Best Practices for Dental Offices

 

This is a compilation of Best Management Practices for dental offices covers the following areas:

  1. Recycling and Waste Reduction
    1. Set up an ongoing system to recycle. Make it easy for employees to recycle by placing clearly marked collection
    2. Purchasing products made from recycled materials conserves resources and is essential to support
  2. Energy Conservation
    1. Equipment/Facility Changes
    2. Employee Practices
  3. Water Conservation
    1. Equipment/Facility Changes
  4. Pollution Prevention
    1. Amalgam
    2. Photo Processing
    3. Dental Chemicals
    4. Other Pollution Prevention
    5. Office

 

  1. Recycling and Waste Reduction

    Assess your solid waste generation (regular, non-hazardous garbage and recyclables), or identify what materials/wastes are currently generated; approximately how much; and how they are being managed (i.e. garbage, recycle, etc.). Look for opportunities to reduce, reuse, and recycle.

    • Make two sided printing and copying standard practice in your business (set copier to default to duplex printing or manually feed to duplex). If your facility still has an old printer without duplex capability, use only for single page documents and ensure multi-page documents are printed on duplex printer.
    • Keep a stack of previously used paper near printers. Use it for drafts, scratch paper or internal memos or designate a draft tray on printers with multiple trays.
    • Reduce unwanted mail by the following:
      • Write to or call senders requesting removal from mailing list.
      • Return labels from duplicate mailings and subscriptions requesting all but one be removed.
      • Visit www.stopjunkmail.org for an on-line guidance
      • Purge your own mailing lists to avoid duplicatis
    • Use electronic files rather than paper ones. Draft documents can be reviewed, edited, and shared on screen.
    • Practice efficient copying by using the size reduction feature (e.g. print two pages of book on one page).
    • Minimize misprints by posting a diagram showing how to load special paper, like letterhead.
    • Minimize printing by eliminating unnecessary forms and reports or sending them electronically.
    • Identify and eliminate unnecessary forms, double-side or redesign forms to use less space (e.g. set word processing defaults for smaller fonts and margins) or have forms on electronic media.
    • Reuse envelopes as both send and return envelopes: Cover up old addresses and postage, affix new, AND/OR Use two way or ‘send and return’ envelopes. Your outgoing envelope gets returned for its return trip.
    • Design marketing materials that require no envelope – simply fold and mail.
    • Eliminate fax cover sheets by using “sticky” fax directory notes or use software that allows you to send and receive faxes directly from your computer without printing.
    • Lease, rather than purchase computers and printers.
    • In the lunch/break room, eliminate disposables by using permanent ware (mugs, dishes, utensils, towels/rags, coffee filters, etc.) and using refillable containers of sugar, salt and pepper, etc. to avoid individual condiment packets. For takeout use your own dishes (encourage caterers to serve “family-style” in reusable serving dishes).
    • Select products with the least packaging and/or which have easily recyclable packaging.
    • Choose vendors who take back products after their shelf life is over (i.e. fluorescent light bulbs) OR Work with vendors to minimize product packaging: Ask vendors to take back packaging and used or damaged products for reuse and recycling. Specify deliveries in reusable or returnable containers.
    • Replace several similar products with one or two that do the same job.
    • Retailers- offer a small incentive to customers who bring their own shopping bags, coffee mugs, etc.
    • Other (e.g. use optical scanners for precise ordering; track material usage to optimize ordering and use of time-sensitive materials).
    1. Set up an ongoing system to recycle. Make it easy for employees to recycle by placing clearly marked collection bins in convenient locations.
      • Recycle or reuse all of following fibers: cardboard (corrugated cardboard boxes); mixed paper (junk mail, scrap and colored paper); newspapers; office paper (white ledger, computer and copier paper).
      • Recycle all glass, plastic, and aluminum in accordance with available recycling programs.
      • Compost Organics: Participate in the composting program for collecting food and yard discards, soiled paper products, and compostable food containers when available.
      • For shipping items, use shredded paper for packaging needs instead of purchasing Styrofoam pellets, bubble wrap or other packing materials. If you receive these, reuse them in your own packaging. The Plastic Loose Fill Council at (800) 828-2214 will direct you to businesses accepting polystyrene peanuts for reuse in your area.
      • Donate or exchange unwanted but usable items (furniture, supplies, electronics, scrap materials, computer disks, etc.) to schools, churches, hospitals, libraries, nonprofit organizations, museums, teacher resource organizations, etc. Enroll in a waste exchange program where your unwanted items can become another company’s resource.
      • Other (e.g. recycle or reuse wood- pallets or from remodeling, carpeting).
    2. Purchasing products made from recycled materials conserves resources and is essential to support the recycling market.
      • Copy, computer or fax paper (35-100% post consumer waste)
      • Folders or other paper products letterhead, envelopes and/or business cards (35-100% post consumer waste)
      • Toilet paper, tissues, and paper towels (35%-100% post consumer waste)
      • Letterhead, envelopes and/or business cards (35-100% post consumer waste)
      • Boxes and bags for retail use or shipping (bags made from recycled paper, recycled plastic soda bottles)
      • Garbage pails or garbage bags (Recycled HDPE trash liner bags instead of LDPE or LLDPE).
      • Other (e.g. pens, pencils, desk accessories, mulch, soil amendments, dumpster lids, utility bins, benches, playground equipment).
  2. Energy Conservation

    If possible, have your energy provider conduct a free audit of your facility’s energy use to provide you with specific suggestions to conserve energy. Review it annual to identify additional opportunities to improve energy savings.

    • Perform regular maintenance on your HVAC (heating, ventilation and air conditioning) and refrigeration systems. Keep a log of all maintenance activities. Note: [R] Indicates a required measure in SF and must completed if applicable.
    • Institute and/or maintain a written policy that inspects permanent filters every 3 months and clean permanent filters with mild detergents when necessary (change replaceable filters every three months)
    • Institute and/or maintain a written maintenance program that checks the entire system for coolant and air leaks, clogs, and obstructions of air intake and vents.
    • Institute and/or maintain a written maintenance program that keeps the condenser coils free of dust and lint.
    • Institute and/or maintain a written maintenance program that keeps the evaporator coils free of excessive frost.
    1. Equipment/Facility Changes
      1. General Facility
        • Use electrical equipment with energy saving features (e.g. Energy Star® logo) and ensure that Energy Star settings are enabled (manual set-up often required).
        • Use hardware programs that save energy by automatically turning off idle monitors (after 15 minutes), computers (30 minutes) and printers (10 minutes). See www.energystar.gov/powermanagement for information and software options.
        • If purchasing new computers, buy EPEAT certified (www.EPEAT.net). If purchasing monitors, consider flat-screen LED monitors which consume approximately 1/3 less energy than larger ray tube monitors.
        • Replace inefficient refrigerators (usually older than ten years) with a new efficient model, such as one labeled Energy Star®.
        • Insulate all hot water pipes, hot water heaters and storage tanks.
        • Use and maintain a written maintenance program for weather stripping (weatherizing and caulking) to seal around windows and doors to close air gaps.
        • Use motion sensors on ice, snack and vending machines and locate in shaded areas.
        • Use occupancy sensors to adjust set points for the air conditioning, and heating equipment and to control other electrical devices and appliances.
        • Use or invest in renewable energy for at least 50% of your energy needs.
      2. Lighting
        • Replace non-dimming incandescent bulbs with compact fluorescents. Replace low wattage dimming and non-dimming incandescent bulbs with cold cathodes. Use halogen lamps only for low wattage spotlighting in retail environments.
        • Replace magnetic ballasts with electronic ballasts and install T-8 or T-5 lamps.
        • Improve exit sign energy efficiency by using light emitting diode (LED) exit signs or electroluminescent (LEC) exit signs.
        • Disconnect unused ballasts in de-lamped fixtures. Replace burned out lamps to avoid ballast damage.
        • Install optical reflectors or diffusers to increase lighting efficiency and reduce the number of fixtures, lamps.
        • Install lighting controls, such as:
          • Occupancy sensors in spaces of variable occupancy, such as restrooms, private offices, storage, etc.
          • Bypass/delay timers.
          • Photocells for exterior lighting and/or areas with significant natural daylight.
          • Time clocks for large banks of lights on circuit breaker that generally operate during off hours.
        • Install dimmable ballasts to dim lights to take advantage of daylight. Use daylight dimmers that turn off automatically when there is sufficient light.
      3. HVAC
        • Use ceiling fans to promote air circulation and reduce the need for air conditioning.
        • Apply window film to reduce solar heat gain. Shade sun-exposed windows and walls to mitigate the effect of direct sunlight during the summer.
        • Use awnings, sunscreens, shade trees or shrubbery. Only applicable for air-conditioned spaces.
        • Use all variable frequency drives (VFDs) on fan and pump motors.
        • Use variable air volume (VAV) systems for central air conditioning.
        • Install an Energy Management System (EMS) for central air conditioning system.
      4. Additional Measures for Building Owners or Large Tenants
        • Convert electric hot water heaters to natural gas, unless building has on-site renewable electricity production.
        • Plant native shrubs or trees near windows for shade.
        • Use a solar water heater or preheater.
        • Replace or supplement an air conditioning (A/C) system with an evaporative cooler.
        • Use economizers on A/C to reduce the operation of the compressor, and ensure the system is operational.
        • Replace single or package A/C unit with one meeting the Energy Star requirement. Seasonal Energy Efficient Rating (SEER) > 13 for most common size of equipment.
        • Convert electric heating system to a natural gas system, unless building has on-site renewable energy production. Conversion must have taken place in the last two years.
        • Replace inefficient or broken windows with double pane energy-efficient windows.
        • Provide shading for HVAC condenser, especially for roof-top units exposed directly to the sun.
        • When repainting building exterior and roofs, choose light colors to reflect more sunlight. Painting should have been performed within the last year.
        • Use an Energy Management System for central air conditioning systems to adjust temperature, speed or other settings to reduce energy use.
          Use variable speed drives on motors where appropriate.
    2. Employee Practices
      1. General Facility and Heating Ventilation and Air Conditioning (HVAC)
        • Set thermostat at 76ºF for cooling, 68ºF for heating; use timing devices to turn system down after hours.
        • Set refrigerator temperature between 38ºF and 41ºF and freezer between 10º F and 20ºF.
        • Seal off unused areas from A/C and/or heating. Block and insulate unneeded windows and other openings.
        • Use a small fan or space heater to condition a small area during off hours instead of heating the entire office.
        • Institute a written policy that ensures blinds and curtains are closed during peak summer period (white reflects) or use ceiling fans to reduce A/C load.
        • Install or use plug load controllers for office equipment that switches equipment off after working hours.
        • Institute a written policy to turn off equipment when not in use.
        • If available, use the standby mode on equipment (e.g. energy saver buttons on copiers).
        • Maintain a written policy that checks and adjusts, when necessary, lighting control devices such as time clocks and photocells.
        • Use “task” lighting with energy efficient bulbs where extra light is needed, rather than lighting an entire area.
        • Rearrange workspace to take advantage of areas with natural sunlight, and design for increased natural lighting when remodeling.
        • Maintain a written policy to turn off lights when leaving and post reminders.
        • Maintain a written policy to clean lighting fixtures, diffusers and lamps so that they are lighting as effectively as possible (dirt can reduce lighting efficiency by up to 50%) and replace aging fluorescent tubes.
  3. Water Conservation
    • Understand your water bill and review it monthly for indications of leaks, spikes or other problems.
    • Learn how to read your water meter and check your usage once a week to be sure the property is leak free.
    • Regularly check for and repair all leaks in your facility (toilet leaks can be detected in tank toilets with leak detecting tablets). Train your staff to monitor and respond immediately to leaking equipment.
    • Use “dry sweeping”, water efficient “spray brooms”, or low flow (<3 gallons per minute [gpm]) spray nozzles with automatic shut-off rather than a garden hose to wash down concrete or asphalt surfaces.
    1. General Equipment/Facility Changes
      1. General Facility
        • Replace all pre-1992 toilets with 1.6 gallons per flush (gpf) toilets. Replace non-efficient toilets (>3.5 gpf) with High Efficiency Toilets (HETs) use an average flush volume of 1.28 gpf compared to an Ultra Low Flow Toilet of 1.6 gpf. Best practice: utilize dual flush toilets. Use WaterSense labeled fixtures.
        • Replace all older urinals with urinals that flush 1.0 gpf or less. Provide additional urinals in men’s restrooms and reduce number of toilets.
        • Install Ultra Low Flush Urinals which have a flush volume of .5 gallons or less. Replace all urinals with models that flush at no more than 1.0 gpf. Replace non-efficient urinals with new ultra low-flow (<0.5 gpm) or install waterless urinals. Use WaterSense labeled fixtures.
        • Install low flow aerators that restrict the flow to a maximum1.5 gpm for lavatory sinks, 2.0 gpm for kitchen sinks, and 2.5 gpm low flow showerheads. Use WaterSense labeled fixtures.
        • Post signs in restrooms and kitchen areas encouraging water conservation.
        • Install low flow, self-closing faucets, either infrared or spring-loaded.
        • Indoors, use dry floor cleaning methods, followed by damp mopping, rather than spraying or hosing with water.
        • Reduce water pressure to no higher than 70 pounds per square inch (psi) by installing pressure-reducing valves with pressure gauge.
        • Change window cleaning schedule from “periodic” to “as needed.”
        • Replace water-cooled air conditioning units with air-cooled model.
      2. Landscaping
        • Test irrigation sprinklers 4 times per year for leaks, water runoff, over watering and dry spots and make necessary adjustments to ensure proper operation and coverage.
        • Repair all broken or defective sprinkler heads/nozzles, lines and valves.
        • Adjust sprinklers for proper coverage – optimizing spacing and avoiding runoff onto paved surfaces.
        • Adjust sprinkler times and/or durations according to seasons, water during non-daylight hours (generally before 7 am or after 9 pm).
        • Mulch all non-turf areas, preferably with recycled wood chips.
        • Use repeat cycles when watering lawn or shrubs in clay soils (if you’re planning to water for 8 minutes, water twice for 4 minutes each).
        • Modify your existing irrigation system to include drip irrigation or soaker hoses where feasible.
        • Use rain shut-off devices as part of irrigation/landscape control measures.
        • Plant drought tolerant ground cover or shrubs (preferably native species), instead of turf.
        • Replace water intensive turf with woodchips, plant based mulch, loose stones or permeable pavers. [Brick and cobblestones will block water from penetrating the ground since they are typically installed with concrete].
        • If installing new turf, limit area and use drought tolerant species (water efficient landscape guidelines are available from your local water agency/utility).
        • Renovate existing landscape to include drought tolerant plants
        • Hydrozone: Group plants with similar water requirements together on the same irrigation line, and separate plants with different water requirements on separate irrigation lines.
        • Plant and maintain a street tree next to your business. If there is no space for a tree, install a sidewalk garden with drought tolerant.
  4. Pollution Prevention

    Assess your facility to identify all hazardous materials at the worksite and determine if those items get used regularly. Consider products like – cleaning products, building materials, pesticides, fertilizers, toners, backup generators, etc. If you contract out for some of these services, your service provider needs to provide you with an inventory of the items to be included in your list.

    • Replace toxic janitorial supplies with less toxic alternatives. Use (or specify in your cleaning services contract) cleaning products, which are safer for the user, building occupants and the environment. For example, you might choose to require products that have been certified by Green Seal as meeting its Standard GS-37.
    • Stop purchasing janitorial products in aerosol cans.
    • Reduce the use of toxic pesticides.
    • Use the least toxic pest control methods and products to reduce or eliminate the use of chemical pesticides such as biological controls, pest resistant plants and traps, baits and barriers.
    • Specify the use of Integrated Pest Management approach in pest control service contracts
    • Correct situations that attract pests by proper food storage, garbage storage and landscaping.
    1. Amalgam
      • Reduce or completely stop placing amalgam fillings. When judged to be medically appropriate, use mercury-free alternatives to amalgam (e.g., gold, ceramic, porcelain, composites, polymers, glass ionomers, cold silver, gallium).
      • Eliminate all use of bulk elemental mercury. Any bulk elemental must be recycled or disposed of as hazardous waste. (It must never be placed into the regular trash, placed with infectious waste (red bag), or poured down the drain.)
      • Install plastic disposable Chairside amalgam traps in both the vacuum system and the cuspidor of each operatory where restoration work is done.
      • Change and recycle these Chairside amalgam traps frequently. Never rinse these traps in the sink.
      • Change and recycle vacuum pump filter screens at least once per month or as directed by the manufacturer. Carefully seal the vacuum screen in its plastic container, including any water that may be present, and store it in an airtight container with other amalgam.
      • If your practice has a dry turbine vacuum unit, then have a licensed amalgam recycler or hazardous waste disposal service pump out and clean the air-water separator tank at least once every 6 months. Perform this service more fre­quently if necessary to maintain suction or if so directed by the vacuum system manufacturer.
      • Have a licensed recycling contractor, mail-in service, or hazardous waste hauler remove your amalgam wastes. Recycling is the preferred method for dealing with amalgam waste. As an alternative, you may have a licensed hazardous waste hauler remove your amalgam waste for disposal. Amalgam waste includes:
        1. Non-contact amalgam (scrap);
        2. Contact amalgam (e.g., extracted teeth containing amalgam);
        3. Amalgam or amalgam sludge captured by chair-side traps, vacuum pump filter screens, and other devices, including the traps, filter screens themselves;
        4. Used amalgam capsules; and
        5. Leaking or unusable amalgam capsules.
      • Maintain a written or computerized log of amalgam waste that you generate, and of amalgam waste that you remove from your vacuum system or plumbing. In addition, obtain receipts or other certified documentation from your recycler or hazardous waste hauler of all amalgam waste recycling and disposal shipments that you make. Keep these receipts on file for at least three years, and make them available to authorized City inspectors upon request.
      • Store amalgam waste in airtight containers. Follow recycler’s or hauler’s instructions, if any, for disinfection of waste and separation of contact and non-contact amalgam. Do not use disinfectant solutions with oxidizers, such as bleach, to disinfect the amalgam. Do not add water or waste fixer to the waste containers.
      • Install clear plastic, easily removable under-sink bottle-traps, and have the contents recycled or disposed of as hazardous waste if they may contain inadvertently spilled mercury-containing material.
      • Obtain one or more mercury spill kits, place them in appropriate easy-to-access locations, and immediately use them as directed by the manufacturer for any spill of mercury-containing material. All spilled mercury-containing material must be recycled or hauled away as hazardous waste.
      • Train staff in the proper handling, management and disposal of mercury-containing material and hazardous wastes. Maintain a training log.
      • Limit the amount of amalgam used to the smallest appropriate size for each restoration. Keep a variety of amalgam capsule sizes on hand to more closely match the amount triturated to the amount needed in the restoration.
      • Refrain from using sodium hypochlorite (bleach) to disinfect vacuum lines, because it speeds the release of mercury from amalgam
        Store, handle, and triturate amalgam away from sinks so that the chance of an accidental spill reaching the sewer is minimized.
      • Maximize the use of the high-speed suction (vacuum) system, because it captures more of the amalgam waste than does the coarse screen in a cuspidor.
      • During amalgam restoration removal procedures, remove wet cuspidors from service and rely solely upon the high-speed suction (vacuum) system to remove debris and saliva
    2. Photo Processing
      • Use digital x-ray equipment.
      • If still using traditional photo processing machines.
        • Replace older x-ray film processing equipment that mixes fixer with developer to equipment that keeps them separate.
        • Switch to mechanical x-ray cleaners.
        • Investigate the major reasons why x-ray images are spoiled in your practice, and take steps to reduce this spoilage.
        • Evaluate the frequency with which your practice changes its photo processing chemistry. Extend the time between chem­istry changes if feasible (i.e., in such a way that images are not lost through being processed in worn out chemistry).
      • Use a licensed hauler for off-site recycling of spent fixer solution or for management as a hazardous waste.
    3. Dental Chemicals
      • Switch to an enzyme or detergent type cleaner for your ultrasonic instrument cleaning bath.
      • Switch to instrument sterilization via a steam autoclave or dry heat oven. If medically appropriate for your practice, switch your cold sterilant from a solution containing glutaraldehyde to something less toxic, such as one with hydrogen peroxide.
      • Evaluate the use of a work surface disinfectant containing less-hazardous active ingredients that are not subject to hazardous waste disposal regulations, such as quaternary ammonium compounds.
    4. Other Pollution Prevention
      • Replace mercury thermometers with digital ones. (And safely dispose of mercury thermometers as universal waste.)
      • Purchase sealants, adhesives, and other restorative materials in package sizes that will result in all the contents being used during the procedure (i.e., with minimal waste).
      • Purchase dental materials in small quantities so that products need not be discarded because of shelf life being exceeded.
      • Evaluate the potential health, safety, and environmental impacts of alternative new products before accepting samples from your dental supplier.
      • Use all of a pharmaceutical, when feasible, removing the need to dispose of it as hazardous waste.
    5. Office
      • Facility Maintenance – Buy recycled paint and low VOC products when available (paint, paint removal products, etc.).
      • Buy cleaners, paints, batteries and other supplies in optimally sized containers for your office to avoid unnecessary packaging, as well as left-over and expired materials.
      • Buy low-mercury fluorescent lamps
      • Buy unbleached and/or chlorine free paper products (copy paper, paper towels, coffee filters, etc.
      • Buy recycled/remanufactured toner and ink-jet cartridges for your office machines.
      • Buy rechargeable batteries and appliances, such as hand-held vacuum cleaners and flashlights.
      • Use non-toxic, low VOC white out and white board pens, etc.
      • Have promotional materials printed with soy or other low VOC inks.
      • Do business with other “green” vendors or services.
      • Buy low-emission building materials, carpets, furniture, etc. for remodeling projects.
      • Contract for or install “green” energy sources.
      • Store any potentially hazardous materials securely, control access and rotate stock to use oldest material first.
      • Inform customers and employees about public transportation options to and from your location (post transit schedules and routes).
      • Patronize services close to your business (e.g., office supplies, food/catering, copy center, etc.) and encourage employees to do the same.

Acknowledgement: This compilation of best practices is based upon Green Business Certification Standards provided by the Monterey County Green Business Program.