Zahid Ali1 BDS, FCPS
Nazish Ashfaq Khan2 BDS, MFDS RCS ENG, FFD RCSI
Saqib Zafar3 BDS, MPhil
Muhammad Saeed Mughal 4 BDS
Syeda Hala Raza5 BDS, FCPS
Mehwash Kashif 6 BDS, FCPS
OBJECTIVE: This study aims to assess the contempory situation of dental waste management in private dental practices in Karachi. METHODOLOGY: A cross-sectional study was done in 5 districts of Karachi (East, West, South, Centre, Malir) from 26th January to 26th April 2021. Total 100 private dental practitioners were recruited using non-probability consecutive sampling. A pretested, 20 items questionnaire was used for recording data of the research participants, and their knowledge, attitude and practices (KAP) of managing dental waste. Inclusion criteria was both male and female dentists, above 25 years of age, who run dental clinics in 5 districts of Karachi. Dental students were excluded. Data were analysed using SPSS version 17. 00 RESULTS: Total 79% of the participants were males and 21% were females. Approximately 68% belonged to the age group of 25-35 years. Total 51% had an experience of 10-20 years and32% were using colour coded bins while 35% were following segregation methods for waste disposal. Only 16% had attended professional training programs for waste management. CONCLUSION: Waste management in dental clinics in Karachi is inadequate and improper. The government should enact monitoring of all dental practices, enforcing the recommended regulations. KEYWORDS: Dental waste management, Knowledge, attitude and practices (KAP), private dental practitioners HOW TO CITE: Ali Z, Khan NA, Zafar S, Mughal MS, Raza SH, Kashif M. Knowledge, attitude and practices of dental surgeons about dental waste management in dental clinics of Karachi. J Pak Dent Assoc 2022;31(3):153-156. DOI: https://doi.org/10.25301/JPDA.313.153 Received: 27 April 2022, Accepted: 28 June 2022
A ccording to WHO, healthcare waste is defined as ‘any disposed material from healthcare activities, which can be a potential source of infection to humans’.1 The infectious biomedical waste produced in Pakistan is not less as compared to other countries.2 Literature shows that approximately 2 kg of waste per bed per day is produced out of which 0.1- 0.5 comprises of risk waste.3 Dental clinics make up a minute amount of healthcare waste in comparison to hospitals. Still, this waste poses grave health and environmental risks if not appropriately managed.4 Most of the waste produced by dental practices is classified into three groups i.e. infectious, chemical and office.5 Hazardous dental waste includes mercury in amalgam, silver, lead, X-ray films and fixer solution, disinfectants, needles, blades, burs, orthodontic appliances, contaminated gauze and latex gloves etc.5 Exposure to infectious biomedical waste can result in dermatological, gastrointestinal, respiratory diseases or worse Hepatitis and HIV / AIDS.6
In order to minimize hazardous outcomes of dental waste, there should be proper waste segregation, handling, transport and disposal. There is limited awareness of handling biomedical waste in third world countries.2 Therefore, professional training for waste management is required for the betterment of knowledge and practices of medical and dental healthworkers.2
The research aimed to appraise the existing situation of waste management in private dental practices in Karachi to assess the severity of the situation and also come up with recommendations for the government to implent in order to minimize exposure and also lead to the safe management of hazaradous waste substances
A cross sectional study was done in 5 districts of Karachi (i.e. East, West, South, Centre, Malir) for three months, from 26th January 2021 to 26th April 2021. 100 private dental practitioners were recruited for the study using nonprobability consecutive sampling. The sample size was calculated using Raosoft software with the accepted margin of error 5%, 95% confidence level, population size of 134 and response distribution of 50%. Ethical approval was acquired from the Ethical Review Committee of the KMDC. Informed consent was taken from all the research participants. A pre-tested, automated, 20 items questionnaire with closedended questions was designed for recording data relating to participants’ demographics and their relevant knowledge and practice of waste handling in dental practices. Pretesting was carried out on 20 doctors for validity. Total 100 private practitioners were given questionnaires which were duly completed and collected.
Both male and female dentists, 25 years of age and above, running dental practices in 5 districts of Karachi were included in the study. Dental students were excluded. Data collected were analyzed using SPSS software version 17.00
Total 100 dentists were invited and participated in this study, with a 100% response rate.The male to female ratio of the practitioners was 1: 3.8 male to female. Among respondents 10% were house officers 55% were general dental practitioners 15% postgraduate trainees and 15% were consultants.
Figure 2 shows the distribution of dental practitioners in 5 districts of Karachi. Table 3 shows the distribution of respondents by their understanding, inclination and practices.
35% participants were following segregation methods of waste disposal, 58% were not and 7% were unaware. In this study we found that most of the practitioners improperly dispose infectious and sharp waste. 70% had no dental waste management policy document and 74% participants did not attend any CDE programs on dental waste management.
76% clinics disposed final dental waste directly into corporation bins, 14% handed it over to certified collectors
A total of 100 participants were recruited for this study, with a 100% response rate. As shown in Fig. 1, the male to female ratio of the practitioners was 1: 3.8 male to female.
Out of 100 participants, 16% had attended professional training programs on waste management, 74% participants had not attended any continuing dental education program on dental waste management, and 10% had no idea regarding any program that offers training regarding waste management. 32% of the participants were using color-coded bins, 62% were not, and 4% were unaware. 35% participants were following segregation methods of waste disposal, 58% were not and 7% were unaware. 70% of practitioners had no dental waste management policy document, 19 % claimed to have a policy document for their clinics and 11% were unaware of any such documents. 58% disposed used x-ray films into a common bin. 51% disposed x-ray lead foil in common bin and only 23% stored and disposed in a separate container. Regarding the disposal of x-ray film fixer solution, 32% emptied it directly into the sewer, 18% diluted the solution and then disposed it into the sewer, 6% returned it to the suppliers and 44% were unaware of the policymadopted by their clinic. Waste collection storage and handling was done by dental assistants in 62% clinics, whereas in 21% of clinics, the cleaner was assigned this task and in 12% clinics dental surgeons themselves were responsible for this duty. 76% clinics disposed final dental waste directly into corporation bins, 14% handed it over to certified collectors and 10% were unaware of how the final disposal took place. 55% stored the final dental waste inside their clinics, 29% outside the clinics, 11% stored in the lab area and remaining 5% had no idea.
and 10% were unaware of how the final disposal took place. 55% stored the final dental waste inside their clinics, 29% outside the clinics, 11% stored in the lab area and remaining 5% had no idea.
Less than 32% of the research candidates used the segregation method. 44% were unaware of the standard methods to dispose x-ray fixer waste. In the studied centers, dental assistants mostly did handling of dental waste by improper methods.
Systematic and organized management of possibly hazardous waste is basic for the wellbeing of patients, dental practitioners and our environment.4
Dental clinicians and their assistants can assure proper sterilization in clinics and handle problems related to dental waste disposal if they follow set guidelines for the management of biomedical waste. 4,7
The entire amount of dental waste processed in a single day can be divided into the following subtypes: infectious, non-infectious and domestic.8 Nabizadeh R et al. reports in a study, that approximately 71.15% of dental waste consisted of domestic waste, 21.40% was infectious waste, 7.26% was chemical waste, whereas only 0.18% was toxic waste.9
According to a study done in Sydney, Australia, it was found that out of 14 dental clinics only 5 were following proper guidelines for the collection and disposal of infectious waste.10 Another study in New Zealand demonstrated that almost 25% of dental facilities directly threw dental sharps in common bins.11
A report of a similar study carried out in Hamadan, Iran, revealed all the amalgam waste was disposed into the main sewerage line and used sharps were thrown into the common waste.9 Research carried out in Pakistan reports that most private practitioners disposed amalgam waste in the dustbin or simply into the sewer, only 6 out of 221 dentists, used a sealed container for storage of amalgam waste.12 Although , dental waste management protocol is outlined by the government, the knowledge regarding this subject is still lacking which suggests the need for continued dental education programs, and the need for continuous monitoring of the practices.2,12
In most developing countries including Pakistan, management of biomedical waste disposal is becoming a major problem and if not addressed promptly it will further worsen the environmental crisis.13 Although guideline documents devised by the Health Department on dental waste management is available, but practitioners do not have a storage standardization policy and hardly any practitioner coordinates with pollution control boards.13
In this study, we found that most practitioners improperlydispose of infectious and sharp waste. 70% had no dental waste management policy document and 74% of participants did not attend any CDE programs on dental waste management.
Universally, yellow plastic bags are used for segregation of infectious waste, whereas sharps should be collected in safety containers.7 These are incinerated or autoclaved and finally buried under the ground of designated dumps.7
The above-mentioned findings of this research reveal the voids in knowledge and application of dental practitioners in Karachi, Pakistan.Small sample size and cross sectional designs were the limitations of study. It is recommended that CDE programs on dental waste management must be planned and initiated which will increase awareness of dental undergraduates and dental personnale towards proper waste management. Waste management should be taught at all levels of dentistry especially dental personnel and dental hygienist and assistants. Further research is recommended with large sample size and longitudinal design for more better results.
Dental waste is perilous to all creatures in the environment. The dental practices of Karachi are handling this insufficiently and improperly. The government ought to take the initiative and enforce adequate monitoring for all dental practices to highlight refractory activity and impose recommended directives.
CONFLICT OF INTEREST
1. Pandey A, Ahuja S, MAdAn M, ASthAnA AK. Bio-Medical Waste Management in a Tertiary Care Hospital: An Overview. J Clin Diagnostic Res. 2016;10.10:DC01-DC03. https://doi.org/10.7860/JCDR/2016/22595.8822
2. Zaib N, Umer N, Masood R. Waste Management at Dental Hospitals Of Rawalpindi-Islamabad Region. Biomedica. 2015;31:277.
3. Khan MJ, Hamza MA, Zafar B, Mehmod R, Mushtaq S. Knowledge, attitude and practices of health care staff regarding hospital waste handling in tertiary care hospitals of Muzaffarabad, AJK, Pakistan. Int J Sci Reports. 2017;3:220-6.
4. 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.
5. Agarwal B, Singh S, Bhansali S, Agarwal S. Waste management in dental office. Indian J Com Med. 2012;37:2201-202. https://doi.org/10.4103/0970-0218.99934
6. Amsalu A, Worku M, Tadesse E, Shimelis T. The exposure rate to hepatitis B and C viruses among medical waste handlers in three government hospitals, southern Ethiopia. Epidemiol Health. 2016;38. https://doi.org/10.4178/epih.e2016001
7. Danaei M, Karimzadeh P, Momeni M, Palenik CJ, Nayebi M, Keshavarzi V, Askarian ME. The management of dental waste in dental offices and clinics in Shiraz, Southern Iran. Int J Occup Environ Med. 2014;25;5:336-18.
8. Vieira CD, de Carvalho MA, de Menezes Cussiol NA, AlvarezLeite ME, dos Santos SG, da Fonseca Gomes RM, Silva MX, de Macêdo Farias L. Composition analysis of dental solid waste in Brazil. Waste Manag. 2009;29:1388-91. https://doi.org/10.1016/j.wasman.2008.11.026
9. Nabizadeh R., Koolivand A., Jafari A.J., Yunesian M., Omrani G. Composition and production rate of dental solid waste and associated management practices in Hamadan, Iran. Waste Manag. Res. 2012;30:619-624. https://doi.org/10.1177/0734242X11412110
10. Zazouli MA, Rostami E, Barafrashtehpour M. Assessment of dental waste production rate and management in Sari, Iran. J Adv Enviro Health Res. 2014;2:120-5.
11. Sushma MK, Bhat S, Shetty SR, Babu SG. Biomedical dental waste management and awareness of waste management policy among private dental practitioners in Mangalore city, India. Tanzania Dent J. 2010; 16:39-43. https://doi.org/10.4314/tdj.v16i2.69867
12. Mumtaz R, Khan AA, Noor N, Humayun S. Amalgam use and waste management by Pakistani dentists: an environmental perspective. Eastern Mediterranean Health J.2010;16:334-39
13. Mushtaq A, Alam M, Shahid Iqbal MS. Management of dental waste in dental hospital of Lahore. Biomedica. 2008;24:61-3.
1. Professor, Department of Oral Maxillofacial Surgery, Abbasi Shaheed Hospital and
Karachi Medical Dental College, Karachi.
2. Assistant Professor, Department of Oral Maxillofacial Surgery, Karachi Medical
Dental College, Karachi.
3. MPhil Scholar, Department of Microbiology, Dadabhoy Institute of Higher Education
4. MPhil Scholar, Department of Microbiology, Dadabhoy Institute of Higher Education
5. FCPS Resident, Department of Oral Maxillofacial Surgery Abbasi Shaheed Hospital
6. Professor, Department of Oral Pathology Karachi Medical Dental College, Karachi
Corresponding author: “Dr. Nazish Ashfaq Khan” < firstname.lastname@example.org >