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.

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.

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 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 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 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 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).

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.

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.

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.