Academic research into radio frequency identification (RFID) has proliferated

significantly over the last few years, to the point where journals (Production and
Operations Management, International Journal of Production Economics, IEEE
Systems Journal, and IEEE Transactions on Automation Science and Engineering)
are producing special issues on the topic. In this paper, we present a literature
review of 85 academic journal papers that were published on the subject between
1995 and 2005. We organize these studies into four main categories: technological
issues, applications areas, policy and security issues, and other issues. All of the
papers in the review are allocated to the main and sub-categories based on their
main focus. Our analysis of these papers provides useful insights on the anatomy
of the RFID literature, and should aid the creation and accumulation of knowledge
in this domain. A comprehensive list of references is also presented. It is hoped
that the review will be a good resource for anyone who is interested in RFID
research, and will help to stimulate further interest in this area. The implications
for RFID researchers and practitioners and suggestions for future research areas are
discussed.

Abstract

Major changes in medical waste disposal practices are expected to occur in the
future because of regulatory requirements from both the Federal and State level;
namely:

• At the Federal level, under the Clean Air Act of 1970 and its recently
enacted Amendments of 1990, EPA proposed air emission standards to
regulate medical waste incineration in February 1995.
 • At the State level, many States are developing new standards to control
medical waste disposal.

Because of the information need to support the implementation of the regulations,

both the Federal Government and the States have conducted various studies. This
paper represents a discussion of what has been learned as a result of these studies.
Major activities have included:

 
   Abstract  

Proper handling, treatment and disposal of biomedical wastes are important

elements of health care office infection control programme. Correct procedure will
help protect health care workers, patients and the local community. If properly
designed and applied, waste management can be a relatively effective and an
efficient compliance-related practice. This review article discusses about the
various types of waste, its management and the hazards of indiscriminate disposal
of hospital waste and in brief about dental waste management.

Keywords: Biomedical waste, dental waste, hospital waste, waste management

   Introduction  

Until fairly recently, medical waste management was not generally considered an
issue. In the 1980s and 1990s, concerns about exposure to human
immunodeficiency virus (HIV) and hepatitis B virus (HBV) led to questions about
potential risks inherent in medical waste. Thus hospital waste generation has
become a prime concern due to its multidimensional ramifications as a risk factor
to the health of patients, hospital staff and extending beyond the boundaries of the
medical establishment to the general population. 

Hospital waste refers to all waste, biologic or non biologic that is discarded and not
intended for further use. Medical waste is a subset of hospital waste; it refers to the
material generated as a result of diagnosis, treatment or immunization of patients
and associated biomedical research. Biomedical waste (BMW) is generated in
hospitals, research institutions, health care teaching institutes, clinics, laboratories,
blood banks, animal houses and veterinary institutes.  

Although very little disease transmission from medical waste has been
documented, both the American Dental Association (ADA) and Center for Disease
Control recommend that medical waste disposal must be carried out in accordance
with regulation.
Hospital waste management has been brought into focus in India recently,
particularly with the notification of the BMW (Management and Handling) Rules,
1998. The rule makes it mandatory for the health care establishments to segregate,
disinfect and dispose their waste in an eco-friendly manner.  

   Potential Implications of Biomedical Waste  

[1],[6]
 

Risk to healthcare workers and waste handlers

Improperly contained contaminated sharps pose greatest infectious risk associated

with hospital waste. There is also theoretical health risk to medical waste handlers
from pathogens that may be aerosolized during the compacting, grinding or
shredding process that is associated with certain medical waste management or
treatment practices. Physical (injury) and health hazards are also associated with
the high operating temperatures of incinerators and steam sterilizers and with toxic
gases vented into the atmosphere after waste treatment.

Risk to the public

Public impacts are confined to esthetic degradation of the environment from
careless disposal and the environmental impact of improperly operated incinerators
or other medical waste treatment equipment.

There may be increased risk of nosocomial infections in patients due to poor waste
management. Improper waste management can lead to change in microbial ecology
and spread of antibiotic resistance. 
   Classification  

Non-hazardous waste

This constitutes about 85% of the waste generated in most healthcare set-ups. This
includes waste comprising of food remnants, fruit peels, wash water, paper cartons,
packaging material etc. 
Hazardous waste
A) Potentially infectious waste
Over the years different terms for infectious waste have been used in the
scientific literature, in regulation and in the guidance manuals and standards.
These include infectious, infective, medical, biomedical, hazardous, red bag,
contaminated, medical infectious, regulated and regulated medical waste.
All these terms indicate basically the same type of waste, although the terms
used in regulations are usually defined more specifically.   It constitutes 10%
of the total waste which includes:

1. Dressings and swabs contaminated with blood, pus and body fluids.
2. Laboratory waste including laboratory culture stocks of infectious agents
3. Potentially infected material: Excised tumours and organs, placenta removed
during surgery, extracted teeth etc.
4. Potentially infected animals used in diagnostic and research studies.
5. Sharps, which include needle, syringes, blades etc.
6. Blood and blood products. 
B)Potentially toxic waste

1. Radioactive waste: It includes waste contaminated with radionuclide; it

may be solid, liquid or gaseous waste. These are generated from in
vitro analysis of body fluids and tissue, in vitro imaging and therapeutic
procedures. 
2. Chemical waste: It includes disinfectants (hypochlorite, gluteraldehyde,
iodophors, phenolic derivatives and alcohol based preparations), X-ray
processing solutions, monomers and associated reagents, base metal debris
(dental amalgam in extracted teeth).
3. Pharmaceutical waste: It includes anesthetics, sedatives, antibiotics,
analgesics etc. 

   Steps in Waste Management  

Medical waste should be managed according to its type and characteristics. For
waste management to be effective, the waste should be managed at every step,
from acquisition to disposal. The following are the elements of a comprehensive
waste management system: waste survey, segregation, accumulation and storage,
transportation, treatment, disposal and also waste minimization.
Waste survey
The survey should differentiate and quantify the waste generated. It should
determine the points of generation, the type of waste at each point and the level of
generation and disinfection within the hospital. This helps to determine the method
of disposal.
Waste segregation
This consists of placing different kinds of wastes in different containers or coded
bags at the point of generation [Table - 1]. It helps to reduce the bulk of infectious
waste as well as treatment costs. Segregation also helps to contain the spread of
infection and reduces the chances of infecting other health care workers.

Waste accumulation and storage

Waste accumulation and storage occurs between the point of waste generation and
site of waste treatment and disposal. While accumulation refers to the temporary
holding of small quantities of waste near the point of generation, storage of waste
is characterized by longer holding periods and large waste quantity. Storage areas
are usually located near where the waste is treated. Any offsite holding of waste is
also considered storage.

To contain spills, storage areas should not have floor drains and should be recessed
to hold liquids. Floor and walls should be impervious to liquid and easy to clean.
They should be disinfected regularly. Refrigeration may be required for prolonged
storage of putrifiable and other wastes. Storage area should be posted with
'EXPLICIT' signs.
Waste transportation

When medical waste is not treated on site, untreated waste must be transported
from the generation facility to another site for treatment and disposal.

Waste treatment

The term 'treatment' refers to the process that modifies the waste in some way
before it is taken to its final resting place. Treatment is mainly required to disinfect
or decontaminate the waste, right at source so that it is no longer the source of
pathogenic organisms. After such treatment, the residue can be handled safely,
transported and stored.

 Needles and syringe nozzle - shredded in needle destroyer and syringe

cutters
 Scalpel blades/ Lancet/ Broken glass should be put in separate containers
with bleach, transferred to plastic/ cardboard boxes; sealed to prevent
spillage and transported to incubators
 Glassware should be disinfected, cleaned and sterilized
 Culture plates with viable culture should be autoclaved; media are placed in
appropriate bags and disposed off. The plates can be reused after
sterilization
 Gloves should be shredded / cut / mutilated before disposal.
  Swabs should be chemically disinfected followed by incineration. If they
contain only a small amount of blood that does not drip, they can be placed
in the garbage.
 Disposable items are often recycled and have the risk of being used illegally.
Dipping in freshly prepared 1% sodium hypochlorite for 30 min. - one hour,
followed by mutilation before disposal should be the policy adopted for such
items.
 Under no circumstances, should heat be used for disposal of amalgam. The
heat will cause mercury to volatize and be released to the environment. So
teeth with amalgam restoration should be treated by immersion in high-level
disinfectant (e.g. Gluteraldehyde) for 30 min. Treated teeth can then be
rinsed.
 Liquid waste generated by the laboratory is either pathological or chemical
in nature. Non-infectious waste should be neutralized with reagents.
 Liquid infectious waste should be treated with a chemical disinfectant for
contamination and then neutralized.

Waste disposal

The waste disposal methods vary in their capabilities, cost, availability to

generation and impacts on the environment. The various disposal methods include
incineration, autoclaving, chemical methods, thermal methods (low and high),
ionizing radiation process, deep burial and microwaving [Table - 2].

Incineration and autoclaving are considered traditional methods. Chitnis et al .

[20] 
have devised a solar heating system for disinfecting infectious waste in
economically less developed countries. They obtained a considerable reduction in
the amount of viable bacteria by this method. However, 'considerable reduction in
viable number of bacteria' seems to be misleading term. The medical waste should
be completely free of pathogenic bacteria before disposal. This would ensure
maximum public hygiene quality.

Untreated medical waste can be disposed off in sanitary landfills. Disposal without
treatment is not recommended for human tissues, sharps and culture from clinical
laboratories.

Waste minimization

Whereas ordinary solid or liquid waste requires no treatment before disposal,

practically all infectious waste must first be treated. The cost for disposal of
infectious waste may be ten times the cost for disposal of ordinary solid waste.
Any measures that decrease the amount of infectious waste generated will
simultaneously decrease the cost of infectious waste disposal.  [9] 

Cost of biomedical waste management

The cost of construction, operation and maintenance of system for managing waste
represents a significant part of overall budget of a hospital if the BMW handling
rules have to be implemented in their true spirit. Self-contained on-site treatment
methods may be desirable and feasible for large healthcare facilities. They will not
be practical or economical for smaller institutes. An acceptable common system
should be in place which will provide regular supply of color coded bags, daily
collection of infectious waste, safe transportation of waste to off site treatment
facility and final disposal with suitable technology.  [2] 

   Dental Wastes of Environmental Concern  

Amalgam

Dental Amalgam particles are a source of mercury, which is known to be

neurotoxic and nephrotoxic. Fetuses and newborn babies are more sensitive to
mercury than adults and there seems to be a great difference in sensitivity among
individuals. [13] 

Management includes disposal of amalgam scrap as hazardous waste or more aptly

sent to a recycler. [14],[15],[16] Waste mercury is disposed similarly. Empty amalgam
capsules are to be disposed off in the garbage.  [17] Since amalgam decomposes on
heating; amalgam scrap should not be disposed in the waste that could eventually
be incinerated. [18] 

To minimize the amount of mercury vapour emitted from waste amalgam, ADA
recommends that it be stored under a small amount of photographic fixer in a
closed container. It should be labeled as 'scrap amalgam'.  [17] 

X-ray wastes
 1. X-ray fixer solution: It is considered a hazardous waste because of its high
silver content. [16] In the environment, free ionic silver acts as an enzyme
inhibitor by interfering with the metabolic processes of organisms.  [14] These
have to be disposed off as a hazardous waste or sent to a silver recovery
system. [14],[17]
2. X-ray developer solution: Developer solution can typically go into the
wastewater drain. [5],[8] Developer and fixer solutions should not be mixed
with fixer solutions. If mixed, they should be separated and treated
independently as required. [14],[17]
3. X-ray cleaner solution: Many cleaners for X-ray developer system contain
chromium. If the cleaner solution used contains chromium, it should be
disposed as a hazardous waste or switch to a non-chrome cleaner. [17]
4. X-ray lead foil / lead shields: The lead foils and lead shields contain pure
lead. [15],[18] Lead is a heavy metal that affects neurological development and
functions and can potentially leach from landfills into the environment.
These are hazardous waste unless they are recycled for their scrap metal
content or disposed off as hazardous waste. [14],[17]

   Plastic in Health Care  

[19]
 

Disposable syringes, bottles, blood and uro bags, catheters, surgical gloves, etc are
some of the examples of plastic usage in health care. Plastic has been associated
with decline in sperm count, genital abnormalities and a rise in the incidence of
breast cancer. Burning of plastics releases carcinogens like dioxin and furan. Once
hailed as a 'wonder material', plastic is now a serious environmental and health
concern, essentially due to its non-biodegradable nature. The options for plastic
waste disposal are environmentally compatible long-term land filling or recycling.
All disposable plastic should be subjected to shredding before disposing off to
vendor. Designing eco-friendly, biodegradable plastics are the need of the hour.
Minimizing the generation of plastic waste is also very important.

   Conclusion  

Safe and effective management of waste is not only a legal necessity but also a
social responsibility. Lack of concern, motivation, awareness and cost factor are
some of the problems faced in the proper hospital waste management. Proper
surveys of waste management procedures in dental practices are needed. Clearly
there is a need for education as to the hazards associated with improper waste
disposal. Lack of apathy to the concept of waste management is a major stymie to
the practice of waste disposal. An effective communication strategy is imperative
keeping in view the low awareness level among different category of staff in the
health care establishments regarding biomedical waste management. 

Proper collection and segregation of biomedical waste are important. At the same
time, the quantity of waste generated is equally important. A lesser amount of
biomedical waste means a lesser burden on waste disposal work, cost-saving and a
more efficient waste disposal system. Hence, health care providers should always
try to reduce the waste generation in day-to-day work in the clinic or at the
hospital.

 
   References  

1. Gordon JG, Rein Hardt PA, Denys GA (2004): Medical waste management.
In: Mayhall CG (ed). Hospital epidemiology and infection control, (3  rd ).
Lippincott Williams and Wilkins publication. Pages: 1773-85.       
2. Rao SK, Ranyal RK, Bhatia SS, Sharma VR (2004): Biomedical waste
management: An infrastructural survey of hospitals, MJAFI, Vol. 60,(4).       
3. Rutala WA, Weber DJ (2005). Disinfection, sterilization and control of
hospital waste. In: Mandell, Douglas and Bennett's Principles and practice of
infectious diseases (6 th ed.). Elsevier Churchill Livingstone Publication. Pages:
3331-47.       
4. Sharma M (2002): Hospital waste management and its monitoring, (1  st ed.),
Jaypee Brothers Medical Publication.       
5. Harrison B (1991): States act to regulate medical waste, JADA, 122: 118-20.    
   
6. Environment management for control of hospital infections: Proceedings of
7 th conference of hospital infection society - India, CME- 9 January 2003.
CMC, Vellore.       
7. Manual for control of hospital associated infection: Standard operative
procedures (1999). National AIDS control organization. Delhi. Pages: 50-
66.       
8. Laboratory diagnosis, biosafety and quality control. National institute of
communicable diseases and national AIDS control organization, Delhi. Pages
26-41.       
9. Seymour Block S (2001): Disinfection, sterilization and preservation, (5  th ed.),
Lippincott Williams and Wilkins publication.       
10. Wilson HF, Edward Bellinger G, Mjor A (1998): Dental practice and the
environment, Int Dent J, 48: 161-6.       
11. Cocchiarella L, Scott Deitchman D, Young D (2000): Biohazardous waste
management: What the physicians need to know, Arch Fam Med, 9: 26-9.       
12. Available from:
http://www.ndc-nihfw.org/html/Legislations/BiomedicalWasteManagement.ht
ml. for more information.       
13. Preben Horsted - Bindslev (2004): Amalgam toxicity - environmental and
occupational hazards, J Dentist, 32: 359-65.       
14. Available from: http://www.p2pays.org/ret/01/00020htm for more
information.       
15. Available from: http.//www.cdphe.state.co.us/hw/photo pdf. for more
information.       
16. Drummond L, Michael Cailas D, Croke K (2003): Mercury generation
potential from dental waste amalgam, J Dentist, 31: 493-501.       
17. Available from:
http://www3.uwm.edu/dept/shwer/publication/cabinet/pdk/guidefordentist.pdf.
for more information.       
18. Fan PL, Bindslev DA, Schmalz G, Halbach S, Berendsen H (1997):
Environmental issues in dentistry - mercury, Int Dental J, 47: 105-9.        
19. Available from: http.//www.plasticsresource.com. for more information.       
20. Chitnis V, Chitnis S, Patil S, Chitnis D (2003): Solar disinfection of infectious
biomedical waste: A new approach for developing countries, Lancet, 362:
1285-6.       
Introduction The term “biomedical waste” has been defined as “any waste that is
generated during diagnosis, treatment or immunisation of human beings or
animals, or in the research activities pertaining to or in the production or testing of
biologicals and includes categories mentioned in schedule I of the Government of
India’s Biomedical Waste (Management and Handling) Rules 1998” [1,2]. Dental
waste is a subset of hazardous biomedical (BM) waste. Dental practices generate
large amounts of cotton, plastic, latex, glass, sharps, extracted teeth and other
materials, much of which may be contaminated with body fluids [3]. Hazards
arising from waste disposal from dental practices can be divided into two main
areas. First, there is the environmental burden of a variety of hazardous products
and second, the more immediate risks of potentially infectious material that may be
encountered by the individuals handling waste [4]. Indiscriminate disposal of BM
or hospital waste and exposure to such waste poses a serious threat to the
environment and to human health. BM waste requires specific treatment and
management prior to its final disposal. The severity of the threat is further
compounded by the high prevalence of diseases such as human
immunosuppressive virus (HIV) and hepatitis B and C [5]. Hospital-acquired
infections have been estimated at 10% of all fatal/life-threatening diseases in the
South-East Asia region and have been identified as one of the indicators for the
management of waste [6]. Alarmingly, the World Health Organization Awareness
of Biomedical Waste Management Among Health Care Personnel in Jaipur, India
Alok Sharma1, Varsha Sharma2, Swati Sharma3, Prabhat Singh4 1MDS. Reader,
Department of Prosthodontics, Jaipur Dental College, Jaipur, India. 2BDS.
Lecturer, Department of Prosthodontics, Jaipur Dental College, Jaipur, India.
3MDS. Senior Lecturer, Department of Periodontics, Mahatma Gandhi Dental
College, Jaipur, India. 4MDS. Reader, Department of Periodontics, MP Dental
College, Vadodara, India.

Corresponding author: Dr Alok Sharma, Department of Prosthodontics, Jaipur

Dental College, Jaipur, India; e-mail: draloksharmamds@gmail.com Abstract
Aims: The study aimed to determine the following among the workforce of the
Jaipur Dental College, b their awareness regarding biomedical (BM) waste
management policy and practices, their attitude towards biomedical waste
management, and their awareness regarding needle-stick injury and its prevalence
among different categories of health care providers.

Methods: A cross-sectional study was conducted using a questionnaire with

closed-ended questions. It was distributed to 144 dentists, nurses, laboratory
technicians and Class IV employees (cleaners and maintenance personnel) at
Jaipur Dental College. The questionnaire was used to assess their knowledge of
biomedical medical waste disposal. The resulting answers were graded and the
percentage of correct and incorrect answers for each question from all the
participants was obtained.

Results: Of the 144 questionnaires, 140 were returned and the answers graded. The
results showed that there was a poor level of knowledge and awareness of
biomedical waste generation hazards, legislation and management among health
care personnel. It was surprising that 36% of the nurses had an extremely poor
knowledge of biomedical waste generation and legislation and just 15% of the
Class IV employees had an excellent awareness of biomedical waste management
practice.

Conclusions: It can be concluded from the present study that there are poor levels
of knowledge and awareness about BM waste generation hazards, legislation and
management among health care personnel in Jaipur Dental College. Regular
monitoring and training are required at all levels.

Key Words: Dental Practice, Biomedical Waste, Hazards 33 OHDM - Vol. 12 -

No. 1 - March, 2013 (WHO) reported a 50% re-use in India of syringes and
needles that are meant for single use [7]. In India, the Ministry of Environment and
Forests has promulgated the Biomedical Waste (Management and Handling) Rules
1998 for proper management of BM waste. These rules are meant to improve the
overall waste management of health care facilities in India [1,2]. However, the
introduction of laws is not sufficient for proper disposal of BM waste. The
awareness of these laws among the general public as well as development of
policies and enforcement that respect those laws are essential [8]. The absence of
proper waste management, lack of awareness about the health hazards from BM
waste, insufficient financial and human resources, and poor control of waste
disposal are the most critical problems connected with health care waste [9].
Although there is increased global awareness among health care professionals
about hazards and also appropriate management techniques, the level of awareness
in India has been found to be unsatisfactory [10-12]. Therefore, the present study
was conducted to assess the level of awareness and attitude among health care
workers in a private dental college in Rajasthan, India. Aims The study had the
following aims relating to the workforce of the college: 1. To determine their
awareness regarding BM waste management policy and practice. 2. To determine
their attitude towards BM waste management. 3. To determine their awareness
regarding needle-stick injury and its prevalence among different categories of
health care providers. Methods The study involved the use of a questionnaire
(Figure 1) with closed-ended questions, which was distributed to 144 staff
members. The study population included 50 dentists, 52 nursing staff, 20
laboratory technicians and 22 Class IV employees (cleaners and maintenance
personnel). Two nursing staff and two Class IV employees did not complete the
questionnaire, therefore 140 subjects participated in the study. All of these subjects
were volunteers and they comprised of 70% of the total workforce (200 subjects) at
the institution. The study was approved by the ethical committee of Jaipur Dental
College, Jaipur, Rajasthan, India and written consent was taken from all the
subjects before they were given the questionnaire. This questionnaire consisted of
40 questions and was designed to obtain information about knowledge of BM
waste generation and waste management practices. The questions were grouped
under four headings: (a) biomedical waste generation, health hazards and
legislation, (b) waste management practices, (c) attitude assessment, and (d)
needle-stick injuries. The questionnaire was pilot-tested on a small group of staff
that included five dentists, five nursing staff, five laboratory technicians and five
Class IV employees. They were requested to complete it and indicate any questions
that they found to be unclear. Confidentiality of the participants was maintained.
The percentage of correct and incorrect answers for each question from all the
participants was obtained. Results Out of 144 subjects, as mentioned above, two
nurses and two Class IV employees failed to respond to Table 1. Level of
knowledge of biomedical waste generation, hazards and legislation among health
care personnel Excellent: 8 correct answers out of 10 Good to average: 4-7 correct
answers out of 10 Poor:
(WHO) reported a 50% re-use in India of syringes and needles that are meant for
single use [7]. In India, the Ministry of Environment and Forests has promulgated
the Biomedical Waste (Management and Handling) Rules 1998 for proper
management of BM waste. These rules are meant to improve the overall waste
management of health care facilities in India [1,2]. However, the introduction of
laws is not sufficient for proper disposal of BM waste. The awareness of these laws
among the general public as well as development of policies and enforcement that
respect those laws are essential [8]. The absence of proper waste management, lack
of awareness about the health hazards from BM waste, insufficient financial and
human resources, and poor control of waste disposal are the most critical problems
connected with health care waste [9]. Although there is increased global awareness
among health care professionals about hazards and also appropriate management
techniques, the level of awareness in India has been found to be unsatisfactory [10-
12]. Therefore, the present study was conducted to assess the level of awareness
and attitude among health care workers in a private dental college in Rajasthan,
India. Aims The study had the following aims relating to the workforce of the
college: 1. To determine their awareness regarding BM waste management policy
and practice. 2. To determine their attitude towards BM waste management. 3. To
determine their awareness regarding needle-stick injury and its prevalence among
different categories of health care providers. Methods The study involved the use
of a questionnaire (Figure 1) with closed-ended questions, which was distributed to
144 staff members. The study population included 50 dentists, 52 nursing staff, 20
laboratory technicians and 22 Class IV employees (cleaners and maintenance
personnel). Two nursing staff and two Class IV employees did not complete the
questionnaire, therefore 140 subjects participated in the study. All of these subjects
were volunteers and they comprised of 70% of the total workforce (200 subjects) at
the institution. The study was approved by the ethical committee of Jaipur Dental
College, Jaipur, Rajasthan, India and written consent was taken from all the
subjects before they were given the questionnaire. This questionnaire consisted of
40 questions and was designed to obtain information about knowledge of BM
waste generation and waste management practices. The questions were grouped
under four headings: (a) biomedical waste generation, health hazards and
legislation, (b) waste management practices, (c) attitude assessment, and (d)
needle-stick injuries. The questionnaire was pilot-tested on a small group of staff
that included five dentists, five nursing staff, five laboratory technicians and five
Class IV employees. They were requested to complete it and indicate any questions
that they found to be unclear. Confidentiality of the participants was maintained.
The percentage of correct and incorrect answers for each question from all the
participants was obtained. Results Out of 144 subjects, as mentioned above, two
nurses and two Class IV employees failed to respond to Table 1. Level of
knowledge of biomedical waste generation, hazards and legislation among health
care personnel Excellent: 8 correct answers out of 10 Good to average: 4-7 correct
answers out of 10 Poor:

Tick the appropriate answer: Your position: ‰ Doctor / Dentist ‰ Class IV

employee ‰ Nurse ‰ Lab technician Section 1: Knowledge of biomedical (BM)
waste generation, hazards and legislation 1. Do you know about BM waste
generation and legislation? Yes ‰ No ‰ Not sure ‰ 2. What agency(ies)
regulate(s) wastes generated at health care facilities? State ‰ Private ‰ Do not
know ‰ 3. Do you think it is important to know about BM waste generation,
hazards and legislation? Yes ‰ No ‰ Somewhat ‰ 4. Biomedical Waste
(Management & Handling) Rules were first proposed in: ‰ 1997 ‰ 1998 ‰ 1999
‰ 2000 5. Amendments to the Biomedical Waste (Management & Handling)
Rules were made in: ‰ 2000 ‰ 2001 ‰ 2003 ‰ 2004 6. Which statement
describes one type of BM waste: ‰ Materials that may be poisonous, toxic, or
flammable and do not pose disease-related risk. ‰ Waste that is saturated to the
point of dripping with blood or body fluids contaminated with blood. ‰ Waste that
does not pose a disease-related risk. 7. According to the Biomedical Waste
(Management & Handling) Rules, waste should not be stored beyond: ‰ 12 hours
‰ 48 hours ‰ 72 hours ‰ 96 hours 8. One gram of mercury (source from dental
amalgam) is enough to contaminate the following surface area of a lake: ‰ 20
acres ‰ 30 acres ‰ 25 acres ‰ 15 acres 9. Who regulates the safe transport of
medical waste? ‰ Pollution Control Board of India. ‰ Transport Corporation of
India. ‰ College Administration. 10. Do you need a separate permit to transport
biomedical waste? Yes ‰ No ‰ Cannot say ‰ Section 2: Level of awareness on
biomedical waste management practice 11. Do you know about colour-coding
segregation of BM waste? Yes ‰ No ‰ Not sure ‰ 12. Do you follow colour-
coding for BM waste? Yes ‰ No ‰ Sometimes ‰ 13. Is the waste disposal
practice correct in your hospital? Yes ‰ No ‰ Cannot comment ‰ 14. Objects
that may be capable of causing punctures or cuts, that may have been exposed to
blood or body fluids including scalpels, needles, glass ampoules, test tubes and
slides, are considered biomedical waste. How should these objects be disposed of?
‰ Black bags ‰ Yellow bags ‰ Clear bags ‰ Sharps container 15. Documents
with confidential patient information are to be disposed of into the paper recycling
bins. True ‰ False ‰ Do not know ‰
The term “biomedical waste” has been defined as “any waste that is generated
during diagnosis, treatment or immunisation of human beings or animals, or in the
research activities pertaining to or in the production or testing of biologicals and
includes categories mentioned in schedule I of the Government of India’s
Biomedical Waste (Management and Handling) Rules 1998” [1,2]. Dental waste is
a subset of hazardous biomedical (BM) waste. Dental practices generate large
amounts of cotton, plastic, latex, glass, sharps, extracted teeth and other materials,
much of which may be contaminated with body fluids [3]. Hazards arising from
waste disposal from dental practices can be divided into two main areas. First,
there is the environmental burden of a variety of hazardous products and second,
the more immediate risks of potentially infectious material that may be
encountered by the individuals handling waste [4]. Indiscriminate disposal of BM
or hospital waste and exposure to such waste poses a serious threat to the
environment and to human health. BM waste requires specific treatment and
management prior to its final disposal. The severity of the threat is further
compounded by the high prevalence of diseases such as human
immunosuppressive virus (HIV) and hepatitis B and C [5]. Hospital-acquired
infections have been estimated at 10% of all fatal/life-threatening diseases in the
South-East Asia region and have been identified as one of the indicators for the
management of waste [6]. Alarmingly, the World Health Organization Awareness
of Biomedical Waste Management Among Health Care Personnel in Jaipur, India
Alok Sharma1, Varsha Sharma2, Swati Sharma3, Prabhat Singh4 1MDS. Reader,
Department of Prosthodontics, Jaipur Dental College, Jaipur, India. 2BDS.
Lecturer, Department of Prosthodontics, Jaipur Dental College, Jaipur, India.
3MDS. Senior Lecturer, Department of Periodontics, Mahatma Gandhi Dental
College, Jaipur, India. 4MDS. Reader, Department of Periodontics, MP Dental
College, Vadodara, India. Corresponding author: Dr Alok Sharma, Department of
Prosthodontics, Jaipur Dental College, Jaipur, India; e-mail:
draloksharmamds@gmail.com Abstract Aims: The study aimed to determine the
following among the workforce of the Jaipur Dental College, India: their
awareness regarding biomedical (BM) waste management policy and practices,
their attitude towards biomedical waste management, and their awareness
regarding needle-stick injury and its prevalence among different categories of
health care providers. Methods: A cross-sectional study was conducted using a
questionnaire with closed-ended questions. It was distributed to 144 dentists,
nurses, laboratory technicians and Class IV employees (cleaners and maintenance
personnel) at Jaipur Dental College. The questionnaire was used to assess their
knowledge of biomedical medical waste disposal. The resulting answers were
graded and the percentage of correct and incorrect answers for each question from
all the participants was obtained.

Results: Of the 144 questionnaires, 140 were returned and the answers graded. The
results showed that there was a poor level of knowledge and awareness of
biomedical waste generation hazards, legislation and management among health
care personnel. It was surprising that 36% of the nurses had an extremely poor
knowledge of biomedical waste generation and legislation and just 15% of the
Class IV employees had an excellent awareness of biomedical waste management
practice. Conclusions: It can be concluded from the present study that there are
poor levels of knowledge and awareness about BM waste generation hazards,
legislation and management among health care personnel in Jaipur Dental College.
Regular monitoring and training are required at all levels. Key Words: Dental
Practice, Biomedical Waste, Hazards 33 OHDM - Vol. 12 - No. 1 - March, 2013
(WHO) reported a 50% re-use in India of syringes and needles that are meant for
single use [7]. In India, the Ministry of Environment and Forests has promulgated
the Biomedical Waste (Management and Handling) Rules 1998 for proper
management of BM waste. These rules are meant to improve the overall waste
management of health care facilities in India [1,2]. However, the introduction of
laws is not sufficient for proper disposal of BM waste. The awareness of these laws
among the general public as well as development of policies and enforcement that
respect those laws are essential [8]. The absence of proper waste management, lack
of awareness about the health hazards from BM waste, insufficient financial and
human resources, and poor control of waste disposal are the most critical problems
connected with health care waste [9]. Although there is increased global awareness
among health care professionals about hazards and also appropriate management
techniques, the level of awareness in India has been found to be unsatisfactory [10-
12]. Therefore, the present study was conducted to assess the level of awareness
and attitude among health care workers in a private dental college in Rajasthan,
India. Aims The study had the following aims relating to the workforce of the
college: 1. To determine their awareness regarding BM waste management policy
and practice. 2. To determine their attitude towards BM waste management. 3. To
determine their awareness regarding needle-stick injury and its prevalence among
different categories of health care providers. Methods The study involved the use
of a questionnaire (Figure 1) with closed-ended questions, which was distributed to
144 staff members. The study population included 50 dentists, 52 nursing staff, 20
laboratory technicians and 22 Class IV employees (cleaners and maintenance
personnel). Two nursing staff and two Class IV employees did not complete the
questionnaire, therefore 140 subjects participated in the study. All of these subjects
were volunteers and they comprised of 70% of the total workforce (200 subjects) at
the institution. The study was approved by the ethical committee of Jaipur Dental
College, Jaipur, Rajasthan, India and written consent was taken from all the
subjects before they were given the questionnaire. This questionnaire consisted of
40 questions and was designed to obtain information about knowledge of BM
waste generation and waste management practices. The questions were grouped
under four headings: (a) biomedical waste generation, health hazards and
legislation, (b) waste management practices, (c) attitude assessment, and (d)
needle-stick injuries. The questionnaire was pilot-tested on a small group of staff
that included five dentists, five nursing staff, five laboratory technicians and five
Class IV employees. They were requested to complete it and indicate any questions
that they found to be unclear. Confidentiality of the participants was maintained.
The percentage of correct and incorrect answers for each question from all the
participants was obtained. Results Out of 144 subjects, as mentioned above, two
nurses and two Class IV employees failed to respond to Table 1. Level of
knowledge of biomedical waste generation, hazards and legislation among health
care personnel Excellent: 8 correct answers out of 10 Good to average: 4-7 correct
answers out of 10 Poor: