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| ORIGINAL ARTICLE |
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| Year : 2020 | Volume
: 4
| Issue : 4 | Page : 174-178 |
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Medical waste management in dental clinics in Tripoli/Libya
Rema A. E Shampe1, Raga A Elzahaf2, Madi Tawfiq Abd-Elwali Al-Jaghbir3, Abdelkader Battah4
1 Department of Dental Technology, Faculty of Medical Technology, Az Zawia University, Zawiya, Libya; Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
2 Department of Public Health, College of Medical Technology, Derna, Libya; Middle East and North African Research Group, The University of Jordan, Amman, Jordan
3 Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
4 Department of Pathology, Microbiology and Forensic Medicine, The University of Jordan, Amman, Jordan
| Date of Submission | 10-Apr-2020 |
| Date of Acceptance | 19-Oct-2020 |
| Date of Web Publication | 28-Dec-2020 |
Correspondence Address:
Dr. Raga A Elzahaf
Department of Public Health, College of Medical Technology, Derna
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/LJMS.LJMS_25_20
Background: Dental clinics are important and essential for the health and safety of individuals in the community and they are indispensable for the provision of medical and therapeutic services for the diagnosis of oral diseases, gum and teeth. As important as the other health centers, good and appropriate management of medical waste in dental clinics is very important to ensure safety for staff in the clinic. Objectives: Evaluating the level of medical waste management in dental clinics in Tripoli/ Libya. Methods: A cross-sectional study was conducted on 201 respondents: dentists, nurses, and assistants dentist chosen from 67 clinics out of 135 clinics. A questionnaire was used to two sections. The data were analyzed by using the IBM Statistical Package for Social Sciences (IBM SPSS) software, version 19.0 (SPSS Inc.). Results: 39.8% of respondents who were separating contaminated blood from non-contaminated waste and 82.1% of respondent's disposal liquid waste such as blood and saliva through the sewage network. However, there was no statistically significant difference in medical waste management between male and female dental staff in Tripoli, Libya (t = 0.376, P = 0.170). Conclusions: The methods of medical waste management practiced in the most dental clinics were inappropriate. The study demonstrated that there was lack of knowledge among workers in dental clinics regarding the disposal procedures and dealing with waste. Therefore, it is necessary to re-assess safety protocols by authorities and intervene quickly by introducing spread awareness of health and safety in dental clinics and in forcing regulations.
Keywords: Dental Clinics, Libya, management, medical waste, Tripoli
How to cite this article:
Shampe RA, Elzahaf RA, Al-Jaghbir MT, Battah A. Medical waste management in dental clinics in Tripoli/Libya. Libyan J Med Sci 2020;4:174-8 |
| Introduction | |  |
Medical waste (MW) is the waste that is produced by healthcare facilities, such as hospitals, private clinics, healthcare centers, research facilities, laboratories and dental clinics which were utilized in diagnosis, and prevention activities, monitoring, drugs in the field of human and veterinary medicine including infectious, hazardous materials as well human body parts.[1] MW in dental clinics has the ability of producing an infectious disease because of the contamination with blood and body fluids.[2] Dental practices produce large amounts of MW, such as glass, plastic, latex, cotton, and other materials. Most of them can be contaminated with infected body fluids. Dental practices also produce tiny amount of other types of waste, such as silver amalgam, mercury, and various chemical solvents.[3] Dentistry is part of health care services and dental waste management (DWM) needs to be organized and arranged.[4]
Dental clinics should comply with MW handling policies according to international regulations. Even though dental clinics produce small amount of healthcare MW comparing to other health care facilities responsible for generating large quantities of MW, which can produce an environmental hazards and serious public health problems if dealing with it in improper way.[5] Dental staff and patients are more exposure to risk of infections and infectious diseases. Therefore, dental clinics are considered a major concern in the community.[2] In addition, poor MW management (MWM) practices contribute to the deterioration of health and the environment.[6]
DWMs in developing countries have no proper health and safety requirements; there is a lack management of MW organization and planning due to insufficient information, financial restrictions and lack to regulations.[7] According to (WHO) reported that many third-world countries had a lack national laws, regulations, and legislation regulating waste management. In Libya, there are lack national laws, regulations, and legislation regulating waste management in the dental clinic. Hence, there is a need to assess improper handling of these wastes. Such research would inform strategies for the prevention of transmit infectious disease contributing to reduce the burden of infectious disease on the individual and the Libyan National Health Service. This study is conducted to investigate the level of MWM in dental clinics to contribute in education and awareness of care, which required in dealing with wastes that are generated in dental management activities.
| Methods | | |
Study design
A cross-sectional descriptive study was used to evaluate the MWM in dental clinics in Tripoli, Libya, from August 2016 to January 2017. The study was approved by the Ministry of Health in Libya.
Data collection
A self-administered questionnaire was distributed in Arabic and filled by to the participants members (i.e., one doctor, two assistant doctors, or nurses) in each clinic targeted dental clinics.
The study population included of 67 dental clinics in Tripoli (i.e., 50% of the total number of clinics), were randomly selected out of 135 dental clinics (privet and public clinics). Date collected from 65 privet dental clinics and two of the largest public dental clinics in Tripoli, Libya. The public dental clinics have a large catchment population and offering them free services. Moreover, other clinics were privet, and the reason for their selection was that they represent the most number. The study sample consisted of 201 participants, which included 67 doctors and 134 assistants doctors.
The questionnaire
An Arabic self-administered questionnaire was used to collect the information from dentists, assistant's dentist and nurses. The questionnaire was derived from other published study dealing with the same topic.[2]
This questionnaire is divided into two parts. The first part included demographic information questions such as gender and years of experience. The second part of the questions designed to MWM, this part included 12 questions focused on evaluate the level of MWM. This section included date on the presence of puncture-resistant containers in the clinics and how they dispose sharp items and if they separate hazardous waste. There were also questions related to disposal amalgam waste, kinds of the clinical waste being separating from the main waste stream on a daily basis and in which separation and storage takes safe place in clinics.
Responses of every individual were summed to get the total score for each sample member. The 12 items of this construct were following the normal scale such that the higher the level of waste management, the higher the assigned score, and vice versa. Theoretically, the lowest potential score on this construct is 12, while the highest potential score is 30. The highest theoretical potential score was computed as follows: (1) the number of the questionnaire items related to the MWM was 12 items, (2) the potential answers were allotted weights based on the number of answer choices such that the option corresponding to the best management is given the highest weight, and vice versa, (3) the highest weights for the 12 MWM items were summed and the sum was 30, (4) the answer choices related to the lowest level of MWM were given weight of “1”, and (5) the lowest weights for the 12 MWM items were summed and the sum was 12. Thereafter, the researchers classified MWM into three levels: Low, moderate, and high. The intervals defining every one of these levels were determined as follows: Interval width = (The highest potential score − the lowest potential score)/(number of categories) = (30 − 12)/3 = 6.
Statistical analysis
Data analysis was performed using SPSS software version 23(IBM, Ottawa, Canada). Descriptive statistics were calculated for all variables. The two-independent sample t-test was used to calculate the mean different between medical of waste management and gender.
| Results | | |
A total of 201 questionnaires were distributed to doctors, assistant doctors, and nurses in dental clinics in Tripoli. The majority of the participants were females 168 (83.3%), and most of them 107 (53.2%) were nurses. 114 (56.7%) of the participants have experience from 1 year to 5 years [Table 1].
Dental waste management
As shown in [Table 2], 39.8% of participants, agreed for the separation of MWs that are contaminated with blood from other normal which not contaminated waste in dental clinics. 89.6% using “normal plastic bags” to separate wastes and only 10.4% using bags with coded colors.
33.8% of the participants applying the system of segregator of the medical and non-MWs in the clinics.
Collection and stored of medical waste
There are several questions have been placed in order to explain the used procedures in collecting the MW. [Table 3] shows the dental staff knowledge about collection process.
Disposal of medical waste
[Table 4] shows disposal process knowledge among dental staff.
Level of medical waste management
The levels of MWM among male and female dental, medical staff in the dental clinics were varying from low to high. About two-thirds (63.7%) of all the dental staff manifested moderate levels of MWM. Meantime, about one-third of the dentists (34.3%) showed high levels of MWM and dental medical staffs with low levels of MWM were few (4; 2.0%). The majority of male dental medical staff 33 (66.7%) has moderate levels of MWM. Meanwhile, only a dental medical staff (3%) exhibited low levels of MWM. The proportions of the female dental medical staff demonstrating low (1.8%), moderate (63.1%), and high (35.1%) levels of MWM were very close to the corresponding levels of their male peers.
The “within sex” comparisons point out that while the percentage of the sample male dental staff showing a moderate level of MWM was slightly higher than that of the female dental staff (66.7% vs. 63.1%), a somewhat higher proportion of the sample female dentists demonstrated high level of MWM (35.1% vs. 30.3%). This finding supports a somewhat higher level of MWM among the female than the male dental staff.
Difference in medical waste management between the male and female dentists
The mean total score on the MWM construct of the research instrument is 21.9% for the male dental staff and 22.6% for the female dental staff, which are highly comparable. It is concluded that there is no statistically significant difference in MWM between the male and female dental staff in the dental clinics in Tripoli (Libya) (P = 0.170).
| Discussion | | |
Management procedure is very important matter, and safe handling of hazardous waste is considered essential. All required the personal need to be aware of possible health hazards that present and must be trained in the suitable way in treating, storage and disposal methods. It was frustrating to find that the worker in dental clinics did not know about any documents explaining waste management.
Segregated system must be at the point of origin is these wastes, and put them into a rigid, leak-proof; puncture resistant container and the container must be categorized in a special way. In this study, only 33.8% of participants separated the hazardous waste. It is still lower than that reported separated rates from most of other studies. For example, in Ajman and according to,[8] they reported that 51.0% separated infectious waste only. Also, a cross-sectional survey on 294 participants showed 50.3% of participants of the study practiced a method which considered a systematic one to segregate waste.[9] Moreover, in a study from India found 94.16% of participants were aware about the categories of waste segregation.[10] In Palestine, 62% of dentists were used puncture-resistant containers to segregated waste[7] and in Riyadh 72% of dental clinics, they were separated waste like needles and sharp instruments.[11]
It is very important to use the system of separation of MW in order to preserve the safety of workers and ensure the nonspread of diseases. In Tripoli, Libya, most of clinics handling with MW such as general waste and sometimes disposed of with municipal waste. Therefore, it is important to train personnel and follow global guidelines. Waste must be separated from the point of origin and put in dedicated containers and leak proofing and labeled as waste type.
Our recorded result showed that 10.4% used bags, which used to separate waste, with coded colors. It is clear that there is no interest in coding the MW basket from each other, which indicates a lack of awareness of the importance of this coding, or lack of training on the separation of waste, by coding. On the other hand, 98.0% of health-care workers used color-coded bags/containers in Ajman dental clinics.[8] In addition, a study on the management of dental health-care waste conveyed on the four groups of dental participation was over to 294 participants in India, shown that 60.2% of participants were used color code of separation of waste.[9]
Segregation of different types of waste considered an important step in the method of waste patient's management. To reduce the rate of infections, it should be segregated hazardous and nonhazardous waste. Separating containers using color-coding helps distinguish MW and general waste and must display instructions for caution, and biohazard symbol and word in bold and a color contrasting the container.
It is important is to have someone in charge of dealing with the waste in dental clinics. In this study, the higher percentage was 79.1% of the workers who handle waste and 70.1% of the clinics have the program to collect, gather, and transfer pages and packages of the waste in comparison with Ajman study[8] which showed that 51.1% was to waste handler. These results suggest that training is required for all physicians to properly dispose of sharps and other infectious and liquid waste, and identification programs for all clinic staff should be done.
Disposal sharp waste requires a great precaution and care. It can lead to serious blood-borne infections to the people who handle it such as hepatitis C, hepatitis B, and HIV infection. In the current study, we found that 49.8% get rid of the used sharp instrument in special packages.
While in the study done in India found 60% used sharp instruments in special packages[5] and 56% of the dentists did implement the manner, which is recommended to for the disposal of sharps.[8] A descriptive survey which was conducted on private dental practices in Turkey with 184 sample size found about 37.8% of participants used puncture-resistant containers to disposal sharp items.[12] Moreover, Al-Khatib et al.[7] found 61.9% of sharp waste placed in puncture-resistant containers (special containers) while 29.9% thrown in trash.
This type of waste requires extreme care and care handling or disposal of sharp objects (scalpels, and needles) may cause infection. By using appropriate guidelines, sharps must be disposed. By gathering sharps in rigid separate container, puncture resistant, sealable, leak poof, and remain in good condition during their whole usage, they should be managed.
In a properly categorized sealed container, the amalgam waste should remain that is appropriate for storing it in a case that it contaminated. The use of dental amalgam is a matter of great controversy mercury, which is a component and element of that restorative material and toxic to living beings and the environment. In our study, 77.1% of participants get rid of the stuffing remain in the rubbish packet. 79% of participants indicate that most of the surveyed clinics dispose of amalgam waste into general trash,[5] and 65.6% of participant's disposal amalgam in the trash.[7] Improper disposal of amalgam affects both the environment and health. Various types of health problems are related to amalgam. Proper handling of mercury is, therefore, one of the good waste management.
According to this study, the level of MWM of dental care staff in dental clinics considered in a good level, found about (63.7%) of the dental staff were in moderate levels subtended and about (34.3%) were in high levels of MWM. In addition, just (2.2%) showed low level of MWM.
There were few limitations of the study; it was conducted in Tripoli (the Libyan capital) only. Thus, it cannot generalize the results on all Libyan cities. Self-administrated data were gathered so is expected that inaccurate bias will occur.
| Conclusion | | |
The separation of dental waste into the appropriate waste categories is incomplete in most of the dental clinics in Tripoli-Libya. Lack of technical expertise to deal with these materials, lack of interest of this problem, or lack of budget to cover all costs may be the reasons for such defect. In general, dental clinics do not treat their waste or use safe methods to handle hazardous waste and improper handling has an impact on the health and environment, causing pollution of water, air, and soil. We recommended that physicians, nursing staff, and workers should be trained in the risks of MW in dental clinics in terms of health, environmental and occupational risks and how to deal with them in terms of collection, transportation, and disposal.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]
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