by Noel Kelsch, RDHAP
The first part of this column topic discussed the importance of patient and staff safety when implementing a practical infection control program that includes green concepts. In conjunction with the Organization for Safety, Asepsis and Prevention (OSAP), Dr. Chris Miller shared some insight on questions that clinicians have submitted. Dr. Miller is professor emeritus of microbiology at the Indiana University School of Dentistry.
1. Is it safe for an office to use machine washable bibs, head rests, and clothes for delivering patient care?
Dr. Miller: Surfaces barriers need to be impervious to moisture so that the underlying surface does not come into contact with the contaminant. Thus most papers and regular woven cloth such as denim will allow moisture to penetrate. Even some single layer non-woven materials may allow penetration. Some types of cloth such as tight-woven pima or waterproofed cloth may resist bacterial penetration.
There is considerable variability against strikethrough (penetration of moisture when the material is contacted), so using a plastic-type material that is well known to prevent moisture penetration may be best from an infection control point of view. Some "plastics" may be more friendly to the environment than others.
2. Can an office use green products that are not hospital grade disinfectant for surface disinfection? What approval must a product have to be used in the dental setting?
Dr. Miller: According to the Centers for Disease Control and Prevention (CDC), dental professionals should use an EPA-registered hospital disinfectant with a low level of activity (such as HIV and HBV label claim). Or, if blood is present, use an EPA-registered hospital disinfectant with intermediate-level (tuberculocidal label claim) activity. The key point is to use an EPA-registered product. If it is "green," then all the better. The EPA has just approved a pilot project through which a disinfectant manufacturer may apply for a special "green" logo for the label, if the product meets certain requirements.
3. Many offices are looking at green products for surfaces such as stone and bamboo. Would you recommend those porous surfaces as good surfaces for the dental setting?
Dr. Miller: From an infection control point of view, it is not wise to use porous surfaces when they may become contaminated with any type of liquid. Microbes can lodge in these pores, possibly hiding from surface disinfectants and becoming available for recontamination of the surface. Labels on surface disinfectants state to use the product on nonporous surfaces.
4. Can an office use a reusable cloth towel for drying hands? If not, why not?
Dr. Miller: Reusable cloth towels can harbor microbes that may not have been washed off your hands. If the towel is reused without washing, it can easily recontaminate the cleaned hands of a subsequent user of the towel. Some microbes may be able to multiply on the moist towel and make things even worse.
5. What are the limitations of going green in the dental setting?
Dr. Miller: Going green is great as long as the green process or procedure does not compromise infection control. Going green involves reducing adverse environment and health impacts. If infection control is weakened, then negative impacts on health (patients and staff) may be enhanced.
One way to assist in not compromising infection control is to make sure any new "green" product or procedure does not countermand any CDC recommendation or OSHA rule for disease prevention in the office.
6. What steps can an office take to go green and keep the patient safe?
Dr. Miller: Some examples to consider for greener infection control and safety are:
- Consider appropriate reusables (that do not compromise infection control) vs. disposables. However, make sure you consider the increased labor and time involved with processing the reusables.
- Consider increasing the use of alcohol-based hand rubs over handwashing to save on water and adding chemicals to the wastewater stream. However, occasionally wash and rinse your hands to remove buildup of glove powder, dead bacteria, sweat, and other debris that remain with the use of hand rubs.
- Consider disinfectant pump sprays or wipes that, in some instances, may reduce adding chemicals to the environment.
- Consider better inventory control and proper mixing of chemicals to reduce discarding of expired/outdated materials.
- Consider recycling (plastics, paper, metals, glass, etc.), depending upon what your local recycler will accept.
- Consider always running full instrument cleaner and sterilizer loads to reduce the number of cycles run per day.
- Consider purchasing infection control supplies that are packaged in recycled materials and have a minimal amount of packing material.
- Consider digital radiography to reduce adding chemicals to the environment and exposing staff to chemicals.
- Consider periodic reviews of the office's exposure control plan and hazard communication plan to maintain the health and safety of all office personnel.
- Consider joining and participating in OSAP (www.osap.org).
7. What tips do you have for going green in the dental setting?
Dr. Miller: Going green in infection control and safety is a personal decision that should take many things into consideration such as:
- Your basic philosophy about health and the environment.
- Scientific evidence that a product or procedure is really "green."
- Infection control efficacy of the product or procedure.
- Ability (or authority) to take action.
- Availability of products.
8. How does "do no harm" fit into going green?
Dr. Miller: Going green may reduce negative impacts of dental infection control on the environment and the health of patients and office personnel.
Going green is an important part of all we do in our day-to-day lives in the dental setting. Following science-based information and doing no harm to our patients or staff must come first. As each of us does our part, we can limit our impact on the earth we love.
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.
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