Kevin Keane of Dentaqua explains the proposed ban on single-use wipes in 2024 and the next steps that dental practices could take.
A government consultation closed at the end of November, having sought views from all four UK nations, on a proposed ban on the manufacture, supply, and sale of wet wipes containing plastic across the UK. This ban is due to come into effect in 2024.
Why is the government introducing the ban?
Wet wipes containing plastic break down into microplastics over time. Microplastics are harmful to the environment and human health. There is huge public support for the ban as it is clearly good for the environment as this will reduce the volume of plastics entering wastewater systems when disposed of incorrectly. It is necessary, however, to understand the impact this ban will have on the dental sector from a cost, availability and safety point of view.
Is the dental industry part of the problem?
In short, yes. The average dental practice uses 400 single-use wipes per week per surgery. Most of these wipes are manufactured using woven plastic material. This has a significant cost to the environment. A four-chair practice will use approximately 75,000 wipes per year. Adopting a more sustainable alternative will mean a small but significant contribution to a more sustainable dental industry.
If the wipes you are currently using are being taken off the market, this may be a good time to look at the ideal replacement for your practice.
The ideal surface disinfectant needs to be:
- Effective against a wide spectrum of bacteria and viruses
- Compatible with your dental clinic surfaces and equipment
- Safe for patients and staff, ie non-toxic
- Low cost.
Some of the sustainable alternatives to plastic single-use wipes are:
- Biodegradable single-use wipes
- Off-the-shelf spray disinfectants (diluted or apply-direct) used with paper towels
- On-site generator (hypochlorous acid) used with paper towels.
The importance of disinfection in the dental practice
Infection control of direct-contact and spatter surfaces is vitally important in dental practices. Chair-side areas become contaminated with bacterial and viral pathogens during treatment. To avoid cross-contamination, it is critical these surfaces are decontaminated between patients.
Efficacy versus materials compatibility
There needs to be a balance between the ability of the disinfectant to inactivate micro-organisms and any damaging effect it may have on dental surfaces and equipment. Damage to expensive equipment has been widely reported with some wipes. Selecting the wrong disinfectant may be cheaper in the short-term but may ultimately cost thousands in equipment damage.
Alcohol-based disinfectants
Although alcohol-based disinfectant wipes and sprays have a wide anti-bacterial range, if there is obvious blood contamination the alcohol causes the blood protein to denature and makes it more difficult to clean. HTM 01-05 advises caution: ‘Alcohol has been shown to bind blood and protein to stainless steel. The use of alcohol with dental instruments should therefore be avoided.’ Furthermore, alcohol is often not recommended for use on dental chair upholstery.
Exposure to toxic chemicals
According to The NHS Cleaning Manual, a hospital treatment room and equipment should be cleaned and disinfected once per week. However, in a busy dental clinic, disinfection can take place 20 or more times per day. If the disinfectant being used contains toxic chemicals, it has the potential to cause adverse health problems for staff who are exposed to it on a continuous basis.
Each time a wipe is used, disinfectant chemical is deposited on the surface. This evaporates into the air that staff and patients breathe. Peer-review studies have reported that regular use of chemical disinfectants and cleaning products may be a risk factor for developing (COPD) Chronic Obstructive Pulmonary Disease in nurses.
Between 2009 and 2015 the Respiratory Health Division, National Institute for Occupational Safety and Health, West Virginia studied exposure to disinfectants in 73,262 health care workers and concluded occupational exposure to cleaning products and disinfectants was significantly associated with a 25% to 38% increased risk of developing (COPD) chronic obstructive pulmonary disease independent of asthma and smoking.
Bio-degradable single-use wipes
Many wipe manufacturers are working on a bio-degradable alternative while some have already rolled-out a bio-degradable option.
Bio-degradable wipes substrate material is generally more expensive than plastic today. As a result, biodegradable wipes can be up to twice the price of the plastic equivalent. This may decrease over time, however, for now this option will significantly increase the cost of disinfection.
When selecting a bio-degradable wipe, it’s important to know that even though the wipe may be cellulose (a biodegradable material), the actual disinfectant used may include toxic chemicals.
A ‘biodegradable wipe’ does not mean it is non-toxic. Toxicity and safety precautions need to be considered when selecting a bio-degradable wipe.
Spray disinfectants
There are lots of spray disinfectants on the market. When selecting a spray disinfectant, ensure that it is non-toxic and compatible with all dental surfaces, ie the leather or synthetic upholstery of the dental chair, hoses and handles on the chair, the plexiglass or acrylic on the dental light, metal trays, plastic surfaces, keypads, etc.
On-site generator
A safe and sustainable alternative to plastic single-use wipes is to use a hypochlorous acid generator. The generator allows you to produce a non-toxic disinfectant from the electrolysis of salt and water. The disinfectant is then applied using paper towels. Some generators on the market have the added bonus that they can be used for multiple applications including surface disinfection, dental water disinfection and impression disinfection.
EU and UK regulation of these generators changed in 2022, banning some generators and requiring the manufacturers to register with ECHA (European Chemical Agency) under the Biocides Directive. This ensures a standard of efficacy by registered suppliers. There are registered hypochlorous acid generators available in the UK that are designed for the dental market.
Conclusion
A ban on single-use wipes containing plastics is likely to come into effect sooner rather than later and as a result you will need to choose an alternative. Your choice should be informed by cost, science and the wellbeing of your staff and patients.
Whatever you choose, it is best to prepare early so that you can contribute to a more sustainable future and have a secure, safe supply for your practice.
References
JAMA Network Open (2019 publication)
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