GREEN DENTISTRY EVOLVES

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GREEN DENTISTRY EVOLVES

• Conference
• UK delegation presentation

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Contents

• Current curriculum in dental undergraduate
  teaching
• Green ethics in the UK
• Relevant regulations and legislations in the UK
• Waste management in UK faculties and our
  university

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In dental teaching hospitals the arrangement
for infection control, control of substances
hazardous to health and safety of equipment,
including that involving ionising radiation, must
be exemplary.

• Quoting the GDC website The First Five Years a
  framework for undergraduate dental education
• Lectures in first and second year on Infection
  Control
• Safe Disposal of Clinical Waste
• Management of Needle Sticks and Sharps Injuries
• Clinical Handbook on Infection Control and Body
  Fluid Exposures
• OSCE in first and second year on cross-infection
  control and safe waste handling

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Ethical and legal requirements of waste management

• All healthcare organisations have a legal
  responsibility to dispose of waste safely
  ensuring no harm is caused either to staff,
  members of the public or the environment. This
  responsibility begins when waste is generated and
  ends with its final disposal, even where properly
  authorised agents are used.
• It is essential that persons handling waste
  exercise care to prevent injury or transmission
  of infection to themselves or others. This is to
  fulfil their responsibilities under the current
  legislation.
• The safe disposal of waste is the responsibility
  of the independent self-employed practitioner
  local authority special collection or authorised
  independent contractor. Certified waste disposal
  companies will provide a consignment note on
  collection of waste.
• (Essex Health Protection Unit-Dental Infection
  Control Guidelines, January 05)

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Segregation of Dental Waste

• Domestic or Ordinary waste packaging
  cardboard/paper, office paper, glass bottles,
  plastic
• Hazardous waste sharps and clinical waste (items
  contaminated with the patients blood or saliva)
• Special waste radiographic developer and fixer,
  prescription only medication, partially used
  anaesthetic cartridges
• Controlled waste lead foil from x-ray film,
  waste amalgam and used amalgam capsules

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Recommended waste management options

• Domestic waste usually disposed in landfill by
  Local Council. Recommended management option is
  recycling.
• Clinical waste is all incinerated via specialised
  waste management companies. (licences and
  destinations). Approved puncture-proof containers
  should be used for sharps.
• Hazardous waste is recommended to be managed via
  incineration or recovery through waste management
  companies. NB fully discharged cartridges are
  treated as hazardous waste and is disposed of via
  the sharps container as clinical waste.
• Controlled waste should be stored separately in
  special containers.

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Current Regulations

• Hazardous waste is subject to the requirements
  of the Hazardous Waste Directive (91/689/EEC).
  This is transposed in England by the Hazardous
  Waste (England and Wales) Regulations (SI
  2005/894). Waste amalgam form dental care,
  collected by a separator or disposed of from
  premises other than through the separator is
  subject to the requirements of these Regulations.
• The Environment Agency is responsible for
  enforcing the Regulations.

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Water Regulations

• A new legislation coming into effect in July 2007
  enforcing the separation of amalgam for waste
  water, following guidance from the Department of
  Environment, Food and Rural Affairs 2005
• Envirodent supply the the Rasch 890 Amalgam
  Separator which has been supplied to some NH
  practices through their local Primary Care Trusts

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Meeting the requirements of these Regulations

• Dentists need to
• Consider whether they need to notify their
  premises to the Environment Agency (if
  producinggt200kg of hazardous waste)
• Ensure that all consignment notes detailing the
  waste, its hazardous properties and method of
  disposal are correctly written and kept by the
  practice for at least 3ys
• Ensure that hazardous waste is not mixed with
  other non-hazardous waste or any other substances
  or materials unless authorised by a permit
• Keep records of amalgam waste produced and sent
  for disposal or recovery

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Duty of Care

• Section 34 of the Environmental Protection Act
  1990 places a duty on anyone importing,
  producing, carrying, keeping, treating or
  disposing of a controlled waste to take measures
  to ensure that the waste is handled and disposed
  of safely. You must prevent the waste causing
  pollution or harming anybody. You must store
  waste safely and ensure it cannot escape from
  your control. If you give waste to someone else,
  you must be sure they are authorised to take it
  and can transport, recycle of dispose of it
  safely. If you break the law, you can be fined an
  unlimited amount.!

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Waste disposal in our university

• Black polythene bags for domestic waste
• Yellow polythene bags for clinical waste
• Yellow sharps bin for disposal of sharps
• Amalgam waste is stored in a sealed container
  under solution which supresses mercury vapour and
  empty capsules are stored in a special container
• Lead foil from radiographic film packets stored
  separately from rest of packet in a plastic
  container.
• Latex free gloves available in each dental bay as
  well as latex free rubber dam
• Radiographic solutions? Paper recycling?

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References

• Infection Control for Dentistry, Advice sheet
  A12, British Dental Association (supported by the
  Department of Health)
• Guidance for Dentists on Waste Dental Amalgam,
  Department of Environment, Food and Rural Affairs
  2005
• Environmental Protection Act 1990
• Environmental Protection (Duty of Care)
  Regulations 1991
• Special Waste Regulations 1996, 1997 waste
  disposal