Integrated Management of Hazardous Solid Waste in Dental Offices of Talara (Peru) and Machala (Ecuador): A Policy Brief Comparing Two Latin American Countries

María Elizabet Cruz Ramos; Jeiner Javier Salvatierra Chuquimarca; Luis Alexander Orrego-Ferreyros

doi:10.12688/f1000research.152652.1

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Policy Brief

Integrated Management of Hazardous Solid Waste in Dental Offices of Talara (Peru) and Machala (Ecuador): A Policy Brief Comparing Two Latin American Countries

[version 1; peer review: 2 approved with reservations]

María Elizabet Cruz Ramos¹, Jeiner Javier Salvatierra Chuquimarca¹, Luis Alexander Orrego-Ferreyros ¹

PUBLISHED 08 Jul 2024

Author details Author details

¹ Facultad de Ciencias de la Salud, Escuela de Estomatología, Universidad Cesar Vallejo, Piura, Piura, 20001, Peru

María Elizabet Cruz Ramos
Roles: Conceptualization, Data Curation, Investigation, Project Administration, Resources, Writing – Original Draft Preparation

Jeiner Javier Salvatierra Chuquimarca
Roles: Conceptualization, Data Curation, Investigation, Project Administration, Resources, Writing – Original Draft Preparation

Luis Alexander Orrego-Ferreyros
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Project Administration, Software, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

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Abstract

Background

The improper management of hazardous solid waste in dental care offices poses significant risks to public health and the environment. Dental offices generate hazardous waste, including biological and chemical contaminants, which can lead to infections, pollution, and harm if not managed properly. Effective waste management practices are crucial, yet compliance varies significantly across regions, especially in Latin America, due to limited resources, inadequate training, and insufficient infrastructure. This study compares hazardous waste management practices in dental offices in Talara, Peru, and Machala, Ecuador, to provide actionable recommendations for improvement.

Policy and Implications

In Peru, hazardous waste management involves critical steps such as conditioning, segregation, transport, storage, treatment, and disposal. Compliance minimizes exposure risks and environmental contamination. Ecuador emphasizes administrative and operational aspects, including policies, records, training, and procedures. Improving practices in both countries can model enhanced waste management across Latin America.

Recommendations

To address challenges in Talara and similar Latin American cities, it is essential to strengthen administrative systems, increase budget allocations for waste management, and develop comprehensive training programs. Waste management should be prioritized within public policy agendas with clear guidelines and accountability measures. Both cities need improved resource allocation, modern waste treatment facilities, and centralized storage solutions. Continuous education and certification programs are crucial. Implementing integrated policies, regular reviews, and robust compliance mechanisms based on Machala’s practices can benefit other regions. Public awareness campaigns and regional collaboration through workshops and research initiatives are also recommended.

Conclusions

Significant disparities in hazardous waste management exist between Talara and Machala. Talara requires strengthened systems and improved infrastructure, while Machala’s practices serve as a model. Tailored interventions can enhance public health and environmental outcomes across Latin America. Regular monitoring, evaluation, and collaboration are essential for sustained improvements.

Keywords

Waste Management, Dental Waste, Dental Offices, Hazardous Waste, Public Health, Environmental Health, Policy, Guideline Adherence

Corresponding author: Luis Alexander Orrego-Ferreyros

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Cruz Ramos ME et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Cruz Ramos ME, Salvatierra Chuquimarca JJ and Orrego-Ferreyros LA. Integrated Management of Hazardous Solid Waste in Dental Offices of Talara (Peru) and Machala (Ecuador): A Policy Brief Comparing Two Latin American Countries [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:762 (https://doi.org/10.12688/f1000research.152652.1) First published: 08 Jul 2024, 13:762 (https://doi.org/10.12688/f1000research.152652.1) Latest published: 08 Jul 2024, 13:762 (https://doi.org/10.12688/f1000research.152652.1)

Introduction

The improper management of hazardous solid waste in dental care offices is a growing challenge globally, with significant repercussions on public health and the environment. Dental offices generate various types of hazardous waste, including biological and chemical contaminants, that can pose severe health risks if not managed properly. These wastes, if inadequately handled, can lead to the spread of infections, environmental pollution, and potential harm to waste handlers and the general population. Effective waste management practices are crucial to mitigate these risks and protect both public health and the environment.¹^,²

Despite the existence of regulations and guidelines aimed at managing hazardous waste, compliance levels vary significantly across different regions and healthcare facilities. In low- and middle-income countries, including many in Latin America, the challenges are exacerbated by limited resources, inadequate training, and insufficient infrastructure.³ The lack of uniformity in compliance with hazardous waste management protocols underscores the need for targeted interventions to enhance the efficacy of waste management practices in these settings.

To address this growing challenge, a comparative study was conducted to evaluate the management practices of hazardous solid waste in dental centers located in Talara, Peru, and Machala, Ecuador. This study aims to identify key differences in compliance with hazardous waste management regulations between the two cities and provide actionable recommendations to improve practices. By focusing on these two cities, the study provides understandings into the specific challenges and successes in hazardous waste management within the Latin American context, offering a basis for broader regional policy implications.

Policy outcomes and implications

Policy outcomes

In Peru, the management of hazardous solid waste in dental offices involves several critical steps. Proper conditioning ensures hazardous waste is correctly packaged and labeled before handling or transport, minimizing exposure risks, and ensuring safe management. Segregation and storage involve separating hazardous waste from non-hazardous waste to prevent contamination, with secure storage areas to avoid leakage and exposure, thereby reducing the risk of cross-contamination and hazardous exposure. Internal collection and transport cover the safe movement of hazardous waste within the dental office, with secure containers minimizing spill and exposure risks. Final or central storage facilities must securely hold hazardous waste until treatment or disposal, preventing environmental contamination and human exposure. Effective treatment processes neutralize or safely alter hazardous waste properties, reducing environmental and health risks. External collection, transport, and final disposal ensure the safe removal of treated waste to its final disposal site, handled by certified external handlers to minimize environmental impact and ensure legal disposal.

In Ecuador, the self-evaluation matrix for dental offices focuses on administrative and operational management aspects. Administrative aspects include establishing policies, maintaining records, training staff, and ensuring compliance with regulatory requirements. High compliance ensures thorough documentation and effective waste management protocols, fostering a culture of safety and compliance. Operational management involves practical waste management procedures, including segregation, storage, internal and external transport, and treatment. High compliance ensures effective implementation of these procedures, reducing risks of contamination and exposure.

Policy implications

Effective management of hazardous solid waste in dental offices protects public health and the environment. Proper conditioning, segregation, and storage prevent cross-contamination and exposure to harmful substances. Effective internal and external transport, treatment, and final disposal mitigate environmental risks. Adhering to administrative and operational standards fosters a culture of safety and compliance, ultimately safeguarding public health and the environment. Improving these practices in Peru and Ecuador can serve as a model for enhancing hazardous waste management across Latin America.

Methods

A study involving 12 dental offices in Talara, Peru, and 11 in Machala, Ecuador, all from the private sector, was conducted to evaluate hazardous waste management practices. This policy brief highlights the critical differences in these practices and provides evidence-based recommendations for improvement.

The instruments used to measure compliance were Forms No. 01 and No. 02 of the NTS No. 144-MINSA/2018/DIGESA, Technical Health Standard: “Integral management and handling of solid waste in health establishments, medical support services, and research centers,” approved by Ministerial Resolution No. 1295-2018/MINSA for Peruvian health establishments.⁴^,⁵ For the evaluation of Ecuadorian health establishments, the Internal Evaluation Matrix “A” from the Manual “Internal management of waste and refuse generated in health establishments,“ approved by Ministerial Agreement No. 00036-2019, was used.⁶

This study's findings underline significant differences in hazardous waste management practices between the two cities. The evidence gathered provides a foundation for targeted interventions and policy recommendations to improve waste management practices in both Peru and Ecuador. By addressing these differences and implementing the recommended changes, we can enhance the overall safety and effectiveness of hazardous waste management in dental offices, ultimately protecting public health and the environment.

Results

The study revealed notable differences in the integrated management of hazardous solid waste between dental offices in Talara and Machala.

Table 1 presents an analysis of the average compliance with the integral management of hazardous solid waste in dental centers in Talara, Peru. This analysis is structured into two main categories: solid waste management components and stages of solid waste management.

Table 1. Average Compliance Percentage for the Integral Management of Hazardous Solid Waste in Dental Centers in Talara (Peru).

Criterion	Mean (SD)
Solid Waste Management Components
Administrative Aspects	18.2 (± 6.7)
Initial Diagnosis of Solid Waste Management	0 (± 0.0)
Preparation of Technical Administrative Documents	36.7 (± 7.8)
Solid Waste Management Stages
Conditioning	94.5 (± 12.8)
Segregation and Primary Storage	93.5 (± 9.8)
Internal Collection and Transport	63.3 (± 7.8)
Final or Central Storage	44.3 (± 10.9)
Treatment	0 (± 0.0)
External Collection, Transport, and Final Disposal	68.7 (± 21.6)

Table 2 offers a detailed evaluation of compliance with the integral management of hazardous solid waste in dental centers in Talara, Peru, categorizing performance in various criteria and stages.

Table 2. Evaluation of Compliance with the Integral Management of Hazardous Solid Waste in Dental Centers in Talara (Peru).

Evaluation by Criterion	n (%)
Solid Waste Management Components
Valoración de los componentes de la gestión de residuos sólidos
Very Deficient	11 (92.0)
Deficient	1 (8.3)
Acceptable	0 (0.0)
Solid Waste Management Stages
Conditioning
Very Deficient	0 (0.0)
Deficient	0 (0.0)
Acceptable	12 (100.0)
Segregation and Primary Storage
Very Deficient	0 (0.0)
Deficient	2 (16.7)
Acceptable	10 (83.3)
Internal Collection and Transport
Very Deficient	0 (0.0)
Deficient	10 (83.3)
Acceptable	2 (16.7)
Final or Central Storage
Very Deficient	4 (33.3)
Deficient	7 (58.3)
Acceptable	1 (8.3)
Treatment
Very Deficient	12 (100.0)
Deficient	0 (0.0)
Acceptable	0 (0.0)
External Collection, Transport, and Final Disposal
Very Deficient	2 (16.7)
Deficient	0 (0.0)
Acceptable	10 (83.3)

Table 3 provides a summary of the average compliance with the integral management of hazardous solid waste in dental centers in Machala, Ecuador, focusing on administrative and operational management aspects.

Table 3. Average Compliance Percentage for the Integral Management of Hazardous Solid Waste in Dental Centers in Machala (Ecuador).

Criterion	Mean (SD)
Administrative Aspects	90.9 (± 21.5)
Operational Management Aspects
Primary Storage	93.5 (± 9.8)
Waste Inactivation	63.6 (± 50.4)
Final Storage	84.1 (± 30.1)

Table 4 offers a concise and meaningful view of the compliance status for the integral management of hazardous solid waste in dental centers in Machala, Ecuador. This table categorizes the centers into three groups: “Non-compliant,” “Partially Compliant,” and “Fully Compliant,” providing a clear perspective on adherence to waste management practices and regulations.

Table 4. Evaluation of Compliance with the Integral Management of Hazardous Solid Waste in Dental Centers in Machala (Ecuador).

Compliance Evaluation	n (%)
Non-compliant	2 (18.2)
Partially Compliant	2 (18.2)
Fully Compliant	7 (63.6)

Table 5 presents a detailed comparative analysis of compliance in the integral management of hazardous solid waste between dental centers in Talara, Peru, and Machala, Ecuador, using a generalized linear model. This model quantifies the differences in compliance between the two countries in terms of proportion ratio (PR) and provides 95% confidence intervals (CI) and statistical significance values (p-value).

Table 5. Generalized Linear Model for Compliance Percentage in Equivalent Criteria for the Integral Management of Hazardous Solid Waste in Dental Centers in Talara (Peru) and Machala (Ecuador).

Country	Compliance Percentage Obtained
Country	PR	CI 95%		p-value
Administrative Aspects
Dental offices in Talara (Peru)	Ref.
Dental offices in Machala (Ecuador)	2.07	1.82	2.35	<0.001
Primary Storage
Dental offices in Talara (Peru)	Ref.
Dental offices in Machala (Ecuador)	0.99	0.90	1.09	0.843
Final Storage
Dental offices in Talara (Peru)	Ref.
Dental offices in Machala (Ecuador)	1.49	1.24	1.79	<0.001

Discussion

This policy brief underscores significant disparities in hazardous waste management practices between dental offices in Talara, Peru, and Machala, Ecuador. The study reveals that, despite the existence of a regulatory framework, Talara faces substantial challenges in administrative management and critical stages such as waste treatment and final storage. These deficiencies may be attributed to factors including limited resources, inadequate training, and potentially a lower prioritization of waste management within public policy and internal management agendas.⁷^–⁹ The administrative shortcomings in Talara impede the development and execution of effective waste management strategies, resulting in suboptimal handling and treatment of hazardous waste.

Conversely, Machala demonstrates a higher level of compliance with hazardous waste management regulations. This city exhibits better integration and application of policies, culminating in more effective waste management practices.²^,¹⁰^,¹¹ The higher compliance observed in Machala suggests a stronger alignment between policy and practice, as well as heightened awareness and training among staff. This effective implementation could be attributed to more robust administrative systems, better resource allocation, and a higher degree of staff training and awareness regarding hazardous waste management protocols.¹²^–¹⁴

The findings underscore the necessity of not only having a robust regulatory framework but also ensuring its effective implementation. Regulatory frameworks are essential; however, without proper execution, their potential benefits remain unrealized. The deficiencies identified in Talara highlight an urgent need for strengthening administrative systems, improving infrastructure, and providing continuous training.¹^,¹⁵^,¹⁶ Addressing these issues may involve increasing budget allocations for waste management, enhancing training programs for dental office staff, and ensuring that waste management is given priority within public policy agendas.¹⁷^–¹⁹

In contrast, Machala’s relatively superior performance underscores the benefits of consistent policy application and the continuous review and updating of waste management practices. Machala's approach can serve as a model for other regions, illustrating how effective policy implementation and regular audits can lead to high compliance rates and improved waste management outcomes.²⁰^–²² The city’s success highlights the importance of ongoing training, clear administrative processes, and a steadfast commitment to maintaining high standards in waste management.

Overall, this comparative study emphasizes the need for targeted interventions to address the specific challenges in each city, with the aim of enhancing the overall effectiveness of hazardous waste management in dental offices. For Talara, this might entail refining administrative protocols and increasing resource availability. For Machala, maintaining and improving current standards through continued emphasis on policy enforcement and regular practice reviews is crucial. By focusing on these tailored interventions, both cities can improve their hazardous waste management practices, thereby benefiting public health and the environment.

Recommendations

Based on the findings from this comparative study on hazardous waste management practices in dental offices in Talara, Peru, and Machala, Ecuador, several recommendations can be made to enhance the effectiveness of these practices, thereby improving public health and environmental outcomes. These recommendations are also applicable to other Latin American cities with similar regulatory frameworks and waste management policies.

To address the significant challenges identified in Talara and similar cities, it is essential to strengthen the administrative systems governing waste management. This can be achieved by increasing budget allocations specifically for waste management to ensure that dental offices have the necessary tools and infrastructure to handle hazardous waste effectively. Additionally, developing comprehensive training programs for dental office staff that focus on the latest waste management protocols and practices will improve their competency in handling hazardous materials. Furthermore, waste management should be given a higher priority within public policy agendas, including establishing clearer guidelines and accountability measures to ensure compliance.

Both Talara and other Latin American cities can benefit from improved resource allocation and infrastructure development. This might involve upgrading waste treatment facilities to ensure that dental offices are equipped with modern waste treatment facilities to handle hazardous materials properly. Implementing centralized storage solutions for hazardous waste can help manage waste more effectively and reduce the risk of contamination. Conducting regular maintenance and audits of waste management systems to identify and address any deficiencies promptly is also essential.

Continuous education and training are critical for maintaining high standards in waste management. Conducting regular training sessions for dental office staff to keep them updated on best practices and regulatory changes in waste management is recommended. Introducing certification programs for waste management personnel will ensure they meet the required standards and can effectively manage hazardous waste.

Machala’s successful practices provide a valuable model for Talara and other Latin American cities. Implementing integrated waste management policies that align with national and international standards, ensuring that waste management policies are regularly reviewed and updated to reflect the latest research and technological advancements, and establishing robust monitoring and compliance mechanisms to ensure that dental offices adhere to waste management regulations are key recommendations based on Machala’s approach.

Community involvement and awareness are crucial for effective waste management. Launching public awareness campaigns to educate the community about the importance of proper hazardous waste management and the role they can play in supporting these efforts is essential. Engaging with stakeholders, including dental professionals, policymakers, and the community, to develop and implement effective waste management strategies is also recommended.

Encouraging collaboration between regions can facilitate the sharing of best practices and resources. Organizing inter-regional workshops and conferences that bring together representatives from different regions to discuss challenges and share successful strategies in waste management, and promoting collaborative research initiatives to study and address common waste management issues faced by dental offices in various regions are valuable steps.

By implementing these recommendations, Talara, Machala, and other similar Latin American cities can significantly enhance their hazardous waste management practices, ultimately benefiting public health and the environment. These targeted interventions will ensure that dental offices operate more sustainably and responsibly, setting a precedent for other regions to follow.

Conclusions

The comparative analysis of hazardous solid waste management in dental offices in Talara, Peru, and Machala, Ecuador, highlights significant disparities. Talara faces substantial challenges due to limited resources and inadequate training, necessitating strengthened administrative systems and improved infrastructure. Conversely, Machala’s effective implementation of waste management practices serves as a model for other Latin American cities. By adopting tailored interventions, both cities can enhance public health and environmental outcomes, setting a precedent for improved waste management across the region.

Future research should explore the factors contributing to the differences in waste management practices and investigate the long-term impacts of improved practices on public health and the environment. Regular monitoring and evaluation, along with collaboration between dental offices, local authorities, and policymakers, are essential for sustained improvements.

Ethics and consent

The study was approved with Official Letter from the Research Ethics Committee of the School of Stomatology N° 0105-2023-/UCV/P dated December 20, 2023. We adhered to the principles of the Declaration of Helsinki. Written consent was obtained from all participants.

Data availability

Underlying data

Figshare: Dataset Hazardous Solid Waste. https://doi.org/10.6084/m9.figshare.25954999.²³

This project contains the following underlying data:

BDresiduos_solidos_xls.xls

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

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VERSION 1 PUBLISHED 08 Jul 2024

Author details Author details

¹ Facultad de Ciencias de la Salud, Escuela de Estomatología, Universidad Cesar Vallejo, Piura, Piura, 20001, Peru

María Elizabet Cruz Ramos
Roles: Conceptualization, Data Curation, Investigation, Project Administration, Resources, Writing – Original Draft Preparation

Jeiner Javier Salvatierra Chuquimarca
Roles: Conceptualization, Data Curation, Investigation, Project Administration, Resources, Writing – Original Draft Preparation

Luis Alexander Orrego-Ferreyros
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Project Administration, Software, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (1)

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Published: 08 Jul 2024, 13:762

https://doi.org/10.12688/f1000research.152652.1

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© 2024 Cruz Ramos ME et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Cruz Ramos ME, Salvatierra Chuquimarca JJ and Orrego-Ferreyros LA. Integrated Management of Hazardous Solid Waste in Dental Offices of Talara (Peru) and Machala (Ecuador): A Policy Brief Comparing Two Latin American Countries [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:762 (https://doi.org/10.12688/f1000research.152652.1)

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Reviewer Report 17 Oct 2024

Jusuf Kristianto, University of Indonesia, Jakarta, Indonesia

Approved with Reservations

https://doi.org/10.5256/f1000research.167439.r326611

Make a Policy Brief recommendation to socialize the Machala practice model that has been successful in increasing public awareness and increasing regional collaboration. The problem of waste in the community will be helped if clinics improve proper waste management, so ... Continue reading

Make a Policy Brief recommendation to socialize the Machala practice model that has been successful in increasing public awareness and increasing regional collaboration. The problem of waste in the community will be helped if clinics improve proper waste management, so that they can help protect the environment of people throughout Latin America.
1.Improve and complete the abstract with the best findings and detailed recommendations for managing waste properly and correctly
2. Introduction should be included with the main research objectives and criticized questions such as what policies can make clinics much better in clinical waste management.
3. The selection research design is made in more detail, including the size of the population and how the sample was selected by the researcher
4. Make research results and continue with a review of the research results and end with a policy (policy brief) that can make the clinic in Machala much better. And create a series of policies that can become recommendations
5. Conclusions and suggestions can be made after a series of results and reviews/studies of the results contain important keywords for Policy Brief

Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader?

Yes
Is the discussion on the implications clearly and accurately presented and does it cite the current literature?

Partly
Are the recommendations made clear, balanced, and justified on the basis of the presented arguments?

Partly

Competing Interests: No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 08 Aug 2024

Martha Chadyiwa, Witwatersrand University, Johannesburg, Gauteng, South Africa; Environmental Health, University of Johannesburg - Doornfontein Campus, Doornfontein, Gauteng, South Africa

Approved with Reservations

https://doi.org/10.5256/f1000research.167439.r307915

The study compares hazardous waste management in dental offices in Talara, Peru, and Machala, Ecuador. Talara faces challenges like limited resources and inadequate training, resulting in poor waste management. Machala, with better administrative systems and training, shows higher compliance ... Continue reading

The study compares hazardous waste management in dental offices in Talara, Peru, and Machala, Ecuador. Talara faces challenges like limited resources and inadequate training, resulting in poor waste management. Machala, with better administrative systems and training, shows higher compliance with regulations. Recommendations include increasing budgets, upgrading facilities, and implementing centralized storage. Continuous education, certification programs, and regular audits are crucial. Adopting Machala’s successful practices and engaging in public awareness campaigns and regional collaboration are advised. Addressing these issues can improve waste management, benefiting public health and the environment across Latin America.

Revise the abstract to include clear sections and more concise recommendations.
In the introduction clearly state the research objectives and questions.
Separate Policy Outcomes and Implications into two sections and provide specific examples.
Provide detailed descriptions of study design, sample selection, and data collection.

For example, This study involved a cross-sectional evaluation of 23 private dental offices (12 in Talara and 11 in Machala). Compliance was measured using specific forms approved by national health authorities.

Clarify table headings and captions, and ensure consistent presentation of data.

For example: Table 1. Average Compliance Percentage for Hazardous Solid Waste Management in Talara (Peru)

In your discussion relate findings to existing literature and discuss study limitations.

For example: The findings align with previous studies highlighting the challenges of hazardous waste management in low-resource settings. Limitations include the small sample size and potential reporting biases.

summarise key findings and implications succinctly.

For example: Significant disparities in hazardous waste management exist between Talara and Machala. Strengthened systems and improved infrastructure in Talara, along with sustained efforts in Machala, can enhance public health outcomes in Latin America.

Provide specific, actionable steps.

For example : Develop comprehensive training programs modelled after successful initiatives in Machala. Implement centralized storage solutions and upgrade waste treatment facilities in Talara.

Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader?

Yes
Is the discussion on the implications clearly and accurately presented and does it cite the current literature?

Partly
Are the recommendations made clear, balanced, and justified on the basis of the presented arguments?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: My research focuses on occupational and environmental health, including how artificial intelligence impacts these fields.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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VERSION 1 PUBLISHED 08 Jul 2024

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Martha Chadyiwa, Witwatersrand University, Johannesburg, South Africa; University of Johannesburg - Doornfontein Campus, Doornfontein, South Africa
Jusuf Kristianto, University of Indonesia, Jakarta, Indonesia

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17 Oct 2024 | for Version 1

Jusuf Kristianto, University of Indonesia, Jakarta, Indonesia

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Approved With Reservations

Make a Policy Brief recommendation to socialize the Machala practice model that has been successful in increasing public awareness and increasing regional collaboration. The problem of waste in the community will be helped if clinics improve proper waste management, so that they can help protect the environment of people throughout Latin America.
1.Improve and complete the abstract with the best findings and detailed recommendations for managing waste properly and correctly
2. Introduction should be included with the main research objectives and criticized questions such as what policies can make clinics much better in clinical waste management.
3. The selection research design is made in more detail, including the size of the population and how the sample was selected by the researcher
4. Make research results and continue with a review of the research results and end with a policy (policy brief) that can make the clinic in Machala much better. And create a series of policies that can become recommendations
5. Conclusions and suggestions can be made after a series of results and reviews/studies of the results contain important keywords for Policy Brief

Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader?

Yes
Is the discussion on the implications clearly and accurately presented and does it cite the current literature?

Partly
Are the recommendations made clear, balanced, and justified on the basis of the presented arguments?

Partly

Competing Interests

No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report

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08 Aug 2024 | for Version 1

Martha Chadyiwa, Witwatersrand University, Johannesburg, Gauteng, South Africa; Environmental Health, University of Johannesburg - Doornfontein Campus, Doornfontein, Gauteng, South Africa

1 Views Cite this report Responses(0)

Approved With Reservations

The study compares hazardous waste management in dental offices in Talara, Peru, and Machala, Ecuador. Talara faces challenges like limited resources and inadequate training, resulting in poor waste management. Machala, with better administrative systems and training, shows higher compliance with regulations. Recommendations include increasing budgets, upgrading facilities, and implementing centralized storage. Continuous education, certification programs, and regular audits are crucial. Adopting Machala’s successful practices and engaging in public awareness campaigns and regional collaboration are advised. Addressing these issues can improve waste management, benefiting public health and the environment across Latin America.

Revise the abstract to include clear sections and more concise recommendations.
In the introduction clearly state the research objectives and questions.
Separate Policy Outcomes and Implications into two sections and provide specific examples.
Provide detailed descriptions of study design, sample selection, and data collection.

For example, This study involved a cross-sectional evaluation of 23 private dental offices (12 in Talara and 11 in Machala). Compliance was measured using specific forms approved by national health authorities.

Clarify table headings and captions, and ensure consistent presentation of data.

For example: Table 1. Average Compliance Percentage for Hazardous Solid Waste Management in Talara (Peru)

In your discussion relate findings to existing literature and discuss study limitations.

For example: The findings align with previous studies highlighting the challenges of hazardous waste management in low-resource settings. Limitations include the small sample size and potential reporting biases.

summarise key findings and implications succinctly.

For example: Significant disparities in hazardous waste management exist between Talara and Machala. Strengthened systems and improved infrastructure in Talara, along with sustained efforts in Machala, can enhance public health outcomes in Latin America.

Provide specific, actionable steps.

For example : Develop comprehensive training programs modelled after successful initiatives in Machala. Implement centralized storage solutions and upgrade waste treatment facilities in Talara.

Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader?

Yes
Is the discussion on the implications clearly and accurately presented and does it cite the current literature?

Partly
Are the recommendations made clear, balanced, and justified on the basis of the presented arguments?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

My research focuses on occupational and environmental health, including how artificial intelligence impacts these fields.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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[14] 14. Calefi DG, Haddad JPA, Pedroso SHSP, et al.: Evidence of cross-contamination of waste workers and transmission of antimicrobial resistance genes by coagulase-negative S taphylococcus isolated from dental solid waste: an intriguing study. Int. J. Environ. Health Res. 2022 Jun 3; 32(6): 1291–1303. PubMed Abstract | Publisher Full Text

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Integrated Management of Hazardous Solid Waste in Dental Offices of Talara (Peru) and Machala (Ecuador): A Policy Brief Comparing Two Latin American Countries

Abstract

Background

Policy and Implications

Recommendations

Conclusions

Keywords

Introduction

Policy outcomes and implications

Policy outcomes

Policy implications

Methods

Results

Table 1. Average Compliance Percentage for the Integral Management of Hazardous Solid Waste in Dental Centers in Talara (Peru).

Table 2. Evaluation of Compliance with the Integral Management of Hazardous Solid Waste in Dental Centers in Talara (Peru).

Table 3. Average Compliance Percentage for the Integral Management of Hazardous Solid Waste in Dental Centers in Machala (Ecuador).

Table 4. Evaluation of Compliance with the Integral Management of Hazardous Solid Waste in Dental Centers in Machala (Ecuador).

Table 5. Generalized Linear Model for Compliance Percentage in Equivalent Criteria for the Integral Management of Hazardous Solid Waste in Dental Centers in Talara (Peru) and Machala (Ecuador).

Discussion

Recommendations

Conclusions

Ethics and consent

Data availability

Underlying data

References

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