Chris Miller, PHD
The management of regulated waste has always been a confusing topic. Part of this confusion is based upon the enactment of local laws at the city, county, or state level. The laws can differ widely from one locality to the next. These differences are mainly in how such waste may be discarded. But requirements are often different for recordkeeping, conditions for waste storage prior to disposal, or special items that are considered regulated waste.
For specific information about waste management in your dental office, check with local agencies and organizations (for example, state dental associations; city, county or state department of health or environmental management; and state board of dental examiners) to determine those procedures, laws, or rules that apply.
What is regulated waste?
Unfortunately, not everyone agrees on what is "infectious" waste. It`s usually referred to as waste capable of causing a harmful infection. But many things besides just the presence of microorganisms influence whether a harmful infection will occur (for example, types of microbes; numbers of microbes; disease-producing ability of the microbes; contact with the body; specific site of entry into the body; activity of non-specific body defense mechanisms; and immunity).
A more proper way to think about "infectious" waste may be to just consider it as "regulated" waste. We know certain wastes are regulated even though we can`t confirm that they may be infectious.
Rules for the management of regulated waste inside the dental office are included in the OSHA Bloodborne Pathogens Standard. This federal standard defines this waste as:
- "...liquid or semi-liquid blood or other potentially infectious materials."
- "...contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed."
- "...items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling."
- "...contaminated sharps."
- "...pathological and microbiological wastes containing blood or other potentially infectious materials."
Examples of such waste include liquid blood or saliva; blood- or saliva-saturated gauze pads, cotton rolls, or dressings that are fresh or dried; any sharp object that could penetrate the skin and is contaminated with blood or saliva; and tissue including extracted teeth.
`Handling` regulated waste
Common sense indicates that direct contact with waste that is potentially "infectious" must be avoided and that such waste needs to be properly contained immediately after it is generated through final disposal. Thus, the important safety concepts that apply are barrier protection and containment.
Barrier protection: The important aspect of "handling" regulated waste is not to handle it! This means that procedures and practices must be instituted that will prevent direct contact with the waste.
Regulated waste is never to be touched with ungloved hands, and contaminated sharps shouldn`t even be picked up with gloved hands. Instead, use tongs, forceps, or cotton pliers, and these should be readily available for such use both at chairside and in the instrument circulation (sterilizing) room.
Be careful when picking up the sharp item with forceps, tongs, or pliers so that the item doesn`t become dislodged from the grasp and "fly" into the air. Contact with mucous membranes or skin by spatter with liquid waste or other contact with solid waste is avoided by wearing protective clothing, eyewear, and a mask in addition to gloves.
Containment: It`s important to place waste in a proper container as soon as possible and keep the number of times the waste is handled at a minimum. For example, instead of placing a disposable contaminated sharp back on the instrument tray when finished using it, discard it in a proper sharps container at chairside so it won`t have to be picked up and handled a second time back in the instrument circulation room.
This is why the Bloodborne Pathogen Standard indicates that sharps containers should be placed where sharps are used or found.
The standard also indicates that containers for regulated waste are to be labeled or color-coded to identify the presence of biohazardous materials. Proper containers are to prevent release of the waste through puncture or leakage as appropriate and are to be closable. They should be closed when moved to prevent release of the waste if dropped during transport.
The containers should be designed not to be easily knocked over, and this, coupled with a suggested work practice of filling the containers only three-quarters full, facilitates proper containment even if they are knocked over.
Please refer to local regulations. In general, though, liquid blood and saliva may be flushed down a drain. Solid regulated waste may be discarded by contracting with a medical waste hauler that will transport it to a facility for treatment and final disposal.
Make sure non-regulated waste (for example, disposable gowns, patient bibs, used plastic surface covers) is not included with the regulated materials being hauled away, for this will lead to unnecessarily larger volumes of waste and increased cost for the service.
Alternatively, you may be allowed to decontaminate the solid waste in your office, properly label it, and discard it in the regular trash.
Published studies from our laboratories have shown that processing open, three-quarters full sharps containers for 60 minutes at 121 degrees Centigrade through a steam sterilizer (or two cycles for 30 minutes at 121 degrees Centigrade) can be used for decontamination of sharps prior to disposal in the regular trash. If extracted teeth are to be decontaminated before disposal, those containing amalgam restorations should not be processed through heat (for fear of releasing mercury vapors), but may be treated with a chemical disinfectant.
Appropriate records are to be kept when using either the medical waste hauler or the in-office decontamination approaches to waste disposal.
Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.