Romsey Dental Care

The following article from Samantha Price of Romsey Dental Care outlines the need to look more closely at plastic waste in the healthcare sector, as well as specifically in dentistry itself.

While most businesses agree that sustainability is imperative for UK businesses going forward, it is also important to stress the cost benefits of running a “green” business. Sam explains that plastic is being wasted needlessly in dentistry and the broader healthcare sector, and focuses on how this concern can be addressed going forward.

www.romseydentalcare.co.uk

BEST PRACTICE SPONSOR 2020
11ROMSEY DENTAL CARE |
DENTISTRY
Founder and Principal
Samantha Price
Practising ethical dentistry with a
view to reducing clinical waste
Founder and Principal Samantha Price established a
small private general dental practice in central Romsey,
Hampshire, over 20 years ago in 1996. Operating from an
attractive Bath stone building, Romsey Dental Care’s team of
ten includes two dentists and two hygienists, and offers a wide
range of the latest dental and cosmetic treatments. Samantha
tells
The Parliamentary Review
about sustainability concerns
in the dentistry sector, leading with one issue that dominates
today’s climate policy debate: plastic waste.
We are committed to offering evidence-based care for our patients, but in recent
times, I have seen that the cross-infection control recommendations accepted by
my profession have led to a ridiculous and unnecessary amount of waste. We are
in the midst of a climate emergency, and official advice from Public Health England
suggests that we should risk-assess our own environment and make decisions
based on that. This doesn’t happen for a number of reasons.
Firstly, there is simply too little time left over after meeting all the other compliance
requirements to analyse each and every scientific article upon which such
recommendations are made. Secondly, these articles are not readily available,
and our compulsory training on cross-infection control never questions the
recommendations. Finally, if we challenge the accepted wisdom individually, we
have to justify this to the CQC, which can be an arduous process. This can lead to
worse outcomes for patients, something demonstrated by an official PHE response
we received: “It is easier sometimes to recommend not to use something rather
than specifying under what circumstances something can be used.”
FACTS ABOUT
ROMSEY DENTAL CARE
»Founder and Principal:
Samantha Price
»Established in 1996
»Based in Romsey, Hampshire
»Services: General and cosmetic
dentistry, implants, tooth
straightening and cosmetic
facial treatments
»No. of employees: 10
Romsey Dental Care
THE PARLIAMENTARY REVIEW
Highlighting best practice
THE PARLIAMENTARY REVIEW
Highlighting best practice
12 | ROMSEY DENTAL CARE
An example: plastic waste
Recommendations state that we
must throw away refillable plastic
spray bottles that are used to spray
disinfectant onto the surgery surfaces
between patients. A plastic item that
can easily be washed and reused is
turned into a single-use item that goes
to landfill. I vehemently object to this
and approached Public Health England
to access the clinical papers upon
which this recommendation is based.
The two papers concluded firstly that
disinfecting a patient’s skin from a
spray bottle prior to injection caused
a
serratia marcescens
infection, and
secondly that a bottle which had not
been washed before refilling caused
a similar infection in a patient during
heart bypass surgery.
Serratia marcescens
is recognised
as an important and potentially
hazardous pathogen, commonly
involved inhospital-acquired
infections, particularlycatheter-
associatedinfections,urinary tract
infections andwound infections.
It could be a life-threatening infection,
but there are a number of reasons
why this recommendation is incorrect.
Serratia marcescens
is naturally
occurring in water and soil, even
sometimes in the mouth, and is an
opportunistic pathogen. This means
it will cause harm when it gets into
the “wrong places” but is otherwise
harmless. Crucially, the evidence
and research are hospital-based, and
the reported incidences upon which
the recommendation is based are
unrelated to the procedures used in a
dental practice.
There are some significant issues
with conclusions drawn from the
papers, with both the unwashed
bottle and injection through skin
being causal factors, plus the fact
that the operation took place in a
sterile body cavity using contaminated
equipment. These must also be seen
as contributing factors.
In conclusion, I suggest that, in a
dental practice operating environment
where spray bottles are used to
disinfect surfaces between patients,
there is no evidence of an infection risk
from this bacterium.
We do not disinfect or inject skin,
unless in a medical emergency, and
we would then use individually packed
sterile alcohol wipes. We do not
Iconic stonework at our
Romsey premises
Our media
constantly feed
the public with
misleading
statistical
analysis
The latest dental and
cosmetic treatments,
available in the heart of
an historic market town
13ROMSEY DENTAL CARE |
DENTISTRY
operate in a sterile body cavity and we
do not deal routinely with severely ill
patients. Beyond this, we can easily
wash our bottles before refill. In fact,
I would suggest that in terms of
perceived risk to the end-consumer,
there is little difference between
spraying a dental surgery surface and
spraying a restaurant table.
My dental nurses spend at least an
hour a day, on top of normal surgery
hours, sterilising, packaging and
resterilising instruments as well as
covering all equipment with plastic.
They then must throw away all this
plastic as well as the plastic impression
trays and other items that previously
we could sterilise or disinfect. All this
goes into clinical waste, for which
we have to pay a premium – not to
mention the cost to the environment,
which is huge.
The need for change
It’s time to task an organisation
with expertise and authority, like
the National Institute for Health and
Clinical Care Excellence – or NICE –
to thoroughly review all the clinical
evidence and the cost of all these
recommendations against the risk they
pose to patients and the environment.
Some years ago, a similar exercise
resulted in a reversal of a previous
recommendation to give prophylactic
antibiotics to patients at risk of
bacterial endocarditis before any
procedure.
The reasoning was that there
was more risk to the patient from
taking the antibiotics than from the
bacteraemia – bacteria forced into the
blood stream from the oral cavity –
and that in any case a bacteraemia was
caused every time someone eats or
brushes their teeth.
Our media constantly feed the public
with misleading statistical analysis,
causing fear and uninformed decisions.
One perfect example is the increased
risk of breast cancer caused by
hormone replacement therapy. Many
women were denied this drug and
suffered years of misery when the
added risk is actually only 0.5 per cent.
My profession is being encouraged
to cause unnecessary damage to the
environment, and this is not evidence-
based practice. We now have to
put the environment as a priority
consideration when considering
relative risks in healthcare and make
pragmatic decisions to reduce “one
use” items in particular.
The benefit of this could huge: millions
of pounds saved in our NHS as well
as a positive impact on our target to
meet carbon emission targets and
reduce the amount of plastic polluting
ourplanet.
We now have
to put the
environment
as a priority
A sustainable dental
surgery
BEST PRACTICE SPONSOR 2020
THE PARLIAMENTARY REVIEW
Highlighting best practice
12 | ROMSEY DENTAL CARE
An example: plastic waste
Recommendations state that we
must throw away refillable plastic
spray bottles that are used to spray
disinfectant onto the surgery surfaces
between patients. A plastic item that
can easily be washed and reused is
turned into a single-use item that goes
to landfill. I vehemently object to this
and approached Public Health England
to access the clinical papers upon
which this recommendation is based.
The two papers concluded firstly that
disinfecting a patient’s skin from a
spray bottle prior to injection caused
a
serratia marcescens
infection, and
secondly that a bottle which had not
been washed before refilling caused
a similar infection in a patient during
heart bypass surgery.
Serratia marcescens
is recognised
as an important and potentially
hazardous pathogen, commonly
involved inhospital-acquired
infections, particularlycatheter-
associatedinfections,urinary tract
infections andwound infections.
It could be a life-threatening infection,
but there are a number of reasons
why this recommendation is incorrect.
Serratia marcescens
is naturally
occurring in water and soil, even
sometimes in the mouth, and is an
opportunistic pathogen. This means
it will cause harm when it gets into
the “wrong places” but is otherwise
harmless. Crucially, the evidence
and research are hospital-based, and
the reported incidences upon which
the recommendation is based are
unrelated to the procedures used in a
dental practice.
There are some significant issues
with conclusions drawn from the
papers, with both the unwashed
bottle and injection through skin
being causal factors, plus the fact
that the operation took place in a
sterile body cavity using contaminated
equipment. These must also be seen
as contributing factors.
In conclusion, I suggest that, in a
dental practice operating environment
where spray bottles are used to
disinfect surfaces between patients,
there is no evidence of an infection risk
from this bacterium.
We do not disinfect or inject skin,
unless in a medical emergency, and
we would then use individually packed
sterile alcohol wipes. We do not
Iconic stonework at our
Romsey premises
Our media
constantly feed
the public with
misleading
statistical
analysis
The latest dental and
cosmetic treatments,
available in the heart of
an historic market town
13ROMSEY DENTAL CARE |
DENTISTRY
operate in a sterile body cavity and we
do not deal routinely with severely ill
patients. Beyond this, we can easily
wash our bottles before refill. In fact,
I would suggest that in terms of
perceived risk to the end-consumer,
there is little difference between
spraying a dental surgery surface and
spraying a restaurant table.
My dental nurses spend at least an
hour a day, on top of normal surgery
hours, sterilising, packaging and
resterilising instruments as well as
covering all equipment with plastic.
They then must throw away all this
plastic as well as the plastic impression
trays and other items that previously
we could sterilise or disinfect. All this
goes into clinical waste, for which
we have to pay a premium – not to
mention the cost to the environment,
which is huge.
The need for change
It’s time to task an organisation
with expertise and authority, like
the National Institute for Health and
Clinical Care Excellence – or NICE –
to thoroughly review all the clinical
evidence and the cost of all these
recommendations against the risk they
pose to patients and the environment.
Some years ago, a similar exercise
resulted in a reversal of a previous
recommendation to give prophylactic
antibiotics to patients at risk of
bacterial endocarditis before any
procedure.
The reasoning was that there
was more risk to the patient from
taking the antibiotics than from the
bacteraemia – bacteria forced into the
blood stream from the oral cavity –
and that in any case a bacteraemia was
caused every time someone eats or
brushes their teeth.
Our media constantly feed the public
with misleading statistical analysis,
causing fear and uninformed decisions.
One perfect example is the increased
risk of breast cancer caused by
hormone replacement therapy. Many
women were denied this drug and
suffered years of misery when the
added risk is actually only 0.5 per cent.
My profession is being encouraged
to cause unnecessary damage to the
environment, and this is not evidence-
based practice. We now have to
put the environment as a priority
consideration when considering
relative risks in healthcare and make
pragmatic decisions to reduce “one
use” items in particular.
The benefit of this could huge: millions
of pounds saved in our NHS as well
as a positive impact on our target to
meet carbon emission targets and
reduce the amount of plastic polluting
ourplanet.
We now have
to put the
environment
as a priority
A sustainable dental
surgery

www.romseydentalcare.co.uk

This article was sponsored by Romsey Dental Care. The Parliamentary Review is wholly funded by the representatives who write for it. The publication in which this article originally appeared contained the following foreword from Rt Hon Elizabeth Truss.

Rt Hon Elizabeth Truss's Foreword For The Parliamentary Review

By Rt Hon Elizabeth Truss

Even by the standards of the day –this has been one of the most exciting and unpredictable years in British politics.

The leadership election we’ve just seen marks a huge moment in our country’s history. This government is taking a decisive new direction, embracing the opportunities of Brexit and preparing our country to flourish outside the EU.

As international trade secretary, I’ll be driving forward work on the free trade agreements that are going to be a priority for the government. Free trade isn’t just an abstract concept bandied around by technocrats. It is crucial for a strong economy and for the ability of families to make ends meet. Free trade benefits people in every part of our country, as British firms export to new markets and people doing the weekly shop have access to a wider choice of goods at lower prices.

The essence of free trade is in the title: freedom. It’s about giving people the power to exchange their goods without heavy government taxation or interference. Commerce and free exchange are the engine room of prosperity and social mobility. I’m determined to tackle the forces who want to hold that back.

One of my priorities is agreeing an exciting new free trade deal with the US, building on the great relationship between our two countries and the Prime Minister and US President. But I’ll also be talking to other partners including New Zealand, Australia and fast-growing Asian markets.

And with the EU too, we want a friendly and constructive relationship, as constitutional equals, and as friends and partners in facing the challenges that lie ahead – a relationship based on a deep free trade agreement. Our country produces some of the world’s most successful exports, and the opportunity to bring these to the rest of the world should make us all excited about the future. It is this excitement, optimism and ambition which I believe will come to define this government.

For too long now, we have been told Britain isn’t big or important enough to survive outside the EU – that we have to accept a deal that reflects our reduced circumstances. I say that’s rubbish. With the right policies in place, we can be the most competitive, free-thinking, prosperous nation on Earth exporting to the world and leading in new developments like AI. To do that, we’ll give the brilliant next generation of entrepreneurs the tools they need to succeed. Since 2015, there has been a staggering 85 per cent rise in the number of businesses set up by 18 to 24 year olds – twice the level set up by the same age group in France and Germany. We’ll help them flourish by championing enterprise, cutting taxes and making regulation flexible and responsive to their needs.

As we do that, we’ll level up and unite all parts of the UK with great transport links, fibre broadband in every home and proper school funding, so everyone shares in our country’s success.

2019 has been the year of brewing economic and political revolution. 2020 will be the year when a revitalised Conservative government turbo charges the economy, boosts prospects for people across the country, and catapults Britain back to the forefront of the world stage.



Rt Hon Elizabeth Truss
Secretary of State for International Development