HTM 07-01: the key changes

Pat Langley navigates the updated Health Technical Memorandum 07-01: A Guide for Dental Practices.

Few would disagree that the practice of dentistry produces huge amounts of waste in the form of single-use items. This needs to change where possible and as a profession, we need guidance on how best to make these changes safely.

A good start on this comes in the form of the updated 2023 version of HTM 07-01, which replaces the previous 2013 edition and details the environmental benefits of the safe management and disposal of healthcare waste. It also presents opportunities for reducing carbon emissions related to waste management.

The updated version even has a shiny new title that focuses on making a commitment to sustainability. For the first time, HTM 07-01: Safe and sustainable disposal of healthcare waste introduces targets for how waste from healthcare premises is dealt with.

This article aims to provide an overview of the updated HTM 07-01, highlighting key aspects dental practices need to be aware of to maintain compliance and uphold best practices.

For those who like to do their own research, the dental section of the updated HTM 01-05 can be found in Section 5.207 of the 145-page memorandum although most of the rest of the guidance also applies to us in dentistry.

Key changes to the guidance

Environmental considerations

HTM 07-01 places considerable emphasis on sustainability. Practices are encouraged to minimise waste generation, recycle where possible, and choose disposal methods with the least environmental impact. Choosing to use digital radiography over traditional film reduces chemical waste, and using reusable instruments where safe to reduce single-use items.

Single-use items

Prioritising reusable equipment seems sensible but for many years the mantra has been to use only single-use items for a very long list of essential items, so this represents a significant change. Please see the box for a list of items that have long been considered single-use.

Much of the list of single-use items, such as needles, partially-used cartridges, gloves, scalpel blades, matrix bands, and rubber dams, must of course remain as single use.

However, a number of items have evolved to be single-use that could helpfully be replaced by sustainable alternatives. Plastic mouthwash cups spring immediately to mind. Many practices have already adopted a more sustainable solution even before the updated guidance was published.

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The more difficult items to decide on are single-use plastic saliva ejectors, aspirator tips and three-in-one syringe tips.

My personal opinion is that these could all be replaced by reusable alternatives, with aspirator tips being what is colloquially referred to as a ‘no-brainer’. High-quality autoclavable aspirator tips are readily available and there is no argument I can think of for the lumen being described as too narrow for steam to penetrate during sterilisation.

The case for saliva ejectors and three-in-one syringe tips being single-use is trickier because the lumens are narrow. So, though, are the lumens in handpieces and there is no realistic suggestion that these should be single-use. I would suggest that if you can theoretically sterilise a handpiece in a vacuum autoclave, you can also sterilise reusable saliva ejectors and three-in-one syringe tips. (Of course, we don’t know for sure that handpieces are sterilised effectively even in a vacuum autoclave.)

Anecdotally, HTM 01-05 is being updated and there is no doubt this is essential. We don’t know when or even if this will happen, so in the meantime practices will need to make their own decisions on what to do based on both safety and environmental considerations.

Waste segregation and disposal

The updated version of HTM 07-01 states that waste from a dental practice should now only be considered as infectious if it has been generated during the treatment of a patient with a known infection. PPE, cotton wool rolls, swabs, bibs, and blood-stained tissues should now all be classified as offensive rather than hazardous unless the patient has a known infection.

Offensive waste goes into ‘tiger stripe’ bags, not orange bags, and the guidance also states that whole extracted teeth without amalgam should now go into offensive waste. There are issues with implementing this guidance because some waste contractors are not supplying tiger stripe bags and collection costs can be more than the costs for collecting orange bags.

However, the large elephant in the room is… how do you know which patients have a known infection and are infectious?

We have spent decades being told that all patients should be considered infectious, so it is a considerable step to move to the position described in the updated guidance that only patients with a known infection should be regarded as posing a risk. I suspect many practices will find this a step too far and may continue to place all waste that is contaminated with bodily fluids into orange bags, despite the guidance.

Orange versus tiger stripe bags

Apart from the different waste streams contained in the orange or tiger-stripe bags, the principal difference is how the waste is ultimately disposed of after your waste disposal contractor has collected it.

Orange bags are used for infectious waste that requires treatment to render it safe. This includes waste contaminated with bodily fluids that has been generated during the treatment of a patient with a known infection. Orange bags should not include non-infectious waste.

Orange bags are sent for alternative treatment methods including autoclaving, to render the waste non-infectious. If treatment facilities are unavailable, the waste may be incinerated as a fallback option, although this is less sustainable.

Tiger stripe bags are used for non-infectious offensive waste. Tiger stripe bags should not include infectious waste. Tiger stripe bags are sent to non-hazardous landfill or energy recovery facilities (ERFs) for incineration. The use of ERFs is encouraged as a more sustainable option, allowing waste to contribute to energy generation.

Storage

All healthcare waste must be stored safely and securely prior to collection and in an area to which patients and the public have no access. Practices must ensure that waste awaiting collection cannot be accidentally accessed through carelessness, such as by storing it in a room that is supposed to be kept locked but is sometimes left open.

Conclusion and summary

The safe management of waste is an essential part of running a compliant practice. The updated guidance provides a robust framework for handling waste responsibly and safely. It is also true that it raises more questions than answers. It will likely be hotly debated for some time.

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