BY NOEL BRANDON KELSCH, RDHAP
My husband, Dave, was flustered. He couldn't find his conduit-fitting and reaming screwdriver. Don't ask me what it's for, but I knew he had to have it before he could finish what he'd started. He made that clear. I had no idea where it could be, but he seemed to think women are fitted with a special homing device that allows them to find any lost item. Having the right tool in the right place at the right time can make all the difference in infection control, and my husband's life.
Federal Occupational Safety and Health Administration, which is there to protect employees, states that all dental offices must have appropriate sharps containers. Contaminated disposable sharps (needles, blades, etc.) comprise the majority of regulated medical waste in dental practices.1 Most waste generated in the dental setting, such as bibs, 2x2's, gloves, etc., can go out with the general trash because it will not release blood. But it should be disposed of in a manner that will not lead to accidental barehanded contact by office or cleaning personnel. All staff must be trained in the handling of all waste.
Regulated medical waste is liquid or semiliquid blood or other potentially infectious materials (OPIM), or items that would release blood or OPIM if compressed. It also includes items that are caked with dried blood or OPIM that could be released during handling. Contaminated sharps and pathologic and microbiologic wastes that contain blood or OPIM are also regulated.
Tips for sharps containers
1. Point of contact - Place contaminated sharps in the sharps container as soon as possible after each use. Do not leave them on the tray or set them aside to go to sterilization. Eliminate the risk as soon as possible and as close to the point of contact as possible.
2. Have multiple sharps containers - There should be a sharps container for each operatory.
3. Some states allow dental offices to sterilize infectious waste in-house - Most offices choose to have waste-hauling services. Check with your state and local medical waste agency to be sure the practice of processing your own waste is allowed before implementing that program. A special permit may be required.
4. Follow your state regulations regarding disposal of pharmaceuticals - Most states require a separate pharmaceutical waste container for waste, such as expired carpules. Local and state regulations vary but dental carpules generally do not go in the sharps container unless they contain dripping blood. Your hauler can give you the specifics on pharmaceutical waste management.
What are the requirements of sharps containers? OSHA is very specific about the makeup of sharps containers. Employers must have closable, puncture-resistant, leak-proof sharps containers that are appropriately labeled and color-coded. The containers must also have an opening that is large enough to accommodate disposal of the entire blood collection assembly (needles, blades, etc.). They should have a fill-to line, and one should be able to tell how full the container is before placing an item inside.2 It should have a lid that will seal completely to prevent spills during transport in case it is dropped.
Where must sharps containers be? If an employee travels from one location to another (e.g., from one patient room to another or from one facility to another), the employee must be provided with a sharps container that is conveniently placed or portable at each location/facility, and is capable of accommodating the entire needle assembly. Employees must have access to sharps containers that are easily accessible to the immediate area where the sharps are used. The operator should have easy access with a horizontal reach. There should not be anything covering visibility and access to the sharps container. The container may not be stored under sinks or in cabinets. It is important to look at traffic in the office and make sure it is not placed in an area on the wall or counter where it could be dislodged or knocked over.3
How does the container need to be labeled? The container needs to be red. Red denotes a biohazard and thus the term "red bagging" regarding contaminated laundry or regulated waste.4 A biohazard symbol must be clearly visible on the container.1
My husband was right. I must have a special homing device. I found his screwdriver right in his toolbox. Each dental professional has to get the tools lined up to finish the task and keep themselves safe. Sharps containers are part of that process. RDH
1. Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. 4th ed. St. Louis, MI: Mosby Elsevier; 217-223.
2. OSHA Regulations: 29 CFR 1910.1030(d)(4)(iii)(A)(2)(i).
3. National Institute for Occupational Safety and Health, US Department of Health and Human Services, Public Health Services, Centers for Disease Control and Prevention. Selecting, Evaluating, and Using Sharps Disposal Containers. Atlanta, GA: 1998. DHHS Publication No. 97-111.
4. From Policy to Practice: OSAP Guide to the Guidelines, OSAP, Annapo
NOEL BRANDON KELSCH, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists' Association.