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    Mitigation of global greenhouse gas emissions from waste: conclusions and strategies from the Intergovernmental Panel on Climate Change (IPCC) Fourth Assessment Report. Working Group III (Mitigation). Bogner Jean,Pipatti Riitta,Hashimoto Seiji,Diaz Cristobal,Mareckova Katarina,Diaz Luis,Kjeldsen Peter,Monni Suvi,Faaij Andre,Gao Qingxian,Zhang Tianzhu,Ahmed Mohammed Abdelrafie,Sutamihardja R T M,Gregory Robert, Waste management & research : the journal of the International Solid Wastes and Public Cleansing Association, ISWA Greenhouse gas (GHG) emissions from post-consumer waste and wastewater are a small contributor (about 3%) to total global anthropogenic GHG emissions. Emissions for 2004-2005 totalled 1.4 Gt CO2-eq year(-1) relative to total emissions from all sectors of 49 Gt CO2-eq year(-1) [including carbon dioxide (CO2), methane (CH4), nitrous oxide (N2O), and F-gases normalized according to their 100-year global warming potentials (GWP)]. The CH4 from landfills and wastewater collectively accounted for about 90% of waste sector emissions, or about 18% of global anthropogenic methane emissions (which were about 14% of the global total in 2004). Wastewater N2O and CO2 from the incineration of waste containing fossil carbon (plastics; synthetic textiles) are minor sources. Due to the wide range of mature technologies that can mitigate GHG emissions from waste and provide public health, environmental protection, and sustainable development co-benefits, existing waste management practices can provide effective mitigation of GHG emissions from this sector. Current mitigation technologies include landfill gas recovery, improved landfill practices, and engineered wastewater management. In addition, significant GHG generation is avoided through controlled composting, state-of-the-art incineration, and expanded sanitation coverage. Reduced waste generation and the exploitation of energy from waste (landfill gas, incineration, anaerobic digester biogas) produce an indirect reduction of GHG emissions through the conservation of raw materials, improved energy and resource efficiency, and fossil fuel avoidance. Flexible strategies and financial incentives can expand waste management options to achieve GHG mitigation goals; local technology decisions are influenced by a variety of factors such as waste quantity and characteristics, cost and financing issues, infrastructure requirements including available land area, collection and transport considerations, and regulatory constraints. Existing studies on mitigation potentials and costs for the waste sector tend to focus on landfill CH4 as the baseline. The commercial recovery of landfill CH4 as a source of renewable energy has been practised at full scale since 1975 and currently exceeds 105 Mt CO2-eq year(-1). Although landfill CH4 emissions from developed countries have been largely stabilized, emissions from developing countries are increasing as more controlled (anaerobic) landfilling practices are implemented; these emissions could be reduced by accelerating the introduction of engineered gas recovery, increasing rates of waste minimization and recycling, and implementing alternative waste management strategies provided they are affordable, effective, and sustainable. Aided by Kyoto mechanisms such as the Clean Development Mechanism (CDM) and Joint Implementation (JI), the total global economic mitigation potential for reducing waste sector emissions in 2030 is estimated to be > 1000 Mt CO2-eq (or 70% of estimated emissions) at costs below 100 US$ t(-1) CO2-eq year(-1). An estimated 20-30% of projected emissions for 2030 can be reduced at negative cost and 30-50% at costs < 20 US$ t(-) CO2-eq year(-1). As landfills produce CH4 for several decades, incineration and composting are complementary mitigation measures to landfill gas recovery in the short- to medium-term--at the present time, there are > 130 Mt waste year(-1) incinerated at more than 600 plants. Current uncertainties with respect to emissions and mitigation potentials could be reduced by more consistent national definitions, coordinated international data collection, standardized data analysis, field validation of models, and consistent application of life-cycle assessment tools inclusive of fossil fuel offsets. 10.1177/0734242X07088433
    Comparison of different types of phacoemulsification tips. II. Morphologic alterations induced by multiple steam sterilization cycles with and without use of enzyme detergents. Tsaousis Konstantinos T,Werner Liliana,Reiter Nicholas,Perez Jesus Paulo,Li He J,Guan Jia J,Mamalis Nick Journal of cataract and refractive surgery PURPOSE:To evaluate the alterations in the morphology and elemental composition of reusable phacoemulsification tips after cleaning and sterilization. SETTING:John A. Moran Eye Center, Salt Lake City, Utah, USA. DESIGN:Experimental study. METHODS:For the main experiment, 2 types of reusable phacoemulsification needles were studied. One tip of each type underwent 1, 2, and 3 autoclave sterilizations with the use of detergents followed by thorough rinsing with sterile water between cycles. Another set of tips underwent the same procedure but without rinsing. Subsequently, phaco tips were examined through scanning electron microscopy and energy-dispersive x-ray spectroscopy to assess morphologic changes and surface deposits. In a second experiment, tips of 8 different types (both reusable and single use) underwent 10 sterilization autoclave cycles without detergents. RESULTS:Residues, mostly comprised of carbon-containing material, were found in extensive areas of tips that were sterilization with enzymes and without rinsing. Smaller and fewer residues were found in tips after sterilization with the use of enzymes and thorough rinsing. Tips that underwent autoclave sterilization without detergents had no bulky deposits on their surface; they mostly had thin layers of sodium and chloride or material discoloration. CONCLUSIONS:Rinsing the phaco tips significantly reduced the size and number of residues after use of enzymatic detergents. However, detergent residues were detected on phaco tip surfaces even after thorough rinsing with sterile water. No major noticeable changes were observed in either single-use or reusable phaco tips after 10 cycles of sterilization without detergents. FINANCIAL DISCLOSURE:None of the authors has a financial or proprietary interest in any material or method mentioned. 10.1016/j.jcrs.2016.02.053
    Guidelines for the cleaning and sterilization of intraocular surgical instruments. Chang David F,Mamalis Nick, Journal of cataract and refractive surgery These Guidelines for the Cleaning and Sterilization of Intraocular Surgical Instruments were written by the Ophthalmic Instrument Cleaning and Sterilization (OICS) Task Force, comprised of representatives of the American Society of Cataract and Refractive Surgery, the American Academy of Ophthalmology, and the Outpatient Ophthalmic Surgery Society. These consensus subspecialty guidelines include evidence-based recommendations regarding issues that may be unique to the cleaning and sterilization of intraocular instrumentation. A newly published OICS Task Force study supports the safety of common short-cycle instrument processing practices for sequential same-day anterior segment surgery. Other studies substantiate the risk of toxic anterior segment syndrome from routine use of enzymatic detergent, whose microscopic residues are difficult to eliminate from intraocular instrumentation. Finally, based on published international outcomes and endophthalmitis rates, future studies should critically evaluate a variety of operating room protocols that may increase cost, waste, and carbon footprint, without any actual safety benefit. 10.1016/j.jcrs.2018.05.001
    A new era for sterilization based on supercritical CO technology. Ribeiro Nilza,Soares Gonçalo C,Santos-Rosales Víctor,Concheiro Angel,Alvarez-Lorenzo Carmen,García-González Carlos A,Oliveira Ana L Journal of biomedical materials research. Part B, Applied biomaterials The increasing complexity in morphology and composition of modern biomedical materials (e.g., soft and hard biological tissues, synthetic and natural-based scaffolds, technical textiles) and the high sensitivity to the processing environment requires the development of innovative but benign technologies for processing and treatment. This scenario is particularly applicable where current conventional techniques (steam/dry heat, ethylene oxide, and gamma irradiation) may not be able to preserve the functionality and integrity of the treated material. Sterilization using supercritical carbon dioxide emerges as a green and sustainable technology able to reach the sterility levels required by regulation without altering the original properties of even highly sensitive materials. In this review article, an updated survey of experimental protocols based on supercritical sterilization and of the efficacy results sorted by microbial strains and treated materials was carried out. The application of the supercritical sterilization process in materials used for biomedical, pharmaceutical, and food applications is assessed. The opportunity of supercritical sterilization of not only replace the above mentioned conventional techniques, but also of reach unmet needs for sterilization in highly sensitive materials (e.g., single-use medical devices, the next-generation biomaterials, and medical devices and graft tissues) is herein unveiled. 10.1002/jbm.b.34398
    Supercritical CO technology: The next standard sterilization technique? Soares Gonçalo C,Learmonth David A,Vallejo Mariana C,Davila Sara Perez,González Pío,Sousa Rui A,Oliveira Ana L Materials science & engineering. C, Materials for biological applications Sterilization of implantable medical devices is of most importance to avoid surgery related complications such as infection and rejection. Advances in biotechnology fields, such as tissue engineering, have led to the development of more sophisticated and complex biomedical devices that are often composed of natural biomaterials. This complexity poses a challenge to current sterilization techniques which frequently damage materials upon sterilization. The need for an effective alternative has driven research on supercritical carbon dioxide (scCO) technology. This technology is characterized by using low temperatures and for being inert and non-toxic. The herein presented paper reviews the most relevant studies over the last 15 years which cover the use of scCO for sterilization and in which effective terminal sterilization is reported. The major topics discussed here are: microorganisms effectively sterilized by scCO, inactivation mechanisms, operating parameters, materials sterilized by scCO and major requirements for validation of such technique according to medical devices' standards. 10.1016/j.msec.2019.01.121
    Time-dependent recontamination rates of sterilised dental instruments. Barker C S,Soro V,Dymock D,Fulford M,Sandy J R,Ireland A J British dental journal OBJECTIVES:To determine time-related recontamination rates of sterilised instruments, following guidance from the UK Department of Health (HTM 01-05) that such instruments within primary dental care may only be stored for 60 days following sterilisation using a vacuum autoclave. MATERIALS AND METHODS:A total of 25 used examination mirrors underwent a washer-disinfector cycle, individual packaging and finally vacuum autoclaving. Immediately after autoclaving, time zero, five mirrors were tested for microbial contamination by aerobic and anaerobic culture. At 31, 60, 90 and 124 days a further five mirrors were removed from their packaging and were similarly tested for microbial contamination. RESULTS:There was no bacterial growth on blood-enriched media under both aerobic and anaerobic conditions after 5 days of incubation at 37°C at any time period from 0 to 124 days post-sterilisation. CONCLUSIONS:There was no recontamination of sterilised instruments in this investigation over the test period of 124 days. This exceeds the recommended limit of 60 days stated by the UK Department of Health. The new guidance, HTM 01-05, appears to place an extra burden on primary care dentists. This burden is not without associated costs, and at present does not appear to be based on published evidence. 10.1038/sj.bdj.2011.869
    Optimizing the surgical instrument tray to immediately increase efficiency and lower costs in the operating room. Canadian journal of surgery. Journal canadien de chirurgie BACKGROUND:Surgical trays are often poorly configured and can be ongoing sources of frustration and excess costs. We conducted an observational study to determine if the use of a customized mathematical inventory optimization model would result in a greater reduction in the number of instruments on a surgical tray than a clinician review of the tray. METHODS:Utilization of instruments on the major orthopedic tray at a large academic hospital was documented over 80 procedures. Processes in the medical device reprocessing department and operating room were observed to comprehensively quantify all associated costs. Results of the observations were applied to a customized mathematical model to determine the ideal tray configuration. For comparison, a clinician review was also performed. RESULTS:The mathematical model alone produced an ideal tray size of 47 instruments, a reduction of 41 instruments from the original size of 88 instruments (47% reduction). This represented $34 440 in annual savings. In contrast, the clinician review alone suggested an ideal tray size of 67 instruments (23% reduction), representing $17 640 in annual savings. When clinicians were provided with the additional information from the model, they reduced the tray size to 51 instruments (42% reduction), producing $31 870 in savings. The mathematical model yielded an additional 22% instrument reduction and $14 230 in savings compared with clinician review alone. CONCLUSION:Our mathematical model is generalizable and can be applied to all specialties and hospitals to determine optimal tray configuration. As such, the financial implications are broad; at our institution, application to all surgical trays would result in $205 000 of savings annually. Surgeons and managers looking to streamline surgical trays should consider this evidence-based approach. 10.1503/cjs.022720
    A comparative carbon footprint analysis of disposable and reusable vaginal specula. Donahue Laura M,Hilton Stephen,Bell Sarah G,Williams Brent C,Keoleian Gregory A American journal of obstetrics and gynecology BACKGROUND:Healthcare systems in the United States have increasingly turned toward the use of disposable medical equipment in an attempt to save time, lower costs, and reduce the transmission of infections. However, the use of disposable instruments is associated with increased solid waste production and may have negative impacts on the environment, such as increased greenhouse gas emissions. OBJECTIVE:The purpose of this study was to inform this discussion; we applied life cycle assessment methods to evaluate the carbon footprints of 3 vaginal specula: a single-use acrylic model and 2 reusable stainless steel models. STUDY DESIGN:The functional unit of the study was defined as the completion of 20 gynecologic examinations by either type of speculum. The greenhouse gas emissions (eg, carbon dioxide, methane, nitrous oxide) across all life cycle stages, which includes material production and manufacturing, transportation, use and reprocessing, and end-of-life, were analyzed with the use of SimaPro life cycle assessment software and converted into carbon dioxide equivalents. RESULTS:The reusable stainless steel grade 304 speculum was found to have a lesser carbon footprint over multiple model scenarios (different reprocessing techniques, autoclave loading/efficiency, and number of uses) than either the reusable stainless steel grade 316 or the disposable acrylic specula. The material production and manufacturing phase contributed most heavily to the total life cycle carbon footprint of the acrylic speculum, whereas the use and reprocessing phase contributed most to the carbon footprints of both stainless steel specula. CONCLUSION:The use of disposable vaginal specula is associated with increased greenhouse gas equivalents compared with reusable alternatives with no significant difference in clinical utility. These findings can be used to inform decision-making by healthcare systems, because they weigh a wide range of considerations in making final purchase decisions; similar analytic methods can and should be applied to other components of health systems' waste streams. 10.1016/j.ajog.2020.02.007
    Action plan for the mitigation of greenhouse gas emissions in the hospital-based health care of the Hellenic Army. Bozoudis Vasileios,Sebos Ioannis,Tsakanikas Aggelos Environmental monitoring and assessment Climate change is a growing threat for human health and well-being, one that will seriously impact and potentially disrupt all economic sectors and supply chains, such as trade, tourism, agriculture, forestry, and fisheries. The environmental impact of the delivery of medical and hospital care, which generates its own greenhouse gas emissions, needs to be examined and analyzed in detail in order to design and implement effective mitigation actions and measures. Hospital internal energy use processes include the energy consumed for hospital operation, such as lighting, heating, cooking, waste treatment, and other functions associated with the logistical and operational support of hospitals. The present research work, which follows the assessment undertaken in a previous study of the transport activities of the 401 Military General Hospital of Athens (401 MGHA), focuses on the carbon footprint of the stationary emission sources of the 401 MGHA; it serves as a second step in the development of an action plan for the mitigation of greenhouse gas emissions in the hospital-based health care of the Hellenic (Greek) Army. A portfolio of energy saving and emission reduction actions is proposed and mapped according to their abatement cost and greenhouse gas (GHG) reduction potential. The highest decrease of GHG emissions is expected to be materialized by the decarbonization of the Greek power sector due to the lignite phase-out and increased share of low carbon fuels and renewable energy sources. Significant emission reduction potential could also be achieved by the replacement of face-to-face hospital visits by telemedicine, primarily by reducing transport-associated emissions. Furthermore, a number of key performance indicators (KPI) are proposed as simple and easily monitored metrics of the hospital's performance towards its sustainable low carbon objectives. Specific KPIs per mitigation action are presented, as well as a general KPI that covers all mitigation actions and sources of emissions in the form of "tCOeq per patient" or "tCOeq per hospitalization day." 10.1007/s10661-022-09871-3
    The carbon footprint of the Chinese health-care system: an environmentally extended input-output and structural path analysis study. Wu Rui The Lancet. Planetary health BACKGROUND:The health sector plays an important part in adapting to climate change; however, the sector is also responsible for significant greenhouse gas (GHG) emissions. In high-income countries, the carbon footprints of health-care systems have been estimated to be 3-10% of the total national GHG emissions, but no in-depth investigation has been done for China. This study aims to examine the carbon footprint of the Chinese health-care system and identify emission hotspots. METHODS:Environmentally extended input-output analysis and structural path analysis were used to assess the lifecycle GHG emissions of the Chinese health-care system. A satellite account of GHG emissions was constructed for 46 economic sectors in China using energy data from the National Bureau of Statistics based on the numbers reported by a large number of enterprises. Data on health expenditure for medical institutions, pharmaceuticals, construction, administration, and research were obtained from multiple Chinese official statistics yearbooks and the national input-output table. FINDINGS:In 2012, China spent CNY 2539 billion on health care, leading to emissions of 315 (68% CI 267-363) megatonnes CO equivalent. Health care accounted for 2·7% (68% CI 2·3-3·1) of China's total GHG emissions. The major contributors of GHG emissions in the health-care system were public hospitals (148 megatonnes [47%]), non-hospital purchased pharmaceuticals (56 megatonnes [18%]), and construction (46 megatonnes [15%]). In medical institutions, energy use for buildings and transport accounted for only 16% of the total carbon footprint, whereas 84% was embodied in the purchased goods and services. INTERPRETATION:China has a much smaller health-care carbon footprint per capita than developed countries, such as the USA and Australia. However, its carbon emissions per unit of health expenditure are relatively high because of the expenditure structure and the carbon intensity of the country's entire economy. The results suggest the need for a nationwide carbon-efficient target for health care and use of low-carbon alternatives in making supply chain choices to achieve reductions in the carbon footprint. FUNDING:Natural Science Foundation of China. 10.1016/S2542-5196(19)30192-5
    Adjusting the global industrial structure for minimizing global carbon emissions: A network-based multi-objective optimization approach. The Science of the total environment Although many scholars have focused on industrial structure adjustment to find the optimal balance between carbon emission reduction and economic growth, few studies have considered the comprehensive influence of the supply chain structure on carbon emissions. Based previous studies, we proposed a novel network-based optimization model. The results showed that carbon emissions would decrease by 4.31%, 6.26 and 8.07% with GDP increasing by 5.53%. 4.45% and 2.50% in different scenarios in the proposed network-based model, which performed better than the previous non-network-based model. There were some principal sectors which played special roles in the optimization of global industrial structure. To achieve the goal of global carbon emission reduction, some sectors should significantly reduce their total outputs such as materials and energy in China, while other sectors could continue to increase their total outputs such as machinery and services in China and South Korea. The results also showed that the change rate of carbon emissions was related with the costs of carbon emissions for the GDP growth. Countries with higher costs of carbon emissions, such as China, India and Russia, would burden more responsibilities. Furthermore, we found that the changes of the industrial structures of countries (regions) were different under global carbon emission reduction. Due to the current technology limitation, the production activities of energy and material industries in developing countries, such as China and India, should be reduced. Technology exportation of developed countries in such industries would be beneficial for the global carbon reduction. 10.1016/j.scitotenv.2022.154653
    Community-Academic Partnership to Improve the Oral Health of Underserved Schoolchildren in Rural North Carolina. Stewart Rachel,Pardi Vanessa,Buck Jennifer,Smallwood Otis,Wright Wanda The Journal of school health BACKGROUND:Dental caries is the most common chronic illness for children. Caries can reduce the quality of life, cause missed classroom hours, and decrease cognition. Strategies to improve children's oral health must be evidence-based, developed, and implemented in consultation with communities. METHODS:A community-academic partnership was formed between East Carolina University School of Dental Medicine and the Bertie County Public School District to develop and implement a school-based oral health prevention program using the PRECEDE-PROCEED Model. RESULTS:The PRECEDE component involved social, epidemiological, environmental, educational, ecological, administrative, and policy factors that informed the development of the oral health program. The PROCEED component consisted of implementation and evaluation. CONCLUSIONS:School-based oral health programs can increase access to care for vulnerable children and improve learning. The application of the PRECEDE-PROCEED model proved to be a valuable method for developing, implementing, and evaluating a school-based oral health program. 10.1111/josh.13129
    Environmental impact and life cycle financial cost of hybrid (reusable/single-use) instruments versus single-use equivalents in laparoscopic cholecystectomy. Surgical endoscopy BACKGROUND:Hybrid surgical instruments contain both single-use and reusable components, potentially bringing together advantages from both approaches. The environmental and financial costs of such instruments have not previously been evaluated. METHODS:We used Life Cycle Assessment to evaluate the environmental impact of hybrid laparoscopic clip appliers, scissors, and ports used for a laparoscopic cholecystectomy, comparing these with single-use equivalents. We modelled this using SimaPro and ReCiPe midpoint and endpoint methods to determine 18 midpoint environmental impacts including the carbon footprint, and three aggregated endpoint impacts. We also conducted life cycle cost analysis of products, taking into account unit cost, decontamination, and disposal costs. RESULTS:The environmental impact of using hybrid instruments for a laparoscopic cholecystectomy was lower than single-use equivalents across 17 midpoint environmental impacts, with mean average reductions of 60%. The carbon footprint of using hybrid versions of all three instruments was around one-quarter of single-use equivalents (1756 g vs 7194 g COe per operation) and saved an estimated 1.13 e DALYs (disability adjusted life years, 74% reduction), 2.37 e species.year (loss of local species per year, 76% reduction), and US $ 0.6 in impact on resource depletion (78% reduction). Scenario modelling indicated that environmental performance of hybrid instruments was better even if there was low number of reuses of instruments, decontamination with separate packaging of certain instruments, decontamination using fossil-fuel-rich energy sources, or changing carbon intensity of instrument transportation. Total financial cost of using a combination of hybrid laparoscopic instruments was less than half that of single-use equivalents (GBP £131 vs £282). CONCLUSION:Adoption of hybrid laparoscopic instruments could play an important role in meeting carbon reduction targets for surgery and also save money. 10.1007/s00464-021-08728-z
    Decreasing operating room costs via reduction of surgical instruments. Nast K,Swords K A Journal of pediatric urology BACKGROUND:Rising costs in health care demand waste reduction and improved efficiency throughout the hospital. Surgeons have an important role in regard to the number of instruments used in procedures. Previous studies have demonstrated instrument maintenance and sterilization cost approximately $0.51-$0.77 per instrument and found that only 13-21.9% of instruments opened are used. OBJECTIVE:The aim of the study was to reduce the surgical trays so that more than 50% of the instruments are used leading to a cost savings of at least 20% per tray. This was begun with the minor urology tray which is primarily used for orchiopexy and hernia repair. STUDY DESIGN:This was a single-site, prospective study. A Plan, Do, Study, Act cycle was used. A multidisciplinary team including urologists, surgical technicians, and a central processing department representative was developed. Inguinal orchiopexy with hernia, scrotal orchiopexy, and inguinal hernia cases were randomly chosen to count the total instruments used in each procedure. The exact instruments were recorded every third case to obtain a sample of variable patients and surgeon preferences. The percentage of utilization was calculated, and a list of instruments used was created. Those not used or used less than 20% of the time were removed. The new list was reviewed with the option to add or eliminate instruments. The approved reduced list was then implemented as the genitourinary (GU) minor tray. Finally, the instruments used in 10 inguinal orchiopexy with hernia cases, 10 scrotal orchiopexy cases, and 10 inguinal hernia cases were counted. The percentage of utilization was calculated. This process was then replicated in other surgical trays. RESULTS:The GU minor instrument tray was reduced from 57 to 35 instruments, a 39% reduction in size. Scrotal orchiopexy uses the least instruments (16.9), a utilization percentage of 48.3% after reduction. Inguinal orchiopexy with hernia repair uses the most number of instruments (25.1) with 71.7% utilization after reduction, compared with 43% before reduction. Using the cost analysis performed by Stockert and Langerman, $11.22 was saved during each procedure; this translates to a cost savings of $3489.42 annually. After reduction, only 10% of the cases required an extra instrument to be opened. Three other surgical trays were reduced using the same method, yielding a potential savings of $14,588. DISCUSSION:Baseline data demonstrates low average instrument utilization rangin from 21.1% to 49.1% per case. It is estimated that each instrument costs from $0.51 to $3.19. Decreasing the number of instruments opened with each surgical procedure is a viable way to decrease costs and efficiency in the operating room. CONCLUSIONS:Initially, the GU minor tray was successfully reduced by 39%, followed by the other surgical trays. A multidisciplinary approach is critical for success. This study showed an excellent opportunity for cost savings by decreasing reusable waste in the operating room. 10.1016/j.jpurol.2019.01.013
    What's in a bin: A case study of dental clinical waste composition and potential greenhouse gas emission savings. Richardson J,Grose J,Manzi S,Mills I,Moles D R,Mukonoweshuro R,Nasser M,Nichols A British dental journal BACKGROUND:Dental practices have a unique position as dental staff use a high number of dental materials and instruments on a daily basis. It is unclear how dentists' and dental care professionals' choices and behaviours around selecting and using materials impact on the amount of unnecessary waste production. Although there are a number of articles exploring the quality and quantity of waste in dental practices, there are no studies on organisational strategies to decrease unnecessary waste. There is no clear economic analysis of the impact on associated cost to dental practices which consequently can affect the access of dental care for disadvantaged groups. METHODS:This study used an audit approach to explore the potential for sustainability in dental practice by measuring the nature and quantity of dental clinical waste, and assessing the feasibility of measuring the financial costs and potential carbon savings in the management of dental clinical waste. CONCLUSIONS:The data from our study would appear to support the view that it is possible to reduce carbon emissions and increase profitability. Successful implementation of an environmentally sustainable approach to waste management will be dependent on the practicalities involved and the financial incentives for adopting such practices. 10.1038/sj.bdj.2016.55