HAZARD CONTROL

GOVERNMENT REGULATORY AGENCIES

Affecting the dental office with regards to protection of employees and patients from potential hazards associated with tx

1. Occupational Safety and Health Administration (OSHA)

Requires employers, including those in the healthcare profession: 1. to establish and carry out a wide range of procedures designed to protect employees, 2. implement and maintain employee exposure-incident records for the duration of employment plus 30 years, and 3. provide specific protective equipment (PPE) to protect staff from infectious diseases & other potential hazards

2. Centers for Disease Control & Prevention (CDC)

Set specific guidelines for infection control & disease containment. Does not have enforcement power over dental practices but the OSHA is charged with investigation and enforcement of the CDCs guidelines.

3. Environmental Protection Agency (EPA)

Regulates and registers certain products used in dental practices, including surface disinfectants. It requires products to undergo and pass specific testing requirements prior to approval for registration.

4. Food and Drug Administration (FDA)

Regulates marketing of medical devices that include equipment and disposables items. It reviews product labels for false or misleading information and sufficient directions for use.

Examples of chemical germicides regulated by FDA:

Antiseptics 2. Disinfectants 3. Drugs 4. Sterilizers

1.

5. Organization for Safety and Asepsis Procedure (OSAP)

National organization of teachers practitioners, dental healthcare workers, and manufacturers, and distributors of dental equipment and products. Develops and communicates standards and information on aseptic technique to dental practices and educational institutions to assist them in the efficacy of their infection control program

HAZARD COMMUNICATION STANDARD

EMPLOYEE RIGHT TO KNOW LAW -addresses the right of every employee to know the possible dangers associated with hazardous chemicals & other related hazards in the workplace. - it requires employers to provide methods for corrective action.

Requisites to comply w/ HCS

1. The dentist must develop & implement a written compliance program which include: a. exposure control plan b. written hazard communication program c. waste and sharp handling management d. injury & illness prevention

2. The dentist must also ensure that hazardous chemicals used in the office are properly labeled and hazardous substances have corresponding MSDS available for staff training and review. 3. The dentist must designate a program coordinator to provide staff training to new employees & once annually thereafter.

Common hazardous materials used in the dental office

1.

2.

3.

Mercury- used in silver filling material to create amalgam Nitrous oxide sedation gasesused for conscious sedation Chemicals for dental x-ray processing- developer & fixer

If mercury spill occurs, ADA recommends the ff:

1. If the spill occurs on carpeted floors, do not use a vacuum cleaner to pick up the droplets. 2. Pick up all visible droplets with a narrow bore tubing connected by a wash-bottle trap to a low volume aspirator on the dental unit. The trap bottle connections keep the mercury in the bottle and prevent it from being sucked back into the dental unit.

3. Use adhesive tape to clean up small spills. 4. If the spilled mercury droplets cannot be reached, dust sulfur powder on them to form a film coating on top of the droplets

5. Keep a commercial mercury spill kit on hand. Follow the manufacturers directions & document the circumstances of the spill with the date and the cleanup procedure used.

* Warning labels must be attached to containers, products and other hazardous materials used in the dental office

Label of these products must include:

1. Identity of the chemical 2. Appropriate hazard warning ( including route of entry & target organ) 3. Name & address of the manufacturer

Members of the dental health team should familiarize themselves with the labels of hazardous substances & be aware of how to clean up spills or handle other emergencies that may arise when handling these products.

Hazardous spill kit includes:

A. Absorbent material - to soak up the liquid B. Scooping device- for a no-touch method to pick up the material C. Hazardous waste bag with a biohazard warning label

MSDS-(Material Safety Data Sheets)

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provides written information about the content & potential hazard of specific products Each potentially hazardous product must have a corresponding MSDS on file in the office Must be provided by the manufacturers or suppliers of products but it is the dentists responsibility to ensure that these sheets are obtained & kept up to date

OSHA requires each MSDS contain:

1. Identification (chemical and common names) 2. Hazardous ingredients 3. Physical and chemical characteristics (boiling point, vapor pressure,etc) 4. Fire and explosion data 5. Health hazard data 6. Reactivity data

7. Spill and disposal procedures 8. Protection information 9. Handling and storage precautions, including waste disposal 10. Emergency and first aid procedures 11. Date of preparation of the MSDS 12. Name and address of the manufacturer

When is this conducted:

A. Provide for new employees at the beginning of employment B. Whenever a new hazardous material is introduced into the office C. At least annually thereafter

Training must include:

a.

b.

c. d.

e.

Hazards of chemical & proper handling The operation where hazardous chemicals are used The availability of MSDSs An explanation of the labeling of hazardous chemicals An explanation of OSHA guidelines

Reducing Hazards in the Dental Office

1. Keeping the number of hazardous materials to a minimum 2. Reading all product labels and following direction for use 3. Storing hazardous chemicals in their original containers 4. Keeping containers tightly closed or covered when not in use 5. Avoiding the combination of 2 or more known hazardous chemicals

6. Wearing appropriate personal protective equipment (PPE) when using hazardous chemicals or when there is potential for accidental exposure on contact with body fluids 7. Washing and thoroughly drying hands before and after wearing gloves 8. Keeping the office well ventilated and avoiding skin contact with known hazardous substances

9. Keeping a functional fire extinguisher in the office

10. Knowing proper cleanup procedures in the event of a chemical spill

11. Disposing of all hazardous chemicals and other substances in the accordance with MSDS instructions or the product label

Blood borne Pathogens Final Standard

- the most significant OSHA regulation affecting healthcare practices. - designed to protect dental office employees by limiting exposure to blood, saliva & other PIMS (potentially infectious materials) BBP- producing microorganism that may infect human

Waste Management
Regulated medical waste - liquid or semi-liquid body fluid - this includes any items in the dental office contaminated with regulated waste (ex. Cotton rolls or gauze) that releases bioburden when compressed - items caked with dried body fluid that have the potential to release bioburden during handling, contaminated sharps, and pathological & microbial wastes containing body fluid

Disposable sharps

Ex.- needles, scalpels, burs, ortho wires Must be disposed of in puncture- resistant, color-coded or labeled, red, closable, leak proof containers.

Needles must be recapped using a one-handed scooping method or a mechanical device

OSHA requires that full sharps containers be removed from the office within 7 days of reaching the fill line on the container Other regulated waste products, including those items saturated or visibly caked with blood or saliva, must be disposed of in closable, leak-proof bags or covered containers.

The containers must either be red or have a biohazard warning label or tag affixed to them, readable from a distance of 5 feet.

Contaminated refuse must be kept covered at all times. Receptacles must have a properly fitting lid, preferably one that can be opened using a foot pedal

Types of waste
Basic types: 1. Regulated medical waste 2. Non-regulated medical waste

Contaminated waste
Items that have had contact with blood or other body secretions

Hazardous waste

Waste posing a risk or peril to human beings or the environment

Infectious waste
Waste capable of causing an infectious disease

Medical waste

Any solid waste that is generated in the diagnosis, treatment or immunization of human being or animals in research pertaining thereto, or the production or testing of biologicals. (The term does not include hazardous waste or household waste. Only a small percentage of medical waste is infectious & needs to be regulated.)

Regulated waste
Infectious medical waste that requires special handling, neutralization, and disposal

Toxic waste
Waste capable of having a poisonous effect

HEPATITIS B VACCINE
Required by OSHA to be administered to all full-time employees who are potential risk for bloodborne pathogens. Must be made to all employees at no cost/charge.

Exposure Incidents

Consists of specific eye, mouth, or other mucous membranes, non-intact skin or parenteral contact with blood or other PIMS that directly results from the performance of an employees duties

What to do?

1.Stop immediately 2.If it involves hands, remove the gloves 3.Injury should be treated with scrupulous first aid measures including the the ff. a. if bleeding, squeeze it gently until a small amount of blood is released b. wash hands thoroughly with antimicrobial soap and water that is comfortably warm to hot

c. after drying, apply a small amount of antiseptic and cover with bandage

Waterline biofilms
- these are film-forming microbes which excrete a glue-like substance that anchors to the metals, plastic, tissue & soil particles. - they attach themselves to the inner surfaces of plastic tubings used to keep handpieces cool and supply air-water syringes where they create an ideal environment for growth

Measures to improve the quality of water in their lines and minimize disease transmission

At the start of each day, run and discharge water from the dental unit waterlines for several minutes Run highspeed handpieces to release air and water for 20-30 seconds after each patient Always follow the manufacturers instructions for proper maintenance of handpieces and waterlines Consider the options to improve water quality such as special filters, chemical therapeutics, and separate water reservoirs

FIRE AND EMERGENCY EVACUATION PROCEDURES

Employers are required by OSHA to have a written fire safety policy consisting of training & the use & maintenance of fire extinguishers Diagram must be provided that clearly marks the exit routes in the event of fire Posting of emergency phone #s for police,fire, and rescue is also required Written evacuation & safety procedures should be provided in the areas susceptible to weather conditions, including hurricane, tornadoes, floods, and earthquakes

The dentist has the legal responsibility of looking after the protection of employees & patients from potential hazards associated with dental treatment but may delegate it to his office manager or safety coordinator