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waste disposal policy

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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).  We follow the guidance set out in HTM 01-05 “Decontamination in Primary Dental Care Practices” and HTM 07-01 “Safe Management of Healthcare Waste” (see pages 152-161 in particular).  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 and who collects them

The practice produces numerous different types of waste, all of which fall into one of two broad categories:

a) Hazardous Wastes – these include bagged or “infectious” clinical waste, sharps, dental amalgam, chemicals, refrigerators, computer monitors, fluorescent tubes, etc.  We no longer use dental amalgam and so we do not produce spent amalgam capsules but we do produce small amounts when, for example, old amalgam fillings are removed (this may be larger pieces of amalgam taken out of a tooth, fillings in extracted teeth or fine amalgam particles produced by the drill when removing the fillings and captured by the amalgam separator units attached to the suction systems).  We also no longer produce hazardous x-ray related wastes such as photo-chemicals (IE fixer and developer) because we have digital x-ray systems.

b) Non-hazardous Wastes – these include bagged hygiene wastes such as gloves, face-masks, paper towels, detergent wipes and other items from the surgeries that are not contaminated; out-of-date pharmaceuticals (non-cytotoxic and non-cytostatic); partially discharged LA cartridges; gypsum; precious metal waste (from old bridges and crowns); batteries and “Domestic” or “Municipal” waste (such as food packaging, empty coffee jars, disposable paper towels that haven’t been used in the surgeries, etc.)  We no longer produce waste x-ray films, wrappers and lead foil because we have a digital x-ray system.

Many of these waste “streams” 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 the different waste types produced so as to ensure correct disposal – it is important that anyone can recognise wastes that have been placed in the wrong container, for example.

Domestic or municipal waste is generally referred to as “mixed” waste by our waste disposal contractor (this now includes recyclable paper and cardboard) and is collected weekly.  This waste type is dealt with by Devon Contract Waste.

Hygiene waste and sharps are collected once a fortnight.  Other types of waste produced in the surgeries, such as bagged or “infectious” clinical waste, amalgam, gypsum, partially discharged LA cartridges, out of date pharmaceuticals, precious metal waste, etc., is collected only when we request the contractor to do so.  These waste types are dealt with by Peake (GB).

EA Registration for waste disposal contractors: Both our waste disposal contractors are licensed waste disposal operators.  We check their registration with the Environment Agency annually to ensure that it is still current.

the necessary paperwork

There is special paperwork related to waste collections:

When a contractor takes away non-hazardous waste we have to ensure that a transfer note is completed.  Our regular domestic waste collections, for example, can be covered by a single transfer note that covers a period of a whole year.

When hazardous waste is collected, we also need a consignment note.  A fresh consignment note is required every time a collection is made, though a single consignment note may list several different hazardous wastes being collected on a single visit.

It is OUR responsibility to either complete or check these documents to ensure that they are correct – NOT the responsibility of the waste contractor.

A laminated Waste Disposal Checklist (see document database – Equipment Testing & Maintenance – Documents – Waste) is kept at reception and MUST BE USED to check the documentation supplied by the contractor’s driver EVERY TIME waste is collected.  Particular attention needs to be paid to the EWC codes to ensure that they are correct.

We keep all our waste disposal documentation, including transfer notes and consignment notes, in a register in the office for a minimum of 3 years (strictly speaking, non-hazardous waste disposal records need only be kept for 2 years but it is easier to keep it all for the same length of time).  The register also contains quarterly returns from the waste contractors, “Duty of Care” contract documents, pre-acceptance audits, periodic waste audits, etc.

EA registration as a producer or hazardous waste: The practice produces nowhere near the 500kg of hazardous waste each year that would trigger the requirement to register as a hazardous waste producer with the Environment Agency (we have checked our hazardous waste production history with Peake and they have confirmed we produce only about a third of this amount).  Accordingly, we do not need to be registered under the Hazardous Waste Regulations.

waste containers and waste collections

All containers used for hazardous waste must be labelled with the name of the practice and other details such as the person who assembled the container (where applicable) and date of disposal.  The majority of hazardous waste is produced in the surgery and so it is normally the responsibility of the clinical team to ensure that these labels are completed.

It is the responsibility of Joanne Giddy’s nurse to order waste sacks and containers for use in the surgeries.  She must also request collections of bagged clinical waste, amalgam, gypsum, partially discharged LA cartridges, out-of-date pharmaceuticals and precious metal waste.  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, hygiene waste sacks, sharps containers and other waste containers are ordered from Peake (GB).

domestic waste (EWC 20 03 01)

Bins in the staff room, office, reception/waiting area and washrooms (ie anywhere except the surgeries) can only be used for the disposal of domestic waste and must NEVER be used for the disposal of sharps, clinical or precious metal wastes.  Every time they put something in the bin, team members are expected to check to ensure that these bins do not contain inappropriate waste types.  If they do, this must be reported immediately to the Practice Director or the Clinical Director who will make sure that the waste is transferred to the correct disposal stream.

Domestic waste is placed into ordinary black bin liners and disposed of in the blue “wheelie bin” outside the practice.  White bin liners may be used inside the bins but these must be placed into a black bag before disposal in the wheelie bin.

We no longer segregate cardboard and paper waste for recycling.  We now have a single “mixed” wheelie bin outside the practice for all domestic waste.  This waste is sorted by the waste disposal contractor and all recyclable items are recovered.

Rather than try to remember all of the things that might be disposed of as “domestic waste”, you should instead remember all of those things that are NOT domestic waste and require disposal in some other manner (see “the different kinds of waste and who collects them”, above).  More detailed instructions for each of the other types of waste are given below.

paper and cardboard (EWC 20 01 01)

We no longer need to separate paper and cardboard waste for recycling – it is disposed of with the domestic or municipal waste (see above).

hygiene or “offensive” waste (EWC 18 01 04)

Most waste produced in the surgeries (by volume) is categorised as hygeine waste (sometimes also referred to as “offensive” waste).  This includes items like:

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)
k) triple spray tips
l) large bore suction tips

PROVIDED that they are not contaminated with blood and have not been produced in the course of treating a patient who is known to be infectious (for example, a person who has HIV or Hepatitis B).

If these items are contaminated with blood or have been produced in the course of treating a patient who is known to be infectious, they must be disposed of as “infectious” clinical waste – see below.

Hygiene waste is initially stored in the surgery “kick-bins”.  The bins are opened and closed with the knee.  There is no need to touch them with your hands (refer to infection control policy).  These bins are lined with white swing-bin liners which are transferred into “Tiger” bags (yellow sacks with a black stripe or stripes) when full.  “Tiger” bags 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 bag is tied shut with string or Sellotape rather than knotting it.  The “Tiger” bags are stored in a dedicated, locked clinical waste bin pending collection by our licensed waste contractor (Peake GB).  These “Tiger” bags MUST NOT be stored together with the orange infectious clinical waste sacks, which have their own locked waste bin.

All team members must take great care when handling hygiene waste. If any is spilled inside or outside the building, it must be cleared away IMMEDIATELY and the area disinfected in accordance with the spillages procedure in the infection control policy.  Spillages must also be reported to the Clincial Director, Joanne Giddy, or the Practice Director, Neil Phillips.

Some kinds of waste produced in the surgery MUST NOT be treated as hygiene waste or even infectious clinical waste: eg sharps, amalgam, uncontaminated gypsum, partially discharged LA cartridges, out-of-date pharmaceuticals and precious metal waste.  See below for information on these.

bagged or “infectious” clinical waste (EWC 18 01 03)

“Infectious” clinical waste is anything produced in the surgeries that might be contaminated with blood, or which has been used in the treatment of an infectious patient (for example, a person with HIV or Hepatitis B) and therefore may pose a risk to health.  It can include anything on the list a) – l) above (see hygiene waste) but may also include things like gypsum waste (ie dental casts, known as working models or study models) contaminated with blood.

As in the case of hygiene waste, “infectious” clinical waste does not include sharps, amalgam, uncontaminated gypsum, partially discharged LA cartridges, out-of-date pharmaceuticals and precious metal waste.  See below for more information on these.

“Infectious” clinical waste is stored in the “nurse’s bin” in each surgery (this is the kick-bin used by the nurse when cleaning the surgery as opposed to the kick-bin beneath the hand-wash basin).  The bins are opened and closed with the knee.  There is no need to touch them with your hands (refer to infection control policy).  There is a small second bin inside each nurse’s bin – behind the hygiene waste bin.  These bins are lined with small white pedal-bin liners which are transferred into orange bags when full.  Orange bags 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 bag is tied shut with string or Sellotape rather than knotting it.  The orange bags are stored in a dedicated, locked clinical waste bin pending collection by our licensed waste contractor (Peake GB).  These orange infectious clinical waste bags MUST NOT be stored together with the yellow and black “Tiger” bags, which have their own locked waste bin.

All team members must take great care when handling “infectious” clinical waste. If any is spilled inside or outside the building, it must be cleared away IMMEDIATELY and the area disinfected in accordance with the spillages procedure in the infection control policy.  Spillages must also be reported to the Clincial Director, Joanne Giddy, or the Practice Director, Neil Phillips.

sharps (EWC 18 01 03)

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 yellow lid, are kept next to the nurse’s hygeine 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 Joanne Giddy or Neil 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 HYGIENE WASTE BIN NOR AN “INFECTIOUS” 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. 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 infection control policy. For guidance on dealing with inoculation injuries, refer to “procedure for inoculation injuries” in the infection control policy.

lead foil (no longer produced)

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 (no longer produced)

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

gypsum (EWC 18 01 04)

Dental casts/study models contain Gypsum.  This must be disposed of in its own separate container, which is stored in surgery 1.  The only exception to this rule is when the cast/model becomes contaminated with blood from any patient, or with saliva from and infectious patient.  In this case, the gypsum must be treated as “infectious” clinical waste (see above).

batteries (EWC 20 01 33)

We now produce far fewer waste batteries since we have switched all electronic devices, where possible, to rechargeable types.  Those batteries that we do need to discard must be placed in the special container kept in reception for this purpose.

amalgam & amalgam capsules (EWC 18 01 10)

The practice ceased using amalgam for dental restorations with effect from November 2010. Accordingly, we no longer produce amalgam capsule waste.

However, we still produce waste amalgam when removing existing amalgam fillings or extracting teeth that have been filled using amalgam, so we still have arrangements for disposal of amalgam waste.

Amalgam is NEVER placed into the hygiene waste bins nor the “infectious” clinical waste bins.  Dental amalgam contains mercury, a toxic heavy metal element that must be disposed of carefully.  It must be stored in the special container provided.

Waste amalgam is stored in its own plastic container.  This is kept in surgery 1.  The container is 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 Joanne Giddy or Neil Phillips). 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 container.

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 Joanne Giddy or Neil Phillips).  The amalgam waste is periodically removed for disposal in the same manner as our other amalgam waste.

partially discharged local anaesthetic (LA) cartridges (EWC 18 01 09)

Partially discharged LA cartridges must be stored in their own 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.

There is a container for partially discharged LA cartridges in surgery 1.  It will be yellow and 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 and/or out of date pharmaceuticals (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 Joanne Giddy or Neil Phillips).

out of date pharmaceutical products (EWC 18 01 09)

Out of date pharmaceuticals must not be disposed of as hygiene waste or “infectious” clinical waste.  They must be placed in the same container 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.

IMPORTANT NOTE: The Midazolam in the emergency drugs kit is a Schedule 3 controlled drug under the Misuse of Drugs Regulations 2001 and so must be denatured prior to being placed in the out of date pharmaceuticals container.  This means that the pot must be opened and the contents poured onto cotton wool.  Then the cotton wool, the pot and the lid should be placed separately into the container.  This is to ensure that the drug cannot be used if it should fall into the wrong hands.

precious metals (EWC 20 01 40)

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 a container in surgery 1.  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 Joanne Giddy or Neil Phillips).

 

Web version 8: 4.8.2016
Previous web versions published 22.11.2006; 30.10.2008; 28.2.2011; 26.1.2012; 18.12.2012; 13.3.2013 (reviewed 20.6.2014); 28.11.2014 (reviewed 5.6.2015)

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