hygeia dental care - cosmetic dentist

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Waste disposal (policy updated 22.11.2006)
It is essential that all waste produced at the practice is disposed of in a safe manner. This protects team members and patients from harm and protects the environment, too. It is official practice policy always to act in an environmentally responsible fashion (refer to the hygeia dental care health, safety & environmental policy). All team members must familiarise themselves with the different types of waste produced by the practice and the correct methods of disposal.

the different kinds of waste
The practice produces several different types of waste:

a) “normal commercial waste” – eg old newspapers, empty coffee jars
b) “controlled waste” – ie clinical waste and sharps
c) “special wastes” – ie lead foil, used x-ray developer and fixer fluid, partially discharged LA cartridges, dental amalgam, spent amalgam capsules and out of date pharmaceuticals
d) precious metals – eg old gold crowns

Waste types b) to d) are by-products of dental treatment in the surgeries. The primary responsibility for the proper disposal of these wastes lies with the clinical personnel (ie dentists, hygienists and dental nurses). However, all team members must be aware of what constitutes controlled, special or precious metal waste to ensure correct disposal.

Normal commercial waste is collected once a fortnight. No special paperwork is associated with the disposal of normal commercial waste. We simply have a contract with a collection service to remove and dispose of it.

Clinical waste and sharps are collected once a week. The special paperwork associated with clinical waste and sharps is called a “Transfer Note”. This is evidence that the clinical waste has been disposed of properly. It isn’t necessary for the waste collector to provide a transfer note every time they come to take clinical waste away (they can just provide one each year) but ours generally do.

Special wastes are collected once every six months. Special wastes are much more tightly controlled than other waste. Every time special wastes are collected, the waste collector must provide us with an individual consignment note to say exactly what they have taken away.

Precious metals are also collected once every six months, but do not require any special paperwork.

Normal commercial waste is collected by Collect A Can (NB they also collect our cardboard and paper waste which we segregate for recycling). Clinical waste and sharps are collected by Peake (GB). Special wastes and precious metals are collected by PHS (formerly Envirodent). All four are properly licensed waste disposal operators.

It is the responsibility of Dr Giddy's nurse to order waste sacks and containers. If she is absent from the practice, this responsibility falls to the person in charge of practice administration while she is away. Clinical waste sacks and sharps containers can be ordered from the Peake (GB) collection driver when he calls on a Friday. Additional special waste/precious metal waste containers can be obtained from PHS on 01204 704633.

normal commercial waste
Bins in the staff room, office, reception/waiting area and washrooms (ie anywhere except the surgeries) can only be used for the disposal of normal commercial waste and must NEVER be used for the disposal of controlled, special or precious metal wastes. Check regularly to ensure that these bins do not contain wastes of this kind. If they do, report this immediately to the practice director or the clinical director and make sure that the waste is transferred to the correct disposal system.

Normal commercial waste is placed into ordinary black or white bin liners and disposed of in the green “wheelie bin” outside the practice.

We segregate cardboard and paper waste for recycling and each has their own special, labeled wheelie bin outside the practice.

Rather than try to remember all of the things that might be disposed of as “normal commercial waste”, you should instead remember all of those things that are NOT normal commercial waste and require disposal in some other manner. Basically, those things that are not normal commercial waste are all those items in categories b) to d) (see “the different kinds of waste”, above). More detailed instructions for each type of waste are given below:

clinical waste
Clinical waste is anything produced in the surgeries that might be contaminated with blood, saliva, bacteria, etc and therefore may pose a risk to health. Some of the wastes produced in the surgeries are more hazardous because of their nature – sharps, for example – and have to be dealt with in a different way (see below). However, the majority of the waste produced in the surgeries (at least by volume) is “normal” clinical waste. This includes (this is not an exhaustive list):

a) examination gloves
b) face masks
c) antibacterial surface wipes
d) saliva ejectors
e) tray liners
f) clinical wipes
g) tork roll (from the wall dispenser)
h) cotton wool rolls
i) disposable mouth rinse cups
j) extracted teeth (provided they have not been filled with amalgam – see below)

It is often impossible to be certain whether a particular item is contaminated or not – just because a pair of examination gloves do not appear to have any blood on them, it does not mean that they aren’t contaminated.

ACCORDINGLY, ALL WASTE PRODUCED IN THE SURGERIES IS DISPOSED OF AS CLINICAL WASTE UNLESS IT IS SHARP, A SPECIAL WASTE OR PRECIOUS METAL WASTE (see below).

Clinical waste is disposed of in the surgery bins. One is located under each nurses’ wash basin. The other is located under each dentists’ wash basin. The bins are opened by foot pedal and closed with the knee. There is no need to touch them with your hands (refer to cross infection control).

The surgery bins can be lined with white swing bin liners but always ensure that when they are emptied, the waste is placed into yellow clinical waste sacks. These sacks must never be filled so that they are more than ¾ full; and the air must be gently squeezed out before sealing them to minimise the risk of bags bursting while being handled. The top of the sack is tied shut with string or Sellotape rather than knotting it. Clinical waste sacks are then transferred to one of the yellow (clinical waste) wheelie bins outside the practice. Clinical waste bins are always locked after bags are placed in them.

All team members must take great care when handling clinical waste. If any is spilled inside or outside the building, it is cleared away IMMEDIATELY and the area disinfected. Spillages must also be reported to the clinical director or the practice director.

sharps
All sharp or potentially sharp objects must be disposed of in a sharps bin. This is to ensure that they cannot harm team members or patients and to protect those people who collect and process our clinical waste.

The sharps bins, which are usually yellow with a white lid, are kept next to the nurse's clinical waste bin in each surgery - ie in the cupboard under the nurse's wash basin (NB All waste containers are replaced periodically by our disposal contractors and labeling/appearance may vary. Team members must make sure to check they are using the correct container. If in doubt, refer to Dr Giddy or Mr Phillips).

Potentially sharp objects means objects that may not be sharp at the time they are disposed of but may become sharp if they break – the most common example is the glass LA (local anaesthetic) cartridge.

SHARP OR POTENTIALLY SHARP OBJECTS MUST NEVER BE DISPOSED OF IN A NORMAL CLINICAL WASTE BIN.

Sharps containers are never filled so that they are more than two thirds full.

Sharps are particularly dangerous because not only are they potentially contaminated with harmful substances, bacteria, etc. (as is all clinical waste) but, being sharp, they have the ability to perforate your skin and introduce these harmful substances directly into your body.

Fully discharged glass LA cartridges may be disposed of in the sharps bin. Partially discharged LA cartridges must be stored in their own special waste container (see below).

For guidance on how to handle and dispose of contaminated/used disposable syringes, refer to “sharps” in the web page on cross infection control. For guidance on dealing with inoculation injuries, refer to “procedure for inoculation injuries” in the web page on cross infection control.

lead foil
The practice installed a digital x-ray system in March 2006 and so we no longer produce lead foil waste (from x-ray film wrappers).

x-ray developer & fixer
The practice installed a digital x-ray system in March 2006 and so we no longer produce waste x-ray developer or fixer fluids.

amalgam & amalgam capsules
Amalgam or amalgam capsules are NEVER placed into the normal clinical waste bin. Dental amalgam contains mercury, another toxic heavy metal element that must be disposed of carefully. It must be stored in the special containers provided.

Waste amalgam is stored in its own plastic containers. There is one in each surgery. They are labeled: “Waste Amalgam Only” or something similar (NB All waste containers are replaced periodically by our disposal contractors and labeling/appearance may vary - team members must make sure they are using the correct container. If in doubt, refer to Dr Giddy or Mr Phillips).

The containers are part filled with a special suppressant solution. This prevents the escape of toxic mercury vapour. If the level of the amalgam waste in the container is such that it breaks the surface of the solution, team members must top it up with water so that the amalgam is completely submerged. The lid must always be kept securely sealed.

Extracted teeth that have amalgam fillings in them must also be disposed of in the special amalgam containers.

The amalgam separation system captures small pieces of amalgam that are picked up by the suction systems. The amalgam separation units are located next to the suction pumps in the staff room. The amalgam waste containers are grey plastic cylinders attached to the underside of the separator units (NB All waste containers are replaced periodically by our disposal contractors and labeling/appearance may vary - team members must make sure they are using the correct container. If in doubt, refer to Dr Giddy or Mr Phillips). These containers are periodically removed. They must be filled with suppressant solution and their lids secured pending collection by a specialist waste contractor.

Waste amalgam capsules from the encapsulated amalgam mixer machine are stored in their own special containers. There is one in each surgery. They are labeled: ”Waste Amalgam Capsules Only” or something similar (NB All waste containers are replaced periodically by our disposal contractors and labeling/appearance may vary - team members must make sure they are using the correct container. If in doubt, refer to Dr Giddy or Mr Phillips).

When the waste amalgam capsule containers in each surgery are full, the contents must be decanted into the larger waste amalgam capsules drum that is kept in the corner cupboard in surgery 1. This is a large plastic drum. It is labeled: “Amalgam Capsules Only” or something similar (NB All waste containers are replaced periodically by our disposal contractors and labeling/appearance may vary - team members must make sure they are using the correct container. If in doubt, refer to Dr Giddy or Mr Phillips).

In the event of accidental mercury spillage, there is special mercury spillage kit to clear up the spill. This is kept in the corner cupboard in surgery 1 next to the emergency drug kit. There is a set of instructions inside the kit.

partially discharged local anaesthetic (LA) cartridges
Partially discharged LA cartridges must be stored in their own special waste container. They are never disposed of in the sharps bin. Only fully discharged cartridges may be placed in the sharps bin.

Left-over anaesthetic in an LA cartridge must NEVER be discharged into the wash basin/drain.

Partially discharged LA cartridges are stored in their own special containers. There is one in each surgery. It will be labeled: “Danger: Contaminated Sharps To Be Incinerated” or something similar. It will also bear a special stamp/label that says the bin is for partially discharged LA cartridges (NB All waste containers are replaced periodically by our disposal contractors and labeling/appearance may vary - team members must make sure they are using the correct container. If in doubt, refer to Dr Giddy or Mr Phillips).

out of date pharmaceutical products
Out of date pharmaceuticals must not be disposed of as normal clinical waste. They must be placed in the same containers as the partially discharged LA cartridges. The most common source of out of date pharmaceuticals is those removed from the emergency drug kit.

Note that any cardboard or plastic packaging can be removed from the pharmaceuticals before they are placed in the partially discharged LA cartridges bin. The cardboard can be disposed of in the same way as other surgery waste.

precious metals
Precious metal wastes come from removed crowns and bridges (whether gold or not), gold inlays and gold onlays. They are collected for recycling.

These wastes are cleaned by hand and in the ultrasonic bath before being stored in the special container provided. There is one in each surgery. It will be labeled: “Precious Waste” or “Crowns, Bridges, Inlays, etc.” (NB All waste containers are replaced periodically by our disposal contractors and labeling/appearance may vary - team members must make sure they are using the correct container. If in doubt, refer to Dr Giddy or Mr Phillips).

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