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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 2  |  Page : 136-140

Dental health-care waste management among dentists of Nellore City - A cross-sectional study


Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India

Date of Submission02-Aug-2018
Date of Acceptance22-Apr-2019
Date of Web Publication20-Jun-2019

Correspondence Address:
Dr. Swati Gurusamy Naidu
Department of Public Health Dentistry, Narayana Dental College and Hospital, Chintareddypalem, Nellore - 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_160_18

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  Abstract 


Background: Waste produced in the course of health-care activities carries a higher potential for infection and injury than any other type of waste. Hence, to avoid the hazards caused by hospital waste, the Government of India issued notification on bio-medical waste (BMW) (management and handling) Rules 1998 which was amended in 2016 under Environment (protection) Act. These new rules fill up the gaps in the old rules to regulate disposal of various categories of BMW. Aim: To assess the awareness and practices toward dental health-care waste management among dentists of Nellore city. Material and Methods: A cross sectional study in Nellore City was conducted among 204 private dental practitioners using a close ended questionnaire. The questionnaire was distributed in the dental clinics by the investigator and collected back the same or consecutive day. Data were analyzed using SPSS version 22 (IBM Corp, Armonk, NY, USA). Chi-square test was used, and P < 0.05 was considered statistically significant. Results: The study results showed that there was no statistically significant association between the responses by dentists on majority of the questions relating to BMW Management and Handling rules. 86.6% of clinicians and 78.1% of academicians responded that they were aware of the BMW rules. 87.8% and 84.4% of clinicians and academicians, respectively, were aware of different categories of waste, whereas 97.1% and 93.8%, respectively, reported that they knew about different color codings of BMW and these responses were not statistically significant (P = 0.05). Majority of the dentists (85.3%) were aware of the category of wastes, but not aware of the color coding followed for the same. Majority of the respondents did not segregate the waste generated in their working place, 85.8% used chair side bins for disposal. Conclusion: Though most of the dentists were aware of the BMW management rules, majority of them practiced inappropriate waste disposal techniques.

Keywords: Awareness, biomedical, dentist, knowledge, practices


How to cite this article:
Naidu SG, Reddy V C, Kumar R V, Sudhir K M, Srinivasulu G, Athuluru D. Dental health-care waste management among dentists of Nellore City - A cross-sectional study. J Indian Assoc Public Health Dent 2019;17:136-40

How to cite this URL:
Naidu SG, Reddy V C, Kumar R V, Sudhir K M, Srinivasulu G, Athuluru D. Dental health-care waste management among dentists of Nellore City - A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Jul 23];17:136-40. Available from: http://www.jiaphd.org/text.asp?2019/17/2/136/260866




  Introduction Top


Bio-medical waste (BMW) is defined as “any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps.”[1] As there is expansion of the health-care facilities in our country, the amount of BMW being generated is also increasing.[2] Dentistry is growing rapidly across the globe, and India is also participating actively in adopting new trends and methods in providing dental healthcare. There is a rapid increase in the number of dental clinics across the nation. With this, quality of dental health and patient care is enhanced manifolds. But, on the other side; it has contributed at large, in generating significant amount of dental health-care waste.[3] Dental care professionals are at high risk for cross-infection when treating patients. In addition, the majority of carriers of infectious diseases are not easily identified. Research has shown that infective hazards are present in dental practice because many infections can be transmitted by blood or saliva via direct or indirect contact, droplets, aerosols, or contaminated instrument and equipment.[4] To protect environment and community from the BMW hazards, the Ministry of Environment and Forest issued notification on BMW (management and handling) Rules 1998 which is now amended in 2016 under environment (protection) Act. So, it is the duty of the every occupier of an institution to take all steps to ensure that BMW is handled without any adverse effect to human and environment.[5] Dental health-care setups are found to generate both infectious and hazardous waste, so it is the time for us to get oriented, updated, and trained to manage health-care wastes scientifically.[6] Various studies [3],[5],[6] are conducted in different parts of India, but no study was conducted in Nellore city. With increasing number of dental clinics in Nellore city, public sensitization tends to become the consequence of improper waste disposal parctices. So, the present study was planned to assess the existing knowledge and practices of the dentists toward dental health-care waste management in Nellore city.


  Material and Methods Top


A descriptive cross-sectional study was conducted to assess the awareness and practices of dental health-care waste among dentists of Nellore city. The source of data was primary in nature, and it was obtained through a questionnaire survey. The study population included all the registered dentists of Nellore city. The study was conducted for 2 months from September 2017 to October 2017. All the dentists who agreed to participate in the study, who gave informed consent, and who were present during the period of survey were included in the study. Ethical approval for the study was obtained from the institutional ethics committee with IEC number: NDC/IECC/10-18/72. The questionnaire which was designed for this study was validated by checking content validity using content validity index with Davis criteria.[7] Expert judgment was used to determine content validity and based on their opinion, the questionnaire was modified. The questionnaire was distributed to ten dentists for reliability. The reliability results obtained by test–retest (Cronbach's alpha) by a pilot study were 0.816 which showed a high agreement.

A list of all the practicing dentists was obtained from local dental association and dental college. From a total of 245 dentists in the list, questionnaires were distributed to 204 dentists who were present during the period of survey. Specially designed questionnaire consisted of 20 close-ended questions divided into two sections. The first section of the questionnaire consisted of the questions related to respondents' age, sex, qualification, designation, and years of clinical experience. Respondents' name was not recorded in order to ensure anonymity. The second section consisted of questions related to the awareness and practices of dental care waste management. The dentists were approached personally by the investigator, and the purpose of the study was explained to them. The questionnaire was distributed to them and were assured of confidentiality of their responses and requested to give appropriate answers. The filled questionnaire was collected back the same or consecutive day. A second visit was made to all the clinics of private practitioners who were not available on the first visit to get the pro formas filled as on the first visit.

Statistical analysis

Results obtained were coded, and analysis was done using a software program IBM SPSS version 22 (IBM Corp, Armonk, NY, USA). Mean was calculated for the demographics. Chi-square test was used. P < 0.05 was considered significant.


  Results Top


Among a total of 204 respondents, 65.2% were males and the rest were females, 59.3% were Master of Dental Sciences graduates, 84.3% were clinicians, whereas 15.7% were clinicians and also academicians. Clinicians with a work experience of 1–5 years accounted for 52.9% [Table 1].
Table 1: Distribution of the study population according to sociodemographic characters

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There was no statistically significant association between the responses given by clinicians and academicians for most of the questions (P = 0.05). Nearly 85.3% of the dentists responded that they were aware of Biomedical Waste Management and Handling Rules 2016, 87.3% were aware of different categories of waste generated, and 96.6% aware of color codings for BMW. On further analysis, they were not able to respond correctly to the detailed questions regarding Biomedical Waste Management and Handling Rules. 50% of the dentists were unaware of the color coding for disposing off waste sharps, about 56% dentists were unaware of the category and color coding for disposal of expired medicines, and 58.8% were unaware of the category and color coding for disposal of items contaminated with blood and body fluids. It was good to know that about 80% of the dentists were aware of the regulation of safe transport of the BMW and 93.65 were aware of the biohazard symbol [Figure 1], [Figure 2] and [Table 2].
Figure 1: Awareness about bio-medical waste among dentists

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Figure 2: BMW rules among dentists

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Table 2: Awareness about biomedical waste among dentists according to their designations

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Majority of the respondents did not segregate the waste generated in their working place, 85.8% dentists used chair side bins for disposal of generated waste. When asked about the method of disposal of lead foil in X-ray films, 10.8% dentists responded that they still threw it in common bins. For disposal of scrap amalgam, 17.6% used common bins. 52.5% of the dentists dispose plaster casts in common bins and only 38.2% store orthodontic bands and wires separately in their clinics which otherwise can be given for recycling. It was good to know that 70% of the dentists disposed the used sharps after breaking the needles and only 10% of dentists directly discard into common bins [Table 3].
Table 3: Dental health care waste management practices among dentists

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  Discussion Top


Dentists have an ethical responsibility to the environment and themselves. Because of the nature of their profession, dentists and dental assistants should not forget that they are at risk for treating patients as well as handling waste in the clinics. SoHence the study was conducted to assess the awareness and practices toward dental health-care waste management among dentists of Nellore city. It was a cross-sectional study conducted by a means of self-administered close-ended questionnaire. The results of the study provided us with a valuable insight of the current practices followed by the dentists.

This study recognized improper disposal of dental waste among most of the dentists who participated. Though the policy is suggested that there is a need to establish appropriate means of dental waste disposal in dental clinics, this study found that the existence of legislation governing waste disposal was not sufficient to motivate practitioners to follow the guidelines. This could be due to lack of initiative by dental practitioners on acquiring new knowledge after training in dental school. In the current study, about half of the dentists were not aware of the proper categories and color codings of BMW although around 85% of the dentists said that they were aware of the BMW rules and regulations by the Government of India 2016, which was similar to studies conducted by Sood et al.[8] and Narang et al.[9] and contrast to the studies conducted by Sudhakar et al.[10] and Kishore et al.[11] where only 57.6% and 36% of dentists were aware, respectively. Only 44.6% and 44.1% of dentists, respectively, were aware that expired medicines should be considered as a cytotoxic waste and should be disposed in yellow container according to BMW rules amended in 2016. This shows that the dentists were not updated on the recent BMW rules 2016. Data of the present study showed that 85.8% of the dentists did not segregate the wastes generated in their clinics, which is similar to studies conducted by Kesavan et al.,[12] Sudhir et al.,[5] and Al-Khatib et al.,[13] in contrast to studies conducted by Narang et al.[9] and Sanjeev et al.[14] If the private clinics have a link up with BMW management company, waste generated in the clinics will be taken from the generating site to the disposal site for proper disposal according to the biomedical rules.

Developer solution does not contain silver, so it can be diluted and led in to sewer, but fixer solution, on the other hand, contains silver which increases the metal load in the sewer which is not allowed as per environment protection rules, so it should be stored separately and sold to buyer who will extract silver from it.[15] It was interesting to note from this study that 61.8% of dentists did not use fixer and developer solution in their clinics. 17.6% of the dentists dispose scrap amalgam into common bins, which is similar to a study conducted by Sudhir et al.[5] who reported the same. Storing of scrap amalgam in a fixer solution is the recommended method by the American Dental Association or it can be sent to a recycler who will retrieve the silver and use it for other purposes. As amalgam decomposes on heating, it should not be given for incineration. 52.5% and 46.1% of dentists used common bins for disposing off plaster casts and orthodontic wires, whereas these can be given for recycling. This waste should be considered as a recyclable waste. According to the Occupational Safety and Health Administration, orthodontic wires are considered as sharp wastes because the ends of these wires can penetrate the skin and their contamination with blood can reasonably be anticipated, so these wires should be considered as recyclable waste.[15]

The most commonly used hazardous waste in our dental practice includes sharp instruments such as needles and syringes. In sharps management, 65.5% dentists practiced breaking the needles before disposing it, 9% directly use common bins, and 22.9% used needle burner to destroy the needles which is the ideal method. This shows that there was a lack of practice of disinfecting the needles before breaking and disposing them.

Most of the practitioners were not aware of the existing medical waste management policy 2016; being dentists, it is the sole responsibility to get acquainted and follow all the enforced rules and regulations. It is clear that the knowledge regarding the BMW among dentists from the present study was good, but practices followed were not appropriate. The outcome of the survey necessitates the need to improvise the waste management techniques in all the private clinics by registering under BMW services. Widespread publicity of a few cases of inappropriate health-care waste management services might help to raise public and professional awareness of the possible consequences of improper procedures. There is a need for continuing dental education on dental office waste management practices to the dental practitioners.

Limitations

The sample of the present study included only dental practitioners but not all categories of health care professionals of Nellore city. Further studies should be recommended considering all cadres of health-care professionals covering whole Nellore district for a strict policy development.

Recommendations

There is a need for continuing dental education regarding amended biomedical rules 2016 for the dental practitioners.

Dentists should try to reduce the BMW generation in their clinics because lesser amount of BMW means a lesser burden on disposal work.

Cooperation between dental associations, government-related ministries, and authorities needs to be established, to enhance dental waste management practices.


  Conclusion Top


Although majority of the dentists claimed that they were aware of the BMW management rules, it did not correlate to their responses given and practices followed. This shows lack of sufficient knowledge on BMW management and a need to improvise the practices of the dentists according to the recommended guidelines.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bio-Medical Waste Management Rules, 2016. Published in the Gazette of India, Extraordinary, Part II, Section 3, Sub-Section. New Delhi: Government of India Ministry of Environment, Forest and Climate Change; 2016.  Back to cited text no. 1
    
2.
Anand P, Jain R, Dhyani A. Knowledge, attitude and practice of biomedical waste management among health care personnel in a teaching institution in Haryana, India. Int J Res Med Sci 2016;4:4246-50.  Back to cited text no. 2
    
3.
Bindra S, Mehrotra N, Chaudhry K, Nagpal K. A study on management of dental health care waste: Hyderabad experience. J Dent Med Sci 2015;14:98-102.  Back to cited text no. 3
    
4.
Singh BP, Khan SA, Agrawal N, Siddharth R, Kumar L. Current biomedical waste management practices and cross-infection control procedures of dentists in India. Int Dent J 2012;62:111-6.  Back to cited text no. 4
    
5.
Sudhir KM, Chandu GN, Prashant GM, Nagendra J, Shafiulla MD, Subba Reddy VV. Awareness and practices about dental health care waste management among dentists of Davanagere city, Karnataka. J Indian Assoc Public Health Dent 2006;8:44-50.  Back to cited text no. 5
    
6.
Singh RD, Jurel SK, Tripathi S, Agrawal KK, Kumari R. Mercury and other biomedical waste management practices among dental practitioners in India. Biomed Res Int 2014;(2014);1-6.  Back to cited text no. 6
    
7.
Davis LL. Instrument review: Getting the most from your panel of experts. Appl Nurs Res 1992;5:194-7.  Back to cited text no. 7
    
8.
Sood AG, Sood A. Dental perspective on biomedical waste and mercury management: A knowledge, attitude, and practice survey. Indian J Dent Res 2011;22:371-5.  Back to cited text no. 8
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9.
Narang RS, Manchanda A, Singh S, Verma N, Padda S. Awareness of biomedical waste management among dental professionals and auxiliary staff in Amritsar, India. Oral Health Dent Manag 2012;11:162-8.  Back to cited text no. 9
    
10.
Sudhakar V, Chandrashekar J. Dental health care waste disposal among private dental practices in Bangalore city, India. Int Dent J 2008;58:51-4.  Back to cited text no. 10
    
11.
Kishore J, Goel P, Sagar B, Joshi TK. Awareness about biomedical waste management and infection control among dentists of a teaching hospital in New Delhi, India. Indian J Dent Res 2000;11:157-61.  Back to cited text no. 11
    
12.
Kesavan R, Reddy VC, Chaly PE, Ingle NA. Awareness and practices of dental care waste management among dental practitioners in Chennai city-a cross sectional questionnaire study. J Indian Assoc Public Health Dent 2011;1:289-96.  Back to cited text no. 12
    
13.
Al-Khatib IA, Monou M, Mosleh SA, Al-Subu MM, Kassinos D. Dental solid and hazardous waste management and safety practices in developing countries: Nablus district, Palestine. Waste Manag Res 2010;28:436-44.  Back to cited text no. 13
    
14.
Sanjeev R, Kuruvilla S, Subramaniam R, Prashant PS, Gopalakrishnan M. Knowledge, attitude, and practices about biomedical waste management among dental healthcare personnel in dental colleges in Kothamangalam: A cross-sectional study. J Health Sci 2014;1:1-12.  Back to cited text no. 14
    
15.
Capoor MR, Bhowmik KT. Current perspectives on biomedical waste management: Rules, conventions and treatment technologies. Indian J Med Microbiol 2017;35:157-64.  Back to cited text no. 15
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