Sustentabilidade ambiental: gerenciamento de resíduos odontológicos no Serviço Público / Sostenibilidad ambiental: gestión de residuos odontológicos en el Servicio Público / Environmental sustainability: dental waste management in the public service

Introdução: os Resíduos de Serviço de Saúde constituem um grande problema para a sociedade e para o meio ambiente, e o conhecimento de seu correto manejo é imprescindível para a formação do profissional da saúde. Objetivo: verificar o conhecimento dos profissionais de Odontologia atuantes nas Unidades Básicas de Saúde de municípios do noroeste do estado de São Paulo, Brasil, sobre o correto manejo dos Resíduos de Serviço de Saúde. Métodos: o instrumento de coleta de dados foi um questionário semiestruturado, preenchido durante as visitas nos estabelecimentos de saúde, a fim de verificar a conformidade do processo de gerenciamento de resíduos Odontológicos. Realizou-se análise descritiva. Além disso, aplicaram-se os testes do qui-quadrado e o Exato de Fisher para verificar associação entre o conhecimento do descarte de resíduos e a informação sobre o tema, ao nível de significância de 1 porcento. As análises foram realizadas no programa BioEstat 5.0. Resultado: do total (n= 74) dos profissionais, a maioria (97,3 porcento) diz saber o que são Resíduos de Serviço de Saúde e todos acreditam que eles podem fazem mal a saúde. No entanto, 41,9 porcento não responderam de forma correta como descartar os sugadores e luvas infectados e 20,3 porcento sobre o descarte de perfurocortantes. Em relação à informação sobre o tema, 40,5 porcento não obtiveram. Conclusão: o conhecimento sobre o correto descarte dos Resíduos de Serviço de Saúde por esses profissionais ainda é falho. Isso reflete a importância de capacitar os profissionais e propor formas de gerenciamento adequadas dos Resíduos de Serviço de Saúde(AU)

Introducción: los residuos de servicios de salud son un grave problema para la sociedad y el medio ambiente, y el conocimiento de su correcta gestión es esencial para la formación de los profesionales de la salud. Objetivo: evaluar el conocimiento de los profesionales de Odontología que trabajan en las Unidades Básicas de Salud de los municipios en el noroeste de São Paulo, Brasil, sobre el manejo adecuado de los residuos de servicios de salud. Métodos: el instrumento de recolección de datos fue un cuestionario semiestructurado, completado durante las visitas a los centros de salud, con el fin de verificar la conformidad del proceso de gestión de residuos dentales. Se realizó un análisis descriptivo. Además, se aplicó la prueba de chi cuadrado y exacta de Fisher para determinar la asociación entre la eliminación de residuos y los conocimientos e información sobre el tema, considerándose un nivel de significación del 1 por ciento. Los análisis se realizaron en BioEstat 5.0. Resultados: del total (n= 74) de los profesionales, la mayoría (97,3 por ciento) afirmó no saber cuáles son los residuos de servicios de salud y todos creyeron que pueden hacer mal a la salud. Sin embargo, el 41,9 por ciento no contestó correctamente sobre la eliminación de dispositivos de succión y guantes infectados, y el 20,3 por ciento sobre la eliminación de objetos punzantes. Con respecto a la información sobre el tema, el 40,5 por ciento no la obtuvo. Conclusiones: el conocimiento sobre la eliminación adecuada de los residuos de servicios de salud por estos profesionales todavía es deficiente. Esto refleja la importancia de la capacitación de los profesionales y proponer formas de gestión adecuadas de los residuos de servicios de salud(AU)

Introduction: medical waste is a serious problem for both society and the environment, and knowledge about its proper management is essential for the training of health care professionals. Objective: evaluate knowledge among dental professionals working in Basic Health Units from municipalities in northeast Sao Paulo, Brazil, about proper management of medical waste. Methods: the data collection tool used was a semi-structured questionnaire completed during visits to the health centers, aimed at verifying the adequacy of dental waste management. A descriptive analysis was performed. Additionally, chi-square and Fisher's exact tests were applied to determine the association between waste disposal, and knowledge and information about the subject, using a significance level of 1 percent. Analyses were conducted on BioEstat 5.0. Results: of the total professionals (n= 74), most (97.3 percent) stated not knowing which are the medical wastes, and all believed that they may be harmful to health. However, 41.9 percent did not provide a correct answer about disposal of infected gloves and suction devices, and 20.3 percent about sharps disposal. With respect to information about the subject, 40.5 percent did not obtain it. Conclusions: knowledge about proper disposal of medical waste is still deficient among these professionals, pointing to the importance of professional training and of proposing forms of proper management of medical waste(AU)

Sustentabilidade ambiental: gerenciamento de resíduos odontológicos no Serviço Público / Sostenibilidad ambiental: gestión de residuos odontológicos en el Servicio Público / Environmental sustainability: dental waste management in the public service

Introdução: os Resíduos de Serviço de Saúde constituem um grande problema para a sociedade e para o meio ambiente, e o conhecimento de seu correto manejo é imprescindível para a formação do profissional da saúde. Objetivo: verificar o conhecimento dos profissionais de Odontologia atuantes nas Unidades Básicas de Saúde de municípios do noroeste do estado de São Paulo, Brasil, sobre o correto manejo dos Resíduos de Serviço de Saúde. Métodos: o instrumento de coleta de dados foi um questionário semiestruturado, preenchido durante as visitas nos estabelecimentos de saúde, a fim de verificar a conformidade do processo de gerenciamento de resíduos Odontológicos. Realizou-se análise descritiva. Além disso, aplicaram-se os testes do qui-quadrado e o Exato de Fisher para verificar associação entre o conhecimento do descarte de resíduos e a informação sobre o tema, ao nível de significância de 1 porcento. As análises foram realizadas no programa BioEstat 5.0. Resultado: do total (n= 74) dos profissionais, a maioria (97,3 porcento) diz saber o que são Resíduos de Serviço de Saúde e todos acreditam que eles podem fazem mal a saúde. No entanto, 41,9 porcento não responderam de forma correta como descartar os sugadores e luvas infectados e 20,3 porcento sobre o descarte de perfurocortantes. Em relação à informação sobre o tema, 40,5 porcento não obtiveram. Conclusão: o conhecimento sobre o correto descarte dos Resíduos de Serviço de Saúde por esses profissionais ainda é falho. Isso reflete a importância de capacitar os profissionais e propor formas de gerenciamento adequadas dos Resíduos de Serviço de Saúde(AU)

Introducción: los residuos de servicios de salud son un grave problema para la sociedad y el medio ambiente, y el conocimiento de su correcta gestión es esencial para la formación de los profesionales de la salud. Objetivo: evaluar el conocimiento de los profesionales de Odontología que trabajan en las Unidades Básicas de Salud de los municipios en el noroeste de São Paulo, Brasil, sobre el manejo adecuado de los residuos de servicios de salud. Métodos: el instrumento de recolección de datos fue un cuestionario semiestructurado, completado durante las visitas a los centros de salud, con el fin de verificar la conformidad del proceso de gestión de residuos dentales. Se realizó un análisis descriptivo. Además, se aplicó la prueba de chi cuadrado y exacta de Fisher para determinar la asociación entre la eliminación de residuos y los conocimientos e información sobre el tema, considerándose un nivel de significación del 1 por ciento. Los análisis se realizaron en BioEstat 5.0. Resultados: del total (n= 74) de los profesionales, la mayoría (97,3 por ciento) afirmó no saber cuáles son los residuos de servicios de salud y todos creyeron que pueden hacer mal a la salud. Sin embargo, el 41,9 por ciento no contestó correctamente sobre la eliminación de dispositivos de succión y guantes infectados, y el 20,3 por ciento sobre la eliminación de objetos punzantes. Con respecto a la información sobre el tema, el 40,5 por ciento no la obtuvo. Conclusiones: el conocimiento sobre la eliminación adecuada de los residuos de servicios de salud por estos profesionales todavía es deficiente. Esto refleja la importancia de la capacitación de los profesionales y proponer formas de gestión adecuadas de los residuos de servicios de salud(AU)

Introduction: medical waste is a serious problem for both society and the environment, and knowledge about its proper management is essential for the training of health care professionals. Objective: evaluate knowledge among dental professionals working in Basic Health Units from municipalities in northeast Sao Paulo, Brazil, about proper management of medical waste. Methods: the data collection tool used was a semi-structured questionnaire completed during visits to the health centers, aimed at verifying the adequacy of dental waste management. A descriptive analysis was performed. Additionally, chi-square and Fisher's exact tests were applied to determine the association between waste disposal, and knowledge and information about the subject, using a significance level of 1 percent. Analyses were conducted on BioEstat 5.0. Results: of the total professionals (n= 74), most (97.3 percent) stated not knowing which are the medical wastes, and all believed that they may be harmful to health. However, 41.9 percent did not provide a correct answer about disposal of infected gloves and suction devices, and 20.3 percent about sharps disposal. With respect to information about the subject, 40.5 percent did not obtain it. Conclusions: knowledge about proper disposal of medical waste is still deficient among these professionals, pointing to the importance of professional training and of proposing forms of proper management of medical waste(AU)

What's in a bin: A case study of dental clinical waste composition and potential greenhouse gas emission savings.

BACKGROUND: Dental practices have a unique position as dental staff use a high number of dental materials and instruments on a daily basis. It is unclear how dentists' and dental care professionals' choices and behaviours around selecting and using materials impact on the amount of unnecessary waste production. Although there are a number of articles exploring the quality and quantity of waste in dental practices, there are no studies on organisational strategies to decrease unnecessary waste. There is no clear economic analysis of the impact on associated cost to dental practices which consequently can affect the access of dental care for disadvantaged groups. METHODS: This study used an audit approach to explore the potential for sustainability in dental practice by measuring the nature and quantity of dental clinical waste, and assessing the feasibility of measuring the financial costs and potential carbon savings in the management of dental clinical waste. CONCLUSIONS: The data from our study would appear to support the view that it is possible to reduce carbon emissions and increase profitability. Successful implementation of an environmentally sustainable approach to waste management will be dependent on the practicalities involved and the financial incentives for adopting such practices.

[Responsible management of dental amalgam mercury: a review of its impact on health]. / Manejo responsable del mercurio de la amalgama dental: una revisión sobre sus repercusiones en la salud.

This review discusses the implications of dental amalgam used in dentistry. We first focus on the status of the fetus, which is the most vulnerable to mercury exposure from maternal dental amalgams because of the chronic form and potential magnitude of exposure. And second, our work covers the awareness of environmental repercussions involved with continued use of this restorative material, a persistent, bioaccumulative and toxic chemical, when best management practices (BMPs) of mercury from the WHO and the American Dental Association are not followed. Although the use of dental amalgam is in decline in the public and private sectors, it is necessary that the measures disseminated by the WHO on BMPs are implemented by professional dentists and taught by academic institutions that may continue to teach its use. It is also essential to promote from the undergraduate level the ethical values and responsibility to health and the environment, considering that the poor handling of mercury contributes to the global burden of environmental mercury. Finally, the findings support important modifications in the clinical field, the principle of precaution, and logistical aspects of the profession in the process of reducing and eventually eliminating the use of mercury.

Environmental implications of anesthetic gases.

For several decades, anesthetic gases have greatly enhanced the comfort and outcome for patients during surgery. The benefits of these agents have heavily outweighed the risks. In recent years, the attention towards their overall contribution to global climate change and the environment has increased. Anesthesia providers have a responsibility to minimize unnecessary atmospheric pollution by utilizing techniques that can lessen any adverse effects of these gases on the environment. Moreover, health care facilities that use anesthetic gases are accountable for ensuring that all anesthesia equipment, including the scavenging system, is effective and routinely maintained. Implementing preventive practices and simple strategies can promote the safest and most healthy environment.

The environmental impact of dentistry.

As dental practitioners, we must recognize that some of the materials and procedures we use to provide dental health services may present challenges to the environment. Realizing this, we can begin to take measures to minimize the production of these wastes and their potential environmental effects. This paper identifies some common wastes produced by dental offices (dental amalgam, lead, silver, biomedical and general office waste) and provides practical suggestions for reducing the impact of our profession on the environment.

Evaluation of dental waste management in two cities in Palestine.

Disposal of dental waste was investigated at 37 randomly selected clinics in Ramallah and AI-Bireh cities: 31 private practices and 6 public/NGO clinics. Dentists were interviewed regarding their disposal of different forms of dental waste. Disinfectants and X-ray processing solution were thrown down the drain. For sharps, 13.5% of dentists used puncture-resistant containers (only in the public/ NGO clinics), 45.9% discarded needles directly in the garbage after being recapped and 40.5% placed the used needles and blades in closed plastic bottles before throwing in the general garbage. Blood-soaked dressings and amalgam waste were also thrown in the garbage. While 10.75% of dentists were vaccinated against hepatitis B, 47% of the staff at private clinics were not.

Foil backing used in intraoral radiographic dental film: a source of environmental lead.

The lead content of the foil backing of 4 types of intraoral film commonly used by dentists was 69% to 85%. An environmental issue exists because these foils are typically thrown out with regular refuse, even though recycling programs exist. For a new adult patient, a full-mouth radiographic series would generate 11.2 g of waste lead; for a 6-month checkup, waste lead would only be produced if radiographs were required. In an experiment that simulated the acidic conditions that might be expected in a landfill site, 3.5-4.4 mg of lead was released during 17-hour incubation in dilute acetic acid. When distilled double-deionized water replaced the acid, 1.0-2.2 mg of lead was released by the same types of foils. Human health concerns also exist when dental assistants handle lead foil while developing radiographs and fail to change their gloves or wash their hands before handling instruments and dental paraphernalia used in the mouth. Although the amount of lead introduced into the oral cavity would be relatively small, the elimination of sources of lead exposure, especially for children, is important.

Understanding the mercury reduction issue: the impact of mercury on the environment and human health.

Mercury has been used in both medicine and dentistry for centuries. Recent media attention regarding the increased levels of mercury in dietary fish, high levels of mercury in air emissions, and conjecture that certain diseases may be caused by mercury exposure has increased public awareness of the potential adverse health effects of high doses of mercury. Dentistry has been criticized for its continued use of mercury in dental amalgam for both public health and environmental reasons. To address these concerns, dental professionals should understand the impact of the various levels and types of mercury on the environment and human health. Mercury is unique in its ability to form amalgams with other metals. Dental amalgam--consisting of silver, copper, tin, and mercury--has been used as a safe, stable, and cost-effective restorative material for more than 150 years. As a result of this use, the dental profession has been confronted by the public on two separate health issues concerning the mercury content in amalgam. The first issue is whether the mercury amalgamated with the various metals to create dental restorations poses a health issue for patients. The second is whether the scraps associated with amalgam placement and the removal of amalgam restorations poses environmental hazards which may eventually have an impact on human health. Despite the lack of scientific evidence for such hazards, there is growing pressure for the dental profession to address these health issues. In this article, the toxicology of mercury will be reviewed and the impact of amalgam on health and the environment will be examined.

Putting dental mercury pollution into perspective.

This paper deals with the issue of amalgam waste from dental offices. The aim is to put into perspective the very small contribution of dental mercury to the overall volume of mercury discharged into the environment each year. While the amount discharged from dental offices is very small compared to other sources, the amount discharged into the environment from amalgam fillings in people's mouths is estimated as less than 2% of the amount from dental offices. At least 50% of mercury in the environment comes from natural sources. The major source of man-made mercury pollution is the industrial burning of fossil fuels. It is important to distinguish between inorganic mercury and organic mercury in terms of the impact on the health of the population.

Amalgam toxicity--environmental and occupational hazards.

OBJECTIVES: To discuss briefly the recent developments in mercury production, consumption and waste handling especially in relation to the use of mercury in dentistry. Furthermore, to discuss the toxicological and reproductive aspects of the mercury body burden of dental personnel. DATA, SOURCES AND STUDY SELECTION: The data discussed are primarily based on published scientific studies and on publications and reviews from governmental and other official authorities which have been published within the last 10 years, References have been traced manually or by MEDLINE. CONCLUSIONS: Global production and consumption of mercury is decreasing, as is the production of amalgam fillings in some countries. By proper measures it is possible to further reduce the environmental burden of mercury from dental clinics. In general, the mercury body burden of the dental personnel can be kept below the normally accepted toxicological limits and reproductive effects have not been proven provided a proper mercury hygiene regimen is adopted.

Impacto dos resíduos de serviços de saúde sobre o homem e meio ambiente / The impact of health services residues on humans and environment

Pesquisas atuais têm questionado se os resíduos originários dos serviços de saúde oferecem um risco maior à população e ao meio ambiente que o lixo dimiciliar. A proposta deste trabalho foi, mediante revisão da literatura, conhecer aspectos relacionados à geração e ao gerenciamento dos resíduos, especialmente aqueles produzidos nos consultórios odontológicos, abordando seus possíveis impactos sobre o homem e o meio ambiente

The incidence of occupational exposures among students in four UK dental schools.

OBJECTIVES: To evaluate: the incidence of occupational exposures (OE) to patient body fluids among a sub-group of dental students; the rate of reporting of incidents; and the association of various factors. DESIGN: Multicentre retrospective analysis. SETTING: Four UK dental schools in 2000. SUBJECTS: Dental students from 4 UK schools completed a confidential questionnaire at the end of the clinical years of their undergraduate course. RESULTS: The response rates ranged from 71-100%, showing that 12-40% of students among the schools had experienced one or more OE incidents since starting their course. No statistically significant association was found between OE incidence and age, sex, dominant hand or time of day; most OE occurred with handling of local anaesthetic syringes. 61-78% of incidents were penetrative in nature, and 28-53% of students had not reported their last OE. OE incidence was associated with school, year of course, presence of patient and presence of an assistant. There were substantial differences in the numbers of students experiencing OE among the schools. CONCLUSIONS: Within the limitations of the survey and variations within the clinical activity of schools, it may be seen that improvements are needed in some schools to reduce cross-infection risks, and increase reporting of incidents. Suggestions are offered which may increase the safety of dental treatment.