Implementing eco-friendly infection control

Preventing pathogen transmission among patients and dental health care personnel is the primary goal of infection prevention in the dental office. During the course of the work day, clinicians repeatedly perform hand hygiene, wear personal protective equipment, clean and disinfect surfaces (or apply surface barriers), sterilize instruments, maintain dental unit waterlines, and use single-use disposable items. These tasks often involve equipment and products that produce much waste, consume excess energy, and use toxic chemicals.

Environmental issues became a major concern in the late 1900s when people recognized their actions were negatively affecting the earth. People began to examine their role in pollution, rampant use of natural resources and occupied space in landfills. The EPA introduced the strategies “reduce, reuse and recycle” to help sustain the earth for future generations. “Re-think” is a fourth strategy recently presented into this hierarchy- to promote eco-friendly choices over traditional practices.? At first glance, the principles of “infection prevention” and “eco-friendly” seem to be mutually exclusive and at odds. However, recent technological and manufacturing advancements are making these areas more compatible.

What you need to know

There are multiple goals associated with eco-friendly infection control. They include: prevent infection transmission in health care settings; improve safety for employees; and preserve and improve the environment. To accomplish this, a combination of traditional and environmentally friendly products, supplies and procedures are available.2 Chris Miller, PhD, was the first to develop a list that considered properties and features in the context of green infection control “do’s and don’ts” as they relate to recyclable and biodegradable materials, energy and water conservation, waste management, and maintenance of infection control standards.3 These considerations give manufacturers and consumers general guidelines for product development, evaluation and use (See Eco-Friendly Dos and Dont’s sidebar).

Reusable vs. disposable

Multiple studies conducted in hospitals show that care for an average patient could generate about 15 pounds of paper and plastic waste per day.4 Much of this comes from single-use disposable items and devices. Unfortunately, these items are occupying space in landfills, as well as consuming energy during manufacturing. Clearly, effective compromises are necessary to maintain an eco-friendly mindset while not compromising patient safety and care. Clinicians should evaluate the advantages and disadvantages of these items during product selection.5

Some single-use disposable items may be biodegradable, may be manufactured from recycled materials and/or are lead free. These include environmental surface barriers, sterilization pouches with lead free indicators, wraps (secured with lead-free tape), and plastic air-water syringe tips. Reusable metal air-water syringe tips are difficult to clean before heat sterilization. Studies show they may not even be free of accumulated bioburden after reprocessing. Because initial cleaning remains at the core of infection control principles and practices, inability to remove debris from used air-water syringe tips before sterilization reinforces a disposable approach. Published infection control recommendations and regulations clearly state to not reprocess and reuse products that are meant for single use only. These products cannot be reliably cleaned, are not heat tolerant, and must be discarded after a single use. Many single-use items will exhibit the universal symbol of a single use disposable item: “2” with a slash through it. Sterilization products, such as wraps and pouches, are manufactured and approved for single use only and do not exhibit this symbol.

Reusables vs. Disposables

Reusables

• May be less expensive

• Reduce volume of waste

• Require less inventory

• Save natural resources

• May be difficult to clean

• May require additional resources to clean (electricity, water, soap)

Disposables

• Save reprocessing time

• Use less energy and chemicals

• Prevent cross-contamination

• May increase waste

• Convenience of use

Chemical considerations

In the past, chemicals used for infection control prevention were fast acting and effective at killing harmful microorganisms. Choices were limited and toxic to the environment. Chemicals used for cleaning and disinfecting in dental facilities often produce volatile organic compounds (VOCs) that effect indoor air quality. And, although chemicals are supposed to be handled, used, and disposed of according to governmental regulations, they’re often flushed down the drain. Water treatment facilities, unfortunately, can’t remove all chemicals from influent water. These chemicals are released into surface waters.6

Environmentally friendly chemical options include products that are less toxic, contain fewer VOCs, are easily disposed of, and are biodegradable.7 Thanks to technology, there are now multiple products that may be categorized in this manner. For example, there are instrument pre-cleaners and ultrasonic cleaning solutions that contain one or more enzymes to enhance removal of organic debris from contaminated instruments. Included are: Hu-Friedy’s Enzymax® Spray Gel , a ready-to-use instrument pre-cleaner; Metrex Total Care’s EmPower , a dual proteolytic ultrasonic cleaner; and Hu-Friedy’s Enzymax Earth, a dual-proteolytic and amylase ultrasonic cleaner. By facilitating rapid breakdown of adherent bioburden into water-soluble components, these enzymatic preparations efficiently clean difficult-to-remove debris from instruments. This type of solution is biodegradable because of its proteinaceous composition. With the addition of an amylase component, degradation of carbohydrate components in plaque, blood and saliva also can be enhanced.

Other areas of infection control prevention have seen more eco-friendly products. The development of a hydrogen peroxide based intermediate level disinfectant for environmental surfaces such as Sci-Can’s Optim 33 TB, allows for an effective disinfectant that degrades to form water. Dental unit waterline asepsis can be accomplished using a complete system such as Hu-Friedy’s Team Vista. The system includes a cleaner that is free of heavy metals (VistaTab) and a maintenance product derived from organic botanicals (VistaClean).

Eco-friendly clinical tips

Clinicians face daily choices with regard to chemical selection, usage and disposal. When considering options that are less toxic, biodegradable, and contain fewer volatile organic compounds, be aware that all products used for disinfection and sterilization must be EPA registered and discarded or recycled according to detailed governmental regulations. Whether traditional products or eco-friendly alternatives chosen, clinicians must have a basic understanding of the chemicals used in their facility and the MSDS data accompanying them. Never assume one product will be used exactly as a similar alternative.

Do your part

There is growing evidence of global climate changes and finite capacity of our planet’s eco-system. All members of society are encouraged to “reduce, reuse, recycle and rethink” as we evaluate our lifestyle choices and attempt to sustain the environment for future generations. Dental facilities can participate in these environmental efforts. Eco-friendly infection prevention applications involve careful consideration of product selection and practices, observing correct waste management methods, and a team effort. Remember your first priority is preventing infection transmission. When products are selected, used, and disposed of judiciously, while at the same time maintaining infection control standards, it is a win-win for all involved.

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References

1. Pockrass F, Pockrass I. The four “R’s” of eco-friendly dentistry. Access. 2008: 22 (8): 18-21.

2. DiMatteo, Going Green: Making your Practice a Green and Eco-Friendly Machine, Inside Dentistry, April 2010, Vol. 6, Issue

4. Aegis Communications

5. Miller, Palenik. Infection Control and Management of Hazardous Materials for the Dental Team, 4th Edition. Chapter 23: Greener Infection Control, Mosby, 2009.

6. Molinari, Infection control going green: oncoming reality-Part 1, www.dentaleconomics.com, March 2009.

7. Molinari, Harte, Practical Infection Control in Dentistry, Third edition, Chapter 17: The Role for Single-Use Disposable Items, Lippincott Williams & Wilkins, 2010.

8. www.epa.gov/owm/

9. Sawchuk, Green Disinfectants and Pathogenic Organisms, www.infectioncontroltoday.com, 12/01/08