Safety glasses prevent eye injuries among dental patients
BY Ava Oleksiak, Christina Campbell, April DiGiovanni, and Erin Relich, RDH, BSDH, MSA
Safety is one of the most important concerns in the medical and dental fields. All health-care professionals should utilize proper personal protection equipment (PPE). PPE is not only crucial for the health-care professional, but also for patients. In the dental field, PPE is designed to protect various regions of the face (e.g., eyes, mouth) from exposure to blood, saliva, and other infectious bodily fluids and materials. Eye infections are common among dentists; many are concerned, but few are using proper safety glasses.1 Dental professionals are often in close contact with their patients and may use a variety of sharp instruments during dental procedures. This increases the likelihood of a needle stick injury. Aside from needlestick incidents, protective eyewear is designed to prevent bodily fluids (e.g., saliva, blood) and dental materials used during procedures from entering the eyes. Herpes simplex virus type 1 (HSV-1) is a threat to the dental team because it can affect the cornea and cause ophthalmic keratitis.2 A patient who has an active HSV-1 lesion in the vesicular phases is likely to produce a herpes-laden aerosol.2
Bodily fluids and dental materials are not the only things that can lead to ocular infections. A female patient not wearing protective eyeglasses sustained an eye infection from a splash of water in a dental unit. The water contained the protozoan Acanthamoeba spp., which caused a serious infection in the patient's eye that left symptoms that persisted for years and later led to a lawsuit against the dentist.3 It is not only essential to protect ourselves as health-care professionals, but also to protect the patient and understand the potential occupational risks that could occur and lead to infection, disease, or injury.
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Safety glasses are one type of PPE that are often neglected in private practices. Injuries to the eyes are almost entirely preventable if practicing dental professionals are more compliant with the use of protective eyewear. One research study found that the compliance rate for routine use of protective eyewear was 60.3% (35/58) for dentists and 34.1% (15/44) for hygienists.4 This study revealed that there is a high incidence of dental professionals practicing without the use of safety glasses.
Jennifer Kushwara Morrone, a patient, became a statistic when her dentist dropped a needle carrying Streptococcus spp., puncturing and injecting the bacteria into her eye during a root canal. She was not wearing eye protection, and her dentist did not follow the proper protocol for an eye injury. Following multiple biopsies, infection removal, and removal of her lens, Jennifer's retina became detached; she lost vision in her right eye.5
There are very few articles assessing how often dental professionals and their patients are wearing protective eyewear. We conducted a study assessing the frequency and demographics of dental professionals using protective eyewear in dental offices around the metro Detroit area in order to:
• Gain knowledge of the persistence of eyewear usage with patients and dental professionals
• Gain an understanding of how much knowledge the dental professionals have about ocular infections, diseases, and injuries that can be sustained from not wearing protective eyewear.
Gaining this knowledge will play a role in increasing the awareness of the importance of proper use of PPE and the risks that come from not adhering to recommendations.
We aimed to discover the percentage of dental professionals who utilize safety glasses routinely in their practices. It was designed to assess knowledge of the role of dental professionals and their individual understanding of diseases transmissible via eye. We also asked whether or not they feel using safety glasses for patients and clinicians should be a mandatory part of the dental practice.
Participants were given a 10-question survey. Five questions required yes or no responses, and one question measured the dental clinician's opinion on the importance of regular use of safety glasses using the Likert scale. Three questions were multiple-choice. We obtained IRB approval before distributing our survey. Participants were asked to complete the questionnaire in November 2014, and received the questionnaire, Research Information Form, and cover letter in an envelope distributed by our group and mentor. The study involved no risk to the participants, and all responses were confidential. Information about the participant confidentiality was included in the cover letters. There was no monetary compensation for participating in the voluntary study.
The participants were selected using a convenience sample method. The sample consisted of various dental professionals (e.g., dental assistants, dental hygienists, dentists) from practices in the metro Detroit area. Clinicians who were not present at the time the survey was distributed were excluded from the study, and all responses from the present clinicians were included. Descriptive statistics of the percentages of the dental clinicians' responses were organized into tables. A chart was used to assess the percentage of responses for the questions using the Likert scale. Another chart was used to list the percentage of yes or no responses. The dental clinicians' years of experience, roles in dental practice, awareness of the risks, and procedures using safety glasses were analyzed in a table.
What We Learned
Of the individuals who responded to the survey, 61.3% were hygienists, 36% were dentists, and 2.66% were dental assistants. Out of the 75 participants, 61.3% had been practicing in the dental field 20 or more years, 13.33% had been in the field 1-4 years, 12% for 15-20 years, 9.33% for 5-10 years, and 4% for 11-15 years. Data also revealed that dental practitioners themselves are very consistent when wearing safety glasses. When asked how often clinicians wore their safety glasses, 88% responded that they always wear them, 6.66% responded that they wear them most of the time, 6.66% responded that they wear them sometimes, and 0% said that never wear them. On the other hand, when it came to a patient wearing safety glasses, the responses differed greatly. When asked how often clinicians had their patients wear safety glasses, 54.66% responded with sometimes, 20% responded with never, 18.66% responded with always, and 6.66% responded with most of the time. Only 10.66% of the participants responded that their office has no safety glasses for patients to wear during dental procedures, while 42.66% said they had a few pairs, and 46.66% responded saying they have many pairs.
When asked if the clinicians themselves or their coworkers have obtained an eye injury in the office, 86.66% responded with no, and 13.33% responded with yes. We asked the same question regarding patients and to whether or not any of their patients had ever obtained an eye injury in the office - 85.33% responded with no, and 14.66% responded with yes. When asked if the clinicians believed diseases could be transmitted through the eye, 96% responded with yes, and 4% responded with no. Out of the 15 clinicians who responded their patients never wear safety glasses during clinical procedures, 66.66% were hygienists, 33.33% were dentists, and 0% were dental assistants. Startlingly enough, although 26.66% of these clinicians have had a patient sustain an eye injury during a clinical procedure, they still continue to avoid routine safety glass use on their patients.
Of the 15 clinicians who answered that their patients never wear safety glasses, a majority of 53.33% stated that they have been in the dental field 20 years or longer, 20% for 1-4 years, 20% for 5-10 years, 6.66% for 11-15 years, and 0% for 15-20 years. When asked if these clinicians wore their safety glasses or not, 73.33% said they always wore theirs, 20% said they sometimes wear them, 6.66% said they wear them most of the time, and 0% said they never wear them.
Clinicians provided the following examples of eye injuries that occurred from not wearing protective eyewear in both practitioners and patients: calculus in the eye, prophy paste in the eye, chemicals in the eye during a composite filling, bleach in a patient's eye when a syringe became dismantled, bonding agent in the eye, an instrument falling into the eye, mint flavoring from floss in eye, and ceiling debris that fell into a patient's eye.
Protection for Patients
The results from the data show that patient safety glasses are necessary for both the clinician and the patient during routine procedures. While clinicians seem to constantly wear their safety glasses to protect themselves from injury and disease, they are often forgetting about the safety of their patients. Eye and face protection must be provided whenever necessary to protect against chemical, environmental, radiological or mechanical irritants and hazards.5 The most frightening part about the data shows that despite the fact that 96% of these participants know that diseases can be transmitted via the eye, only 18.66% make the effort to protect their patients from these risks consistently. The results reveal that dental hygienists are more likely to have their patients unprotected as opposed to dentists by a small margin of 3.22%. A majority of these participants have been in the dental field for over two decades; however, the other half has only been practicing for the last decade.
These results indicate that time spent in the dental field is not correlated with whether or not patients are using safety glasses to protect their patients. Of the 15 participants who state that their patients never wear eyewear, 100% of these clinicians believe infectious diseases can be contracted through the eye. Although clinicians know there is a need for safety glasses use in the field, it is a need that has continued to be neglected decade after decade, leading to injuries, diseases, and lawsuits. OSHA requires that the eyewear be impact resistant, American National Standards Institute certified, and compliant with the American National Standard Practice for Occupational and Educational Eye and Face Protection, but any form
of eye protection such as eye glasses or sunglasses is better than no protection.6
Unfortunately, for someone like Jennifer Kushwara Morrone, there are no second chances. She will forever live with the consequences of a careless practitioner. Because Jennifer had to leave her job due to her injury, she now dedicates her time to helping raise awareness of the importance of eye protection in the dental office. She is currently working on a petition that would make eye protection in the dental chair mandatory.7 There needs to be a greater awareness dedicated to patient eye safety in dental practices so incidents can be avoided. It is a small detail that can make all the difference. RDH
Christina Campbell, April DiGiovanni, and Ava Oleksiak are all currently senior dental hygiene students at the University of Detroit Mercy School of Dentistry. They are all pursuing a BSDH in addition to an RDH, and will be graduating in May of 2015. Erin Relich, RDH, BSDH, MSA, worked with April, Ava, and Christina as their faculty mentor in conducting their research and composing their article. She is an assistant professor and dental hygiene clinical coordinator of the dental hygiene program at the University of Detroit Mercy.
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3. Barbeau J. Lawsuit against a dentist related to serious ocular infection possibly linked to water from a dental handpiece. J Can Dent Assoc. 2007;73:618-22.
4. Shimoji S, Ishihama K, Yamada H, et al. Occupational safety among dental health-care workers. Adv Med Educ Pract. 2010;11: 41-7.
5. Eye and face protection eTool: OSHA requirements. United States Department of Labor. https://www.osha.gov/SLTC/etools/eyeandface/employer/requirements.html. Accessed January 16, 2015.
6. Safety and health topics: Eye and face protection. United States Department of Labor. https://www.osha.gov/SLTC/eyefaceprotection/. Accessed January 16, 2015.
7. Kelsch N. Jenn's vision. RDH Magazine. Published October 16, 2014. Accessed January 16, 2015.