Hospital Waste Management.ppt

Biomedical waste and waste management

1. Good morning

2. Waste Management

3. Contents
•INTRODUCTION
•CLASSIFICATION
•SOURCES OF HEALTH CARE WASTE
•COMPOSITION OF HEALTH CARE WASTE
•RATIONALE OF WASTE DISPOSAL
•HEALTH HAZARDS OF HEALTH CARE WASTE
•CATEGORIES OF WASTE GENERATED IN DIFFERENT
DEPARTMENT OF DENTAL HOSPITAL
•LEGAL IMPLICATIONS
•STEPS IN WASTE DISPOSAL
•TREATMENT AND DISPOSAL TECHNIQUE FOR DENTAL
HEALTH CARE WASTE
•METHOD NEEDED TO BE ADAPTED FOR PROPER
MANAGEMENT OF THE HEALTH CARE WASTE IN A
DENTAL CAMP/CLINICAL SETTING
•CONCLUSION
•REFERENCES

4. Introduction

5. Waste management practices can
be broadly classified into two main
types
•Medical health care waste/Dental
health care waste management
•Residential waste management

6. Medical health care
waste/Dental health care
waste management

7. CLASSIFICATION
Classification of health care waste
•WHO classification:
1.INFICTIOUS WASTE–Waste suspected to
contain pathogens e.g.-laboratory cultures; waste
from isolation wards; tissues, materials, or
equipments that have been in contact with infected
patients; excreta
2. PATHOLOGICAL WASTE –Human tissues or
fluids e.g.-body parts; blood and other body
fluids; fetuses
3. SHARPS –Sharp waste e.g.-needles; infusion
sets; scalpels; knives; blades; broken glass.

8. 4.PHARMACEUTICAL WASTE –Waste containing
pharmaceuticals eg-pharmaceuticals that are expired
or no longer needed; items contaminated by or
containing pharmaceuticals.
5. GENOTOXIC WASTE –Waste containing
substances with genotoxic properties e.g.-waste
containing cytostatic drugs; genotoxic chemicals.
6. CHEMICAL WASTE -Waste containing chemical
substances eg –laboratory reagents; film developers;
disinfectants that are no longer needed; solvents.
7. WASTES WITH HIGH CONTENT OF HEAVY
METALS–Batteries; broken thermometers; blood
pressure gauges.

9. 8.PRESSURIZED CONTAINERS –Gas
cylinders; gas cartridges.
9. RADIOACTIVE WASTE –Waste
containing radioactive substances e.g.-unused
liquids from radiotherapy or laboratory
research; contaminated glassware; packages or
absorbent paper; urine and excreta from
patients treated or tested with unsealed
radionuclides

10. •US Classification:
The USA uses a separate classification laid down
by centre for disease control,Atlanta ;
which is enunciated below
1.Microbiological waste : which includes
cultures and stocks of infectious diseases.
2.Sharps : which include needles, syringes,
scalpels, blades etc.
3.Human blood, blood products and body
fluids
4.Animal wastes

11. 5.Pathological wastes –tissues, sections,
organs and supply specimens.
6. Cytotoxic wastes
7. Radioactive wastes
8. Communicable disease isolation wastes
which includes certain highly
communicable waste such as Marburg,
Lossa and Ebola viruses.

12. •Hospital waste classification (Gerig 1993)
I. Biohazardous waste
1.Corpses and parts of human body
2.Waste impregnated with blood
3.Wound dressings and casts of plaster
4.Dialytic waste
5.Waste from isolation wards, laboratories, excreta
6.Radioactive waste
7.Chemical waste from laboratories
8.Disposable materials like IV sets, syringes
9.Waste from stores
10.Sharp objects like glass, cans etc.
II. Non Biohazardous waste
1.Dry household waste e.g.-floor refuse like dust, paper trash
2.Wet garbage from kitchen and pantry

13. SOURCES OF HEALTH CARE
WASTE
•The institutions involved in generation of
bio-medical waste are
•“ 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.

14. •Government hospitals
•Private hospitals
•Nursing homes
•Physicians offices/ clinics
•Dentists office /clinics
•Dispensaries
•Primary health care centers
•Medical research and training
establishments
•Mortuaries
•Blood bands and collection centers

15. •Animal houses
•Slaughter houses
•Laboratories
•Research organizations
•Vaccination centers
•Bio-technology institutions/ production
units
All these health care establishments generate
waste and are therefore covered under Bio-
medical wasterules.

16. COMPOSITION OF HOSPITAL
WASTE
The amount of waste generated per bed varies
with the type of hospital, however, on an
average, 1-5kg of waste per bed per day is
generated. The type of waste generated is.
a) Non Hazardous –85%
b) Hazardous –15%
Hazardous but not infective 5%
Hazardous but infective 10%

17. Waste generation depends on
numerous factors such as
•Established waste management methods
•Type of health care establishments
•Hospital specializations
•Proportion of reusable items employed in
health care
•Proportion of patients treated on a day care
basis.

18. •80%general health care waste, which may
be dealt with by the normal domestic and
urban waste management system.
•15%pathological and infectious waste
•1%sharp waste
•3%chemical and pharmacological waste
•less than 1%special waste, such as
radioactive or cytotoxic waste, pressurized
containers, or broken thermometers and
used batteries

19. •A survey done in Bangalore revealed that
the quantity of solid wastes generated in
hospitals and nursing homes
•½ to 4 kgper bed per day in government
hospitals
•½ to 2 kgper bed per day in private
hospitals
•½ to 1 kgper day in nursing homes

20. •The total quantity of hospital wastes
generated in Bangalore is about
40 Tonnes per day.
•Out of this nearly 45 to 50% is
infectious.
•Segregation of infectiouswastes from
non-infectious waste is done in about
30%of hospitals.

21. No comprehensive data is available till
now regarding quantity of waste
generated in dental hospitals/clinics.
•A survey conducted in Davangere in the year 2006
•Significant lack in the awareness of dental health
care waste management
•Lack of segregation of the dental health care waste
generated
•Most of the practitioners were not aware of the
Bio-medical waste management and handling
rules
•Colour coding for different category of waste
generated.

22. RATIONALE FOR WASTE
DISPOSAL
•To prevent Nosocomial infection or
Hospital acquired infection
•To protect Health care providers
•To prevent risk to general population
(when hospital waste is thrown in open
area without proper treatment, it is
hazardous)
•To protect environment

23. HEALTH HAZARDS OF HEALTH
CARE WASTE
Exposure to hazardous health care waste
can result in disease or injury due to one or
more of the following characteristics
•It contains infectious agents
•It contains toxic or hazardous chemical or
pharmaceuticals
•It contains sharps
•It is genotoxic and
•It is radioactive

24. The main group at risk are
•Medical doctors/Dental doctors, nurses, health
care auxiliaries, and hospital maintenance
personnel’s.
•Patients in health care establishments
•Visitors to health care establishments
•Workers in support service allied to health care
establishments such as laundries, waste handling
and transporting
•Workers in waste disposal facilities such as land
fills or incinerators including scavengers
•There are chance of environmental pollution as
result of improper handling and management of
such waste.

25. Hazards from infectious waste and
sharps

26. Hazards from chemical and
pharmaceutical waste

27. Hazards from genotoxic waste

28. Hazards from radioactive waste

29. Public sensitivity

30. CATEGORIES OF WASTE
GENERATED IN DIFFERENT
DEPARTMENT OF DENTAL
HOSPITAL

31. Oral medicine
•Rubber Gloves,
•Exposed X-ray films,
•Lead foils,
•Covers of the X-ray films,
•Developer solution,
•Fixer solution.

32. Oral surgery/Periodontics
•Needles and syringes,
•Scalpels and blades,
•Extracted tooth,
•Excised tissues,
•Items contaminated with blood and body fluids
including cotton, dressing, bedding
contaminated with blood,
•Waste comprising of outdated contaminated and
discarded medicines,
•Condemned instruments.

33. Conservative and
Endodontics/Community
Dentistry
•Amalgam and mercury,
•Out dated contaminated filling materials
like cements, Composits,
•Endodontic reamers, files,

34. Prosthodontics
•Plaster of Paris cast,
•Alginate impression materials, ZOE,
impression compounds,
•Acrylic materials,
•Crown and bridges.

35. Oral pathology
•Disinfectants, dyes, reagents,
•Laboratory cultures,
•Specimens of microorganisms,
•Human cell cultures.

36. Orthodontics
•Orthodontic brackets
•Bands
•wires.
•Condemned instruments

37. LEGAL IMPLICATIONS
Occupational Safety and Health
Administration (OSHA)
Blood-born pathogens,
Hazardous materials and
Safe use of Chemicals in the laboratory.
OSHA have regulations on infectious sharps

38. The Environmental Protection Agency
•The Environmental Protection Agency has standards,
many of which are applicable to dentistry, for work
place exposure levels to chemicals, heat and radiation
and for discharge and final treatment of waste
materials.
•If the waste were dumped illegally, the dental
practice involved also would be held responsible.
•Therefore one should establish the credentials of any
waste hauler. Speaking to other clients and to local
health authorities is essential.
•The environmental protection agency usually
approves haulers.

39. •They are awarded a unique identification
contractor number, which should appear on
all the paperwork.
•A receipt of shipment should be provided on
removal of the waste.
•Several weeks after removal, a manifest
should come through the mail indicating the
exact manner in which the waste was
treated and its final site of disposal.
•Employees also must be aware of their state
(possible local) requirements concerning
sterilization, disinfection and management.

40. Center for Disease Control and Prevention (CDC)
•The Center for Disease Control and Prevention
(CDC)and American Dental Association
guidelines/recommendations contain important
valuable information.
•The new CDC guidelines for infection control make
two recommendations for general medical waste.
•First, a medical waste management programme for the
practice needs to be developed. This written program
must follow federal, state, and local regulations.
•Second, dental practices also need to ensure that all
personnel who handle and dispose of potentially
infectious waste are trained in appropriate methods and
that they are informed of the possible safety and health
hazards.

41. •CDC has recommendations for handling infected
sharps it recommends that sharp containers to be
located as close as is practical to the work area. This
means that each operatory should have at least one
sharps container.
•The new CDC infection control guidelines have a
recommendation for discharging blood or other body
fluids to sanitary sewer. The CDC indicates that one
should pour blood, suctioned fluids, or other liquid
waste carefully into a drain connected to a sanitary
sewer system, provided that local sewer discharge
requirements are met and that the state has declared
this is to be an acceptable method of disposal.
•One must wear appropriate personal protective
equipment while performing this task.
•The new CDC guidelines allows extracted teeth to be
returned to the patient.

42. The Environment (Protection) Act,1986
•An act to provide for the protection and improvement
of environment and prevention of hazards to human
beings, other living creatures, plants and property.
•The Central Government shall have the power to take
all such measures as it deems necessary or expedient
for the purpose of protecting and improving the
quality of the environment and preventing controlling
and abating environmental pollution.

43. Bio-Medical waste management in Indi
•Bio-Medical waste(Management and
Handling) Rules 1998, prescribed by the
Ministry of Environment and Forests,
Government of India, came into force on 28th
July 1998. This rule applies to those who
generate, collect, receive, store, dispose, treat
or handle bio-medical waste in any manner,

44. Waste
category
Contents Treatment &
disposal
options
Colour
code
Type of
container
Human
anatomical
Humantissues,organs,body
parts
Incineration/
deepburial
Yellow Plasticbag
AnimalwasteAnimaltissues,organsbody
parts,carcasses,bleedingparts,
fluidbloodandexperimental
animalsusedinresearch,waste
generatedbyveterinaryhospital
colleges,dischargesfrom
hospitalsandanimalhouses
Incineration/
deepburial
Yellow Plasticbag
Microbiology
and
biotechnology
waste
Laboratoryculturesstocks,
specimenofmicroorganisms
liveorattenuatedvaccines,
humanandanimalcellculture
usedinresearchandindustrial
laboratories,wastesfrom
productionofbiologicaltoxins,
dishesanddevicesusedfor
transferofcultures
Local
autoclaving/mi
cro-waving
incineration
Yellow/
Red
Plastic
bag/disinfected
container
The table shows the categories of bio-medical waste, types of waste and
treatment and disposal options under rule 1998.

45. Continuation
WastesharpsNeedles,syringes,scalpels,
blades,glassetcthatmay
causepunctureandcuts.This
includesbothusedand
unusedsharps
Disinfection/
chemical
treatment/
autoclaving/
microwaving
andmutilation
shredding
Blue /
white
translucent
Plasticbag
punctureproof
container
Discarded
medicines
andcytotoxic
Waste comprisingof
outdated,contaminatedand
discardedmedicines
Incineration/
destruction
anddisposal
insecured
landfills
Black Plasticbag
SoiledwasteItemscontaminatedwith
bloodandbodyfluids
includingcotton,dressing,
soiledplastercasts,linen,
bedding,othermaterial
contaminatedwithblood
Incineration/
autoclaving/
microwaving
Yellow/
Red
Disinfected
container/
plasterbag
SoiledwasteWastegeneratedfrom
disposableitemsotherthan
thewastesharpssuchas
tubing,catheters,intravenous
setsetc
Disinfection
bytreatment/
autoclaving/
microwaving
andmutilation
/shredding
Red/Blue
/white
translucent
Disinfected
container
plasticbag

46. Continuation
LiquidwasteWastegeneratedfrom
laboratory,washing,cleaning,
housekeepinganddisinfecting
activities
Disinfection
bychemical
treatment
Not
applicable
Notapplicable
Incineration
ash
Ashfromincinerationofany
bio-medicalwaste
Disposalin
municipal
landfill
Black Plasticbag
Chemical
waste
Wastegeneratedfrom
chemicalsusedinthe
productionofdisinfection
materialsandinsecticidesetc
Chemical
treatmentand
dischargeinto
drainsfor
liquidand
secured
landfillfor
solids
Black Plasticbag

47. Central pollution control board
•The recommended segregation and colour coding as
per central pollution control board reputations and
used on convenient disposal methods as follows
•Yellow ;human anatomical waste-all removed parts
from the body during operation (placenta, aborted
foetus, biopsy pieces of tumor etc).
•Red :solid infectious waste-cotton, gauge, bandage,
adhesive plasters etc, which are soaked / in contact
with blood, pus-urine or any other body fluids
including removed plaster of Paris cast.
•Blue :plastic and rubber disposables : IV sets,
syringes, nasogastric tube, separation tube, rubber
drain and unused glass vials.

48. STEPS IN WASTE DISPOSAL
•Segregation
•Decontamination
•Deformation/destruction
•Containment/Label/Transport
•Disposal

49. 1. Segregation
•Separate collection of different categories of waste reduces
chances of injury and reduces the quantity of hazardous waste.
•The key to minimization and effective management of health
care waste is segregation (separation)
•Identification of the waste & appropriate handling
•Treatment and disposal of waste by type reduce costs and do
much to protect public health.
•Segregation should always be the responsibility of the waste
producer, should take place as close as possible to when the
waste is generated and should be so maintained in storage
areas and during transport.
•The most appropriate way of identifying the categories of
health care waste is by sorting the waste into colour-coded
plastic bags / containers.

50. 2. Decontamination
•Disinfection reduces chances of infection.

51. 3.Deformation/Destruction
•Prevents misuse of the needles, syringes and
gloves.

52. 4.Containment/Label/Transport
•Use a heavy duty puncture proof narrow mouthed
plastic container to collect the waste sharps.
•A narrow mouthed container facilitates collection,
minimizes/obstructs unnecessary handling and
removal. A storage location for health care waste
should be designated inside the health care
establishment or research facility.
•The waste in bags or containers, should be stored in a
separate area, room or building of a size appropriate
to the quantities of waste produced.

53. •Unless a refrigerated storage rooms is
available, storage times for health care waste
should not exceed the following ;
Temperature climate : 72 hrs in winter
Warm climate : 48 hrs in summer
Warm climate : 48 hrs dried cool climate and 24
hrs in hot climate.

54. Recommendations of storage facilities for health
care waste are :
•The storage area should have an impermeable, hard
standing floor (with good training) it should be easy to
clean and disinfect.
•There should be a water supply for cleaning purposes.
•The storage areas should afford easy access for staff in
charge of handling the waste.
•It should be possible to lock the store to prevent access
by unauthorized persons.
•Easy access for waste collections vehicles is essential.
•Those should be protection from the sun.
•The storage area should be inaccessible animals, insects
and birds.
•The storage area should not be situated in the proximity
of fresh food stores or food preparation areas.

55. Label
Label the container properly
•All waste bags or containers should be labeled with
basic instructions on their content and information on
the waste producer. This instructions may be written
directly on the bag or container or on preprinted
labels, securely attached.
•It is also recommended that the 2 digits of the yr of
manufacture of the packing specified on the package,
as well as special code designating the type of
packaging.
•Waste category
•Date of collection
•Place in hospital where produced (ex. wards)
•Waste destination

56. •In cases of problems involving questions of liability,
full and correct labeling allows the origin of the waste
to be traced.
•Labeling also warns operative staff and the general
public of the hazardous nature of the waste.
•The hazards posed by container contents can be
quickly identified in case of accident, enabling
emergency services to take appropriate action.
Transportation
•Use heavy duty gloves while handling waste sharps
especially while transporting –avoid transporting
manually –use trolley.

57. 5.Final disposal
•Incineration, mutilation/shredding prevents
reuse/send to the recycler or bury in concert
pit.

58. Thank you

59. GOOD MORNING

60. Contents
•INTRODUCTION
•CLASSIFICATION
•SOURCES OF HEALTH CARE WASTE
•COMPOSITION OF HEALTH CARE WASTE
•RATIONALE OF WASTE DISPOSAL
•HEALTH HAZARDS OF HEALTH CARE WASTE
•CATEGORIES OF WASTE GENERATED IN DIFFERENT
DEPARTMENT OF DENTAL HOSPITAL
•LEGAL IMPLICATIONS
•STEPS IN WASTE DISPOSAL
•TREATMENT AND DISPOSAL TECHNIQUE FOR DENTAL
HEALTH CARE WASTE
•METHOD NEEDED TO BE ADAPTED FOR PROPER
MANAGEMENT OF THE HEALTH CARE WASTE IN A
DENTAL CAMP/CLINICAL SETTING
•CONCLUSION
•REFERENCES

61. TREATMENT AND DISPOSAL
TECHNIQUE FOR DENTAL
HEALTH CARE WASTE
•The disposal technologies are based on the
type of waste, category of waste and the
geographical conditions.

62. 1. Anatomical waste –Yellow bag:
•This is to be either incinerated or seat to deep
burial.
•Deep burial is not acceptable technology for
major towns / cities with population above 5
lakh as per the central pollution control board
regeneration.
•The incineration is also not allowed on
individual basis, bed must be a common
disposal or central facility as per CPCB
stipulations

63. Characteristics of waste suitable and incineration
•Low healing value –above 2000 kcal/ kg for
single chamber incinerators and above 3500
kcal/kg for pyrolytic double chamber
incinerators.
•Content of combustible matter above 60%
•Content of noncombustible solids below 5%
•Content of noncombustible fumes below 20%
•Moisture content below 30%

64. Waste type not to be incinerated
•Pressurized gas containers
•Large amounts of reactive chemical waste
•Silver salts and photographic or radiographic
wastes (x-ray films)
•Halogenated plastic and rubber disposables
used in the hospitals.
•Waste with high mercury or cadmium content
such as broken thermometers & used batteries
•Sealed ampoules containing heavy metals

65. 2.Infectious solid waste –Red bag:
•Infectious waste (cotton, guaze, bandages,
dressing pads etc) can be either incinerated
whenever applicable
OR
•Autoclaved wherever it is available.
•The autoclaved material can be dispensed of
by land filling.

66. 3. Plastic and rubber disposables –
Blue bag
•This should never be incinerated or burnt
The method of disposing then plastic / rubber material is
•Chemical disinfections by 1% bleeding solution for 1 hr after
mutilation
•Autoclaving and shredding
•Once it is thoroughly disinfected and mutilated it should be
sent for receipting industry where the facilities for receipting
the plastics are not available it can be sent for land filing or
burial.
•Sharps : puncture proof transparent container (white / light
blue) : needles have to be destroyed before disposal. They
should also be disinfected by 1% sodium hypochlorite solution
before disposal.

67. COLLECTION AND DISPOSAL
OF WASTE WATER
•Pathogenic microorganisms
•Hazardous chemicals
•Pharmaceuticals
•Radioactive isotopes

68. •Waste water generated in the health care
establishment consists :
The liquid waste contaminated with
–Blood and blood products
–Body fluids
–The secretions and excretions of the patients
–Intravenous fluids etc

69. ORAL MEDICINE
•Rubber Gloves
Disinfect
Mutilated
Sanitary land fills
Autoclaving

70. •Exposed X-ray films
Receipting industry where the
facilities for receipting the plastics
Land filing or burial

71. •Lead foils
Can be recycled and used
again
Can be used for the
manufacture of
batteries
Certified buyer
If incinerated liberates poisonous gases

72. •Covers of the X-ray films
Can be recycled and used again

73. •Developer solution
Developersolutiondoesn’tcontain
silver
soitcanbedilutedandledinto
sewer

74. •Fixer solution
If led into sewer it increases
the metal load in the sewer
Stored separately and
sold to a certified buyer
Theextractedsilver
particlecanbeusedin
themanufactureofbatteries
orelectricwires.

75. ORAL
SURGERY/PERIODONTICS
•Needles and syringes, scalpels and
blades
Needles have to be
destroyed before disposal.
They should also be disinfected by
1% sodium hypochlorite
solution before disposal
Can also be disposed
in a sanitary landfills
Now day’s needle
burners are available
which can be used
to destroy the needles

76. •Extracted tooth
They are considered potentially infectious
The easiest and most effective
procedure is sterilization by heat.
Problems involves the treatment
of the teeth containing
amalgam restorations.
Soamalgamrestoredteethcanbedisinfectedbefore
disposal,ideallyoneshoulduseasterilizingchemical
(e.g.-fullstrengthgluteraldehyde)
Exposureshouldbefor30min.

77. •Excised tissues, items contaminated
with blood and body fluids including
cotton, dressing, bedding
contaminated with blood
Canbeeitherincineratedwhenever
applicable.
Autoclaved
wherever it is available.
The autoclaved material
can be dispensed of by land filling

78. •Waste comprising of outdated
contaminated and discarded medicines
Incineration/destructionanddisposalinsecuredlandfills

79. •Condemned instruments
Can be disposed with waste sharps
in sanitary land field
They can be recycled
If recycling facility is not available

80. CONSERVATIVE AND
ENDODONTICS/ PREVENTIVE
AND COMMUNITY DENTISTRY
•Amalgam and mercury
StoringitunderphotographicordentalX-ray
fixersolutionorsubmerged
inasolutionofbleachandwaterin
atightlyclosed,unbreakablecontainer.
When feasible,
sell it to a certified
buyer who can
recycle mercury
Placecontaminateddisposablemercurycontainingmaterialina
double-sealedpolyethylenebagsforproperdisposal.
Applybiohazardstickerandcanbedisposedinsanitarylandfills.

81. •Out dated contaminated filling materials like
cements, composits
They can be treated as outdated medicines and can be
Incineration / destruction and disposal in secured landfills

82. •Endodontic reamers, files
They can be treated as infected sharps
Dispose in to sanitary land fill
Disinfect them

83. PROSTHODONTICS
•Plaster of Paris cast
This can be stored separately
and can be sold to a buyer who uses it
as a raw material for cement manufacturing.

84. •Alginate impression materials, ZOE,
impression compounds, Acrylic
materials
There is a need for establishment
of specific guidelines for disposal
of these items.

85. •Crown and bridges
Can be recycled if sold to a certified buyer

86. ORAL PATHOLOGY
•Disinfectants, Dyes, Reagents-
Disinfectionbychemicaltreatment,diluted
andledintosewer.

87. •Laboratory cultures, Specimens of
microorganisms, Human cell cultures:
Treated as a infectious waster

88. ORTHODONTICS
•Orthodontic brackets and wires
Theycanbetreatedasinfectedsharps
Orthodontic brackets
and wires separately these can be
treated as recyclable waste.

89. METHOD NEEDED TO BE
ADAPTED FOR PROPER
MANAGEMENT OF THE HEALTH
CARE WASTE IN A DENTAL
CAMP/ CLINICAL SETTING.

90. CLINICAL SETTING.

92. DENTAL CAMP

93. Few points to remember are
•Dispose the waste on daily basis
•Maintain record for needle prick injury, day to day
waste collection and final disposal
•Review of the exercise once 15 days
•One responsible staff to inspect the system of each
and every department
•Once the system is established it goes on very
smoothly. Initially there might be some practical
problems but the team work of motivated and
committed staff can make the system viable and
practical for any dental hospital or a dental clinic

94. CONCLUSION

95. REFERENCES
• Dr. Pusphanjali K, Dr. Shaik hyder Ali K.H, Srivastava B.K. Safe
management of Dental health care waste –A practical approach.
JIDA 2003; 74:29-33.
• Park's:Text Book of Preventive and Social Medicine; 18th Edition;
BANARSIDAS BHANOT
• Dr. Sudhir K.M, Dr. Chandu G.N, Dr. Prashant G.M, Dr. Nagendra J, Dr.
Md Shafiulla, Dr. V.V. Subba Reddy, Awareness and practice about
dental health care waste management among dentists of
Davanagere city, Karnataka.JOURNAL OF THE INDIAN
ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2006;8:44 -50.
• Dr. Pusphanjali K. Dental Health care waste and its implications.
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH
DENTISTRY 2004; 4:8-10.
• CHRIS H. MILLER, CHARLES JOHN PALENIK. Infection control and
Management of hazardous materials for the Dental team.3rd Edition :
ELSEVIER MOSBY.
• ELLEN DIETZ’S Safety standards and infection control for dental
assistants: DELMAR/THOMSON LEARNING.
• S.L Goel, R Kumar.Hospital management services : Deep and Deep
Publications PVT LTD.
• Bio-Medical waste(Management and Handling) Rules1998. Ministry
of forest and environment Govt. of India, July 27, 1998.
• Environmental Protection Act, 1986, Govt of India.
• www. google.com.

96. Thank you