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C.5 FIRE PLAN

[Insert facility’s Policy Header Information]

PURPOSE
To establish procedures that ensure the safe evacuation in case of a fire, minimize risk of injury to both patients and dental staff, and comply with facility safety regulations.

PROCEDURE


FIRE EVACUATION PLAN

The dental clinic will comply with all Fire Procedures set by the [Facility] Health Department. A copy of the [Facility] Fire Plan is located [location].

The evacuation of the dental clinic in care of fire is outlined in the Facility’s Fire and Safety Manual. A map of primary and secondary escape routes is posted [state location(s)]. All staff will become familiar with this map and evacuation procedures. A copy of the evacuation plan is located in the [location]. There are assigned locations of specific dental personnel as described in the plan

When a fire is discovered in the dental area the person discovering the fire will [insert appropriate procedures].

If a fire is announced in another part of the facility [insert facility policies regarding response and evacuation procedures]

Patients in the area will be moved out of the fire area following the primary exit. If that exit is not accessible, the secondary route will be used. All dental staff and dental patients will gather [state primary gathering location] to facilitate accounting for all persons present in the dental clinic at the time of the evacuation.


C.5 MERCURY HYGIENE


PURPOSE

To establish procedures that ensure the recycling of products containing mercury, minimize mercury exposure to both patients and dental staff, and comply with State regulations.

PROCEDURE

Dentists and their staff use certain toxic substances that may lead to the contamination of water systems and the environment. In order to prevent contamination, dental offices should implement proper waste management procedures. Subsequently Indian Health Service (IHS) has developed waste management guidelines for the use of mercury amalgam.


Dental amalgam can contain up to 50 percent mercury. Although mercury in amalgam form is very stable, it should not be disposed of or rinsed down the drain. This is important because the amalgam waste could end up in municipal garbage, medical waste, or in the sewer system. If the waste is incinerated the mercury could be released to the environment, and if it reaches the sewer system it could contaminate drinking water or accumulate in fish. The best method of dealing with amalgam waste is by recycling it. Mercury can be recovered through a distillation process and reused in other products.
If required by State regulations: “Amalgam waste will be collected using amalgam separators in wastewater.”
The following document summarizes the different types of mercury amalgam wastes, management practices for dealing with amalgam waste that conform to IHS guidelines, and some Do’s and Don’ts when dealing with amalgam waste as outlined by the American Dental Association (ADA).

Types of Amalgam Wastes

  • Non-contact amalgam (scrap): Excess mixture that is left over after a dental procedure.

  • Contact amalgam: Amalgam that has been in contact with the patient. Examples include extracted teeth with amalgam restorations, carving scrap collected at the chair, and amalgam captured by the chair side traps, filters or screens.

  • Chair side traps: Amalgam that is captured during amalgam placement or removal procedures.

  • Vacuum pump filters: Filters and traps contain amalgam sludge or water. Some recyclers will accept whole filters, while others may require special handling requirements for this material.

  • Amalgam sludge: This is a mixture of liquid and solid material collected within the vacuum pump filters.

  • Empty amalgam capsules: Amalgam that may be left over in the capsules after mixing the precapsulated dental amalgam.

Amalgam Waste Management Practices



Scrap Amalgam Handling

  • Dental scrap amalgam should be collected and stored in two designated, air-tight, wide-mouthed plastic containers. One should be labeled CONTACT AMALGAM (amalgam that has been in contact with the patient’s mouth), and the other should be labeled NONCONTACT AMALGAM.

  • NOTE: some recyclers may require special handling requirements for extracted teeth such as shipping the tooth in a disinfectant.

  • Make sure that the container lid is tightly sealed.

Amalgam Capsule Handling

  • Stock capsules in a variety of different sizes.

  • After mixing the amalgam, place the empty capsules in a wide-mouthed, airtight container that is labeled AMALGAM CAPSULE WASTE.

  • Capsules that cannot be emptied should also be placed in containers labeled AMALGAM CAPSULE WASTE.

  • Make sure that the container lid is tightly sealed.

Disposable chair-side traps

  • Open the chair-side unit to expose the trap.

  • Remove the trap and empty its contents into a wide-mouthed, airtight container that is marked CONTACT AMALGAM.

  • Make sure that the container lid is tightly sealed.

  • Chair-side traps that are only used for procedures not involving amalgam can be thrown in the regular garbage.

  • Different states have different requirements for the disposal of infectious waste that is in the traps with the amalgam such as blood or saliva. Check with your local recycler or contact the Area Office of Environmental Health for the proper procedures.

Reusable Chair-side Traps

  • Open the chair-side unit to expose the trap.

  • Remove the trap and empty its contents into a wide-mouthed, airtight container that is marked CONTACT AMALGAM.

  • Make sure that the container lid is tightly sealed.

  • DO NOT rinse the trap under running water.

  • Replace the trap into the chair-side compartment.

  • Different states have different requirements for the disposal of infectious waste that is in the traps with the amalgam such as blood or saliva. Check with your local recycler or contact the Area Office of Environmental Health for the proper procedures.

Vacuum Pump Filters

  • Change the filter to the manufacturers suggested schedule.

  • Remove the filter. Hold the filter over a tray or another container that can catch any spills. Next pour out as much liquid as possible without losing any noticeable amalgam. The amalgam-free liquid can then be rinsed down the drain.

  • Place the lid on the filter and put it in the box in which it was originally shipped. Once the box is full, the filters can be recycled.

Line Cleaners

  • Use only non-bleach, non-chlorine containing solutions when flushing the wastewater lines and vacuum systems. A list of ADA approved cleaners is posted at the end of this document.

American Dental Association (ADA)

Do’s and Don’ts for Dealing with Amalgam Waste


DO

DON’T

Do use precapsulated alloys and stock a variety of capsule sizes.

Don’t use bulk mercury.

Do recycle used disposable amalgam capsules.

Don’t put used disposable amalgam capsules in biohazard containers, infectious waste containers (red bags) or regular garbage.

Do salvage, store, and recycle noncontact amalgam (scrap amalgam).

Don’t put non-contact amalgam waste in biohazard containers, infectious waste containers (red bags), or regular garbage.

Do salvage contact amalgam pieces from restorations after removal and recycle the amalgam waste.

Don’t put contact amalgam waste in biohazard containers, infectious waste containers (red bags), or regular garbage.

Do use side-chair traps to retain amalgam and recycle the contents.

Don’t rinse chair-side traps containing amalgam over drains or sinks.

Do recycle contents retained by the vacuum pump filter or other amalgam collection devices, if they contain amalgam.

Don’t rinse vacuum pump filters containing amalgam or other amalgam collection devices over drains or sinks.

Do recycle teeth that contain amalgam restorations. (Note: Ask your recycler whether or not extracted teeth with amalgam restorations require disinfection)

Don’t dispose of extracted teeth that contain amalgam restorations in biohazard containers, infectious waste containers (red bags), sharps containers, or regular garbage.

Do manage amalgam waste through recycling as much as possible.

Don’t flush amalgam waste down the drain or toilet.

Do use line cleaners that minimize the dissolution of amalgam.

Don’t use bleach or chlorine-containing cleaners to flush waste water lines.


Recycling

As mentioned earlier the recommended method for amalgam disposal is by recycling the waste through an Environmental Protection Agency (EPA) approved vendor. The following actions should be taken to properly recycle your amalgam waste.



  • Carry the amalgam capsules in a variety of different sizes to reduce the amount of waste produced.

  • Personal protective equipment such as gloves, masks, and protective eyewear should be worn when handling amalgam waste.

  • Some vendors have special requirements for the handling, storing, and transportation of amalgam waste, so be aware of any special conditions. Dental clinics that need to find a recycler should contact their county or local waste authority to inquire about an amalgam waste recycling program.

  • Amalgam waste should be stored in covered plastic containers that are clearly labeled.

  • Always store different types of amalgam waste (e.g., contact and noncontact) in separate containers.

  • Do not store amalgam waste under liquid. This would require the liquid to be treated as hazardous waste. Storage in tight-fitting covered containers and routine recycling should minimize any occupational exposures.



ADA Approved Line Cleaners

The following line cleaners do not contain bleach or chlorine:

Biocide (Biotrol International), BirexSe (Biotrol International), DRNA Vac (Dental

Recycling North American Inc.), E-Vac (L&R Manufacturing Co.), Fresh-Vac

(Huntington), GC Spray-Cide (GC America Inc.), Green and Clean (Metasys),

Microstat 2 (Septodont USA), Patterson Brand Concentrated Ultrasonic

Cleaner/Disinfectant Solution (Patterson Dental Supply, Inc.), ProE-Vac (Cottrell Ltd.),

Pure-Vac (Sultan Chemists Inc.), Sani-Treet Plus (Enzyme Industries Inc.), SRG

Evacuation (Icon Labs), Stay Clean (Apollo Dental Products), Turbo-Vac (Pinnacle

Products), Vacusol Ultra (Biotrol International), Cavicide (Metrex Research Corp.),

Vacuum Clean (Palmero Health Care).

Use of a chlorine free cleaner will reduce the dissolution of amalgam. Check with your manufacturer to determine which line cleaner would be appropriate for use with your equipment.



C.6 SAFETY

PURPOSE


To establish procedures that ensure the safety of both patients and dental staff, and comply with facility safety regulations.

PROCEDURE

All dental personnel will have eye protection such as safety glasses, safety side shields for prescription glasses, full face shields, goggles or other eye protection approved by [Facility]. Eye protection will be worn when the individual is using the high or slow speed handpiece or is assisting when these headpieces are being used. The [program director] will delegate the authority of requiring protective wear for dental personnel to the provider in charge of their assigned area of dental care delivery.

Appropriate eye protection will be provided to the employee and patients at no cost to the employee.

Trays will be fabricated in the lab away from any open flames.

The lathes in the dental lab will have protective shields on them.

Filtered glasses will be furnished to the employee for working with the light source for light cured restorative materials.

There will be no smoking in the dental clinic or in the dental offices.

No open toed shoes will be worn in the patient care or dental laboratory areas (See Dress Code, Section A.12)

The Facility Safety Policy and Procedure will be adhered to on all occasions and a copy of this document is found in [location].

All dental personnel will be familiar with Facility Fire, Safety and Disaster Plan. All dental personnel will know the emergency codes and how to report them to the correct location for emergency response.

All dental personnel will adhere to protocol within the Infection Control Policies and Procedures manual.

All job injury related incidents would be reported according to protocol set forth by [facility]. (see document [appropriate document])

All OSHA safety regulations will be strictly followed. Posted notification of guidelines will appear in the sterilization area and a copy of the regulations kept [location].

Eye wash stations are located [state location] for quick access as needed.

Other Individuals in Treatment Areas

The dental provider will determine if an individual not receiving dental treatment may be present in the dental operatory during treatment. Family, siblings, or other individuals who pose a safety threat to themselves or others, or who potentially interfere with safe and effective dental treatment may be asked to wait outside the treatment area. Insert any instructions or handouts to parents/guardians.


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