How to Dispose Biomedical Waste In Orthodontic
Original Article
Practice: A Review
To cite: Nidhi Saini, Rajiv
1Nidhi Saini, 2Rajiv Ahluwalia, 3Kunal Sharma, 4Himanshu Garg, 5Ankit
Ahluwalia, Kunal Sharma,
1,3,4,5
Himanshu Garg, Ankit
PG Student, 2Professor and Head, Dept. of Orthodontics and Dentofacial Orthopaedics,
1,2,3,4,5
Santosh Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
How to Dispose Biomedical
Waste In Orthodontic
Practice: A Review
ABSTRACT
Proper management of biomedical waste produced in Orthodontic practice is an important
J Contemp Orthod 2020;4(4):
component of environmental health protection. Wise handling and disposing of biomedical waste
34-38.
is very critical. In Orthodontic practice, a number of biomedical wastes are produced. This article
Received on:
19-11-2020
is designed to explore and review on the issues such as categories related to biomedical waste
Accepted on:
and procedures of handling and disposal methods of biomedical waste management in
11-12-2020
Orthodontic practice and formulate a simplified scheme.
Source of Support: Nil
Conflict of Interest: None
Key words
Biomedical waste; management; Orthodontics; practice; schedule; segregation.
INTRODUCTION
In a new ruling released by the government on March 27, 2016,
the segregation and treatment methods of biomedical waste were
TWastes can be categorized as municipal waste, clinical or
amended.[4]
biomedical waste, electronic waste, industrial waste,
agricultural waste etc. In this article, we will focus on
Regulations related to Biomedical waste management-
biomedical waste. Biomedical waste (BMW) has been defined
It is the obligation of the owner of the dental clinic to segregate
as “any waste that is generated during the diagnosis, treatment,
the orthodontic waste in appropriate category. In case of a visiting
or immunization of human beings or animals, or in the research
orthodontist, the duty falls on the orthodontist to guide the dentist
activities pertaining to or in the production or testing of
about proper segregation and disposal.
biological or in health camps and also includes categories
mentioned in the Schedule I of the Biomedical Waste
The Bio-Medical Waste Management Rules, 2016 includes:
(Management and Handling) rules
1998.”[1,2] With the
Schedules - I to IV
notification of the Biomedical Waste rules, the hospitals have
started proper waste management by disposal of their waste in
Forms -I to V
an eco-friendly and responsible manner. Improper waste
Form I - Accident reporting
management can lead to change in microbial ecology and may
Form II - Application for authorization or renewal of
be antibiotic resistance.[3] The best disposal options are
authorization [To be submitted by occupier of health care
prevention of release of toxic substances from dental clinics to
the environment.[4]
facility
(HCF) or common bio-medical waste treatment
facility (CBMWTF)]
India is likely to generate about 775.5 tons of medical waste per
day by 2022 from the current level of 550.9 tons per day
Form III - Authorization (Authorization for operating a
growing at compound annual growth rate (CAGR) of about
facility for generation, collection, reception, treatment,
7%.[5] Total quantity of waste generated from dental clinics is
storage, transport and disposal of biomedical wastes)
about
0.161 kg/clinic/day with
0.130 kg and 0.026 kg of
Form IV - Annual report [To be submitted to the
infectious and recyclables, respectively.[6] Dental waste is a
subset of hazardous biomedical waste. It is generated during
prescribed authority on or before 30th June every year for
various procedures and includes cotton, latex, syringe, glass,
the period from January to December of the preceding
sharps, human body parts, and fluids (such as blood), dental
year, by the occupier of health care facility or common
materials and chemicals.[7]
bio-medical waste treatment facility]
34
Form V - Application for filing appeal against order
Any violation of the provisions of the said rules attracts action
passed by the prescribed authority.
under the environment (protection) act,1986, as amended to
date, wherein there is provision for punishment of imprisonment
for a term which may extend to five years with fine upto one
Rules - 1 to 18
TABLE I: SCHEDULE 1- Biomedical wastes categories and their segregation, collection, treatment, processing and disposal options.[9]
Categories
Types Of Waste
Disposal Option And Processing
Type Of Bag And
Container
Yellow
Human Anatomical Waste: Human tissues,
Yellow colored
Incineration or Plasma Pyrolysis or deep burial.
organs, body parts like
non-chlorinated
plastic bags
extracted teeth, bone fragments etc.
Soiled Waste: Items contaminated with blood,
Incineration or Plasma Pyrolysis or deep burial. In absence of
body fluids like dressings, plaster casts, cotton
above facilities, autoclaving or micro- waving/ hydroclaving
swabs and bags containing residual or discarded
followed by shredding or mutilation or combination of
blood and blood components.
sterilization and shredding. Treated waste to be sent for
energy recovery.
Expired or Discarded Medicines:
Yellow coloured
Expired
`cytotoxic drugs to be returned back to the
Pharmaceutical waste like antibiotics, cytotoxic
non-chlorinated
manufacturer or supplier for incineration at temperature
drugs including all
items contaminated
plastic bags or
>12000C or to common bio-medical waste treatment facility
with cytotoxic drugs along with glass or plastic
containers
or hazardous waste treatment, storage and disposal facility
ampoules, vials etc.
for incineration at
>12000C. All other discarded medicines shall be either sent
back to manufacturer or disposed by incineration.
Chemical Liquid Waste: Liquid waste generated
Separate collection
After resource recovery, the chemical liquid waste shall be
due to use of chemicals in production of
system leading to
pre- treated before mixing with another wastewater. The
biological and used or discarded disinfectants,
efflu
combined discharge shall conform to the discharge norms
etchants, Silver X-ray film developing liquid,
ent treatment
given in Schedule-III.
discarded Formalin, infected secretions,
system
aspirated body fluids, liquid from laboratories
and floor washings.
Chemical Waste: Chemicals used in production
Yellow colored
Disposed of by incineration or Plasma Pyrolysis or
of biological and used or discarded disinfectants
containers or non-
Encapsulation in hazardous waste treatment, storage and
chlorinated plastic
disposal facility
bags
Discarded linen, mattresses, beddings
Non-chlorinated
Non- chlorinated chemical disinfection followed by
contaminated with blood or body fluid, Routine
yellow plastic bags
incineration or Plazma Pyrolysis or for energy recovery.
mask and gown.[11]
or suitable packing
In absence of above facilities, shredding or mutilation or
material
combination of sterilization and shredding. Treated waste to
be sent for energy recovery or incineration or Plazma
Pyrolysis.
Contaminated Waste (Recyclable)
(a)
Red colored non-
Autoclaving or micro-waving/ hydroclaving followed by
Red
Wastes generated from disposable items such as
chlorinated plastic
shredding or mutilation or combination of sterilization and
tubing, syringes
(without needles and fixed
bags or containers
shredding. Treated waste to be sent to registered or
needle syringes) aligners, retainer boxes and
authorized recyclers or for energy recovery or plastics to
vaccutainers with their needles cut) and gloves
diesel or fuel oil or for road making, whichever is possible.
Plastic waste should not be sent to landfill sites.
White
Waste sharps including Metals: Needles,
Puncture proof,
Autoclaving or Dry Heat Sterilization followed by shredding
syringes with fixed needles, needles from needle
Leak proof,
or mutilation or encapsulation in metal container or cement
tip cutter or burner, scalpels, blades, brackets,
Tamper proof
concrete; combination of shredding cum autoclaving; and
archwires, metal
ligature
ties,bands,
containers
sent for final disposal to iron foundries (having consent to
removable or fixed appliances like class
2
operate from the State Pollution Control Boards or Pollution
corrector appliances or any other contaminated
Control Committees) or sanitary landfill or designated
sharp object that may cause puncture and cuts.
concrete waste sharp pit.
This includes both used, discarded
and
contaminated metal
Puncture proof
Disinfection
(by soaking the washed glass waste after
Blue
a) Glassware: Broken or discarded and
contaminated glass including medicine vials and
and leak proof
cleaning with detergent and Sodium Hypochlorite treatment)
boxes or
or through autoclaving or microwaving or hydroclaving and
ampules except
those
containers with
then sent for recycling
contaminated with cytotoxic wastes
blue colored
b)
Metallic body implants such as micro
marking.[11]
implants and
mini plates
Journal of Contemporary Orthodontics, Oct-Dec 2020;4(4):34-38
35
Nidhi Saini et al
lakh rupees, or with both.[8]
cost of handling and disposal. This first step is considered the
most crucial step. Efficient segregation ensures proper
bio-
Table II: Orthodontic waste disposal protocol[12]
Orthodontic Materials
Criteria for waste disposal
Impression Material (Discarded/Used)
Immerse in 1% Sodium hypochlorite solution11 and dispose as general
waste
Dental Casts (Discarded/Used)
Immerse in 1% Sodium hypochlorite solution11
and dispose as general waste
Wires, steel ligatures, burs, blade, needle after
White sharp container
being burnt
Metallic brackets, bands, buttons and other
White sharp container
attachments
Plastic and Ceramic brackets
Red Bag
Removable appliances with wire component like
White sharp container
expansion appliances (Used/broken not to be
worn by patient anymore)
Orthodontic mini-implant, vials, ampules
Blue container
Wax bite registration
Red Bag
E-chain, elastic ligatures, elastics
Red Bag
Surgical and examination gloves
Red Bag
Blood or saliva contaminated cotton, gauze,
Yellow Bag
linen, paper, sutures
Face masks, gowns11
Yellow Bag
Syringe after breaking hub in needle destroyer
Red Bag
Extracted teeth and tissues
Yellow Bag
Discarded and unused medicines9
Yellow Bag
Plastic suction tips, eye shield
Red Bag
Aligners
Red Bag
Primer bottle, composite syringe
Red Bag
medical waste management in orthodontic practice.
The
SCHEDULE[9]
biomedical waste should be collected in containers/ bags in
1. Schedule I: Biomedical wastes categories and their
such a way that it does not overflow.[4]
segregation, collection, treatment, processing and
disposal options. (Table 1)
Advantages of Segregation:
2. Schedule II: Standards for treatment and disposal of bio-
Prevents the mixture of medical waste like sharps with the
medical wastes
general municipal waste.
3. Schedule III: List of Prescribed Authorities and the
Stops illegal reuse of certain components of medical
Corresponding Duties
waste like used syringes, needles and other plastics.
4. Schedule IV
Aids in recycling certain components of medical waste like
a) Part A: label for bio-medical waste containers or
plastics.
bags. (Figure 1, 2)
Pre-Treatment:
b) Part B: label for transporting bio-medical waste bags
or containers. (Figure 3)
After segregation and collection, waste needs to be pre-treated
by the owner of the clinic as mentioned in table I.
Management of wastes in Orthodontic practice
Refer to Table II
Proper labelling of containers/ bags:
Segregation at source:
In accordance to the new rules clear labelling of the biohazard or
Segregation means the separation of different categories of
cytotoxic waste with help of symbol on containers and bags must
be done.
waste generated at source and thus minimizing the risks and
36
Storage
According to BMW management rules
2016, only non-
chlorinated plastic bags, gloves and blood bags should be used.
Once the above steps have been completed, then biomedical
The carry bags used in BMW are to be treated as per the Plastic
waste is stored in a proper place for transportation. Caution
Waste Management Rules,
2011. Before the healthcare
sign should be placed on the storage area.
workers and others involved in handling of BMW can start
their jobs they must be trained before and the training should be
repeated at least once every year. Immunization like hepatitis B
and tetanus should be provided for free to all healthcare
workers and those involved in handling of BMW for protection
against diseases. Major accidents caused such as blasts
occurring while handling BMW etc. and the remedial actions
taken must be reported to State Pollution Control Board.
Personnel safety devices
Heavy-duty rubber gloves, face masks, goggles, head cap,
Fig. 1 Cytotoxic label for bio-
Fig. 2 Biohazard label for bio-
aprons and boots etc. should be used to prevent contamination
medical containers or bags
medical waste container or bags
of worker’s cloth and skin by bio hazardous or infected waste.
CONCLUSION
Orthodontists should make themselves aware regarding the
proper biomedical waste management in order to reduce
the hazardous effect caused by BMW not only to
environment but to themselves, dental
Conflict of interest & source of funding
The author declares that there is no source of funding and there
is no conflict of interest among all authors.
Abbreviations used:
1.
BMW - Biomedical Waste
2.
HCF - Healthcare Facility
Fig. 3 Label for transporting bio-medical waste containers or bags.
3.
CBMWTF - Common Biomedical Waste Treatment
Transportation
Facility
Before transportation, the Container /bags containing BMW
REFERENCES
should be tied/ lidded and labels for each bag/container
1.
Government of India, Ministry of Environment and
should also be clearly placed. Covered wheel barrows or
Forests. Bio-Medical Waste
(Management and
trolleys should be used for transportation of waste. Manual
Handling) Rules. Gazette of India; 1998.
loading of waste should be avoided. Transportation is done
2.
Government of India, Ministry of Health and Family
in special vehicles to prevent direct contact of waste by the
Welfare. National Guidelines on BMW (Management
transportation worker, the scavengers and the public.[4]
and Handling) Rules. Government of India, Ministry of
Health and Family Welfare; 1998.
Treatment, Disposal and Processing
3.
Gordon JG, Denys GA. Infectious Wastes: Efficient and
Every healthcare facility/clinic generates BMW. It is thus
Effective Management. In: Block SS. Disinfection,
required that the establishment must set up waste treatment
sterilization, and preservation. 5th ed. Philadelphia, PA:
modalities such as autoclave and microwave system or make
Lippincott Williams & Wilkins; 2001.
sure that the requisite treatment of waste occurs at a
4.
Ahluwalia R, Garg H, Sharma K, Kaur P, etal. Quit
CBMWTF. In case a CBMWTF service is available within 75
looking left and right: be aware how to dispose
km, treatment and disposal facility must not be established by
biomedical waste in dental practice: a review. J Clin
any occupier at the healthcare facility.
Den Res Edu • Jul - Dec 2018; 9(16): 45-48.
Journal of Contemporary Orthodontics, Oct-Dec 2020;4(4):34-38
37
Nidhi Saini et al
5.
ASSOCHAM-Velocity study - Unearthing the Growth
Curve and Necessities of Bio Medical Waste
Management in India. The Associated Chambers of
Commerce and Industry of India March
6.
2018.
Available
at:
http://publication.assocham.tv/data/productfile/100-
Bio_Medical%20Report%202018_ Final%204.pdf.
7.
Krishnappa P, Sreekantaiah P, Hiremath SS, etal.
Quantification of Dental Health Care Waste Generated
among Private Dental Practices in Bengaluru City. J Int
Oral Health 2015;7(6):84-7.
8.
Sharma A, Sharma V, Sharma S, Singh P. Awareness of
biomedical waste management among health care
personnel in Jaipur, India. Oral Health Dent Manag
2013;12:32-40.
9.
Delhi Pollution Control Committee.
10.
Available
at:https://www.dpcc.delhigovt.nic.in/bio-
medical-waste.html
11.
Bio-Medical Waste Management Rules, 2016 Published
in the Gazette of India, Extraordinary, Part II, Section 3,
Sub-Section
(i), Government of India Ministry of
Environment, Forest and Climate Change. Notification;
New Delhi, the 28th March, 2016.
12.
Gautam V, Thapar R, Sharma M. Biomedical waste
management: Incineration vs. environmental safety.
Indian J Med Microbiol 2010;28: 191-2.
13.
Bio-Medical Waste Management (Amendment) Rules,
2018. Published in the Gazette of India, Extraordinary,
Part II, Section 3, Sub-Section (i), Government of India
Ministry of Environment, Forest and Climate Change.
Notification; New Delhi, the 16th March, 2018.
14. Mithun K, Ashith M V, Harshitha V, Pereira V A, etal.
Infection Control in Orthodontics: A Review. Ind J
Forensic Med & Toxicology, April-June 2018;12(2):10-15.
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