Waste management is an important aspect of planning and carrying out oral healthcare missions. In areas with few resources for waste disposal, one must have an alternate plan to avoid contributing to the pollution of land and water. It also is important to avoid exposing the local population to waste that contains sharp contaminated items or other materials that may be capable of releasing blood or saliva when handled.
Waste bags and bins. Keep waste bags and bins readily available in all areas. Keep one container near the patient chair for gauze and other debris that may be placed in the general trash. At the end of the day, place smaller waste bags in large, heavy-duty plastic bags for disposal. Place sharps containers in the treatment area and the instrument recycling area. Other regulated medical waste must be kept in appropriate containers separate from the general trash and disposed of accordingly (see below).
Sharps. Keep puncture-proof containers labeled with the word “biohazard” in all treatment areas. Use these containers to dispose of sharp items (such as used needles, broken anesthetic carpules, and contaminated scalpel blades and sutures) immediately after use.
Proper disposal of waste generated in the clinic depends on the type of materials to be discarded.
Regular waste. Much of the waste generated during clinic activities falls into the category of “regular waste.” Items such as gloves, paper towels, gauze, packaging and other materials necessary to conduct patient treatment need to be discarded appropriately. Determine how the locale manages regular waste and make arrangements to have clinic waste removed, incinerated, or otherwise disposed of along with that of the local households.
Medical/biohazardous waste. Dispose of all biohazardous material in accordance with local laws. If there are no local laws, incinerate all burnable biohazard waste and bury the ash. Adding an accelerant (such as kerosene) to the waste pile before lighting helps ensure that all waste is thoroughly destroyed. Never add accelerant once the waste has been lit.
If moisture or local restrictions prevent medical waste from being burned, bury it. Choose a site downhill from any wells, free of standing water, and away from flood zones and agricultural areas. Dig a pit large enough to contain all the medical waste generated. Before leaving the mission, seal the waste pit with concrete.
Sharps. If possible, find a local medical-waste disposal service. If no such service is available, fill sharps containers with a solidifier (e.g. isolyser or cement) and deeply bury them in a waste disposal area away from play areas, animal grazing areas, and water before leaving the location.
Hazardous chemical waste. Because disposal of hazardous chemicals is difficult in most locations, avoid bringing these items with you.
If proper transport, handling, and disposal are possible, refer to the chart in Appendix I - "Sterilization and High-Level Disinfection" to determine which product or process is best suited to the available resources and location. Choose a product that is safe for disposal in land, is not adversely affected by extreme temperatures, has minimal health hazards, can be transported in sufficient amounts to serve the mission’s needs, and has minimal environmental hazards. Chemical products have limited acceptability in many remote locations where proper disposal and control simply are not possible. As such, consider alternatives to be the primary choice, rather than a compromise.