49. Waste management in the dental office. Environmental protection aspects.

Question 1

1. What are the 3 pillars of sustainability?

Answer 1

• environmental
• social
• economic

Question 2

2. What is ecological footprints

Answer 2

The area-projected measure of biosphere transformation.

How many land and water does a human society need in a given technological developmental state for self-sustaining and for the absorption of produced waste.

Question 3

3. What are the main footprint emitters?

Answer 3

1/ Energy use
2/ Materials use
3/ Water use
4/ Waste management (0.2% contribution to carbon footprint)
5/ Travels

Question 4

4. What are the most important points of FDI (World Dental Federation) political statement of sustainability in dentistry (2017) ?

Answer 4

1/ prioritize primary prevention in patient care
2/ Sustainable good practice in the dental office
3/ Mitigation of consumption
4/ Environmental aspects in procurement: e.g. single-use vs. Multiple-use materials and tools
5/ Commitment to sustainability of dental industry - eco-efficient technologies and material
6/ Continuous education of sustainability by professional organizations

Question 5

5. What are Barriers of environmental sustainability in dentistry (based on de Leon et al)?

Answer 5

1/ Infrastructural: properties of the built environment; municipal infrastructure; production and procurement chains
2/ Institutional: special rules of infection control in healthcare facilities versus municipal waste segregation methods
3/ Educational: gaps of educationg sustainability; lacking knowledge in waste management, environmental protection and ecology
4/ Individual: time constraints; restricted knowledge; lack of awareness or interest

Question 6

6. What is carbon footprint?

Answer 6

Shows, how many greenhouse gases (GHG)
are emitted directly and indirectly into the atmosphere through a company production, a human lifestyle or a product life cycle
- Unit: t CO2e/year (emission based)

Question 7

7. Characteristics of carbon footprint

Answer 7

1/ Makes a significant part of the ecological footprint -> calculation, audit and mitigation strategies are the base of sustainability efforts
2/ Measurement according to international environmental economical standards (f.e. life-cycle assessment, LCA)

Question 8

8. Characteristics of Ecological footprint of healthcare

Answer 8

1/ Healthcare actually cannot be regarded as sustainable in an ecological point of view
2/ Globally, healthcare sector is responsible for 5% of the GHG emissions of all of the countries; in the USA 10%, in Hungary 4.3%
3/ Increasing social and economical demand for estabilishing more sustainable healthcare systems

Question 9

9. Ecological footprint of dentistry
   a/ What are the most Most important, measurable inputs of dental ecological footprint?

Answer 9

1/ Most important, measurable inputs of dental ecological footprint
- Staff commuting to work
- Staff travel related to work
- Patient travel
- Procurement
- Energy use
- Water use
- Waste management

2/ Using the upper mentioned inputs we are able to determine the ecological footprint of dental treatments

Question 10

9. Ecological footprint of dentistry
   b/ What are the applied method for ecological footprint of dentistry?

Answer 10

Applied methods: hybrid analysis -> lifecycle assessment + environmental input-output analysis

Question 11

9. Ecological footprint of dentistry
   c/ What are the possibilities for decreasing the carbon footprint of dentistry in travel?

Answer 11

o Reduce Travel needs by optimizing patient attendance to visits
o Reduce the Distance between home and workplace
o Location of Dental office and dental lab
o Use and support Sustainable methods of travel : walking, cycling, public transport,
etc.

Question 12

10. What are the Pillars of effective waste management?

Answer 12

1/ Preventing waste generation
- conscious purchase
- reduce, reuse, recycle

2/ Segregating waste properly
- selective waste collection: separate non dangerous and dangerous
- prevent throwing non-contaminated into dangerous waste care
- amalgam separators – special containers.

3/ Regular control – „waste audit”

Question 13

11. What is the 3R/4R principle in waste management

Answer 13

Conscious purchasing & reduction of consumption (Rethink) -> 0. Step!
- Reduce: water use, paper use
- Reuse, if possible
+) Use of multiple-use goods and products where possible
+) Donating or selling products which are no longer in use -> social and environmental sustainability!
- Recycle -> selective waste collection!

Question 14

12. Selective waste collection
    - How do we selectively collect waste

Answer 14

1/ Collection of non-dangerous municipal waste in every room (paper, plastic, glass, metal, compost)
2/ Separate collection and delivery of Dangerous electric waste
3/ Separate collection of non-dangerous and dangerous healthcare waste in clinical wards; separate collection of pharmaceutical waste based on correct labelling

Question 15

13. Amalgam waste
    a/ What are the problems of . Amalgam waste

Answer 15

• Problem: dental suction units -> sewer system -> water pollution; environmental mercury loadMinamata treaty (2017)

Question 16

What is healthcare waste?

Answer 16

Waste generated at healthcare providers during their services containing human or animal biological products

Question 17

14. Classification of special dangerous healthcare waste

Answer 17

1/ Contaminated sharp instruments which can cause pinprick accidents or could be contaminated with microorganisms
2/ Waste from blood derivatives or containing biological remnants
3/ Single-use devices contaminated with blood

Question 18

15. Management of healthcare waste with combustion

Answer 18

1/ Waste combustion facilities are sources of heavy air pollution -> toxic materials into the air: dioxines, furanes, heavy metals, organic combustion products -> health + environmental risks!

2/ In Hungary, the management of dangerous healthcare waste is regularly done by combustion.

3/ Most efficient way of waste management in terms of infection control, however, the most expensive and pollutant at the same time

Question 19

16. What are some non-combustion technologies for the management of healthcare waste

Answer 19

1/ Thermic (steam sterilization,microwave)
2/ Chemical (chlorine and non-chlorine)
3/ Irradiation (ionising radiation)
4/ Biological (enzimatical degradation)

Question 20

17. How do we dispose waste?

Answer 20

1/ sharp disposables should be placed in a solid sharps container
2/ contaminated patient borne waste should be placed in a color coded (yellow) waste bin
3/ liquid waste must be poured into a drainer toilet that is directly linked to a sewer sanitary system
4/ amalgam scrap must be placed in designated containers