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This is a revised Presentation with New Order of Slides - Dont' focus on the content but on the order and titles - let's discusss

This is a revised Presentation with New Order of Slides - Dont' focus on the content but on the order and titles - let's discusss

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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.
  • How much garbage, per capita, is eliminated through recycling is somewhat hard to quantify. While it is possible to consider the tonnage of household waste, look at the percentage recycled, divide it by the number of people in the country and come up with a number, it may not be extremely accurate. For many countries, recycling statistics are not even available.There are three also three major components to any recycling program, as indicated by the phrase, "Reduce, reuse, recycle." While, from a purely technical standpoint, the recycling is only the last portion of the plan, the other two factors are considered part of a comprehensive recycling program. As such, it is truly impossible to say how much consumers have reduced, if at all, or how much they reuse after the initial use has been completed. To realize how much garbage is eliminated through recycling, it is first necessary to consider how much waste, by weight, is produced, then figure out how much is recycled. After those two things are done, a simple matter of division will give a rough estimate. For the purposes of this exercise, the United States, Canada, Mexico and the United Kingdom will be considered.The United States produces 220 million tons of municipal waste, of which approximately 32 percent is recycled either by traditional recycling means or by organic composting, according to the United Nations. That means approximately 66 million tons of garbage is recycled every year. Given a U.S. population of approximately 300 million, that equals .22 tons, per capita, being recycled.Canada produces 13.38 million tons of municipal garbage each year, of which approximately 39 percent is recycled via the same means as the United States. Therefore, 5.21 tons of waste is recycled every year. The population of Canada is approximately 33 million. That means that approximately .15 tons of garbage is recycled per capita.In Mexico, approximately 36 million tons of waste are produced every year. Only 3.3 percent of that waste is recycled, which equals 1.2 million tons. With the population in Mexico standing at approximately 110 million, that means approximately .01 tons of waste is recycled.
  • About 100,000 whales, seals, turtles and other marine animals are killed by plastic bags each year worldwide, according to Planet Ark, an international environmental group. www.seattlepi.com/national
  • New York Times: 2.5 monthsMilk Carton: 5 yearsCigarette Butt: 10-12 yearsPlastic Bag: some say 10-20 years…other sources say 100 yearsDisposable diapers: 75 years -450 yearsTin Can: 100 years-200 yearsPlastic Bottle: 450 yearsGlass Bottle: 1,000,000 yearsStyrofoam: NEVER
  • 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!
  • 'Gross' Messaging Used To Increases Handwashing, Fight NorovirusScienceDaily (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.See also:Health & MedicineTeen HealthToday's HealthcareDiseases and ConditionsScience & SocietyEducational PolicyPublic HealthDisaster PlanReferenceInfluenza pandemicHepatitis ARett syndromeStem cell treatmentsIn 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
  • 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.
  • Time weight average is all on inserts that you receive with a product: Use example here.
  • 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
  • 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.

Omar versionv2 Presentation Transcript

  • 1. Eco-Friendly Infection Control- Understanding the Balance practical applications for going green and “doing no harm”
  • 2. 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. 10/7/2010 2
  • 3. What is Dentistry’s Environmental Footprint – More than you think The Environmental Impact of Dentistry Every Year Dental Practices Generate •680 million disposable infection control barriers •1.7 billion instrument and sterilization pouches •28 million liters of toxic x-ray fixer •4.8 million lead foils Dental vacuum systems waste 9 billion gallons of water a year. Reference Eco Dentistry
  • 4. Issue 1: Amalgam Is the Most Important Problem • EPA estimates 3.7 tons of mercury waste per year from dental offices • Only 11 states and 19 localities require amalgam separators • EPA’s separator requirements only in 10 states
  • 5. Issue 2: Photochemical Waste
  • 6. Issue 3: Reducing Your Carbon Footprint
  • 7. What if it was really simple? • I am the ONLY person RESPONSIBLE for my behavior. • I choose to change the environment…to make the world better place for everyone.
  • 8. Amalgam Solution – Very Simple and Greatest Step Towards Green • Capture and recycle • Install an Amalgam Separator. • Switch to Composites.
  • 9. Amalgam– Capture & Recycle • Scrap amalgam and amalgam waste include any left over bulk amalgam, spent capsules, and disposable chairside-traps. • 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. • These need to be appropriately labeled and stored in tightly closed containers for recycling.
  • 10. Amalgam – Install a Separator • Install an Amalgam Separator The BENEFITS: • Amalgam separators are solids collectors installed on the vacuum lines of dental offices. They capture the amalgam before it reaches the sewers. • 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.
  • 11. Amalgam – Separator Solutions • Install an Amalgam Separator Available Solutions Show SolmeteX and ECO II PureLife Incentive Program
  • 12. Amalgam - Regulations • Install an Amalgam Separator The Regulations • Current States • EPA Regulation
  • 13. Amalgam Alternatives – Switch to Composites • Switch To Composites • Switch to Composites. 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
  • 14. Photochemical Waste Solution • Shift to Digital X-Rays • 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. For more information on the potential cost savings afforded by the shift to digital x- ray, please refer to <our Lean Mean and Green article…>
  • 15. Photochemical Waste Solution • Implementing a Proper Waste Compliance Program. • 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.
  • 16. Reduce CO2 FootPrint • 3.1 Buy Eco-Friendly Products • 3.2 Improve Energy Efficiency • 3.3 Source from Eco-Friendly Suppliers
  • 17. Reduce CO2 FootPrint • 3.1 Buy Eco-Friendly Products • 3.2 Improve Energy Efficiency • 3.3 Source from Eco-Friendly Suppliers
  • 18. Reduce CO2 Footprint • Buy Eco-Friendly Products • 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.
  • 19. Reduce CO2 Footprint • 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
  • 20. Reduce CO2 Footprint • Source from Eco-Friendy 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 • Important Note: Always consider patient care first when considering green products – not all green substitutes areappropriate within an infection control and dental setting.
  • 21. Some other Simple Ideas that Work • Source from Eco-Friendy 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 • Important Note: Always consider patient care first when considering green products – not all green substitutes areappropriate within an infection control and dental setting.
  • 22. Get a Recycling Bin 66 million tons of Garbage NOT in the Landfill
  • 23. Plastic bags.. Don’t have to be eaten to harm the animals
  • 24. Statistics on the Amount of Time Items Take to Decompose Paper: 2.5 months Milk Carton: 5 years Cigarette Butt: 10-12 years Plastic Bag: some say 10-20 years…other sources say 100 years Disposable diapers: 75 years -450 years Tin Can: 100 years-200 years Plastic Bottle: 450 years Glass Bottle: 1,000,000 years Styrofoam: NEVER
  • 25. Other Benefits of Going Green • Save Green
  • 26. Other Benefits of Going Green • Benefits of Digital X-Ray
  • 27. Other Benefits of Going Green • Benefits of Energy Efficiency
  • 28. Other Benefits of Going Green • Some Companies Offer Subsidies
  • 29. Other Benefits of Going Green • Improve and Grow Your Practice
  • 30. Green Infection Control and Understanding the Balance Your Responsibility
  • 31. 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
  • 32. OUR responsibility • Follow the Medical Model-Wellness based • Reduce and Save • Stay up to date
  • 33. Where did you start? Medical Model • Good • Better • Best 10/7/2010 33
  • 34. 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!
  • 35. Misconceptions • Green products cost more • Green products are not as effective • Green cleaning is too complicated • Green is difficult to implement
  • 36. 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
  • 37. 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
  • 38. 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 that waste.
  • 39. Green Products 10/7/2010 39
  • 40. Green Products 2 10/7/2010 40
  • 41. Green Products 3 10/7/2010 41
  • 42. Green Companies PROVIDE PURELIFE PROFILE AND OTHER COMPANIES 10/7/2010 42
  • 43. Green Companies 2 10/7/2010 43
  • 44. Green Companies 3 10/7/2010 44
  • 45. In the Long Run • Improves health • Helps reduce Worker’s Comp claims and premiums • Helps reduce turnover, which in turn impacts: – Recruiting – Hiring – Training – Impact of service
  • 46. 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
  • 47. How can reductions be made? 1) Behavioural Changes 2) Policy and Process Changes 3) Technological Changes
  • 48. How can I get others to change? In order to make a change after receiving information you must: • See the need • Know the action • Value the action • Repeat the action
  • 49. UNDERSTANDING CHAIN OF INFECTION AND STANDARDS OF INFECTION CONTROL AND GOING GREEN
  • 50. Chain of Infection Pathogen SusceptibleHost Source Entry Mode 10/7/2010 50
  • 51. 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 10/7/2010 51
  • 52. Standard Precautions 1990’s: protect 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 10/7/2010 52
  • 53. Exposure Prevention Strategies • Engineering controls • Work practice controls • Administrative controls 10/7/2010 53
  • 54. 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
  • 55. Behavior and techniques
  • 56. Washing Your Hands The single most important way to reduce the risk of disease transmission. 10/7/2010 56
  • 57. Clean Hands Save Lives 88% of disease spread through hand contact 10/7/2010 57
  • 58. Update Hand washing statistics
  • 59. Hand hygiene • Hand washing • Hand antisepsis • Surgical hand antisepsis • Hand care • Preventive measures 10/7/2010 59
  • 60. 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) 10/7/2010 60
  • 61. • Transient microorganisms: acquired through direct contact, on surface layer • Resident Flora: Usually normal flora of skin, attach to deeper layers 10/7/2010 61
  • 62. Efficacy of Hand Hygiene Preparations in Reduction of Bacteria Good Better Best Plain Soap Antimicrobial Alcohol-based soap handrub Source: http://www.cdc.gov/handhygiene/materials.htm 10/7/2010 62
  • 63. Gloving is not a substitute for Hand washing! 10/7/2010 63
  • 64. Hand Hygiene Definitions • Handwashing – Washing hands with plain soap and water • Antiseptic handwash – Washing hands with water and soap or other detergents containing an antiseptic agent • Alcohol-based handrub – Rubbing hands with an alcohol-containing preparation • Surgical antisepsis – Handwashing with an antiseptic soap or an alcohol-based handrub before operations by surgical personnel 10/7/2010 64
  • 65. Hand washing • Lathering: Pulls microorganisms away form the skin’s crevices and suspends them • Rinsing: washes them off your hands 10/7/2010 65
  • 66. 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
  • 67. Everyone understands
  • 68. Something everyone can relate to…
  • 69. Direct to the Point
  • 70. Simple Concise
  • 71. So what worked? • Grossness • Increased hand washing in females 26 percent 8 percent in males • SO what do we do?
  • 72. 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
  • 73. How can I get others to change? In order to make a change after receiving information you must: • See the need • Know the action • Value the action • Repeat the action
  • 74. Your hands are only as clean as the towel you use to dry them
  • 75. Disposables
  • 76. 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 10/7/2010 76
  • 77. Barrier Protection
  • 78. 10/7/2010 78
  • 79. Create a Barrier 10/7/2010 79
  • 80. 10/7/2010 80
  • 81. 10/7/2010 81
  • 82. Wipe wipe wipe What are you Breathing?
  • 83. • 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
  • 84. 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.
  • 85. And So? • 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.
  • 86. Do No Harm
  • 87. Aspiration Pneumonia ICU one DAY~$14,401  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
  • 88. Resources for Change
  • 89. Safe disposal of chemicals
  • 90. 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
  • 91. Sources • recycleitnow.net • OSAP.ORG • DONOHARM.ORG • CDC.ORG • plasticsresource.com • pbs.org/pov/borders/2004/water/water_disposable.html • refillnotlandfill.org • bottledwaterblues.com • sks-bottle.com • www.earth911.org • www.thedailygreen.com
  • 92. APPENDIX 10/7/2010 92
  • 93. 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).
  • 94. What is Carbon? • The base for all life (as we know it) • Graphite is soft and most common carbon allotrope • Diamond is very hard & expensive! • Coal and Oil (are carbon based) – When burnt with air causes carbon dioxide to be emitted
  • 95. What’s Carbon Dioxide (CO2) • It’s a gas (at standard room temperature and pressure) • We breathe it out • Used by plants in photosynthesis • Makes drinks fizz • Colourless and odourless (in low concentrations) • Trace gas in the Earth’s Atmosphere (0.039%) • A Greenhouse Gas
  • 96. Greenhouse Gases • A “blanket” keeping our planet warm • Without them Earth would be very different and too cold to support life (over 30oC colder)
  • 97. Where is the CO2 coming from? • 40% of gas emitted from Volcanoes is CO2 • Volcanoes emit about 130 – 230 million tCO2 /year • Human activity is about 130x that of volcanoes – 27 billion tCO2/year • Other natural sources emit about 1000x as much as volcanoes
  • 98. Look closely at: • Extraction • Production and transportation of raw materials • Manufacture and service provision • Distribution • End use • Disposal and Recycling
  • 99. Want to know your foot print? Resources for change… • http://www.epa.gov/climatechange/emissions /ind_calculator.html
  • 100. Simple concepts • US grown Organic Cotton • Biodegradable • Natural fibers chlorine free 10/7/2010 100
  • 101. 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 that waste.
  • 102. How can reductions be made? 1) Behavioural Changes 2) Policy and Process Changes 3) Technological Changes
  • 103. How can I get others to change? In order to make a change after receiving information you must: • See the need • Know the action • Value the action • Repeat the action