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  • Infection control in the dental setting requires the clinician to weigh the benefits and risks of every task they perform. This course gives you the tools to incorporate practical applications for going green and “doing no harm”. Small eco-friendly changes in your infection control practices can save you time, money and lives while helping the environment and the world.
  • Infection control in the dental setting requires the clinician to weigh the benefits and risks of every task they perform. This course gives you the tools to incorporate practical applications for going green and “doing no harm”. Small eco-friendly changes in your infection control practices can save you time, money and lives while helping the environment and the world.
  • Infection control in the dental setting requires the clinician to weigh the benefits and risks of every task they perform. This course gives you the tools to incorporate practical applications for going green and “doing no harm”. Small eco-friendly changes in your infection control practices can save you time, money and lives while helping the environment and the world.
  • Infection control in the dental setting requires the clinician to weigh the benefits and risks of every task they perform. This course gives you the tools to incorporate practical applications for going green and “doing no harm”. Small eco-friendly changes in your infection control practices can save you time, money and lives while helping the environment and the world.
  • Infection control in the dental setting requires the clinician to weigh the benefits and risks of every task they perform. This course gives you the tools to incorporate practical applications for going green and “doing no harm”. Small eco-friendly changes in your infection control practices can save you time, money and lives while helping the environment and the world.
  • Dentists have a unique opportunity to make a very significant positive impact on the environment by taking a few simple steps.
  • Dental offices account for as much as 20-80% of the mercury pollution in our wastewaters. The most common use of mercury is in the preparation of dental fillings, which uses amalgam material, consisting of approximately 50% mercury. EPA States that 50% of mercury in our wastewaters
    Mercury pollution is highly toxic and contaminates our lakes and rivers, causing harmful neurological effects for young children and pregnant woman and their developing fetuses who consume the contaminated fish. One in ten women of childbearing age is exposed to mercury at levels above what is considered safe according to the Center for Disease Control and Prevention.
  • The lead foil inside each x-ray packet is a leachable toxin and can contaminate the soil and groundwater in landfill sites. The fixer that Dental offices use to develop x-rays is a hazardous material.
    After mercury, x-ray related waste poses the second largest environmental threat in a dental office.
    Dental offices generate many different forms of waste as a result of x-ray processing:
    Lead. The lead foil inside each x-ray packet is a leachable toxin and can contaminate the soil and groundwater in landfill sites. Lead aprons should not be thrown into the regular garbage since the lead can contaminate soil and groundwater via the landfills and must be recycled.
    Fixer/Developer. The fixer that Dental offices use to develop x-rays is a hazardous material that should not be simply rinsed down the drain. Onsite treatment of waste fixer minimizes the risks associated with this material. The accumulation of silver in spent fixer can exceed the allowable discharge limits into the sanitary sewer. Photographic developer has trace amounts of silver from the process.
  • Reducing your carbon footprint means reducing the amount of waste produced and the amount of energy used. The solutions involve (1) buying eco-friendly dental products featuring less packaging, chemicals or using biodegradable or recyclable materials, (2) using more energy efficient lighting and HVAC, (3) partnering with suppliers that are eco-friendly, carbon neutral or have taken steps to become more green through their practices. It is crucial to remember that reducing your carbon footprint while important is a very small step compared to the huge impact your practice can make by simply eliminating mercury and photochemical waste.
    Let’s look at some numbers to illustrate the point. Dentists account for less than 0.1% of the US population. They also account for much less than 1% of all plastic waste generated. Yet, they account for over 20% of mercury pollution in our wastewaters. A staggering number for such a relatively small community. Clearly, the issue of toxic waste, mercury in particular, is by far the most important issue to address. Did you also know that it is one of the easiest way to become green. Indeed, by installing an amalgam separator, dental practices can eliminate 99% of mercury waste from entering our wastewaters.
    So the good news is that going green is relatively simple if it is done the smart way. It’s also the quickest and best way to make a real difference to the environment. Just imagine the fact that for a few hundred dollars, a dental practice can eliminate mercury pollution once and for all!
    It is not every industry that can be empowered to make such a significant difference to the environment with so little effort or investment. There lies the opportunity to make a positive change today!
  • Infection through any of these routes requires that all of the following conditions be present:
    An adequate number of pathogens, or disease-causing organisms, to cause disease.
    A reservoir or source that allows the pathogen to survive and multiply (e.g., blood).
    A mode of transmission from the source to the host.
    An entrance through which the pathogen may enter the host.
    A susceptible host (i.e., one who is not immune).
    The occurrence of all these events is considered the “chain” of infection. Effective infection control strategies prevent disease transmission by interrupting one or more links in the chain of infection.
  • If you have worked in the dental setting for a number of years you are familiar with “universal precautions introduced in the mid 80’s. Universal precautions is a set of infection control and safety procedures to protect against bloodborne disease transmission. In dentistry universal precautions include handwashing, personal protective equipment such as gloves, eyewear, and face protection, Controls to prevent injury and proper handling of patient care items and contaminated surfaces. As the word universal suggests, the precautions are applied when treating all patients, regardless of health history, or presumed risk of bloodborne disease.
  • In the 90’s standard precautions were introduced to help to reduce the risk of healthcare associated infections. Standard precautions simply expand the idea of what fluids are considered infectious. While universal precautions focus mainly on preventing exposure to blood, standard precautions guard against exposure not just to blood, but to all body fluids (except sweat, which is not infected).
    For in-patient setting like hospitals, standard precautions expanded the set of infection control procedures required for safe patient care. In routine dentistry, however, there is a little practical difference between universal precautions and standard precautions. All the precautions traditionally used to protect against blood and blood-contaminated saliva also protect against exposure to any other fluids that would typically be encountered in the dental setting.
  • Primary methods used to prevent occupational exposures to blood in health care settings include Standard Precautions, engineering controls, work practice controls, and administrative controls. Engineering controls that eliminate or isolate the hazard are the primary strategies for protecting DHCP and patients.
    Where engineering controls are not available or appropriate, work practice controls that result in safer behavior and personal protective equipment (PPE) can prevent exposure. This all fits into going green. As we look for products that are engineered to prevent infection and save the environment we save the environment. As we develop work practice controls that save supplies and reduce chemical waste we are saving the environment. As a our office has in place administrative controls that promote office health and safety we are saving the environment.
    Administrative controls are policies and procedures that reduce the risk of exposure to certain diseases, such as TB.
  • Chris Miller said it best in his description of going green. Going green has 2 aspects it must reduce environmental impacts and REDUCE adverse health effects. All of this with keeping the patient and the health care provider safe!
  • Disinfectant regulations
  • Once you understand a the process of the particular item you can then take measures to limit the carbon footprint by reducing the carbon footprint in one of these areas.
  • Capture and Recycle. Dentists should collect and store all contact and non-contact scrap amalgam for recycling. It is important to note that not all recyclers can handle mercury. Indeed mercury waste cannot be landfilled or incinerated as this releases the toxins in the atmosphere and groundwater. Mercury waste needs to be sent to an approved recycler that can reprocess the mercury. Scrap amalgam and amalgam waste include any left over bulk amalgam, spent capsules, and disposable chairside-traps. These need to be appropriately labeled and stored in tightly closed containers for recycling.
  • Install an Amalgam Separator. The ADA estimates that 25% of amalgam waste still makes it to the wastewaters even after the use of chair-side traps and other capturing methods. The ADA’s best management practices (BMP) recommend the use of amalgam separators which are certified to collect over 98% of amalgam waste. Amalgam separators are solids collectors installed on the vacuum lines of dental offices. They capture the amalgam before it reaches the sewers. Currently over 10 states have mandated the use of amalgam separators in dental offices and we expect this trend to continue. It is the view of PureLife that amalgam separators represent the single most effective way for dental offices to reduce their impact on the environment. It is also one of the easiest and least costly solutions to implement.
  • PureLife offers the Easiest, Most Affordable and Comprehensive amalgam waste solution on the market. We achieve through our deep collaboration with leading recyclers and waste collection system vendors. In addition, we’ll help you pay for it by absorbing most of the cost, as part of our commitment to the environment.
    1.1 The Program:
    PureLife can be your One-Stop-Shop providing:
    Amalgam Separators: best in class, low maintenance easy to install and certified with a rating of 99.8% effectiveness for mercury removal.
     
    Complete Amalgam Recycling Program: easy and affordable storage, disposal and recycling for all your amalgam waste –we will provide your office all the necessary containers with prepaid mailing labels to our designated recycling facilities
     
    Documentation and Certification: you will be in full compliance and we will send you the complete documentation and certification for your records and peace of mind - recycling is the only way to remove all liabilities from the doctor and we will send you a recycling certificate for your records.
     
    1.2 The Incentives:
    As part of its commitment toward the environment, PureLife offers the following incentives:
    Amalgam separators at discounts of 30% or more off retail prices
    Amalgam collection and recyclcing services at discounts of 30% or more off retail prices
    Free certificates of recycling
    Free PureWater certification (our PureLife certification for Mercury pollution prevention) for qualified customers
    Even more savings for customers that also purchase dental supplies from us (enabling us to use a portion of our profits to pass on even greater discounts)
     
  • Dental waste compliance is becoming increasingly difficult to manage. In addition, non-compliance can be hazardous to your pocket book in addition to your health. Indeed the ultimate financial responsibility lies on the doctor. Only when the waste has been successfully recycled is the liability removed. In some instances doctors have been fined heavily and have had to finance expensive clean up efforts. Going green means staying clear of those risks and doing right by your patients, your staff and your local community.
    OSHA compliance rules differ from state to state. In addition, local regulations can also apply. One example is dental amalgam where in addition to state regulations, POTWs (Publically Owned Treatment Works) from Seattle, San Francisco, Milwaukee, Wichita, Kansas, and many other communities and counties have ruled that dentists must install amalgam separators (devices that separate mercury from the waste waters) in their dental offices.
    Going green means being in compliance with the many state and local OSHA and EPA regulations dealing with waste. It also means adhering to the ADA’s best management practices (BMPs).(provide link to BMPs document)
  • One sure-way of reducing mercury waste is to switch from mercury amalgam to non-mercury alternatives (i.e. composites, gold, ceramics). These are certainly more challenging to do as procedures but also carry with them higher price premiums (from 1.5x to over 8x compared to amalgam as shown in the exhibit below) and so can be accretive to a practice’s top line. But mercury alternatives can be slightly less resistant to wear and tear and in the case of composites or glass monomers have been know to have lower longevity, not to mention higher costs to the patient. As such, mercury amalgam remains pervasive in the dental industry and measures need to be put in place to control the extent of amalgam related pollution. It is also important to note that all-composite practices that perform procedures on patients with amalgam fillings and/or remove those fillings do need to follow the steps mentioned above (i.e. collect and recycle scrap amalgam and use an amalgam separator).
  • 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 cannisters must be changed and recycled according to the manufacturer’s suggestions. Full cannisters 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.
  • About 50% of dentists have already shifted to digital x-ray equipment. Digital x-rays do not require film fixer and developer, both of which are known for creating highly toxic waste. While typical digital X-ray systems are capital intensive, costing on average 3-4x conventional film X-ray systems, they have lower operational costs namely due to reduced amount of consumables (fixer, developer etc.) associated with the development of film X-ray, not to mention significant cost savings in reduced waste management and recycling. In fact depending on the office, digital X-ray systems can pay for themselves in as little as 2-3 years. Digital systems also provide more tools for the dental practitioner and offer an enhanced service to the patient. Digital X-ray systems also deliver up to 80% less radiation to the patient.
  • Waste from x-ray procedures such as fixer, developer, lead-foil and lead aprons are toxic and potentially harmful and need to be handled, stored and disposed of or recycled in accordance with strict and detailed OSHA compliance rules, which can vary from state to state. Solutions are available from many recyclers in the form of pickup services or more affordable mail-in services. Not all recyclers will deal with all types of waste and so, practices need to balance for themselves the pros and cons of using one single provider and whether the added convenience of a pick up service outweighs the extra costs vs. mail-back programs. Most programs also include a sharps/bio-hazard service which is mandatory by law.
  • Products featuring reduced packaging or recyclable packaging with lead-free ink
    Products made from 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, prohy angles and prophy cups)
    Certified carbon neutral or carbon free products – products whereby the manufacturer or distributor has donated a portion of profits to offset or cancel the effects to the environment.
  • 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
  • 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
    Important Note: Always consider patient care first when considering green products – not all green substitutes are appropriate within an infection control and dental setting.
  • The PureSkin glove brand, sold exclusively through PureLife Dental, is the Industry’s first and only 100% eco-friendly glove, manufactured using biofuels and featuring recycled packaging.
    PureSkin Latex Powder Free gloves are specifically designed for the dental setting, offering a precise fit, great grip, easy doning and a great value during tough economic times.
  • To ensure you always use the proper technique consider the the type and length of the procedure you’ll be performing, the degree of contamination you’re likely to encounter and the persistence of antimicrobial activity you’ll need.
  • Surface of a soap bubble. According to the CDC the most common way disease is spread is hand contact. An estimated 88% of disease is spread through this method.
  • Hand hygiene the proper handwashing, hand antisepsis or surgical hand anitsepsis is a simple act that goes a long ways toward protecting you and your patients and reducing the risk of disease transmission.
  • CDC recommends that hands be cleaned:
    When they are visibly dirty.
    After touching contaminated objects with bare hands.
    Before and after patient treatment, that is, before glove placement and immediately after glove removal.
    Photo credit: Centers for Disease Control and Prevention, Atlanta, GA.
  • Your skin is home to two groups of microorganisms:Transient, and Resident.
    Transient microorganisms are acquired through direct contact with patients or contaminated environmental surfaces. These Microorganisms, which colonize the top layers of skin and generally can be removed with routine handwashing and are frequently associated with healthcare acquired infections.
    Resident flora attach to deeper layers of the skin. Although these microorganisms are harder to remove, they are less likely to be associated with healthcare-related infections and disease transmission.
    In hospitals, lapses in hand hygiene have resulted in mayor disease outbreaks, many healthcare-associated infections and the spread of anti-biotic resistant infections. Studies show that when hand hygiene improves health care associated infections decline.
    In the dental setting, the risk of health-care acquired infection is much lower. Patients generally are not in urgent medical distress and more susceptible to infection. In addition, dental workers wear gloves for every patient care procedure.
    Even though personal protective equipment is the norm today for all direct patient care activities, Gloving is not a substitute for hand washing!
  • Plain soap is good for reducing bacterial counts, but antimicrobial soap is better and alcohol-based handrubs are the best, providing activity that prevents or inhibits survival of microorganisms after the product is applied.
  • 'Gross' Messaging Used To Increases Handwashing, Fight Norovirus
    ScienceDaily (Dec. 19, 2008) — Research conducted by University of Denver (DU) Associate Professor Renée Botta suggests that it takes "gross" messaging to get undergraduate students to wash their hands more frequently after going to the bathroom.
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    In fall quarter 2007, researchers posted messages in the bathrooms of two DU undergraduate residence halls. The messages said things like, "Poo on you, wash your hands" or "You just peed, wash your hands," and contained vivid graphics and photos. The messages resulted in increased handwashing among females by 26 percent and among males by 8 percent.
    "Fear of spreading germs or getting sick by not washing didn't mean much to students," says Botta, the lead author of the study and an associate professor in the Department of Mass Communications and Journalism Studies. "What got their attention was the knowledge that they might be walking around with "gross things" on their hands if they didn't wash."
    Observations in two control dorms over the same four-week period showed handwashing decreased 2 percentage points among females and 21.5 percentage points among males.
    "We tried gross messages, germ messages and you'll-get-sick messages. And the only ones that stuck was gross," says Assistant Director of Health Promotions Katie Dunker, one of a team of five who conducted the pilot study. "We found that the 'gross factor' is what works, and we were able to increase hand washing behavior by a lot."
    The findings are generating interest. Universities including UC Santa Barbara, Wyoming, Colorado State and CU–Colorado Springs want to borrow DU's techniques in hopes of improving student handwashing behavior on their campuses.
    "The relevance of the message is really, really important," she says. "You can threaten that they'll get the flu or promise a flu-free winter, but if they don't really care about that, your message is going to fall flat," Botta says.
    What was clear, she adds, was that the grossness campaign brought positive results not only in the study but also in a campus emergency that broke out last April. A week before the study was to be expanded to the entire University, a Norovirus outbreak made 63 students ill over a four-day period. Handwashing was identified as an important way to prevent the disease from spreading.
    The study appears in the October edition of the Journal of Communication in Healthcare.
    Adapted from materials provided by University of Denver, via EurekAlert!, a service of AAAS.
    Email or share this story:  
    Need to cite this story in your essay, paper, or report? Use one of the following formats: APAMLA
    University of Denver (2008, December 19). 'Gross' Messaging Used To Increases Handwashing, Fight Norovirus. ScienceDaily. Retrieved February 2, 2009, from http://www.sciencedaily.com­ /releases/2008/12/081215184341.htm
  • While infection control guidelines specifically suggest using surface barriers on hard to clean surfaces there are many big benefits to using covers on easy to clean surfaces too. Using covers is quick. It is safer and more efficient. Changing the barrier takes less time and requires on potentially irritating chemicals.
    Surface barriers are available for use on almost every surface. Impervious to moisture, plastic wrap, plastic sheets, and plastic backed paper can be purchased precut and fitted for hoses, light handles and fixtures.
    Surface cover save the time and work required for cleaning and disinfection. They also eliminate the wait for disinfectant contact times to elapse. Surfaces that remain covered during treatment need not be disinfected between patients. Just remove and replace the barrier. I like to take this bag barrier and turn it inside out after use. That allows me to place all my trash and debris in the bag all in one step.
  • The purpose of Personal Protective equipment is to create a barrier between the health care professional and the bacteria, viruses and materials that have the potential to do harm.
  • Simple items such as bibs are vital in creating a barrier for patients.
  • Wiping eliminates the chemical aerosol that can lead to asthma and other problems.
    Follow label directions and make sure you are allowing the setting time before the next patient.
  • Time weight average is all on inserts that you receive with a product: Establish a program for monitoring occupational exposure to regulated chemicals that follows federal, state, and local regulations. This must include the key factors to assess the risks of chemical exposure including duration, intensity, and route of exposure.
    Ensure that no employee is ever overexposed to the TWA.
    Material and Safety Data Sheet (MSDS) information must be available for all products that are in the dental setting. MSDS sheets include information on TWA.
    All employees must be educated, and the purpose of the HazCom standard is to ensure that hazards of all chemicals produced or imported be evaluated and that employers transmit the information concerning such hazards directly to employees. Information is conveyed through a comprehensive hazard communication program. The program includes a written clinic/office program manual, container labeling and other forms of warning, Material Safety Data Sheets (MSDSs), and employee training.
  • Tidbit: Health hazards associated with the use of germicides in healthcare vary from mucous membrane irritation to death. Every disinfectant that is being used in the dental setting has a side effect, safety precautions for its use and should only be used for the intended purpose. Use example of product here
  • Purelifegnymeetingsunday

    1. 1. Eco-Friendly Infection Control- Understanding the Balance practical applications for going green and “doing no harm”
    2. 2. Eco-Friendly Infection Control- Understanding the Balance practical applications for going green and “doing no harm”
    3. 3. Eco-Friendly Infection Control- Understanding the Balance practical applications for going green and “doing no harm”
    4. 4. Eco-Friendly Infection Control-Understanding the Balance practical applications for going green and “doing no harm”
    5. 5. Eco-Friendly Infection Control- Understanding the Balance practical applications for going green and “doing no harm”
    6. 6. 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
    7. 7. What You Need to Know Your Responsibility
    8. 8. So What’s The Problem? Dentistry’s Impact on the Environment Is… Much Greater than You Think!
    9. 9. 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!
    10. 10. Mercury / Amalgam Waste • Over 20% of US mercury consumption • Regulated in 12 states • EPA now adopting nationwide regulation Sources: EPA, ADA, SolmeteX By Far the Biggest Environmental Issue
    11. 11. 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)
    12. 12. 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
    13. 13. In order to make a change after receiving information you must: • See the need • Know the action • Value the action • Repeat the action
    14. 14. UNDERSTANDING CHAIN OF INFECTION AND STANDARDS OF INFECTION CONTROL AND GOING GREEN
    15. 15. Chain of Infection Pathogen Source ModeEntry Susceptible Host
    16. 16. 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
    17. 17. 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
    18. 18. Exposure Prevention Strategies • Engineering controls • Work practice controls • Administrative controls
    19. 19. 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
    20. 20. 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.
    21. 21. 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
    22. 22. 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.”
    23. 23. 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
    24. 24. 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
    25. 25. 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
    26. 26. Simple concepts • US grown Organic Cotton • Biodegradable • Natural fibers chlorine free
    27. 27. 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!
    28. 28. 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.
    29. 29. 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).
    30. 30. Carbon offset example • Online ordering and limiting catalogues • Carpooling and telecommuting • Limiting packaging • Biodiesel
    31. 31. Look closely at: • Extraction • Production and transportation of raw materials • Manufacture and service provision • Distribution • End use • Disposal and Recycling
    32. 32. Want to know your foot print? • http://www.epa.gov/climatechange/emissions/ind_calcu Resources for change…
    33. 33. Where did you start? • Good • Better • Best
    34. 34. Misconceptions • Green products cost more • Green products are not as effective • Green cleaning is too complicated • Green is difficult to implement
    35. 35. 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
    36. 36. 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
    37. 37. So What’s The Solution?
    38. 38. The Solution to Mercury Waste 1. Capture and Recycle Waste Amalgam 2. Install an Amalgam Separator 3. Try Switching to Composites
    39. 39. The Solution to Mercury Waste 1. 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.
    40. 40. 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 collectors installed 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
    41. 41. 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.
    42. 42. The Solution to Mercury Waste The 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)
    43. 43. The Solution to Mercury Waste NEW 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
    44. 44. The Solution to Mercury Waste 3. 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
    45. 45. The Solution to Mercury Waste Additional 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.
    46. 46. The Solution to Photochemical Waste 1. Shift to Digital X-Rays 1. Implement a Waste Compliance Program
    47. 47. The Solution to Photochemical Waste 1. 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
    48. 48. The Solution to Photochemical Waste 2. 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
    49. 49. Reduce Your Carbon Footprint 1. Buy Eco-Friendly Products 2. Improve Energy Efficiency 3. Source from Eco- Friendly Suppliers
    50. 50. Reduce Your Carbon Footprint 1. 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)
    51. 51. Reduce Your Carbon Footprint 2. 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
    52. 52. Reduce Your Carbon Footprint 3. 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.
    53. 53. Reduce Your Carbon Footprint PRODUCT RESOURCES: Eco-Friendly Products Eco-Friendly Gloves • Eco-friendly packaging• Manufactured using bio-fuels • Eco-friendly packaging • Carbon-Free shipping
    54. 54. Reduce Your Carbon Footprint Cotton Products Line Cleaners • Neutral Ph • Amalgam sep. - friendly • Natural organic cotton • Eco-friendly packaging
    55. 55. What About Infection Control? Each task that we perform has a green aspect
    56. 56. The single most important way to reduce the risk of disease transmission. It is Going Green! Washing Your Hands
    57. 57. Clean Hands Save Lives 88% of disease spread through hand contact
    58. 58. Hand hygiene • Hand washing • Hand antisepsis • Surgical hand antisepsis • Hand care • Preventive measures
    59. 59. 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)
    60. 60. • Transient microorganisms: acquired through direct contact, on surface layer • Resident Flora: Usually normal flora of skin, attach to deeper layers
    61. 61. 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
    62. 62. 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
    63. 63. Everyone understands
    64. 64. Something everyone can relate to…
    65. 65. Direct to the Point
    66. 66. Simple Concise
    67. 67. So what worked? • Grossness • Increased hand washing in females 26 percent 8 percent in males • SO what do we do?
    68. 68. 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
    69. 69. 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:
    70. 70. Your hands are only as clean as the towel you use to dry them
    71. 71. 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
    72. 72. Barrier Protection
    73. 73. Create a Barrier
    74. 74. Wipe, wipe, wipe What are you Breathing?
    75. 75. • 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
    76. 76. 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.
    77. 77. http://www.doa.state.wi.us/docs_vie w2.asp?docid=2518. • Template for getting started
    78. 78. Resources State environmental agencies • www.epa.gov/epahome/state.htm Healthcare Environmental Resource Center • http://www.hercenter.org/dentistwastes.cfm Healthcare Without Harm • www.noharm.org
    79. 79. Sources • recycleitnow.net • OSAP.ORG • DONOHARM.ORG • CDC.ORG • plasticsresource.com • pbs.org/pov/borders/2004/water/water_disposable.htm • refillnotlandfill.org • bottledwaterblues.com • sks-bottle.com • www.earth911.org • www.thedailygreen.com

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