by Noel Kelsch, RDHAP
Get your pen out. You will want to take notes for the letter you are going to write to the editor about what I am going to say. Many of you are making a grave mistake. You are literally putting people’s lives at risk in the name of going green.
The concept of going green can be seen everywhere these days. For me, going green means that we make an attempt in our everyday activities to consider how the environment is affected by our actions. We then incorporate methods to limit the impact on the earth and make that part of our lifestyles.
Professor Chris Miller stated it best about the relationship between infection control and going green. “Green infection control and safety are disease prevention and safety procedures and products that further reduce adverse health and environmental impacts.”
One simple way to measure how we affect the environment is to look at the carbon footprint we create. A carbon footprint is the total number of greenhouse gases emitted. It is really interesting to look at some of the activities we undertake and how each action or product we choose has a complex set of reactions involved. The production of a simple product, for example, involves extraction, production and transportation of raw materials, manufacture and service provisions, distribution, end use, and disposal and recycling. Once you understand the production process of the particular item, you can then take measures to limit the carbon footprint by reducing it in one of those areas.
Want to know your carbon footprint and have some resources to make changes in your life? Go to: www.epa.gov/climatechange/emissions/ind_calculator.html.
Taking care of me; taking care of you
Jim Henson was a humanitarian who changed the world’s perspective through the use of puppets. I think about him often. Kermit’s slogan was “It’s not easy being green” (I actually think it is very simple being green). I think of the Muppets puppeteer for the way his life ended.
Jim had a rigorous schedule and frequently flew coast to coast. He had a sore throat one day but went to work anyway, boarding a plane. After eight days of working while feeling ill, he consulted a doctor and was told to take aspirin since there was no sign of pneumonia. He went home and told his wife that he thought he was dying. He was dying.
This genius, a master puppeteer, died in 1990 of a treatable disease. The cause of death is listed as organ failure due to infection by Streptococcus pyogenes, a severe Group A streptococcal infection. S. pyogenes is the bacterial species that causes strep throat, which led to his death.
Had Jim simply taken an antibiotic early on, he probably would still be with us. So why did this happen? Remember what you have to keep in mind with infection control. According to the Centers for Disease Control and Prevention, for an infection to occur, you must have an infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host.
Each step has to be present for the infection to occur. Clinicians have the responsibility to remove as many of these conditions as possible. Many areas of infection control that might work in your home will not work in the health-care setting.
So what does the above have to do with going green? Here is an example for you to consider. You let yourself overwork, not get enough sleep, feel tons of stress, and do not eat right (susceptible host). Your next mistake is to let that ill patient who did not want to reschedule sit in the chair (infectious agent). He coughs during the appointment (portal of exit), and fomites land on the counter (reservoir). You then choose to use a green product as a disinfectant that is not an EPA-approved hospital grade disinfectant (does not have the ability to render the infectious agent nonvital). You later touch the counter, and the disease is transmitted from your finger when you touch your nose (mode of transmission, portal of entry). You then acquire the virus, continue to work, and treat patients despite the illness. You finally end up in the emergency room with a virus because your immune system is shot.
While you were saving the environment by using a green cleaner, you cost the environment with:
- The drive to the hospital
- The products, disinfectant, and disposables used at the hospital
- The medications used at the hospital and subsequently at home
- The staff’s travel
- The paperwork for insurance
The list goes on and on.
To make matters worse, there is no way of calculating how many other people you spread the disease to. The dental setting has infection control standards that we must keep. We have to remove as much of the chain of infection as we possibly can.
Taking care of you is going green! It really is that simple.
Incorporating the green concept into the dental office means that we have to look at both the practice of dentistry and the practice of going green. Going green cannot overrule evidence-based practices that keep our patients and staff safe.
We are responsible for keeping a safe environment and not causing cross-contamination. Our first focus has to be “do not harm.” When we choose products, we need to focus on the issues we face as health-care providers and then on the issue of which product best allows us to limit our carbon footprint. In making green choices, we have to research the methods the company uses to transport the item, the packaging, the contents in the item, and how each product impacts the environment before, after, and during use. We must make evidence-based decisions in going green in infection control.
What can you do to limit the chain of infection and go green? Each link of the chain below contains two examples of simple things you can do. Each action limits your carbon footprint by simply limiting the spread of disease.
- Infectious agent — 1) Do not allow sick people in your chair unless there is an emergency. 2) Send dental professionals who are sick home.
- Reservoir — 1) Do not wear artificial nails. 2) Clean and disinfect all surfaces that may come in contact with pathogens, and look for hidden areas such as the bib chain.
Portal of exit — 1) Barrier protection. 2) Personal protective equipment.
Mode of transmission — 1) Wear personal protective equipment. 2) Proper hand hygiene.
Portal of entry — 1) Do not allow staff to practice clinically if there are weeping wounds on their hands. 2) Use the scoop method or a sharps device when recapping needles.
Susceptible host — 1) Eat right, reduce stress, and get plenty of sleep. 2) Keep up with your vaccinations.
It sounds so complex! Keeping it simple
I have spent my entire life going green. I was sent to the compost pile with all of the leftovers since I was old enough to walk. Twenty years ago, I was simply laughed at when I took my backpack on my walk to the store to carry my groceries home, answering the bag boy’s question of paper or plastic with “neither.” There is no doubt in my mind that going green is a lifestyle I choose. Incorporating the green concept into the dental office means that we have to look at both the practice of dentistry and the practice of going green.
In some areas of my life, going green is a concept that needs to be examined closely. The reasoning behind going green means that you must look at the big picture and realize that doing no harm goes way beyond the practice of medicine.
Some very simple things that we can do in dentistry to make this happen include:
- Buy instrument cassettes, since they increase the longevity of instrument life and reduce the risk of sharps injuries.
- Collect and recycle waste amalgam. The mercury can end up in wastewater and be highly toxic, especially to pregnant mothers and young children. (Dentists account for over 20% of mercury pollution in the United States.)
- Install amalgam separators since they have been proven to stop over 99% of waste mercury from entering our waters.
- Look for products with green or greener packaging and look for suppliers who have established green initiatives. Tell manufacturers about your concerns with packaging. Don’t buy items with too much packaging, and ask manufacturers to ship in bulk.
- Look for carbon neutral suppliers as a way to reduce your carbon footprint.
- Ask yourself whether the green option contradicts the “do no harm” principle, particularly with infection control. Research pros and cons of the green alternatives by contacting suppliers.
- Recycle the foil from X-rays or, better yet, switch to digital systems, eliminating all of those chemicals.
- Buy autoclave pouches that have recyclable materials (such as paper and plastic).
- Buy products that have containers that can be refilled.
- Use energy-efficient lightbulbs.
- Turn down the heater or turning up the air conditioning; one or two degrees does make a difference.
- Turn off the computer, radio, etc. when you are not using it.
- Operate autoclave only when full.
- Share a ride to work, taking the train, or walking to work.
- Avoid placing single-use items on the tray until you need them. They have to go into the trash if they are on the tray you use. Have a covered, side-dispensing tray and dispense as needed.
- Get your energy from a company that is a green energy supplier.
- Make patients aware of items that can be recycled and the recycling programs in your community.
- Dispense only the material you need for a procedure.
- Insulate the attic and water heater.
- Buy supplies once a month, saving on the trips to the store.
- Filter your own water. Don’t buy bottled water.
- Have patients bring their own goodie bags.
We have a choice. The examination of the ingredients we put into the environment is vital. In the dental setting, it is a more complex task — the added responsibility of doing no harm. The task of doing no harm must come first.
What about green cleaners?
There have been some major concerns about the effects of cleaning and disinfection products, and rightly so. We really do need to be aware of the products’ impact on our lungs, skin, and all of our organs. We need to know what exposure means over time. This has led to the development of products that contain a green claim in their formulation.
The problem with these products is that most of them have not been tested to confirm if they are able to meet the needs of infection prevention. The Health Care Without Harm Association stated that there is little literature or research available on green cleaners use in infection control. Until those studies are conducted and the product receives EPA certification, it cannot be used in the dental setting for disinfection.
In the meantime, choose products that have green packaging, green distribution, and green recycling. Become aware of what you are being exposed to and become familiar with the time weighted averages (TWA) and precautions that come with every EPA-registered disinfectant. These reports tell us what we need to do to avoid exposure (ventilation, personal protective equipment, time limitations, etc.) and the risks in being exposed.
My favorite part of going green: A compost pile
Every office can make a small change. One of the things I have done in my office is develop a compost pile. All of us can make an impact on the world with a simple compost pile. If you do not have a place in your office to start a compost pile, take the material home for your own garden. If you do not have a place at home, take it to a community garden. I interviewed Jack Brandon, a master gardener about his thoughts on going green and having a compost pile.
Why is a compost pile so important in gardening?
It enriches your soil. It is a soil conditioner, mulch, and fertilizer all in one. It replaces the vital nutrients the plants remove each season. It will feed your soil all the microorganisms that it may be missing. It makes the soil drain and retain properly.
Why is it considered green?
It is green because you do not put it into the garbage disposal or send it to the landfill. I not only think about the environment we are saving but, if you are using store-bought soil enhancers, there is the transportation to the store, plastic bags, etc., when it can be right in your own backyard. It saves you money, as well as a trip to the dump. It eliminates so many parts of the carbon footprint some people create in gardening. This is a low-tech solution that does not have a cost involved in saving the environment.
What things can you put in a compost pile?
Anything that is green or anything from the kitchen that is not dairy, meat, or a chemical. A great detailed list about composting is www.epa.gov/wastes/conserve/rrr/composting/by_compost.htm.
Noel Brandon Kelsch, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She is a member of the Organization for Safety and Asepsis Procedures and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamine and drug use. She is immediate past president of the California Dental Hygienists’ Association, and is on the board of directors for the Simi Valley Free Clinic.