1. Chapter 23 Chemical & Waste Management Copyright 2003, Elsevier Science (USA). All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher. PowerPoint ® presentation slides may be displayed and may be reproduced in print form for instructional purposes only, provided a proper copyright notice appears on the last page of each print-out. Produced in the United States of America ISBN 0-7216-9770-4

2. Copyright 2003, Elsevier Science (USA). All rights reserved. Introduction In the day-to-day practice of dentistry, the dental assistant is exposed to a wide variety of chemicals that are used for treatment procedures, cleaning instruments and surfaces, disinfection and sterilization, laboratory procedures, and dental x- ray processing. The heart, kidney, liver, and lung tissues can be damaged by the chemicals. The result could range from short-term discomfort (e.g., burns or rashes) to life-threatening conditions (e.g., cancer, sterility, organ failure). In the day-to-day practice of dentistry, the dental assistant is exposed to a wide variety of chemicals that are used for treatment procedures, cleaning instruments and surfaces, disinfection and sterilization, laboratory procedures, and dental x- ray processing. The heart, kidney, liver, and lung tissues can be damaged by the chemicals. The result could range from short-term discomfort (e.g., burns or rashes) to life-threatening conditions (e.g., cancer, sterility, organ failure).

3. Copyright 2003, Elsevier Science (USA). All rights reserved. The proper use The proper storage The proper handling The proper spill cleanup The proper disposal method The proper use The proper storage The proper handling The proper spill cleanup The proper disposal method  For all of the chemicals used in the dental office, it is important for a dental assistant to understand:

4. Copyright 2003, Elsevier Science (USA). All rights reserved. Hazardous Chemicals n A hazardous chemical is defined as any chemical that has been shown to cause either a physical or health hazard. n A hazardous chemical is any substance that can: catch fire can react or explode when mixed with other substances is corrosive is toxic n A hazardous chemical is defined as any chemical that has been shown to cause either a physical or health hazard. n A hazardous chemical is any substance that can: catch fire can react or explode when mixed with other substances is corrosive is toxic

5. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 23-1 Chemical hazard warning labels. Fig. 23-1

6. Copyright 2003, Elsevier Science (USA). All rights reserved. n Inhalation of gases, vapors, or dusts of chemicals can cause direct damage to the lungs. n Skin: Some chemicals are absorbed through the skin. n Ingestion (swallowing): Eating in an area in which chemicals are used or eating with hands that are contaminated with chemicals is a common way of ingesting harmful chemicals. n Inhalation of gases, vapors, or dusts of chemicals can cause direct damage to the lungs. n Skin: Some chemicals are absorbed through the skin. n Ingestion (swallowing): Eating in an area in which chemicals are used or eating with hands that are contaminated with chemicals is a common way of ingesting harmful chemicals. Primary Methods of Chemical Exposure

7. Copyright 2003, Elsevier Science (USA). All rights reserved. Types of Chemical Toxicity n Acute chemical toxicity results from high levels of exposure over a short period of time. This frequently is caused by a chemical spill, in which the exposure is sudden, and often involves a large amount of the chemical. Chronic chemical toxicity results from many repeated exposures, generally to lower levels, over a much longer time  months or even years. n Acute chemical toxicity results from high levels of exposure over a short period of time. This frequently is caused by a chemical spill, in which the exposure is sudden, and often involves a large amount of the chemical. Chronic chemical toxicity results from many repeated exposures, generally to lower levels, over a much longer time  months or even years.

8. Copyright 2003, Elsevier Science (USA). All rights reserved. Personal Chemical Protection n Hand protection: When using chemical disinfectants, wear a utility-type glove made from a chemical- resistant material, such as natural rubber, neoprene, or industrial-grade nitrile. n Eye protection: Protect the eyes from fumes and splashes while pouring chemicals such as x-ray processing solutions, ultrasonic solutions, disinfectants, and sterilants. n Protective clothing: Wear a rubber or neoprene apron when mixing or pouring the chemical. n Inhalation protection: Facemasks should be fluid-repellent and provide respiratory protection. n Hand protection: When using chemical disinfectants, wear a utility-type glove made from a chemical- resistant material, such as natural rubber, neoprene, or industrial-grade nitrile. n Eye protection: Protect the eyes from fumes and splashes while pouring chemicals such as x-ray processing solutions, ultrasonic solutions, disinfectants, and sterilants. n Protective clothing: Wear a rubber or neoprene apron when mixing or pouring the chemical. n Inhalation protection: Facemasks should be fluid-repellent and provide respiratory protection.

9. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 23-2 Cleanroom nitrile gloves. Fig 23-2

10. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 23-3 Chemical resistant polyvinyl chloride (PVC) goggles. Fig. 23-3

11. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 23-4 Disposable respirator with tapered angle to fit facial contours around nose and chin. Fig. 23-4

12. Copyright 2003, Elsevier Science (USA). All rights reserved. Control of Chemical Spills n Accidents and spills should not be common occurrences. n Planning and practice of dealing with such spills should minimize employee exposure to harmful chemicals. n Refer to the material safety data sheet (MSDS) for the specific product for accurate information on how to manage spills. n Accidents and spills should not be common occurrences. n Planning and practice of dealing with such spills should minimize employee exposure to harmful chemicals. n Refer to the material safety data sheet (MSDS) for the specific product for accurate information on how to manage spills.

13. Copyright 2003, Elsevier Science (USA). All rights reserved. Mercury Spill Kits n Mercury spill kits should be available in all dental offices in which amalgam is used. n Exposure to even small amounts of mercury is very hazardous to the health of dental personnel. Mercury can be absorbed through the skin or through the inhalation of mercury vapors. n Mercury spill kits should be available in all dental offices in which amalgam is used. n Exposure to even small amounts of mercury is very hazardous to the health of dental personnel. Mercury can be absorbed through the skin or through the inhalation of mercury vapors.

14. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 23-5 Mercury spill kit. Fig. 23-5

15. Copyright 2003, Elsevier Science (USA). All rights reserved. Eye Wash Stations n OSHA regulations require an eye wash unit to be installed in every place of employment in which chemicals are used. n There are a wide variety of styles available. n When turned on, the eye wash unit will irrigate the eyes with a soft, wide flow of water necessary to bathe away contaminants without causing additional damage. n Employees must be trained in the proper use of the eye wash station, and the unit should be inspected every 3 months to make certain it is functional. n OSHA regulations require an eye wash unit to be installed in every place of employment in which chemicals are used. n There are a wide variety of styles available. n When turned on, the eye wash unit will irrigate the eyes with a soft, wide flow of water necessary to bathe away contaminants without causing additional damage. n Employees must be trained in the proper use of the eye wash station, and the unit should be inspected every 3 months to make certain it is functional.

16. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 23-6 Countertop eye and eye/face washes that provide water to the face and eyes gently wash away contaminants. Fig. 23-6

17. Copyright 2003, Elsevier Science (USA). All rights reserved. Ventilation n Good ventilation is a necessity when dealing with any type of chemical. n Many dental offices are equipped with special exhaust systems in the laboratory and sterilization and darkroom areas for fumes and dust. n Radiographic processing chemicals can cause contact dermatitis and irritation of the eyes, nose, throat, and respiratory system due to the vapors and fine particles of chemicals. n Good ventilation is a necessity when dealing with any type of chemical. n Many dental offices are equipped with special exhaust systems in the laboratory and sterilization and darkroom areas for fumes and dust. n Radiographic processing chemicals can cause contact dermatitis and irritation of the eyes, nose, throat, and respiratory system due to the vapors and fine particles of chemicals.

18. Copyright 2003, Elsevier Science (USA). All rights reserved. Storing Chemicals n All dental materials contain chemicals, and the chemical components in some are more hazardous than others. n When changes in the chemical composition of materials occurs, the product may no longer retain its effectiveness. n A basic “safe” policy is to store dental medications and chemicals in a dry, cool, dark place where they are not exposed to direct sunlight. The manufacturer’s instructions for storage can be found on the MSDS and should be followed. n All dental materials contain chemicals, and the chemical components in some are more hazardous than others. n When changes in the chemical composition of materials occurs, the product may no longer retain its effectiveness. n A basic “safe” policy is to store dental medications and chemicals in a dry, cool, dark place where they are not exposed to direct sunlight. The manufacturer’s instructions for storage can be found on the MSDS and should be followed.

19. Copyright 2003, Elsevier Science (USA). All rights reserved. Disposal of Chemicals n Empty containers can hold residues that can burn or explode. n Never fill an empty container with another substance because a dangerous chemical reaction could occur. n Follow the label and the MSDS on how to dispose of empty containers. n Empty containers can hold residues that can burn or explode. n Never fill an empty container with another substance because a dangerous chemical reaction could occur. n Follow the label and the MSDS on how to dispose of empty containers.

20. Copyright 2003, Elsevier Science (USA). All rights reserved. Types of Hazardous Waste n Ignitable is flammable or combustible. n Corrosive is either highly acidic or basic with a pH less than 2.0 or greater than 12.5, respectively (water has a pH of 7.0). n Reactive is chemically unstable or explosive, has a violent reaction with water, or is capable of giving off toxic fumes when mixed with water. n Toxic contains arsenic, barium, chromium, mercury, lead, silver, or certain pesticides. n These types of hazardous waste are listed by the Environmental Protection Agency (EPA). n Ignitable is flammable or combustible. n Corrosive is either highly acidic or basic with a pH less than 2.0 or greater than 12.5, respectively (water has a pH of 7.0). n Reactive is chemically unstable or explosive, has a violent reaction with water, or is capable of giving off toxic fumes when mixed with water. n Toxic contains arsenic, barium, chromium, mercury, lead, silver, or certain pesticides. n These types of hazardous waste are listed by the Environmental Protection Agency (EPA).

21. Copyright 2003, Elsevier Science (USA). All rights reserved. OSHA Hazard Communication Standard n OSHA issued the Hazard Communication Standard because employees have the right to know the identity and hazards of chemicals that they use in the workplace. n The Hazard Communication Standard is also known as the “Employee Right-to-Know Law.” It requires employers to implement a Hazard Communication Program. n OSHA issued the Hazard Communication Standard because employees have the right to know the identity and hazards of chemicals that they use in the workplace. n The Hazard Communication Standard is also known as the “Employee Right-to-Know Law.” It requires employers to implement a Hazard Communication Program.

22. Copyright 2003, Elsevier Science (USA). All rights reserved. Hazard Communication Program n Written program n Chemical inventory n Material safety data sheets (MSDS) n Labeling containers n Employee training n Written program n Chemical inventory n Material safety data sheets (MSDS) n Labeling containers n Employee training

23. Copyright 2003, Elsevier Science (USA). All rights reserved. Requirements of the Written Program n Identify the individual who is responsible for the program. n It must also describe staff training. n Describe how chemicals are handled in the office. n Provide a description of all labeling and safety measures. Describe how to respond to chemical emergencies such as spills or exposures. n Identify the individual who is responsible for the program. n It must also describe staff training. n Describe how chemicals are handled in the office. n Provide a description of all labeling and safety measures. Describe how to respond to chemical emergencies such as spills or exposures.

24. Copyright 2003, Elsevier Science (USA). All rights reserved. Requirements for the Chemical Inventory n A comprehensive list of every product used in the office is required. n When a new product containing a hazardous chemical is added to the office, it must be added to the chemical list, and the MSDS for that product is placed in the MSDS file. The manufacturer or distributor must provide an updated MSDS when appropriate. n A comprehensive list of every product used in the office is required. n When a new product containing a hazardous chemical is added to the office, it must be added to the chemical list, and the MSDS for that product is placed in the MSDS file. The manufacturer or distributor must provide an updated MSDS when appropriate.

25. Copyright 2003, Elsevier Science (USA). All rights reserved. Material Safety Data Sheets n MSDSs contain health and safety information about every chemical in the office. n They provide comprehensive technical information and are a resource for employees working with chemicals. n They describe the physical and chemical properties of a chemical, health hazards, routes of exposure, precautions for safe handling and use, emergency and first aid procedures, and spill control measures. n The manufacturers of products that contain hazardous chemicals are required to provide MSDSs. n The MSDSs should be organized in binders. n MSDSs contain health and safety information about every chemical in the office. n They provide comprehensive technical information and are a resource for employees working with chemicals. n They describe the physical and chemical properties of a chemical, health hazards, routes of exposure, precautions for safe handling and use, emergency and first aid procedures, and spill control measures. n The manufacturers of products that contain hazardous chemicals are required to provide MSDSs. n The MSDSs should be organized in binders.

26. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 23-8 Material safety data sheets for quality control recordkeeping. Fig. 23-8

27. Copyright 2003, Elsevier Science (USA). All rights reserved. Requirements for Employee Training n Staff training is required: When a new employee is hired When a new chemical product is added to the office Once a year for all continuing employees n Records of each training session must be kept on file. n Training records are to be retained for at least 5 years. n Staff training is required: When a new employee is hired When a new chemical product is added to the office Once a year for all continuing employees n Records of each training session must be kept on file. n Training records are to be retained for at least 5 years.

28. Copyright 2003, Elsevier Science (USA). All rights reserved. Labeling of Chemical Containers n The label must contain –Identity of the hazardous chemical (s) –Name and address of the manufacturer or responsible party –Appropriate warnings n The label must contain –Identity of the hazardous chemical (s) –Name and address of the manufacturer or responsible party –Appropriate warnings