key: cord-0047034-fluw47iu
authors: Hawkey, Nicola
title: Sustainability in a COVID-19 world
date: 2020-07-06
journal: BDJ In Pract
DOI: 10.1038/s41404-020-0449-x
sha: 8dc4cb4369533988ca0f579ef85943e42895254e
doc_id: 47034
cord_uid: fluw47iu

nan

A s practices across the UK gradually re-open their doors, clinicians up and down the country are dressed head to toe in full PPE, much of which is single use and much of which is made of plastic.

Guidance across the UK on public health and PPE is country specific but the primary focus is protecting human health and stopping the spread of COVID-19. At this point in time even the most environmentally concerned among you will need to follow the public health guidance specific to your country. This will sadly mean a lot of plastic. At the moment, that is what you must do until the restrictions ease or the guidance changes. It's not a comfortable place to be but while there are so many unknowns about the virus the guidance must be followed. The BDA Return to Practice toolkit is a resource to use to help you manage that. 1 Over the last two years or so many of you have been increasingly looking at environmental sustainability in your practices. Many of you have been doing as much as you can to reduce, reuse and recycle where the guidance allows. A circular economy is the main aim of environmental sustainability yet our old friends HTM 01-05 2 and 07-01 3 have been a constant reminder that becoming environmentally sustainable has not always been an easy ride.

Throughout this spring we have fought vigorously to ensure that Governments understand that financial viability of practices is key and we will continue to do so. The difficulty now is that going to the dentist is going to be a very different experience from now on. With patient prioritisation meaning that routine check-ups are out the window for the time being, chances to create ways to reduce, reuse and recycle are slim.

In 2018 PHE wrote the report Carbon modelling within dentistry, towards a sustainable future. 4 While some of the data sources in it are small, the take home headline was that staff and patient travel accounted for roughly 60% of the carbon footprint in dentistry in 2013/14. Comparing that with now, new academic studies have shown that global carbon dioxide emissions dropped roughly 17% during the forced confinement (not dental specific). 5 As dental practices were shut to face to face treatment to a greater or lesser degree across the UK -patient and staff travel would have dropped instantly.

For practices located in towns and cities where public transport is available to staff -that used to be the most environmentally sustainably suggestion. Now however using public transport is a more uncomfortable thought for many. Car sharing has always been suggested as an appropriate means of reducing a carbon footprint -but that now is fraught with uncertainty -single car occupancy feels much safer. The toolkit for a greener dental practice written in the heady days of pre-COVID-19 suggested encouraging staff/ colleagues that live close to the practice to cycle or walk. However you and your teams proceed, these days even travelling to work is a balancing act of COVID-19 risk reduction and lowering our own carbon footprint. 6

Think about some of the newer innovations that you may have introduced into the practice in advance of re-opening for face to face treatment. Have any of you installed washing machines to launder scrubs each night to prevent staff taking them home to wash? 1 A year ago -that would have been unthinkable. From an environmental perspective, that may be better.

Take telephone triage and the 3 As… now that is an interesting concept for environmental sustainability. For NHS practice in England and Wales in a target driven system, encouraging patients not to visit the practice by car (or at all) was unthinkable. Similarly, in Scotland and Northern Ireland, item of service demands that patients attend, be treated and claims made. No face to face treatment became a stark reality in England on 25 March 2020. Now however, practices have become adept at remote triage. The question is if, and how, will this be embedded? All practices whatever the income stream will have been remotely triaging patients and there may also have been some investment across practices made in new technology or software to accommodate that.

Remote triage may even be the opportunity needed to solve some of the thorny issues facing dentistry around domiciliary care etc. For instance, the provision of remote consultation for some vulnerable patient groups in care homes may be a vital tool over the coming months. It may be the start of a way forward to give those in care homes (or other residential settings) the link to dental care that they need and a way to give consistent preventive advice in a safe environment.

We have been working on sustainability for a while and we will now look at how to take into account how the world has changed in the last few months. 7 Where we can, we will continue to lobby for environmental sustainability in a way that works for dentists.

Available online at: www.bda.org/advice/ Coronavirus/Pages/returning-to-work

Decontamination Health Technical Memorandum 01-05: Decontamination in primary care dental practices

Management and disposal of healthcare waste (HTM 07-01)

Available online at: www. gov.uk/government/publications/carbon-modellingwithin-dentistry-towards-a-sustainable-future

Temporary reduction in daily global CO2 emissions during the COVID-19 forced confinement. Nat Clim Chang 2020

Sustainable dentistry: A how-to guide for dental practices

Available online at: www.bda.org/ about-the-bda/campaigns/sustainable/Pages/ Sustainability-in-dentistry