Infection control in a green dental practice

March 17, 2020

Dental practices should follow the same sorts of safeguards that everyone else follows, but with their own, industry-specific focuses-especially as infection control is concerned.

Being ecologically responsible is nothing new. There have always been efforts to take care of the planet, but in recent years, that concern seems to be more widespread. Between concerns with global warming, waste, and pollution, there is more of an effort to be responsible planetary stewards, and those efforts extend to dental practices. Practices should follow the same sorts of safeguards that everyone else follows, but with their own, industry-specific focuses-especially as infection control is concerned.

According to the Eco Dentistry Association, every year, dental practices generate:

  • 4.8 million lead foils

  • 28 million liters of x-ray fixer

  • 3.7 tons of mercury waste

  • 1.7 billion sterilization pouches

  • 680 million chair barriers, light handle covers, and patient bibs

The association further identifies the four processes most responsible for dental practice waste:

  • Infection control methods, including disposable barriers and sterilization items and toxic disinfectant

  • Placement and removal of mercury-containing dental material

  • Conventional x-ray systems

  • Water waste from conventional vacuum systems

Reduce waste and pollution
Curbing the sheer amount of waste produced by the dental practice for infection control is a great place to start.

“We do generate a lot of plastic waste from using barriers in dental treatment rooms, which then reduces the amount of disinfectants we need to use after patient treatment,” infection prevention speaker, author, and consultant Mary Govoni says. “But that, of course, all ends up in a landfill. Even though some of those plastic items are marketed and sold as biodegradable, it’s not in our lifetime-probably 80 years before that happens. So it’s kind of a balance between what kind of equipment would be best served by covering it with a plastic barrier and things that can be disinfected.”

Dental professionals are encouraged to think about what individual pieces of equipment really need for proper disinfection.

“I see lots of practices that put big, huge plastic bags over their entire patient chair, which I think isn’t necessary, because you can easily disinfect the chair,” Govoni says. “Some people are proponents of using more cloth barriers on things, which can then be washed after use, but cloth barriers are not impervious. And so if blood or saliva or aerosols happen to soak through those cloth barriers, you still have to disinfect underneath. And then we have to look at how much energy we use to launder those cloth barriers. So it’s, again, walking the fine line, trying to be aware of how much plastic waste we have and try to reduce it as much as we can.”

Pouches
One area that seems particularly waste-producing is the use of pouches for instrument sterilization. When used singly, pouch material introduces plastic into landfills. However, there are alternative products there are more environmentally responsible. Those pouches are not perfect, however.

“One item that is a huge waste creator is the pouches that we put our instruments in,” infection prevention consultant and speaker Jackie Dorst, RDH, BS, says. “The paper that we wrap our cassettes in, that’s a huge amount of waste that goes into the landfill, and it really cannot go into your paper recycling area, because of the plastic/paper combination with it. There are some reusable pouches, however there are two drawbacks to them: Those reusable pouches are not reusable forever. They can only be used for, like, 20 cycles, and somehow you have to keep a record. And then, even at the end of those 20 cycles, the pouch is no longer viable. You have to discard it. So it requires more time and education and thought to use some of the environmentally friendly products.”

“Some of them, after they’ve been through a sterilization cycle several times, start to look sort of brown and dingy, which certainly wouldn’t instill confidence in a patient if they saw that as their instrument pack waiting for them in a treatment room,” Govoni adds. “And you have to track how many times each one of those pouches was used so that you don’t go over the maximum number of times that fabric will work. In other words, the pores will open up during the cycle and then close up again during the sterilization cycle. And then, after so many uses, they don’t work anymore. I just can’t imagine any dental practice accurately tracking just because of busy-ness.”

Environmental protection
Even something as simple as being mindful of how disinfectant is applied can help not only the environment, but the team members’ health.

“I’m a huge proponent of indoor air quality in dental practices and not spraying surface disinfectants,” Govoni says. “We know that the numbers of dental team members who have developed asthma is relatively high in dentistry, and it’s believed to be because of exposure to the disinfectants that we’ve sprayed and sprayed and sprayed for so many years. Using a wipe that’s pre-moistened, or pre-saturated, with the disinfecting solution also makes sense. And just from an overall standpoint, I encourage all the practices that I work with to establish a recycling program. Look at all of the packaging materials that you can recycle and the shipping materials, and all of those things.”

Dentistry can also ensure that it doesn’t add toxic waste into the ecosystem. To its credit, the industry has already pushed forward in recycling efforts to reclaim the silver and mercury from traditional amalgam fillings. 

“The EPA stated, many years ago, that dentists should install amalgam separators,” Dorst says. “The deadline for that is coming up in June of this year. All dental offices should have amalgam separators installed, so that silver and the mercury are removed from all of the water and fluids in the dental office. That’s going to be a great contribution to reducing the toxicity of those heavy metals in our water.”

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Sterilization is normally achieved through steam heat. However, in some cases, steam sterilization is not always appropriate. In those cases, a cold sterilization solution (high level disinfectant) is used. The downside of that, of course, is that it is deadly chemical.

“That’s a toxic chemical, but most state regulations still allow the spent chemical it to be poured down the drain,” Dorst says. “That chemical can be detrimental to the water treatment plant, and it would kill the good bacteria that help to digest the sludge. So, many dental offices now are eliminating the use of cold sterilization solution, because they have found all of their items that normally were heat-sensitive, can be replaced with heat-tolerant items.”

High tech ecology
Technology is an all-around boon for the dental industry. From speed to simplicity to cost effectiveness, there seems to be no end to the technology’s benefits. Ecological responsibility can be added to that list.

“High tech has been a huge environmental savior for us in the dental office,” Dorst says. “Just envision all of the patient paper charts. We had file cabinets full of those paper charts, and once the dental office converted to a digital record, keeping them saved all of that paper.

“Not only did it save the paper, dental offices saved the patient radiographs in the chart,” she continues. “All of that film was stored in the charts, also. So, converting to a digital record keeping system was a huge, environmentally friendly saver for the dental office.”

But high tech systems aren’t just useful for reducing paper. Consider, for example, the benefits of intraoral scanning.

“When we transitioned into scanning-versus taking an impression and then using that impression for pouring the stone model-the digital, high tech component of doing digital scans and creating a model from the digital scan has saved both on the impression material, dental stone and the water that it required to do those processes.”

Regrettably, selling dentists on the notion of the intraoral scanning can be an uphill battle.

“The issue that I see is that dentists tend to be slower adopters of the technology,” Govoni says. “They like their tried and true systems. So, if I’m a dentist that loves the results I get with taking a polyvinyl impression, then I’m probably going to stick with that closely. And it’s not just the dentists but, some of the team members can be pretty change-averse-‘We’ve already done it this way and it’s working okay.’ But they don’t really realize how inefficient it is.”

It doesn’t even have to be a “dental” function in order to be a positive change.

“It can even be something as simple as sending out electronic statements to patients,” Govoni says. “You don’t pay for stamps; it’s quick; and it’s not using a lot of resources.”

Ultimately, ecological responsibility occurs at many levels in the practice.

“What really needs to happen is to encourage practices to take a good, hard look at how they are consuming resources; how they’re allocating resources; considering the environment; and considering things like climate change when they do that,” Govoni says. “But, again, we tend to be slower adopters in dentistry, and so that’s sometimes not at the top.”