Healthcare waste in the dental practice is helpfully segmented into colour coded waste streams, which is meant to make the identification of the correct waste stream for various products an easy task. Yet there can often be a sense of the lines blurring.
What waste stream do these used gloves go in? I’m throwing out expired PPE, how should it be disposed of? What is the best way to abide by the practice’s waste disposal responsibilities whilst maintaining a green approach?
A big question that plagues many is: when does waste become infectious?
Luckily, disposal strategies do not have to be overly complex, and questions such as these can have clear answers.
Consulting the guidelines
The dental practice must look to a variety of sources for their waste management guidance. Keeping up with each is essential as part of your legislative responsibilities, and can help to demystify some waste management grey areas.
The Care Quality Commission expands upon The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – which itself states that all premises and equipment used by the service provider must be clean1 – only by saying that domestic, clinical, and hazardous waste must be managed in line with current legislation and guidance. If this is unmet, they cannot prosecute but do have the power to take regulatory action.2
They refer all dental professionals to the Healthcare Technical Memorandum (HTM) 07-01: Safe and Sustainable Management of Healthcare Waste as a best practice framework for healthcare waste management.3 The document itself recognises some of the previous confusion surrounding infectious waste: it notes that key changes have been made to avoid offensive waste from being incorrectly classified as infectious, and in turn improve the effectiveness of waste management systems.4
Luckily, this makes it the document to turn to when needing clarification on infectious waste.
Drawing up definitions
Initially, the HTM 07-01 directs clinicians elsewhere once again, citing Annex III of Directive 2008/98/EC ‘Waste Framework Directive’ for the infectious definition.4 Here, infectious is used to describe ‘substances and preparations containing viable microorganisms or their toxins which are known or reliably believed to cause disease’,5 and so the waste we are considering would be contaminated by such microorganisms.
It begs the question, should every potential piece of infectious waste be tested before it enters a waste stream? The answer is a definite no, and HTM 07-01 reinforces this. It is unfeasible, and there are ways to manage dental waste with your own clinical discretion.
Offensive waste is considered as such due to an unpleasant odour and appearance, but may not always appear as such – take single-use PPE for example.4 It will become infectious when it comes into contact with a patient who is requiring or currently receiving treatment for an infection or is carrying a transmissible disease. If the patient has a history of known infection, like a bloodborne virus or C. difficile, they may also lead to infectious waste. If the waste item is a culture, stock, or sample of infectious agents from laboratory work or has been in contact with such, it is also classified as infectious.4
An item can still be designated as purely offensive waste if it has been contaminated by a non-infectious patient’s bodily fluids. Healthcare-specific items would include single-use instruments like a tongue depressor and non-infectious PPE.4 When there is no good reason to believe the item is hazardous or infectious, it should simply be placed in the offensive waste stream.
Greater impacts
Ensuring every member of the dental practice is aware of details such as this is essential for several reasons. Not only are dental professionals held to these standards by regulation, but the appropriate actions can also help the world around us.
The NHS clinical waste strategy, published in March 2023, is key to HTM 07-01. By following the guidance, the strategy aims to put the NHS on its way to meeting its net zero ambitions by 2040.6
Central to all of this is maintaining a 20-20-60 waste split, whereby 20% is sent to incineration (yellow bag), 20% is simply infectious and therefore can be treated before disposal (orange bag), and 60% is offensive waste (yellow and black bag).6
Ensuring your practice can manage each waste stream is essential. Initial Medical provides practices with a range of clinical waste solutions, each colour coded for clear disposal of waste items. This includes our new sustainable Griff Pac rigid containers. These ultra-lightweight fold flat clinical waste containers are made from corrugated polypropylene and are resistant to liquid contamination. They are suitable for the disposal of a wide range of waste including soft waste, aspirator tips, cannulas, and suction tubing. Initial Medical can also provide practices with simple-to-understand colour code posters, to help every member of the team quickly identify the requirements for each waste stream.
Waste management doesn’t have to be unclear and inefficient. With the help of a waste management service, and by referring to the appropriate legislation, differentiating between infectious and offensive waste is easier in everyday workflows.
References:
- The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. (Online) Available at: https://www.legislation.gov.uk/uksi/2014/2936/regulation/15/made [Accessed February 2024]
- Care Quality Commission, (2023). Regulation 15: Premises and equipment. (Online) Available at: https://www.cqc.org.uk/guidance-providers/regulations/regulation-15-premises-equipment [Accessed February 2024]
- Care Quality Commission, (2023). GP mythbuster 99: Infection prevention and control in General Practice. (Online) Available at: https://www.cqc.org.uk/guidance-providers/gps/gp-mythbusters/gp-mythbuster-99-infection-prevention-control-general-practice [Accessed February 2024]
- NHS England, (2022). Health Technical Memorandum 07-01: Safe and sustainable management of healthcare waste. (Online) Available at: https://www.england.nhs.uk/wp-content/uploads/2021/05/B2159iii-health-technical-memorandum-07-01.pdf [Accessed February 2024]
- Directive 2008/98/EC of the European Parliament and of the Council of 19 November 2008 on waste and repealing certain Directives. (Online) Available at: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32008L0098 [Accessed February 2024]
- NHS, (2024). NHS clinical waste strategy. (Online) Available at: https://www.england.nhs.uk/estates/nhs-clinical-waste-strategy/ [Accessed February 2024]