Infection control going green: oncoming reality – Part 1

March 1, 2009
Environment–friendly (i.e. "green") infection control is not an oxymoron, and you should prepare to include this important consideration in infection control purchase decisions.

by John A. Molinari, PhD

For more on this topic, go to and search using the following key words: environment-friendly, medical waste, infectious waste, OSHA, recycle, Dr. John Molinari.

Environment–friendly (i.e., “green”) infection control is not an oxymoron, and you should prepare to include this important consideration in infection control purchase decisions.

Documentation of several occupational risks for health-care workers (HCW) a number of years ago triggered the development, refinement, and routine use of effective precautions designed to protect care providers against a variety of bloodborne, airborne, contact, and other infectious pathogens.

The major emphasis was correctly placed on protecting the prime targets of accidental exposures — health-care providers; however, during the past few decades, we also have seen an increasing number of HCW express concerns regarding the potential harmful effects that disposable covers, single-use items, chemical disinfectants, sterilants, medical waste, and other items present for the global environment.

A new era of environmental concern already has entered into the practical application of infection control precautions. This effort is especially evident in many hospitals, where facilities have undertaken aggressive action to protect the environment in the area of waste management.

Using some hospital experiences as reference points, the following discussion considers a few of the issues involved, including what is being done and future approaches for advancing eco-friendly goals.

The gradual switch from reusable materials to single-use, disposable items in all types of health-care facilities has led to a dramatic increase in the amount of generated waste. One study reported that care for the average hospitalized patient could generate an average of 15 pounds of waste per day.

Added to this is the fact that many people harbor misconceptions about potential hazards of health-care waste, believing that even small amounts of blood or other body fluids on used items — such as gloves, gauze, masks, covers, instrument wraps, and patient bibs — present a high risk for bloodborne disease transmission.

For those who believe this misinformation, the term medical waste is synonymous with “infectious” waste. This is incorrect. The overwhelming percentage of this waste is indeed contaminated, but is not considered infectious and has not been found to present a disease risk. OSHA regulations clearly state this.

As a result, it has been calculated that about 80% of a medical facility's waste can go into general trash containers and does not require special treatment or disposal. Analysis of waste in dental offices by some state OSHA agencies also suggest that 3% of the contaminated dental waste is infectious.

Hospitals have addressed this problem, in part, by designing programs to recycle more and reduce the amount of waste deposited in the waste stream.

Please keep this in mind as you work with regulated medical waste haulers in determining a) how much waste needs to be specially handled and disposed of in landfills, and b) the additional costs to you for these services.

Another approach to reducing the amount of disposed waste involves the implementation of “paperless charts” at your practice.

I have seen published figures from office surveys that estimate there are 12.3 pieces of paper in a typical patient chart. More and more health facilities, including many hospitals, dental schools, and individual practices, are making great strides toward becoming paperless. This will save tons of paper trash annually.

You probably already use certain eco-friendly measures in your practice without even realizing it. For example, the use of an amalgam separator prevents introduction of mercury in restorative material from entering ground-water systems.

While dentistry certainly has not been shown to present a public health or environmental risk in this area, the fact that amalgam is separated out demonstrates dentistry's professional commitment.

As you read this column, you also may be thinking for the first time about what new types of eco-friendly products are now available commercially, as well as those being developed. The next installment of this series will consider representative examples that you can look for and evaluate.

Dr. John A. Molinari received a PhD in microbiology from the University of Pittsburgh School of Dental Medicine. Currently, he is professor and chairman of the Department of Biomedical Sciences at the University of Detroit Mercy School of Dentistry. Contact him via telephone at (313) 494-6632, cell phone (248) 231-5864, or e-mail at [email protected].

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