All healthcare providers have a duty of care to ensure that medical waste is suitably managed
and disposed of in line with healthcare waste disposal legislation. We should expect all staff working with potentially hazardous materials to be aware of waste management protocols. However, it is of course human nature to make mistakes. The consequences of improper disposal of dental waste can be dire, therefore professionals should take measures to minimise the chance of such errors occurring.
Better understanding fosters diligence. Everyone knows that safely disposing of waste is
important. However, a deeper understanding of why and the potential consequences of not doing so
will help ensure staff are especially mindful while going about their duties.
What could go wrong?
Recently, members of the public were horrified to learn about a catastrophic failure in waste
disposal. A company working for the NHS had been unable to incinerate waste in a
timely fashion and kept quiet about it. This consequently resulted in stockpiling hundreds of tonnes of hazardous materials including human body parts.[i] This incident did not pose a direct threat to the
public, but nonetheless the story was widely covered in the press and was met with shock and disgust. It is a
timely reminder that such failures can have disastrous consequences, both practically and to a
Such stories are attention grabbing. However, even small-scale lapses can create big problems,
particularly in the aggregate.
Mercury has historically been widely used in dental amalgam. Its vapour has long been
known as a health hazard. The phrase “Mad as a hatter” is commonly believed to have
originated from people witnessing hat makers in the throes of mercury poisoning, due to the use
of mercury nitrate to cure felt.[ii] Whether this origin is fictional or not, the threat of mercury vapour
to you, your staff and your patients is very real. Mercury poisoning can result in irreversible
neurological damage.[iii] It is for this reason that mercury suppression agents are utilised.
Silver has seen widespread use in medical applications thanks to its intrinsic antibacterial,
antiviral and antifungal properties. It is well known as a classic constituent of dental amalgam. Also, more recently silver nanoparticles have been incorporated into a host of different
biomaterials used for everything from implant coatings to treatments for oral cancers.[iv] However, these same qualities make it potentially harmful in the wild. While the vast majority of silver can
be safely removed by bodily processes, dissolved silver can accumulate in organs and fat
deposits.[v] In humans, excessive exposure to silver can lead to irreversible pigmentation of the
skin and/or eyes (argyria and argyrosis respectively).[vi] Silver is comparatively safe as far
as hazardous elements go, however, high concentrations of silver contaminating and accumulating in
water is a concern. Even trace amounts entering the sewage system will add up.[vii]
Blood & sharps
The primary danger from sharps is the potential to be exposed to bloodborne viruses such as
Hepatitis and HIV. There are still tens of thousands of needlestick injuries a year and around 10% of
which occur after disposal. Thankfully, the risk of transmission isn’t absolute. However, even when no
illness develops this can be a very stressful and anxiety provoking experience for those
affected.[viii] Even on materials that are not sharp, appropriate care should be taken with items
contaminated with blood.
Keep it simple, keep it safe
The more complicated a system, the more room there is for mistakes to creep in.
The Department of Health has outlined a colour coding system which is considered best practice for
healthcare waste management and segregation. Initial Medical follows these recommendations
and has produced Colour Coding Characters. These are expressly designed to be easy to understand and
easy to remember. This system facilitates easy understanding and recall, keeping things
simple so mistakes aren’t made.
Environmental law specifies that waste producers, such as your practice, have a “cradle to
grave” responsibility over that waste. This ranges from control and storage, through transportation, until
eventual disposal. By using a reputable partner you can rest assured that your obligations are
met and therefore all materials will be disposed of with the utmost care.
For further information please visit www.initial.co.uk/healthcare-waste or Tel: 0870 850 4045
[ii] Martin G. As mad as a hatter. The Phrase Finder. Link:
https://www.phrases.org.uk/meanings/mad-as-a-hatter.html [Last accessed November 15,
[iii] Mahaffey K. Mercury exposure: medical and public health issues. Transactions of the American
Clinical and Climatological Association. 2005; 116: 127-154. Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1473138/ [Last accessed November 15, 2018].
[iv] Bapat R., Chaubal T., Joshi C., Bapat P., Choudhury H., Pandey M., Gorain B., Kesharwani P.
An overview of application of silver nanoparticles for biomaterials in dentistry. Materials Science
and Engineering: C. 2018; 91: 881-898. Link:
https://www.sciencedirect.com/science/article/pii/S0928493117335956 [Last accessed
November 15, 2018].
[v] Noronha V., Paula A., Durán G., Galembeck A., Cogo-Müller K., Franz-Montan M., Durán N.
Silver nanoparticles in dentistry. Dental Materials. 2017; 33(10): 1110-1126. Link:
https://www.sciencedirect.com/science/article/pii/S0109564117303767 [Last accessed
November 15, 2018].
[vi] Drake P., Hazelwood K. Exposure-related health effects of silver and silver compounds a
review. The Annals of Occupational Hygiene. 2005; 49(7): 575-585. Link
https://academic.oup.com/annweh/article/49/7/575/148203#1208935 [Last accessed November
[vii] Eckelman M., Graedel T. Silver emissions and their environmental impacts: a multilevel
assessment. Environmental Science & Technology. 2007; 41(17): 6283-6289. Link:
https://pubs.acs.org/doi/abs/10.1021/es062970d [Last accessed November 15, 2018].
[viii] The NHS Staff Council. Managing the risks of sharps injuries. NHS Employers. 2015. Link:
wellbeing/Managing-the-risks-of-sharps-injuries-v7.pdf [Last accessed November 15, 2018].