Dental amalgam: new regulations from 1 July 2018

Following a recent post in our Dental Practice Management Solutions (Facebook Group - https://www.facebook.com/groups/DPMSCQC/​) from a dental engineer, we've done some research regarding the use of amalgam separators in sinks.

Question:

“What are you all fitting on your decon sinks to comply with the new guidelines coming in January?”

From BDA:

"After discussions with the British Dental Industry Association, the BDA's position is that, providing amalgam separators are fitted to suction units and correct waste handling controls are adhered to, the amount of amalgam particulate going down a manual cleaning sink or through a washer disinfector would be negligible. Therefore, it is the BDA's view that separators on these areas are not necessary."

The response was mixed and many of practices indicated that they are going to follow the advice from the BDA. But how good is their advice? Having a look at their recommendation, it fails to refer to any specific guidance which prompted us to do my own research.

So, where can you find the best guidance❓

Being a healthcare provider, you may want to look into Health Technical Memorandum (HTM) specifically HTM-2022 supplement 1. This document was published in 2003, so it is not a new set of rules or good practices, it is also free to download from the government website:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/153577/HTM_2022_S1.pdf?fbclid=IwAR0HeHfeDFKR1SCWUy_zG7aFdpkjWkIzSQ9L7h5OD8afbI8KCIeC9bXY6E8​

The document is quite useful, and it dedicates few pages (Appendix 1) to the use amalgam.

⚖️ Starting with some legal issues:

Both waste-water and waste are covered by laws intended to protect human health and the environment. The Water Industry Act 1991 (section 118) requires that anyone discharging trade effluents into the sewers gets permission first from the sewerage undertaker. Breach of section 118 is a criminal offence. The Environment Agency would expect to use their powers (under section 132) to impose conditions on such permissions, limiting how much mercury goes into the sewers.

⚖️ *Section 111* of the above Act makes it an offence to discharge matter into a public sewer likely to ‘affect prejudicially the treatment and disposal of its contents’. Waste amalgam released into drains might in some circumstances be considered as having that effect. For example, it might mean that sewage sludge is less readily incinerated or spread on farmland because of difficulty in meeting pollution limits at the sites in question.

⚖️ *Section 33(c)* of the Environmental Protection Act 1990 makes it an offence to ‘deposit, recover or dispose of controlled waste in a manner likely to cause pollution of the environment or harm to human health’.

⚖️ *Section 34* of the Environmental Protection Act 1990 imposes a statutory duty of care on those concerned with controlled waste, including everyone who produces it (except for householders’ own refuse) and thus includes dentists producing waste amalgam. Among other things, waste holders must make sure that it is transferred only to an authorised person, and parties to any transfer must complete, sign and keep a transfer note. Breach of the duty is a criminal offence. Practical guidance for meeting the duty is in ‘Waste management: the duty of care – a code of practice’.

⚖️*The Special Waste Regulations 1996* impose additional safeguards where waste meets the definition of special waste. At present, waste amalgam and associated packaging, which typically arise from dental practices, are not generally considered to be special waste by the enforcing authorities. However, the European Commission has proposed that amalgam should be added to the EC Hazardous Waste List. If the EU agrees to this, waste amalgam would become special waste. (Here is your change that is coming in January)

But what else we can find in this document and does it explain what you should do with your decon sinks?

Absolutely, have a look at the 6 good practices below (especially number 3):

1. Use amalgams effectively; this will reduce waste and cost.

2. Install amalgam separators as soon as possible; fit them either to existing equipment or when replacing equipment. Other traps and sieves may still be useful as supplements.

3. Make sure that amalgam separators protect all the normal routes such as spittoons, sinks or basins by which amalgam might enter the drains. When working with amalgam, do not use any unprotected routes into the drains. This includes the cleaning of instruments and utensils. Waste amalgam must not be put directly down the drains and never flushed down the toilet. During refurbishment or cleaning, care should be taken to ensure that sediments in pipes are not flushed into drains.

4. Keep waste amalgam separate from other waste. This will help with the recycling of its silver and mercury content; but if the recycling is not feasible, it will make disposal safer. Use only authorised waste management firms – and remember the duty of care. Specialised firms offer sealed container systems and separate collection. Dispose of packaging with amalgam residues either in clinical waste containers or as normal refuse, or through other general arrangements for packaging waste.

5. Follow any regulatory advice from local sewerage operators or other bodies, for example the WRAS Guide highlighted elsewhere in this Supplement

6. Take stock of equipment in use now; operational procedures and additional measures needed to follow the code.

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