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All Posts in Category: Environment

The History of Medical Waste Disposal

garbage collection

DSNY archival photo: Department of Street Cleaning collection cart

Life Before Medical Waste Management: Unsanitary and Even Deadly

 
Imagine you could take a time machine back to, say, the late 1800s in New York City. You’re walking down the sidewalk and pass a dead horse lying on the cobblestone street. It’s the same dead horse that lay there yesterday…and the day before. Everywhere you turn there are piles of trash. Most other city folks have grown accustomed to the smell, but to a newcomer like you—accustomed as you are to proper sanitation—the mingling odors of manure, urine, dead animals and other wastes nauseates you. If you lived in this environment long enough, your chances of contracting a contagious and perhaps deadly disease were very high.
 
It’s tempting to look back through history and wish you were born into a “simpler time.” The fact is the health and sanitation laws and regulations on disposal of biohazardous waste that are in place today make our cities and towns much more pleasant (not to mention healthier) than in those halcyon days of yore.
 
Take sanitation workers. We don’t spend a lot of time thinking about how these men and women make our lives better just by virtue of doing their job. Yet the majority of Americans enjoy clean water and air. When you walk to work every morning you don’t have to tramp through dangerous human and animal waste clogging the streets and sidewalks and overflowing into the oceans and rivers.
 

Dawn of Public Health Reform

 
In the U.S. and England in the 19th century, there was a much different standard of sanitation than these countries enjoy today. That began to change in the mid to late 1800s. British sanitary reformer Edwin Chadwick famously conducted research into the poor conditions of prisons and hospitals in England. His research precipitated the passage of the Public Health Act of 1848 and inspired reforms in the United States. U.S. Colonel George E. Waring, a cavalry officer in the Union army, helped to establish sanitary engineering as a profession, which boosted its presence in modern life.
 
Fellow Briton Joseph Lister was the first to connect modern germ theory with medical sanitation. The germ theory of disease linked the existence of microorganisms, or germs, to the onset of diseases. Humans acted as hosts for these microorganisms, and their growth and reproduction caused illness. In the 1870s Lister applied the germ theory to hospital-borne illnesses, with poor medical sanitation the cause.
 

Medical Sanitation Extends Human Life Expectancy in the Twentieth Century

 
According to the medical journal Modern Drug Discovery, modern sanitation efforts led to Americans enjoying longer lives.
 
Most medical historians believe that the sanitation movement, and its attendant improvements in urban health and food safety, contributed far more to the increase in Western life expectancy in the 20th century (primarily through the prevention of infectious diseases) than did much of modern medicine.
Holzbog horse drawn street cleaning cart

Holzbog horse drawn street cleaning cart

 
Indeed in the twentieth century waste technology began to improve by leaps and bounds, and stricter sanitation laws were introduced. The purpose of the Solid Waste Disposal Act of 1965 was to reduce waste and protect human and environmental health by introducing waste management technologies and standards designed to decrease pollution and promote better municipal waste disposal.
 
There were those who didn’t feel the SWDA went far enough. In the summer of 1988, medical waste washed up on five East Coast beaches. Congress responded by enacting the Medical Waste Tracking Act of 1988. Regulations on how medical waste could be disposed of became more stringent—and as a result our environment is cleaner and our lives are healthier.
 
So the next time you see one of Cyntox’s medical waste professionals doing a pickup of your red bags and sharps containers, take a moment to reflect on what your work and home life would look life without the benefit of good biohazardous waste management!

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Healthy Smiles and a Healthy Environment: Safe Dental Waste Disposal

dental wasteProper disposal of dental waste is crucial to safeguarding staff, patients, and the public, as well as protecting the environment. Laws differ by state, so check with your dental waste disposal provider to make sure you are compliant. However, there are certain guidelines that every dental practice should know and follow.  
 
Soft soiled waste disposal Blood and body fluid precautions are designed to reduce the risk of spreading diseases such as Hepatitis C and D. Following these precautions means safely disposing of soiled soft waste generated in your procedure room. Your dental waste disposal provider will supply you with small and large red bags or other red waste receptacles. Place your soft soiled waste, such as blood or saliva-saturated cotton or gauze, extracted teeth, and surgically removed hard and soft tissue in the small red bags. The small bags should be kept close at hand in every procedure room. This minimizes staff and patient exposure to dental waste. When they are full (but never to overflow), seal or fasten the bags shut and place them in the larger red bag or receptacle for pick-up.
 
Mercury-containing amalgam disposal Dental amalgam is of particular concern because of the potential for mercury in the amalgam to be released into the environment, where it is especially toxic to fish (the leached mercury accumulates in their tissues.)
 
In an effort to help dentists safely recycle Amalgam wastes, the America Dental Association (ADA) developed “Best Management Practices for Amalgam Waste” (BMPs). These best practices for handling and disposing of amalgam waste include the following:
  • Choose amalgam capsules (individually-dosed containers of amalgam) of different sizes to reduce waste. Be sure to properly dispose of used amalgam capsules as well as amalgam scrap (the excess mix left over after the procedure.)
  • The ADA does not recommend using bulk elemental mercury (liquid or raw mercury).  If you have bulk elemental mercury in the office, ask your dental waste disposal provider if they accept bulk mercury. It should never be poured down the drain or placed in the red bag where you normally place soft soiled waste, nor mixed in with your regular solid waste.
  • The use of chairside traps and filters in your office vacuum system is a safe way to control dental amalgam. Disposable—rather than reusable—amalgam traps are preferable. Check with your dental waste disposal provider to see if they accept disposable amalgam traps along with your other amalgam waste.
  • When handling amalgam, staff should wear protective gear such as utility work gloves, fluid resistant face masks, and safety glasses.
  • Always use the designated sealed receptacle marked for amalgam waste given to you by your dental waste disposal provider. Make sure you talk to your provider about what can and should be placed in this container.
  • Choose a provider who complies with the ADI-ANSI standard.
 
Dental sharps disposal Disposing of dental sharps is the same as with medical sharps—place needles, scalpels, glass carpules, burs, acid etch tips, files, blades, orthodontic wire, etc. in designated sharps containers. Always keep these containers close at hand and be careful to not overfill them.
 
Chemicals, disinfectants and sterilizing agents disposal Always check the Material Safety Data Sheets (MSDS) for safe handling and disposal of all chemicals, disinfectants and sterilizing agents. If possible, avoid using chemical sterilants; instead opt for steam or dry heat to sterilize your instruments. Sterilant absorbed on cloths or paper products, as well as emptied, rinsed sterilant containers can be placed with your regular solid waste.
 
Silver and lead waste disposal Silver and lead waste disposal generated primarily through X-ray film and related equipment requires special attention. They include:
  • Spent X-ray fixer solution (used to develop X-rays)
  • Undeveloped X-ray film
  • Lead foil in X-ray packets
  • Lead aprons
Never throw these away in the regular garbage, down the sink or in with compost. Contact your dental waste disposal provider to find out if they handle these particular silver and lead wastes.
 
Following these guidelines for dental waste management is the best way to assure your staff and patients that you are protecting their health and safety and being mindful of your impact on the environment.  
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zika virus

Should I Be Worried About the Zika Virus?

The latest mosquito-borne disease to cause concern in the medical world is the Zika virus. Although the first cases of Zika in humans were discovered in Uganda and Tanzania in 1952, an outbreak in Brazil and Colombia in 2015 made national news in the U.S.  So just how prevalent is Zika, how does it spread and what harm can it cause?

Just the facts: what you need to know about Zika
Zika has been called an emerging virus: According to the World Health Organization (WHO), “from 1 January 2007 to 6 April 2016, Zika virus transmission was documented in a total of 62 countries and territories.” WHO has declared the virus and associated birth defects an international public health emergency.

Spread mainly through mosquito bites, WHO recently stated that six countries (Argentina, Chile, France, Italy, New Zealand and the United States) have now reported locally acquired infection through sexual transmission from an infected man to his  partners. Zika can also be spread from mother to child during pregnancy or around the time of delivery. Some cases of transmission through blood transfusions have been reported in Brazil.

According to the Centers for Disease Control and Prevention (CDC), symptoms of the virus are generally mild and include a low fever, skin rash and conjunctivitis—what is commonly known as “pink eye.” These symptoms usually last less than a week. However, some patients are asymptomatic.

Zika can be diagnosed in the laboratory by testing serum or plasma to detect virus, viral nucleic acid, or virus-specific immunoglobulin M and neutralizing antibodies. Currently, there is no specific antiviral treatment available for Zika virus disease. Rest, fluids and the use of analgesics and antipyretics are recommended.

The CDC is advising health care providers with patients who are complaining or actively displaying symptoms of the Zika virus to ask their patients about their recent travel history. If they suspect the presence of the virus, it should be reported to their state or local health department.

Zika in the U.S.
The CDC reports that the number of cases in the United States is relatively small right now, at 358 patients (as of April 13, 2016.) Furthermore, all 358 cases were travel-related. Locally acquired Zika cases have been reported in the U.S. territories of Puerto Rico, the U.S. Virgin Islands and American Samoa. Estimates put the number of cases in U.S. territories at 471 (as of April 13, 2016.) Authorities are paying particularly close attention to Puerto Rico because of the quick spread of the virus in that territory.

It’s important to note, however, that the mosquito that transmits the virus, Aedes aegypti, is present in more U.S. states than previously believed. According to a recent article in TIME, the current state count is 30. As spring turns to summer and humidity rises, the number of states with the Zika-carrying mosquito could increase.

Concern for pregnant women and women planning to get pregnant
The locus of concern in the medical community is primarily around pregnant women and women who are planning to conceive in the next two months. This is due to the association of the presence of the Zika virus in the mother with a serious birth defect of the brain in the infant called Microcephaly. Just this month, the director of the Centers for Disease Control and Prevention, Dr. Thomas R. Frieden, announced that “there is no longer any doubt that Zika causes microcephaly.”

Microcephaly is a condition where a baby’s head is smaller than normal because the brain has not developed properly during pregnancy. Depending on how severe the birth defect, Microcephaly can cause related problems such as seizures, developmental delays, intellectual disability, problems with movement and balance, feeding problems, and hearing and vision loss. It has also been found that Zika can cause premature births.

The CDC reported, “Zika’s damage is likely worst when it hits a fetus in the first trimester of pregnancy, the crucial time in brain development. By the time the baby’s immune system begins to combat the virus, much of the damage has been done.”

No vaccine for Zika… yet
According to BBC News, a Zika vaccine is in development and could be ready for human trials as early as September. Again the focus of the vaccine is for pregnant women to prevent microcephaly in their infants.

So just how worried should you be about the Zika virus? As Zika is a developing story and medical experts are learning new features of the virus that indicate Zika is worse than they originally thought, we recommend vigilance. This includes staying informed and taking precautions in areas where mosquitoes are present by wearing insect repellant containing DEET (diethyltoluamide) or IR 3535 or Icaridin and proper clothing that covers exposed skin, like long pants and long-sleeved shirts. If you are pregnant or plan to become pregnant in the next eight weeks, it’s advisable not to travel to areas where Zika is prevalent.

Clean water, sanitation and hygiene are all factors in preventing disease, particularly mosquito-borne viruses like Zika. Proper biomedical waste management, including laboratory waste management and syringe and sharps disposal, are also essential safeguards against the spread of disease. If you have any questions about medical waste regulations in your area, please contact cyntox.
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