Eco-Friendly Infection Control-Understanding the

Balance

practical applications for going green and “doing no harm”

Eco-Friendly Infection Control-Understanding the

Balance

practical applications for going green and “doing no harm”

Eco-Friendly Infection Control-Understanding the

Balance

practical applications for going green and “doing no harm”

Eco-Friendly Infection Control-

Understanding the Balance

practical applications for going green and “doing no harm”

Eco-Friendly Infection Control-Understanding the Balance

practical applications for going green and “doing no harm”

Goals

• Define the concept of going green and its relevance to infection control in the dental setting

• Understand the practical application of the chain of infection to going green

• Identify the solutions for maintaining infection control standards and going green

• Develop a plan for changes in infection control in the dental setting to minimize the impact on the environment

What You Need to Know

Your Responsibility

So What’s The Problem?

Dentistry’s Impact on the Environment Is…Much Greater than You Think!

Dentistry’s Environmental Impact

•About 50% of mercury in waste waters is from dental practices•28 million liters of toxic x-ray fixer •4.8 million lead foils•680 million disposable infection control barriers

Sources: EPA, ADA, Eco Dentistry Association

More than You Think!

Mercury / Amalgam Waste

•Over 20% of US mercury consumption•Regulated in 12 states•EPA now adopting nationwide regulationSources: EPA, ADA,

SolmeteX

By Far the Biggest Environmental Issue

Photochemical Waste

Sources: EPA, Eco-Dentistry Association

After Amalgam, the Second Largest Issue

•Lead (4.8 million lead foils per year)•Silver•Developing Chemicals (28 million liters of fixer per year)

Reducing Your Carbon Footprint

Sources: Climax Global Energy, EDA

Plastics, Paper and Other Waste

• Dentists discard over 680 million disposable infection control barriers every year

• Americans produces 28 million tons of waste plastics per year

In order to make a change after receiving information you

must:• See the need• Know the action• Value the action• Repeat the action

UNDERSTANDING CHAIN OF INFECTION AND STANDARDS OF INFECTION CONTROL

AND GOING GREEN

Chain of Infection

Pathogen

Source

ModeEntry

Susceptible Host

Universal Precautions, 1980’s:Protects against exposure to blood, some other body fluids

•Hand washing•Personal protective equipment •Controls to prevent injuries•Proper management of patient care items and environmental surfaces

Standard Precautions 1990’s:Protects against exposure to blood, body secretions,Excretions, nonintact skin, mucous membranes•Hand washing•Personal protective equipment •Controls to prevent injuries•Proper management of patient care items and environmental surfaces

Exposure Prevention Strategies

• Engineering controls• Work practice controls• Administrative controls

Practical Application

• Behavior and techniques• Sustainable equipment: Recycle, Reuse• Disposables• Do no Harm• Resources for Change• Evaluation of supplies and materials green

factors• Safe disposal of chemicals

What does going green MEAN?

Adopting practices that reduce your overall impact on the environment. Adding

sustainability principles and considerations into the planning process of work or personal

lifestyle.

Adopting practices that reduce your overall impact on the environment. Adding

sustainability principles and considerations into the planning process of work or personal

lifestyle.

But what about doing no harm?

“Green infection control and safety is disease prevention and safety procedures and products that further reduce adverse health and environmental impacts”. Chris Miller DDS

Can I make my own wipes to go green?

• Yes if you want to put the patient at risk…• OSAP “In general cotton fibers in gauze

may shorten the effectiveness of some disinfectants”

• Practical Infection Control “Disinfectants should not be stored in containers with 2x2’s because it may shorten the effective shelf life.”

What are we looking for?

• EPA registration #, Hospital disinfectant• Compatibility• Cleans and disinfects• Low allergy• Ease of use• Contact time and shelf life• Low TWA risks• Green Factors

Aspiration Pnuemonia• When bacteria are implicated, they are usually of the anaerobic oral flora• Bacteroides• Prevotella• Fusobacterium• Peptostreptococcus• They may also be admixed with aerobic

bacteria:Streptococcus pneumoniae • Staphylococcus aureus• Haemophilus influenzae • Pseudomonas aeruginosa

Aspiration Pneumonia

• An incentive spirometer is $250• Pulse ox is $150• Admission kit is $150, • IV tubing is $80• One dose of 650 mg of Tylenol is $10• Antibiotics PRN $720• ICU rooms are averaging $13,041 24 hours • Staff, Transportation, uniforms, sheets,

drapes, single use supplies

ICU one DAY ~ $14,401

Simple concepts

• US grown Organic Cotton• Biodegradable• Natural fibers chlorine free

Going Green Means

• You uses the safest materials available that have the least impact on the environment

• Going green means you do not cross contaminate and end up sending someone to the hospital!

So what next?

• Reduce waste where possible and when not possible use environmentally friendlier supplies that feature recyclable materials or packaging.

• Buy from suppliers who are environmentally friendly or have eco-friendly initiative such as carbon offset programs as a way to reduce waste or offset the impact of carbon emissions.

So what is a Carbon Footprint?

• A carbon footprint is a measure of the impact our activities have on the environment in terms of the amount of green house gases produced, measured in units of carbon dioxide equivalents (CO2e).

Carbon offset example

• Online ordering and limiting catalogues• Carpooling and telecommuting• Limiting packaging• Biodiesel

Look closely at:

• Extraction• Production and transportation of raw

materials• Manufacture and service provision• Distribution• End use• Disposal and Recycling

Want to know your foot print?

• http://www.epa.gov/climatechange/emissions/ind_calculator.html

Resources for change…

Where did you start?

• Good • Better• Best

Misconceptions

• Green products cost more• Green products are not as effective• Green cleaning is too complicated• Green is difficult to implement

Reality

• Green products are competitively priced/cost neutral “green saves green”

• Green products can be more effective and have higher return on investment

• A good program is easy to monitor, train and maintain

• You may already be doing some green things you do not know about

5 Simple Steps for Change

• Determine the need• Involve the team and Develop a plan• Acquire “Green” products and equipment

& Provide training• Implement the plan, products &

procedures• Re-evaluate

So What’s The Solution?

The Solution to Mercury Waste

1. Capture and Recycle Waste Amalgam

2. Install an Amalgam Separator

3. Try Switching to Composites

The Solution to Mercury Waste1. Capture and Recycle Waste Amalgam

•Scrap amalgam and amalgam waste include any left over bulk amalgam, spent capsules, and disposable chair-side traps.

•Dentists should collect and store all contact and non-contact scrap amalgam for recycling.

•Mercury waste needs to be sent to an approved recycler for mercury.

CAUTION: NOT all waste services handle mercury.

2. Install an Amalgam Separator

ADA estimates that 25% of amalgam waste makes it to the wastewaters even after the use of chair-side traps and other capturing methods.

•Amalgam separators are solids collectorsinstalled on the vacuum lines of dental offices.

•They capture the amalgam before it reaches the sewers.

•The ADA’s best management practices (BMP) recommend the use of amalgam separators which are certified to collect over 98% of amalgam waste.

The Solution to Mercury Waste

The Solution to Mercury Waste

• Solutions available from SolmeteX & PureWater

• Discounts and subsidies available from PureLife Dental

• Part of PureLife’s Green Incentives Program

•Affordable, easy to install and operate and are available in various for small and large practices•Recycling is made easy with prepaid recycling and mail-in labels. • ISO 11143 certified and can remove over 99.5% of mercury, exceeding OSHA and EPA regulatory requirements.

The Solution to Mercury WasteThe Regulations…

•12 States have mandatory Amalgam Separator regulations (including ME, NH, MA, VT, RI, CT, NY, NJ, OR, MI)

•Several other States have local mandatory programs (Seattle, San Francisco, Milwaukee, Wichita, Kansas, and many other communities and counties)

The Solution to Mercury WasteNEW EPA RULE – How Will It Affect You?

Sept 27, 2010: EPA announced it expects to propose a rule in 2011 and finalize it in 2012, regulating amalgam separators

• Rule should apply to all 50 States

• Degree of enforcement unclear

• Details still to be determined

Source: EPA

The Solution to Mercury Waste3. Switching to Alternatives: Composites, Ceramics, Gold

PROS:• Good for the environment• Will boost your bottom line -> higher price premium 1.5x to 8x vs. amalgam

CONS:• Less resistant to wear and tear• More challenging to perform

Sources: EPA, Frederick Eichmiller, DDS VP & Science Officer Delta Dental of Wisconsin, Water & Wastes Digest September 2007, Association of Clean Water Agencies, US Geological Survey

The Solution to Mercury WasteAdditional Tips:

Sources: EPA, ADA

• Change chairside amalgam traps as often as necessary• Flush the vacuum system with disinfecting line solution before changing the chairside trap• Replace vacuum pump filters regularly as recommended by the equipment manufacturer• Amalgam separators spent canisters must be changed and recycled according to the manufacturer’s suggestions. Full canisters must never be rinsed out or disposed of in the trash or in a hazardous waste container as these will ultimately be incinerated, causing very toxic mercury emissions into the atmosphere.

The Solution to Photochemical Waste

1. Shift to Digital X-Rays

1. Implement a Waste Compliance Program

The Solution to Photochemical Waste1. Shift to Digital X-Rays

Source: Kodak

•Digital X-ray systems do not require film, fixer or developer•Up to 80% less radiation to the patient•More tools for the dental practitioner•Enhanced service to the patient

The Solution to Photochemical Waste2. Implementing a Waste Compliance Program

•Handled in accordance with strict and detailed OSHA compliance rules - These rules can vary from state to state.

•Solutions are available from many waste providers in the form of pickup services or more affordable mail-back services.• Solutions available from

SolmeteX

• Discounts and subsidies available from PureLife Dental

• Part of PureLife’s Green Incentives Program

Reduce Your Carbon Footprint

1. Buy Eco-Friendly Products

2. Improve Energy Efficiency

3. Source from Eco-Friendly Suppliers

Reduce Your Carbon Footprint1. Buy Eco-Friendly Products

• Reduced or recyclable packaging, lead-free ink

• Biodegradable or recyclable materials – focus on high volume disposable items (i.e. barrier sleeves, syringe tips, plastic cups etc.)

• Autoclavable products vs. disposables when practical (i.e. stainless steel suction tips, prophy angles and prophy cups)

Reduce Your Carbon Footprint2. Improve Energy Efficiency

• Install energy efficient HVAC system• Use natural light as much as possible• Use efficient lighting (i.e. halogen or LED)

when possible

• Install energy efficient windows, save over 30% of energy costs• Turn off all electrical equipment when not

in use

Reduce Your Carbon Footprint3. Source from Eco-Friendly Suppliers

• Use suppliers that have taken real tangible steps towards being more eco-friendly

• Use suppliers with eco-friendly products

• Use carbon-neutral suppliers with offset programs

Note: Always consider patient care first when considering green products – not all green substitutes are appropriate within an infection control and dental setting.

Reduce Your Carbon FootprintPRODUCT RESOURCES: Eco-Friendly Products

Eco-Friendly Gloves

• Eco-friendly packaging• Manufactured using bio-fuels• Eco-friendly packaging• Carbon-Free shipping

Reduce Your Carbon Footprint

Cotton Products Line Cleaners

• Neutral Ph• Amalgam sep. - friendly

• Natural organic cotton• Eco-friendly packaging

What About Infection Control?

Each task that we perform has a green aspect

The single most important way to reduce the risk of disease transmission.

It is Going Green!

Washing Your Hands

Clean Hands Save Lives88% of disease spread through hand

contact

Hand hygiene

• Hand washing• Hand antisepsis• Surgical hand antisepsis• Hand care • Preventive measures

Hands Need to be Cleaned When?

• Visibly dirty• After touching

contaminated objects with bare hands

• Before and after patient treatment (before glove placement and after glove removal)

• Transient microorganisms: acquired through direct contact, on surface layer

• Resident Flora: Usually normal flora of skin, attach to deeper layers

Efficacy of Hand Hygiene

Good Better

Best

Plain Soap

Antimicrobial soap

Alcohol-based handrub

Source: http://www.cdc.gov/handhygiene/materials.htm

Preparations in Reduction of Bacteria

How do we get the message out?

• Facts? Ethics? Understanding? Culture?• It make you sick, there are germs

involved? • Decrease in COMPLIANCE, 2.0 female,

21.5 males

Everyone understands

Something everyone can relate to…

Direct to the Point

Simple Concise

So what worked?• Grossness

• Increased hand washing in females 26 percent 8 percent in males

• SO what do we do?

How does it apply?

• Preach in a toilet?• How can I transfer this to practice?• Do I bring gross examples with me?• A minute in the MORNING

How can I get others to change?

• See the need• Know the action• Value the action• Repeat the action

In order to make a change after receiving information you must:

Your hands are only as clean as the towel you use to dry

them

Barrier surface protection

• Speedy turnaround• Safety and efficiency• Available for almost all surfaces• Eliminate the wait time• Limit chemical exposure and release to the atmosphere

Barrier Protection

Create a Barrier

Wipe, wipe, wipe

What are you Breathing?

• OSHA exposure limits to these chemicals is governed by OSHA time weighted average (TWA) for these chemicals.

• For information on work place exposure and methods for reducing exposure go to OSHA.org

Toxicological, environmental and occupational concerns associated with disinfection and sterilization practices

• Disposal of chemical need to be addressed

• Some chemicals can be neutralized by reaction with chemicals such as sodium bisulfite or glycine.

http://www.doa.state.wi.us/docs_view2.asp?docid=2518.

• Template for getting started

Resources

State environmental agencies• www.epa.gov/epahome/state.htmHealthcare Environmental Resource

Center• http://www.hercenter.org/dentistwastes.c

fmHealthcare Without Harm• www.noharm.org

Sources• recycleitnow.net• OSAP.ORG• DONOHARM.ORG• CDC.ORG • plasticsresource.com • pbs.org/pov/borders/2004/water/water_disposa

ble.html

• refillnotlandfill.org • bottledwaterblues.com • sks-bottle.com • www.earth911.org• www.thedailygreen.com