How do you balance environmental responsibility with responsibility to your patients? Susanna Nelson looks at the practices who are thinking globally and acting locally.
There are a number of complex and even conflicting aspects to environmental responsibility in the health professions. On the one hand there is the need to reduce unnecessary waste; on the other the imperative that hygiene standards protect patient health.
At an individual practice level, dentists and their staff can implement a number of measures to reduce waste and increase efficiency-and practices are increasingly opting to do this where possible. But a more effective model of sustainability involves industry-wide, and indeed, global, solutions.
The recently opened three-dentist Australia Dental practice at Clontarf in Queensland has taken the challenge of environmental waste seriously. On its website the practice touts its thorough waste separation and recycling programs and its support of ‘innovative biodegradable disposable materials’.
“In addition to an amalgam trap, we also have a filtered water system, which means the water used in our equipment and devices is chemically free and, along with the amalgam, isn’t polluting the environment once it enters the waterways,” says practice manager Anita Roe.
Roe runs a paperless office-all patient documentation is stored electronically, using an iPad to record the patient’s medical history and details. Email, rather than faxing, is standard, which reduces paper usage. In addition, the practice doesn’t print individual business cards, which can be wasteful when a dentist leaves the practice, instead supplying a universal card that any of the dentists can use. Roe says the practice runs a web-based practice program to eliminate the need for a huge server and storage disks, reducing plastic office waste and power usage, and elected to pay for the highest possible percentage of green power when it connected its electricity.
ME Dental, servicing the Toowoomba region of South East Queensland, opened in 2011 and is one of two Australian practices accredited by the US-based Eco-Dentistry Association. The Eco-Dentistry Association has 800 members worldwide, and provides guidance to dental professionals around the world on how they can create a green dental practice.
“Green habits are widespread in other parts of the community but when it came to our profession we found it really wasn’t the norm,” says practice manager Amy Leicht. “When we looked closely at how a dental practice operates we found there were many ways that we could implement and sustain green practices. Becoming a member of the Eco-Dentistry Association helped us to see where we could make those changes.”
Since it opened, the practice has implemented measures such as Enviropack reusable sterilisation pouches, remote power boards for electrical appliances, sensor lighting for the bathroom, accessible recycling bins, energy-saving hand dryers, reusable suction tips, a water-conserving dental chair set up and LED lighting where possible-for example, in dental chairs and exit lights. It anticipates a ‘silver’ rating from the Eco-Dentistry Association, with room to move to ‘gold’ as it expands.
The endeavours of individual practices around the country demonstrate the commitment many dentists have to sustainability and professional responsibility, but it is clear that much more can be achieved when the relevant authorities, industry organisations and experts collaborate on best practice.
The overwhelming success of the Dentists for Cleaner Water project, an initiative of the Victorian branch of the ADA (ADAVB) in collaboration with the EPA and the water retailers, demonstrates the importance of research and planning in successful environmental outcomes. The project’s founder, ADAVB CEO Garry Pearson, says that the willingness of all the partner organisations to be involved in the project determined its efficacy and widespread uptake.
The Australia Dental practice is one of a handful of Queensland dental practices to have installed an amalgam separator system, which removes the pollutant from the waste stream and includes professional waste removal to responsibly dispose of it. By contrast, more than 902 dental surgeries in Victoria have committed to installing international standard-compliant amalgam separators as a direct result of the Dentists for Cleaner Water project, which provided stepped financial incentives benefiting early adopters.
In addition to the work conducted by Garry Pearson and the ADAVB to develop the program, Dentists for Cleaner Water was also made possible with the help of the Australian Dental Industry Association, along with trade waste collector Sweeney Todd and heavy metal recycler CMA ecocycle, who ensured that the waste was safely collected and recycled.
A national rollout of the program is now on the cards, and the United Nations Environment Program’s (UNEP) Global Mercury Partnership promises to mandate global action on dental waste management through a global, legally binding instrument on mercury, expected in 2013. Australian dentists who have installed compliant amalgam separators are likely to be ahead of the curve when the UNEP makes a ruling in this area. The waste management issue of what to do with amalgam is only one aspect of a complex problem. “I thought the amalgam separator was a great idea and was an early adopter of the system,” says Dr Adeline Chong. “Everything in dentistry is expensive, relatively speaking,” she says. “The amalgam separator was not one of our most expensive purchases, and has been worth the outlay.” But Dr Chong says that other aspects of green dentistry can be challenging when they come into conflict with patient health outcomes.
“We’d love to recycle and re-use everything-especially our plastics-but infection control is of paramount importance and we just can’t risk contamination of our surgery and our patients’ health,” says Dr Chong. “If there’s any risk of contamination, we throw it away.”
Waste management and the need to re-use and recycle are two areas that come into conflict when so many of the materials used in dental practice constitute a biohazard risk. While some surgery items can be re-used-Dr Chong says that the Australia Dental practice has reduced waste by opting to sterilise and re-use micro fibre towels in its sterilisation room, rather than paper towelling-the safety of patients will always trump environmental concerns when it comes to re-use.
“Recycling in dentistry is the next big issue to be tackled. It is difficult because bio-degradable plastic requires a different set of processing requirements-it cannot just go into landfill,” says Garry Pearson of ADAVB. The need for stringent infection control measures also comes into play: “Public health outcomes are the first priority, then the health of dentists and their staff. Against these considerations, environmental concerns must come third.”
Australian Dental Industry Association (ADIA) CEO Troy Williams says that energy inputs into sterilisation of reusable dental products make their use less sustainable than well-produced biodegradable disposables-for example, wax-coated paper cups. He also notes that bio-hazardous material does not enter the waste stream or landfill, so their path into the environment cannot be measured in the same way as comparable products in other industries.
Williams says that there are only small efficiencies to be gained from energy saving on dental equipment itself, which is not a big user of electricity, and he sees the amalgam issue as a waste management issue which is more or less under control.
“The global indications are that amalgam will cease to be a restorative agent within 25 years-therefore it is a waste management issue rather than an ongoing sustainability issue,” says Williams. These days, amalgam tends to enter the environment through extraction of existing fillings rather than new placements.
Williams believes that planning for economies of scale represents the greatest opportunity for waste and energy reduction: “In terms of the broader supply chain issues related to minimising resource use, probably the greatest area for reform is in the purchasing patterns of dental practices. Some practices tend to order their products in a piecemeal fashion, which increases packaging and transport costs. There are very few dental practices that will look at their resource needs over anything more than a month. If they looked at their purchasing patterns over the longer term it would allow them to exercise a bit of management to reduce their costs in freight, but also in packaging.”
Of course, an added benefit of waste reduction is cost reductions. “Our expenses are less than we would expect to pay if we were running a non-green practice,” says Amy Leicht.