Reductions in clinical waste and environmental emissions through recycling and waste segregation in a dental school: a cross-sectional study

OPEN RESEARCH Reductions in clinical waste and environmental emissions through recycling and waste segregation in a dental school: a cross-sectional study Aisyah Ahmad Fisal,*1 Maryani Mohamed Rohani,2 Nor Azlida Mohd Nor3 and Tengku Nurfarhana Nadirah Tengku Hamzah4 Key points Proper recycling and waste sorting in dental schools can reduce the amount of rubbish that goes to biohazard bins, helping to cut down pollution and protect the environment. By recycling items like sterilisation pouches instead of throwing them away, this initiative helped reduce greenhouse gas emissions, which is good for the planet. Sorting waste properly means that less clinical waste needs special (and expensive) disposal. This could help reduce costs for hospitals and dental clinics in the long run. Dental students learned how to manage waste responsibly, preparing them to practice ecofriendly dentistry in their future careers. Abstract Introduction The increasing generation of plastic waste in healthcare settings, particularly in dentistry, highlights the need for structured recycling and waste segregation initiatives. Aim This study evaluates the effectiveness of a recycling initiative implemented in a dental school in Kuala Lumpur, Malaysia. Methods A 12‑month recycling initiative (April 2023 – March 2024) was implemented. The primary outcome measured was the total amount of recyclable waste collected, while secondary outcomes included monthly trends in plastic and paper waste generation and reductions in clinical waste production. Results A total of 443.57 kg of recyclable waste was collected, with plastic making up 53.9%. The highest collection occurred in March 2024 (179.78 kg). Clinical waste production significantly declined post-implementation, with a notable reduction in April 2023 (936.5 kg) compared to April 2022 (1,919.3 kg; p <0.05). However, this reduction may also reflect reduced personal protective equipment usage following the loosening of COVID‑19 restrictions. Additionally, the initiative offset approximately 813.06 kg of CO₂ emissions by diverting recyclable waste from clinical disposal. Conclusion This study highlights the impact of a structured recycling and waste segregation initiative within a dental school in Kuala Lumpur, demonstrating significant reductions in clinical waste while enhancing recycling efforts. Future research should explore long-term sustainability, cost-effectiveness, and broader applications of such recycling programs in other healthcare settings. Introduction Malaysia, classified by the World Bank as an upper middle-income country, is grappling Lecturer in Special Care Dentistry, Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Malaysia; 2Senior Lecturer in Special Care Dentistry, Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Malaysia; 3Senior Lecturer in Dental Public Health, Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Malaysia; 4Lecturer in Paediatric Dentistry, Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Malaysia. *Correspondence to: Aisyah Ahmad Fisal Email address: 1 Refereed Paper. Submitted 6 March 2025 Revised 22 May 2025 Accepted 8 June 2025 https://doi.org/10.1038/s41415-025-8913-y with the growing plastic waste crisis typical of developing countries.1,2,3 Although Malaysia’s recycling rate has risen from 5% in 1993 to 24.6% in 2017, challenges such as a ‘buy-anddiscard’ mentality, lacking public knowledge and technical expertise on recycling, and inadequate policies continue to hinder waste minimisation among households. 2,4,5 The problem has been further compounded with the alarming consumption of single-use plastics since the 1970s and Malaysia’s role as a leading alternative destination for plastic waste imports following China’s 2017 ban.3,4 Addressing these issues requires immediate implementation of effective strategies for waste minimisation and recycling. Among recyclable materials, plastic is the main focus due to its environmental impact. A meta-analysis of healthcare waste (HCW) BRITISH DENTAL JOURNAL | ONLINE PUBLICATION | NOVEMBER 21 2025 © The Author(s) 2025. management in 78 countries revealed that plastic materials made up approximately 35% of medical waste.6 Despite its recyclable potential, less than 10% of global plastic waste is recycled.7,8 The vast amount of plastic ends up in landfills, dumps and oceans, while a small percentage is incinerated for energy recovery.7 While developing countries tend to generate more plastic waste than developed nations, there is conflicting evidence regarding regional HCW trends.1,6,7 While waste segregation and recycling initiatives have been introduced in Malaysian medical healthcare facilities, 9,10 dentistry remains largely overlooked in waste management research. Disposable sterile wrappings, commonly used in both medical and dental settings, play a significant role in waste production. Sterile wrappings can 1 RESEARCH be reusable (made of muslin or non-woven cloth) or disposable, such as autoclavable sterilisation pouches (ASPs). ASPs consist of a fused paper and polypropylene plastic sheet, which can be separated and recycled if handled correctly. ASPs should be handled properly to ensure they are discarded as non-contaminated HCW or general waste. However, improper disposal practices lead to two key issues: first, non-contaminated ASPs are sometimes mistakenly discarded in biohazard bins, unnecessarily increasing contaminated clinical waste; and second, if ASPs are mishandled and become soiled with bodily fluids, they must be disposed of as biohazard waste, further contributing to contaminated waste generation. Waste segregation plays a crucial role in preventing such misclassification, as evidenced by a study in a Malaysian healthcare facility that found general plastic, papers, and rejected medical parts were inappropriately disposed of in biohazard bins.11 Dental schools provide an ideal environment to implement sustainable waste segregation practices, as they can instil environmentally responsible habits among future dental professionals. This study evaluated the impact of a structured recycling and waste segregation initiative in a dental school in Kuala Lumpur, Malaysia, assessing its effectiveness in reducing clinical waste and improving recycling efficiency. Methodology The recycling and waste segregation project was conducted at the Faculty of Dentistry, Universiti Malaya, Malaysia from April 2023 to March 2024. Recycling bins of 60 L and 120 L capacity were placed in various clinical settings to facilitate waste segregation. The clinics involved included specialty clinics, postgraduate clinics, undergraduate policlinics, and the primary care unit. This project focused primarily on ASPs as they are used almost exclusively within the faculty. To ensu (...truncated)