactive substance and activity on a given day, period of storage should be mentioned on the label clearly and the words “ R adioactive hazard ” 30 Park K. Park’s Textbook of Preventive and social medicine. 24th edition

31. Steps of handling of biomedical waste W aste management survey Segregation Accumulation /Storage Transportation Treatment Disposal Minimization Singh A, Kaur S. Biomedical waste management in dental office. Baba Farid University Dental Journal. 2011;2(2):120-3 . 31

32. Management of hospital waste 1) Waste survey: The survey should differentiate and quantify the waste generated. It should determine the points of generation , the type of waste at each point and the level of generation and disinfection within the hospital. This helps to determine the method of disposal . 2) Waste segregation : This consists of placing different kinds of wastes in different containers or coded bags at the point of generation . It helps to reduce the bulk of infectious waste as well as treatment costs . Segregation also helps to contain the spread of infection and reduces the chances of infecting other health care workers. Hegde V, Kulkarni RD, Ajantha GS. Biomedical waste management. Journal of Oral and Maxillofacial Pathology. 2007 Jan 1;11(1):5. Survey Segregate Segregate Advantages of waste segregation : 1)It prevents mixing of infectious and non infectious waste thus minimizing the high cost. 2) It reduces the accidental infection of health care worker and waste handlers . 3) It allows rapid disposal of infectious waste which should not be kept in hospital premises for long time. 32

33. 3) Accumulation and storage: Waste accumulation and storage occurs between the point of waste generation and site of waste treatment and disposal . While accumulation refers to the temporary holding of small quantities of waste near the point of generation, storage of waste is characterized by longer holding periods and large waste quantity. Storage areas are usually located near where the waste is treated. The waste should not be stored more than 12 hrs. 4) Transportation: When medical waste is not treated on site, untreated waste must be transported from the generation facility to another site for treatment and disposal. Storage Transportation Hegde V, Kulkarni RD, Ajantha GS. Biomedical waste management. Journal of Oral and Maxillofacial Pathology. 2007 Jan 1;11(1):5. 33

34. 5) Treatment : Process that modified the waste to disinfect or decontaminate the waste so that they are no longer a source of pathogens and can be handled,transported and stored safely. Different methods of treatment : Incineration Chemical disinfection Wet and dry thermal treatment Microwave Land disposal Inertization Steam sterilization and autoclaving Types of incineration : Double chamber pyrolytic Single chamber pyrolytric Rotary kilns Single chamber Double chamber Park K. Park’s Textbook of Preventive and social medicine. 24th edition 6 ) Disposal The waste disposal methods vary in their capabilities, cost, availability to generation and impacts on the environment. The various disposal methods include incineration, autoclaving, chemical methods, thermal methods (low and high), ionizing radiation process, deep burial and microwaving. 7) Minimization Any measures that decrease the amount of infectious waste generated will simultaneously decrease the cost of infectious waste disposal. 34

35. Vehicles for transport … INTERNAL TRANSPORT Push cart Waste trolley Wheel barrow 35 Park's Textbook of Preventive and Social Medicine EXTERNAL TRANSPORT Cycle rickshaw Waste van lorry

36. Disposal of solid waste Dumping Sanitary landfill Incineration Composting Manure pits Burial

37. Dumping Refuse is dumped in low lying areas . This is the easy method of waste disposal and is suitable for reclamation of land . Its exposed to flies and rodents Source of bad odor Contributes to pollution of environment Refuse humus bacterial Drawbacks : essential of public health Soben peter edition 5 37

38. 2) controlled tipping Material is placed in trench and at the end of the day adequately compacted and covered with earth . Types: Trench method : Ramp method : Area method : Chemical, bacteriological and physical changes occur in buried refuse. The temperature increases upto 60 degree within 7 days killing all pathogens . It takes 4- 6 month for complete decomposition . 6-10 ft deep and 12-36 ft wide terrain and moderately sloping filling land depression . It is deposited and sealed in the exposed surface with mud over it . essential of public health Soben peter edition 5 38

39. 3 ) Incineration : Refuse can be disposed of by burning or incineration . Burning is loss to community in terms of much needed manure . 4) Composting : It is process of nature where matter breaks down under bacterial action resulting in formation of relatively stable humus called as compost which has relatively manurial value to soil . The principal by products are co2, water and heat. Various method of composting are : Bangalore method Mechanical Manure pits Burial essential of public health Soben peter edition 5 39

40. Bangalore method: Aka anaerobic method Depth more than 3 ft are not recommended because of slow decomposition . The pit should be located atleast 800 m away from city limits . First layer refuse is spread over the trench Over this night soil is added . Then alternative layer of refuse and night soil are added till the heap rises above 1 ft . The top layer should be refuse. Within 7 days as a resultant of bacterial action considerable heat of 600 degree C is generated . At the end of 6 months the decomposition is complete . Bangalore method essential of public health Soben peter edition 5 40

41. Mechanical method : Aka aerobic method The refuse is first cleared of salvageable materials such as rages, bone, metal, glass and other It is the pulverized in the pulverizing equipment in order to reduce the size of particles to less than 2 inches . It is then mixed with nightsoil sewage in rotating machine and incubated . The entire process take 4-6 weeks . Mechanical method essential of public health Soben peter edition 5 41

42. Dental Aspects of waste Disposal

43. 1) MERCURY CONTAINING WASTE Dental amalgam are source of mercury that is neurotoxic and nephrotoxic . It should be placed in white rigid receptacles with mercury suppressant , it should be sent to mercury recovery process prior to final disposal. Neelakantan A, Reddy Y, Dhaded S. BIOMEDICAL WASTE MANAGEMENT IN DENTISTRY. Guident . 2017 Jun 1;10(7). 43

44. MERCURY CONTAINING WASTE DO’S - Store unused elemental mercury in sealed containers. - Use a “mercury spill kit” in case of a spill of mercury - Use suction traps and disposable amalgam - Separators on dental suction units - Required amalgam amount should only be mixed or use premeasured amalgam capsules. - Use mercury containers to store all scrap/old amalgam. - Always use gloves, mask, and glasses while cleaning the suction traps. - The container is to be labelled “hazardous waste: scrap amalgam”. - Appropriate use of amalgam substitutes can be considered DONT’S Never use a vacuum cleaner, broom or paintbrush or household cleaning products such as ammonia or chlorine - Never allow mercury to go down the drain. - Do not walk around or leave the spill area until the contaminants are removed. - Amalgam scrap should not be disposed with waste that would be eventually incinerated since amalgam decomposes on heating. - Amalgam capsules, extracted teeth with amalgam restorations , cotton rolls and gauze with amalgam particle should not be incinerated. - Do not place elemental mercury in the garbage Singh A, Kaur S. Biomedical waste management in dental office. Baba Farid University Dental Journal. 2011;2(2):120-3 .

45. Lead foil packets Each x ray packet is toxic and can contaminate the soil . It Can be done by collecting the packets of the lead in a marked container . Once container is full contact the certified waste carrier for recycling . Do not throw the lead foil in regular garbage . Lead aprons Should not be thrown in regular garbage . Should contact the certified Waste carrier to recycle the disposal of unwanted lead apron. Silver containing waste Silver is in fixer solution . It can be managed using 2 option : Onsite treatment and disposal 3/4 Offsite treatment and disposal Recycling is better method Neelakantan A, Reddy Y, Dhaded S. BIOMEDICAL WASTE MANAGEMENT IN DENTISTRY. Guident . 2017 Jun 1;10(7). Onsite treatment is silver recovering units are available to remove the silver from fixer. Offsite treatment means recycling through environment protective agency. 45

46. X ray developer Developer can be flushed down the drain as long as the the ph of the solution does not exceed the ph standard of local sanitation agency. If the ph is greater than the local ph of developer should not be discharged in sanitary sewer and should be contacted to local sanitation agency for guidance . Methyl methacryalate : Liquid is extremely inflammable . When powder is mixed with liquid this becomes less inflammable and can be disposed in regular trash . Neelakantan A, Reddy Y, Dhaded S. BIOMEDICAL WASTE MANAGEMENT IN DENTISTRY. Guident . 2017 Jun 1;10(7). 46

47. Gypsum containing waste : Gypsum is toxic to environment . Thus when gypsum is mixed with biodegradable waste it produces hydrogen sulphide gas which is toxic, malodorous and has serious ramifications for public health and safety, so appropriate disposal methods should be followed . The two main disposal options for gypsum wastes are: Gypsum recycling Landfill in a separate cell that has been set aside for such waste. Neelakantan A, Reddy Y, Dhaded S. BIOMEDICAL WASTE MANAGEMENT IN DENTISTRY. Guident . 2017 Jun 1;10(7). 47

48. Disposal of Alginate Biologically inert and ecologically harmless and biodegradable . Disposal of Dental burs Single used burs should be disposed off into sharp container and reusable burs should be sent to sterilization . Disposal of Extracted tooth Infected tooth should be placed in infectious hazard waste container . Its taken up by the medical waste management company and then incinerated . Amalgam containing tooth should be disposed off separately as it cannot be incinerated as mercury will evaporate in air . Neelakantan A, Reddy Y, Dhaded S. BIOMEDICAL WASTE MANAGEMENT IN DENTISTRY. Guident . 2017 Jun 1;10(7). 48

49. DISPOSAL OF PHOSPATE BONDED INVESTMENT Used Ph bonded investment material are milled and powdered using ball milling machine to be used as recycled investment Material . These powder is then mixed with calculated quantity of mono-ammonium making it suitable for reuse , with adequate expansion and mechanical properties. Disposal of waxes Waxes can be recycled . Neelakantan A, Reddy Y, Dhaded S. BIOMEDICAL WASTE MANAGEMENT IN DENTISTRY. Guident . 2017 Jun 1;10(7). 49

50. What are the product substitute that you can do according to IDA? P roduct substitution practices include using alternative products with less or non-hazardous components or Precapsulated amalgam instead of bulk mercury. Digital radiography. Steam sterilization instead of chemical sterilization. Non-hazardous biodegradable detergents for clean-up. Non-chromium containing X-ray system cleaner using technologies that generate less toxic or less volume of waste.  INDIAN DENTAL ASSOSIATION

51. Disposal of chemicals, disinfectant agents All these chemicals have hazardous impact on environment. So instruments should be sterilized using steam or dry heat. Halogenated sterilants should not be poured into the drains- can explode. Non chlorinated plastic containers should be preferred to minimize environment impacts. Agarwal A.Waste management in dental office.Ind J of Comm Med.2012 37(3);201-202 5

52. Disposal of implants The process starts with: Collection of post crematory waste separation of metals from other remanats like ashes and bones Separated metals transported to collection centre Ferrous and non ferrous metals are separated by custom made metal separating process With spectrometer technology, the chemical specification is verified by medical casting industry Metals are melted in the furnaces and poured in molds to form metal ingots. These metals are then sold back to medical casting industry for fabrication of new prosthesis and implants. G.V Gayathri.Present scenario of implants recycling:where are we heading to?Int.J.Oral health Sci.2013,3;37-41 5 1

53. Red bag Baghele ON, Phadke S, Deshpande AA, Deshpande JP, Baghele MO. A simplified model for biomedical waste management in dental practices-A pilot project at Thane, India. European Journal of General Dentistry. 2013 Sep 1;2(3):235 .

54. Rubber dam Impression material with tray cotton Extracted tooth Blood with gauze Yellow bag Gp points Cpd Baghele ON, Phadke S, Deshpande AA, Deshpande JP, Baghele MO. A simplified model for biomedical waste management in dental practices-A pilot project at Thane, India. European Journal of General Dentistry. 2013 Sep 1;2(3):235 .

55. Baghele ON, Phadke S, Deshpande AA, Deshpande JP, Baghele MO. A simplified model for biomedical waste management in dental practices-A pilot project at Thane, India. European Journal of General Dentistry. 2013 Sep 1;2(3):235 . Blue bag

56. Black bag Baghele ON, Phadke S, Deshpande AA, Deshpande JP, Baghele MO. A simplified model for biomedical waste management in dental practices-A pilot project at Thane, India. European Journal of General Dentistry. 2013 Sep 1;2(3):235 . 5 6

57. Disposal of infected protective wears All waste from HIV and AIDS patients must be treated as infected waste Disposal plastic aprons and gloves must be worn when handling infected materials Dispose off infected waste as follow: Place into a disposal YELLOW plastic bag and seal Place this inside a second YELLOW bag and seal. “STANDARD UNIVERSAL PRECAUTION” label to be put outside of yellow plastic bag in a prominent position. Remove protective wear and dispose of as clinical waste. Wash hands Make arrangements for collection and disposal of bagged waste Bags should be sent for incineration.

58. Management of waste in covid-19 The medical and domestic waste generated by the treatment of patients with suspected or confirmed COVID-19 infection are regarded as infectious medical waste. Double-layer yellow color medical waste package bags and “gooseneck” ligation should be used. The reusable instrument and items should be pretreated, cleaned, sterilized, and properly stored. Management of medical waste The medical waste (including disposable protective equipment after use) should be transported to the temporary storage area of the medical institute timely. The surface of the package bags should be marked and disposed according to the requirement for the management of medical waste . Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. International Journal of Oral Science. 2020 Mar 3;12(1): 1-6 .

59. Dental unit waste water Dental unit wastewater represents the whole liquid wastes of dental unit, waters coming from the aspiration system and the bowl-rinse water outlet . In Italy, as the incoming dental unit water, also the dental unit drainpipes are directly connected to the urban sewer system, thanks to specific municipal permissions In this way the dental unit wastewater are legally considered as domestic wastewater, that is wastewater coming from human metabolism and domestic activities, and so suitable to be introduced in the urban sewer system . Recently, in 2013, the Italian judged dental unit wastewater as industrial wastewater, that is wastewater of industrial or commercial buildings, so unsuitable for the urban sewer system Cataldi ME, AL RAKAYAN SA, Arcuri C, Condò R. Dental unit wastewater, a current environmental problem: a systematic review. ORAL & implantology . 2017 Oct;10(4):354 .

60. Belgaum green environment management Pvt Ltd Yearly bond is obtained from the company . This plant is about 75 km from our place where the waste is treated . A slip is given to us in which it mentions different colored bags given to the company . The van comes twice a week to collect the waste on Tuesdays and Friday . Biomedical waste management in our campus

61. Conclusion Health professionals need to have a basic knowledge on disposal of wastes. Further the health professional maybe called up on giving advice in some special situations or coping with waste disposal problems when there is a disruption or breakdown of community health services in natural disasters. 61

62. References Park K. Park’s Textbook of Preventive and social medicine. 17 th edition Jabbalpur 2002 Park K. Park’s Textbook of Preventive and social medicine. 24th edition B.K Mahajan M.C. Gupta Textbook of preventive social medicine. 3 rd edition 2003 Public health dentistry. Soben Peter .5 th edition G.V Gayathri.Present scenario of implants recycling:where are we heading to?Int.J.Oral health Sci.2013,3;37-41 62 Veena Benakatti , Hema Kanathila ,BIOMEDICAL WASTE MANAGEMENT IN DENTAL OFFICE-A review world journal of advance healthcare research 2018 , 2;177-181

63. RS Dhanya.Management of Biomedical waste in dental clinics.Int J of Oral Care and Research.Oct -Dec 2016 (4);288-290 how do you recycle resin and silicone.AZOM.azom.com Zutai Zhang.Recycling of used phosphate bonded investment material with additional Mono-ammonium phosphate.J.Dent Mat 2005:24(1):14-18 Agarwal A.Waste management in dental office.Ind J of Comm Med.2012 37(3);201-202 Oral Health.Centres for Disease Control and Prevention guidelines. 63

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