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PubMed1997

Environmental issues in dentistry--mercury. FDI Commission.

One of the consequences of placing amalgam restorations is that mercury is required for the trituration process. In turn, this raises the issue of the possible environmental impact of mercury. This report considers ways in which any impact can be modified and reduced by careful attention to mercury usage and hygiene in the dental practice, the use of filters and separators in waste water pipes and the appropriate disposal of waste contaminated with amalgam. The total amount of mercury discharged into the environment varies considerably in different parts of the world due to both natural and human activities. The extent to which dentistry adds to this total also varies according to local circumstances and requirements. Recommendations are given for further development of ways to reduce mercury discharge and for further research into the environmental impact of the metal.

Dental Amalgam↗

PubMed2001

Impact of introduction of sharps containers and of education programmes on the pattern of needle stick injuries in a tertiary care centre in India.

Documentation of needlestick injuries was started in the Christian Medical College Hospital, Vellore in 1993. In 1995 large sharps containers were introduced, accompanied by an intensive education programme. Details of documented injuries from 1993 to 1999 were analysed using the Epi-Info software. A total of 347 injuries occurred, mainly due to improper disposal of needles, re-capping and carelessness during use. The percentage of injuries attributed to disposal fell from 69.2% in 1995 to 38.5% in 1996 (after the education programme). A further decrease was noted after the additional introduction of small sharps containers. In 1995, 73% of injuries involved housekeeping staff, this fell to 12% in 1998. Relatively simple interventions decreased the numbers of injuries, and we recommend that all healthcare institutions should have a system of documenting needlestick injuries, and take measures to decrease their incidence.

Academic Medical Centers↗

PubMed2000

Minimization and management of wastes from biomedical research.

Several committees were established by the National Association of Physicians for the Environment to investigate and report on various topics at the National Leadership Conference on Biomedical Research and the Environment held at the 1--2 November 1999 at the National Institutes of Health in Bethesda, Maryland. This is the report of the Committee on Minimization and Management of Wastes from Biomedical Research. Biomedical research facilities contribute a small fraction of the total amount of wastes generated in the United States, and the rate of generation appears to be decreasing. Significant reductions in generation of hazardous, radioactive, and mixed wastes have recently been reported, even at facilities with rapidly expanding research programs. Changes in the focus of research, improvements in laboratory techniques, and greater emphasis on waste minimization (volume and toxicity reduction) explain the declining trend in generation. The potential for uncontrolled releases of wastes from biomedical research facilities and adverse impacts on the general environment from these wastes appears to be low. Wastes are subject to numerous regulatory requirements and are contained and managed in a manner protective of the environment. Most biohazardous agents, chemicals, and radionuclides that find significant use in research are not likely to be persistent, bioaccumulative, or toxic if they are released. Today, the primary motivations for the ongoing efforts by facilities to improve minimization and management of wastes are regulatory compliance and avoidance of the high disposal costs and liabilities associated with generation of regulated wastes. The committee concluded that there was no evidence suggesting that the anticipated increases in biomedical research will significantly increase generation of hazardous wastes or have adverse impacts on the general environment. This conclusion assumes the positive, countervailing trends of enhanced pollution prevention efforts by facilities and reductions in waste generation resulting from improvements in research methods will continue.

Biomedical Technology↗

PubMed2003

Evaluation of a safety resheathable winged steel needle for prevention of percutaneous injuries associated with intravascular-access procedures among healthcare workers.

OBJECTIVE: To compare the percutaneous injury rate associated with a standard versus a safety resheathable winged steel (butterfly) needle. DESIGN: Before-after trial of winged steel needle injuries during a 33-month period (19-month baseline, 3-month training, and 11-month study intervention), followed by a 31-month poststudy period. SETTING: A 1,190-bed acute care referral hospital with inpatient and outpatient services in New York City. PARTICIPANTS: All healthcare workers performing intravascular-access procedures with winged steel needles. INTERVENTION: Safety resheathable winged steel needle. RESULTS: The injury rate associated with winged steel needles declined from 13.41 to 6.41 per 100,000 (relative risk [RR], 0.48; 95% confidence interval [CI95], 0.31 to 0.73) following implementation of the safety device. Injuries occurring during or after disposal were reduced most substantially (RR, 0.15; CI95, 0.06 to 0.43). Safety winged steel needle injuries occurred most often before activation of the safety mechanism was appropriate (39%); 32% were due to the user choosing not to activate the device, 21% occurred during activation, and 4% were due to improper activation. Preference for the safety winged steel needle over the standard device was 63%. The safety feature was activated in 83% of the samples examined during audits of disposal containers. Following completion of the study, the safety winged steel needle injury rate (7.29 per 100,000) did not differ significantly from the winged steel needle injury rate during the study period. CONCLUSION: Implementation of a safety resheathable winged steel needle substantially reduced injuries among healthcare workers performing vascular-access procedures. The residual risk of injury associated with this device can be reduced further with increased compliance with proper activation procedures.

Blood-Borne Pathogens↗

PubMed1996

Dental clinics--a burden to environment?

To estimate environmental burden of mercury from dental clinics, a survey was conducted in 1993 at dental clinics in northern part of Sweden. Factors regarding amalgam separators, maintenance and disposal of collected sludge, age of clinics, cleaning of waste pipes, and sorting and handling of amalgam contaminated products were investigated. The result showed that many were not familiar with maintenance of the amalgam separator. A majority, 68%, were working in clinics older than 10 years, but only 9% reported that waste pipes had been cleaned or changed. Classification of amalgam contaminated products as high-risk and low-risk waste differed a lot, as well as handling of waste products. The result shows that there is need for more information and attention to all individuals working in Dental Care on how to reduce environmental burden of mercury from dental clinics.

Adult↗

PubMed2001

Occupational hygiene practices of dentists in southern Thailand.

OBJECTIVES: The aims of this study were to investigate the prevalence and nature of infection control, radiation control and handling of mercury, reported by dentists in southern Thailand. METHOD: A cross-sectional study with self-report questionnaire to all 220 dentists working in 14 provinces in southern Thailand in 1997. RESULTS: 178 dentists (80.9%) aged 22-54 years responded. All reported wearing personal protective measures, at least sometimes and using high level disinfection (formerly sterilisation) procedures for handpieces. Most (93.8%) reported changing sterilised handpieces for each patient. The most commonly reported method of high level disinfection was alcohol (37.1%). Just over two-thirds (68.0%) reported having HBV vaccination. Most (94.3%) reportedly took precautions when radiographs were taken and (89.9%) reported protecting their eyes with a UV/blue light shield or filter while using these units. About half of dentists (51.7%) reported storing excess amalgam under water compared with 20.1% that they stored it in a closed box. 77.7% reported using sealed mercury amalgam capsule systems, at least sometimes. Nearly half (47.1%) reported disposing of used capsules in the bin. CONCLUSIONS: The present study has indicated that occupational hygiene practices of dentists in southern Thailand are generally consistent with published guidelines for infection control and also with other populations of dentists studied in the areas of infection control and radiation protection. Further continuing education and investigation of appropriate interventions to promote good occupational hygiene standards may also be needed.

Adult↗

PubMed1994

Disposing of hazardous waste. An update on waste management studies.

Waste management in the dental office is not a limited issue involving only dentists from the Region of Hamilton-Wentworth. While the ODA has had the opportunity to work with the Hamilton Academy of Dentistry and has the support of this society for a two-phased project, the Metro Toronto component societies will be joining the existing MOEE/Hamilton study. The MOEE in Halton-Peel has informed us that they will be conducting a similar survey and study. The committee would like to thank the Executive of the Hamilton Academy of Dentistry who have provided needed follow-up on this project. We look forward to the cooperation of individual dentists in all communities involved in this environmental study. Dentists are encouraged to complete the survey and to consider volunteering to take part in the in-office sample study. If you have any questions, we invite you to contact members of the Health Care Committee or the staff in the Department of Professional Affairs.

Dental Waste↗

PubMed2005

Variations in hospital waste quantities and generation rates.

The relationship between public health and improper collection, handling, and disposal of solid wastes in general, and hospital wastes in particular, is quite clear. Hazardous and nonhazardous wastes generated from different divisions of two of the largest public hospitals (capacity of approximately 400 beds each) in Kuwait were quantified and generation rates were determined. The generation rates were related to some important factors such as the number of patients, number of beds, and the type of activity conducted in different sections of the hospitals. The relationship between the waste generation rate and the number of patients was more applicable than that expressed in terms of the number of beds. The rates observed were in the range of 4.89 to 5.4 kg/patient/day, which corresponds to 3.65 to 3.97 kg/bed/day, respectively. These generation rates were comparable with those reported in the literature for similar hospitals. Minimal waste quantities were collected in the weekends. The study indicated that the hospitals surveyed provide some segregation of hazardous and nonhazardous wastes. Hazardous wastes contributed about 53% of the total quantity of wastes generated at the hospitals.

Data Collection↗

PubMed2005

[Disposal of insulin syringes by diabetic patients. Report of 100 patients].

Elimination of syringes and needles is regulated in hospitals. However, the regulations remain unknown of diabetic patients who do not eliminate correctly their syringes of insulin. We propose to analyze the present situation concerning the management of used syringes of insulin by diabetic patients. This study was conducted in a clinic for diabetics and it involved 100 diabetic patients treated with insulin. The results of this study shaved an insufficiency in the management of syringes of insulin by diabetic patients. Thus, education and a conscionsness-raising of diabetic patients on management and correct use of syringes are necessary.

Adolescent↗

PubMed1994

The epidemiology of needlestick and sharp instrument accidents in a Nigerian hospital.

OBJECTIVES: To characterize the epidemiology of percutaneous injuries of healthcare workers (HCWs) in Ile-Ife, Nigeria. DESIGN: A cross-sectional survey of a random sample of HCWs regarding details of needlestick and sharp instrument injuries within the previous year. SETTING: University hospital and clinics in Ile-Ife, Nigeria. PARTICIPANTS: Hospital personnel with potential occupational exposure to patients' blood. RESULTS: Needlestick accidents during the previous year were reported by 27% of 474 HCWs, including 100% of dentists, 81% of surgeons, 32% of nonsurgical physicians, and 31% of nursing staff. The rate of needlestick injuries was 0.6 per person-year overall: 2.3 for dentists, 2.3 for surgeons, 0.4 for nonsurgical physicians, and 0.6 for nursing staff. Circumstances associated with needlestick injuries included unexpected patient movement in 29%, handling or disposal of used needles in 23%, needle recapping in 18%, accidental stick by a colleague in 18%, and needle disassembly in 10%. Sharp instrument injuries were reported by 15% of HCWs and most commonly involved broken glass patient specimen containers (39%). Almost all HCWs were aware of the potential risk of HIV transmission through percutaneous injuries, and 91% considered themselves very concerned about their occupational risk of HIV acquisition. CONCLUSIONS: The high frequency of percutaneous exposure to blood among HCWs in this Nigerian hospital potentially could be reduced by simple interventions at modest cost.

Accidents, Occupational↗

PubMedDate not supplied

Radioguided surgery of breast cancer: radiation protection survey.

The aim of this study was to estimate the radioactive risk for surgical staff performing radioguided sentinel lymph node (SN) biopsy and to calculate the contamination level in the operating room for assessment of the possible need for specific radiation protection procedures. We studied 20 patients who were selected for quadrantectomy and SN biopsy. The day before surgery a volume of 0.15 mL of 99mTc-nanocoll was injected: the activity was 3.11 +/- 0.85 MBq in group A (15 pts) and 11.6 +/- 0.6 MBq in group B (5 pts). External radiation to staff was evaluated by measuring the exposure rate in air one hour after radiopharmaceutical administration. The air KERMA rate during surgery was estimated considering the physical decay of 99mTc. Contamination of disposable materials and surgical instruments in the operating room was measured using a contamination monitor, whereas the residual activity in the SN and the injection site was measured with a gamma probe. The exposure rate at 20 cm from the injection site was 0.75 microSv/h when the most radioactive patients (group B) were treated. Contamination in the operating room proved to be negligible. Considering the number of radioguided treatments carried out by a surgeon in one year, an equivalent effective dose of 0.075 mSv was estimated; the recommended dose limit according to the relevant Italian law, DL 230/95, is 1 mSv/yr. Surgical staff therefore do not require a classification of "exposed workers" and there is no need to supply the operating room with special containers for radioactive waste.

Breast Neoplasms↗

PubMed2001

What do pharmacists think about New York state's new nonprescription syringe sale program? Results of a survey.

Access to sterile syringes can prevent transmission of blood-borne diseases such as human immunodeficiency virus (HIV) and hepatitis B and C. We conducted survey of attitudes of pharmacists to aid in development of the Expanded Syringe Access Demonstration Program (ESAP) in New York State. ESAP is an HIV prevention initiative that authorizes nonprescription sale of hypodermic needles and syringes by registered pharmacies in New York State beginning January 1, 2001. As part of planning for program implementation, the New York State Department of Health (NYSDOH), in collaboration with the New York State Education Department, conducted mailed survey of all 4, 392 licensed pharmacies in New York State during the summer of 2000. Some surveys (171) were returned as undeliverable. Of the 4,221 eligible respondents, 874 (20.7%) completed surveys were received, of which 574 (65.7%) indicated that their pharmacy would likely participate in ESAP. An additional 11.0% were not sure. Only 139 (15.9%) indicated that they would definitely not participate; 7.4% left this question blank. There were 608 responses to questions on safe disposal practices. Of these, 315 (51.8%) respondents indicated that their pharmacy sold sharps containers, and an additional 29 made them available at no cost. Only 133 (21.9%) respondents to this question did not offer sharps containers and were not interested in doing so. In all, 54 responses indicated that they accepted used hypodermic needles and syringes for disposal. Some (170, 28%) that did not accept sharps for disposal were interested in doing so. More than half (382, 63.0%) did not wish to do so. NYSDOH considered respondent suggestions and minimized ESAP requirements. By March 31, 2001, only 3 months after ESAP became effective, more than half of all licensed pharmacies in New York State were registered for ESAP. Survey results provided useful information to NYSDOH and good indication of likelihood of registration. The high level of pharmacy participation in ESAP may be reflective of NYSDOH attention to issues raised by pharmacists, as well as the direct effects of outreach to pharmacy chains regarding ESAP.

Attitude of Health Personnel↗

PubMed1993

[What efforts are being made by dentists in the Flemish region for the limiting of amalgam rejection? A study conducted on a representative sample of 373 Flemish dentists on the subject of amalgam waste: extent of the problem, waste management and foreseeable solutions].

The great Amalgam debate is also taking place in Flanders (Belgium). Mercury amalgam has been used for dental fillings since the last century. Over that time, questions have occasionally been raised with regard to its safety (mercury vapour given off by the amalgam fillings and the possible dangers that these could cause to the patient and the dentist) and with regard to the ecological impact of amalgam waste. Some materials used to treat dental patients endanger the environment. The most important polluting materials are the heavy metals, in particular mercury. This study investigated the answers to the following research questions: What is the total volume of amalgam that is used in Flemish dentistry and what part ended up in the household waste? How do Flemish dentists manage (store and dispose of) their dental amalgam waste? Are Flemish dentists using any alternatives (amalgam separators or alternative materials for dental fillings) for amalgam? A randomly selected group of 500 dentists working in the Flemish part of Belgium was invited to answer a mail questionnaire. A total of 373 dentists responded (response rate 74.6%), providing a representative sample. Of the 5000 kg amalgam being used in one year in Flemish dentistry, about 1.200 kg is discharged either into the sewage or into the household waste. Furthermore, a supplementary 1.900 kg amalgam (extracted teeth with amalgam fillings or bored out amalgam fillings) is also being discharged either into the sewage or into the household waste. Although dental amalgam is the restorative material most used in Flanders, composite materials are becoming more widely used. Only 5% of the respondents were using an amalgam separator.

Attitude of Health Personnel↗

PubMed1994

Compliance with universal precautions and needle handling and disposal practices among emergency department staff at two community hospitals.

BACKGROUND: To describe rates of needle disposal and barrier use within the emergency departments at two privately owned community hospitals in two suburbs of Minneapolis, a study was conducted. This study consisted of direct observation of a cohort of emergency department personnel providing patient care followed by a self-administered survey of the same personnel. METHODS: From June through August 1990, seven specially trained registered nurses observed emergency department personnel for a total of 400 hours. The observers documented the appropriate rates of use of gowns, goggles, masks, and gloves. Observers also noted methods of needle disposal and frequency of needle recapping. After observation, surveys that included items requesting estimates of rates of use for each barrier, as well as estimates of the rates and methods of needle recapping and disposal, were distributed. For each observed and corresponding self-reported behavior, 95% confidence intervals were calculated and compared. RESULTS: A total of 1,822 procedures were recorded. Gloves were observed to be used when appropriate 67.2% of the time, followed by goggles (50.7%), masks (16.0%), and gowns (15.3%). Self-reported barrier rates were slightly higher in all cases except for goggle use. About one third (34.4%) of the needles were recapped; 78.1% of these were recapped two-handed. CONCLUSIONS: Previous studies have documented low universal precautions compliance rates at urban teaching hospitals. Our data indicate less than optimal levels of compliance also at community hospitals, and show that personnel are less than fully aware of their own noncompliance.

Emergency Service, Hospital↗

PubMedDate not supplied

The management of sharps in the emergency department: is it safe?

In this study, we observed the management of sharps by health care workers including physicians, nurses, technicians, and students in the Emergency Department of the University of California-San Diego Medical Center. Twenty-eight percent of 418 observed sharp utilizations were managed in such a way that excess risk was conferred to the user, another person, or both. Twenty-seven percent conferred excess risk to the user and 12% to another person. Twenty percent of 322 recappable needles were recapped using a two-handed technique; 64% were disposed of uncapped. Four sharps (1%) were inadvertently thrown in the trash. Of the 418 observed sharp utilizations, none resulted in a puncture wound, although the four that were thrown in the trash represent a very high risk of injury to others. Physicians were observed handling the highest percentage of sharps in manners associated with excess risk while technicians and students managed sharps with the least risk. Among sharps used on patients who were IV drug abusers with unknown HIV status, 29% (n = 28) were handled with excess risk to the user, another person, or both. Of 24 sharps used on known HIV-infected patients, there were no practices observed that subjected either the user or another person to excess risk.

California↗

PubMed2001

Drugs in the environment: emission of drugs, diagnostic aids and disinfectants into wastewater by hospitals in relation to other sources--a review.

After administration, pharmaceuticals are excreted by the patients into wastewater. Unused medications are sometimes disposed of in drains. The drugs enter the aquatic environment and eventually reach drinking water if they are not biodegraded or eliminated during sewage treatment. Additionally, antibiotics and disinfectants are supposed to disturb the wastewater treatment process and the microbial ecology in surface waters. Furthermore, resistant bacteria may be selected in the aeration tanks of STPs by the antibiotic substances present. Recently, pharmaceuticals have been detected in surface water, ground water and drinking water. However, only little is known about the significance of emissions from households and hospitals. A brief summary of input by different sources, occurrence, and elimination of different pharmaceutical groups such as antibiotics, anti-tumour drugs, anaesthetics and contrast media as well as AOX resulting from hospital effluent input into sewage water and surface water will be presented.

Anesthetics↗

PubMed2002

Afterbirths in the afterlife: cultural meaning of placental disposal in a Hmong American community.

Interviews were conducted with 94 Hmong Americans in California's Central Valley to explore attitudes regarding placental disposition and the cultural values that affect those attitudes. Research indicated a persistence of the traditional belief that placentas should be buried at home. The placenta is perceived to be essential for travel by the soul of the deceased into the spirit world to rejoin ancestors. Older respondents (older than age 35) and those who self-identified as animists were most likely to believe in the importance of home placental burial. Comments by respondents indicated some reluctance on the part of Hmong patients to ask health care providers for permission to take placentas home. Incorporating non-Western patients' traditional health care practices into Western health care delivery may be facilitated by an awareness of the reluctance of some patients to verbalize their wishes.

Adult↗

PubMed2006

Developing a master plan for hospital solid waste management: a case study.

Disposal of about 1750tons of solid wastes per day is the result of a rapid population growth in the province of Khuzestan in the south west of Iran. Most of these wastes, especially hospital solid wastes which have contributed to the pollution of the environment in the study area, are not properly managed considering environmental standards and regulations. In this paper, the framework of a master plan for managing hospital solid wastes is proposed considering different criteria which are usually used for evaluating the pollution of hospital solid waste loads. The effectiveness of the management schemes is also evaluated. In order to rank the hospitals and determine the share of each hospital in the total hospital solid waste pollution load, a multiple criteria decision making technique, namely analytical hierarchy process (AHP), is used. A set of projects are proposed for solid waste pollution control and reduction in the proposed framework. It is partially applied for hospital solid waste management in the province of Khuzestan, Iran. The results have shown that the hospitals located near the capital city of the province, Ahvaz, produce more than 43% of the total hospital solid waste pollution load of the province. The results have also shown the importance of improving management techniques rather than building new facilities. The proposed methodology is used to formulate a master plan for hospital solid waste management.

Data Collection↗