“The study of history is the best medicine for a sick mind; for in history you have a record of the infinite variety of human experience plainly set out for all to see; and in that record you can find yourself and your country both examples and warnings; fine things to take as models, base things rotten through and through, to avoid.” Livy
History is a record of things that have happened that have brought us to the place we are today. History often contains education that helps people not repeat the mistakes of those before them. Each time a needlestick event happens in our office, it gives us the history to make a change so that it does not occur again. The Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control (CDC) have developed policies and procedures to “stop history from repeating itself.”
The history of current prevention
On Nov. 6, 2000, the future of risks regarding needlesticks to health-care professionals was changed forever. The Needlestick Safety and Prevention Act was signed into law because occupational exposure to bloodborne pathogens from accidental sharps injuries posed a serious risk. Congress felt that a modification to the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard was necessary to give more specifics regarding OSHA’s requirement for employers to identify, evaluate, and implement safer medical devices. The act also mandated additional requirements for maintaining a sharps injury log, and for the involvement of nonmanagerial health-care workers in evaluating and choosing devices.
These revisions clarified the need for employers to select safer needle devices as they become available, and to involve employees in identifying and choosing the devices. Prior to the act, only a few dental devices incorporated safety features (e.g., anesthetic syringe needles with sliding sheaths), and most dental health-care personnel were uncertain about how to select and evaluate the safer devices now available on the market.
OSHA’s Bloodborne Pathogens Standard, including its 2001 revisions, applies to all employers who have employees with reasonably anticipated occupational exposure to blood or other potentially infectious materials (OPIM). These employers must implement the applicable requirements set forth in the standard. Some of the new and clarified provisions in the standard apply only to health care activities, but some of the provisions, particularly the requirements to update the exposure control plan and keep a sharps injury log, will apply to non-health care as well as health care activities.
The Centers for Disease Control (CDC) worked closely with interested parties to put together a solid program, including forms to meet the needs and requirements of this program. These forms can be easily adapted to any item that presents a risk in the dental environment. The CDC gives health-care professionals the following guidelines for developing their programs:
Every dental office should develop and implement a program to prevent sharps injuries to dental personnel and patients. A staff person knowledgeable about or willing to be trained in injury prevention (i.e., a safety coordinator) should be assigned to:
- Promote safety awareness
- Facilitate prompt reporting and postexposure management of injuries
- Identify unsafe work practices and devices
- Coordinate the selection and evaluation of safer dental devices
- Organize staff education and training
- Complete the necessary reporting forms and documentation
- Monitor safety performance
Ideally, these activities should be described in a written plan, and mechanisms for staff feedback should be available. This feedback will assist the safety coordinator in reviewing the effectiveness of the plan and making the modifications needed.
Identifying safer dental devices
Information on specific brands and products of safer dental devices can be obtained from vendors, purchasing agents, scientific literature, lists published on the Internet or trade journals, and other health care facilities. A variety of devices should be considered, and the choice should not be limited to the product of any one vendor.
Developing evaluation criteria
Evaluation criteria are used to measure the design and performance of safer devices during the screening and clinical evaluation phases, and are different for each phase. Criteria for the screening phase will help determine whether the device is safe to use on patients, has safety features to protect dental personnel from sharps injury, is readily available for purchase, is easy and practical to use, and is compatible with other equipment. Criteria for the evaluation phase help determine impact on patient care, acceptability by users, and cost. The evaluation criteria for both phases should be unbiased, and the evaluation forms should be easy to use and score.
Screening devices
Screening assists dental personnel in making decisions about clinical and safety considerations before evaluating a dental device in the clinical setting. Screening usually consists of physically examining the safer device, then comparing it to the traditional device and established evaluation criteria. No device should be used on a patient before it has been screened to ensure that it meets clinical and patient safety needs.
Evaluating devices
Device evaluation involves a trial (or pilot test) to determine the acceptability of a safer dental device in an actual clinical setting. This process includes identifying a safe dental device to test, selecting the area of the facility to be used as the test site and the staff who will use the device, selecting evaluation criteria, and determining how long the test will last. The testing should include plans for quickly bringing back the traditional device should the dental device being tested be determined unsafe. The device evaluation should provide the safety coordinator with enough information to make an informed decision on whether to continue using the safer device.
Forms that are available to help implement a program are:
Screening form:
http://www.cdc.gov/oralhealth/infectioncontrol/pdf/screening.pdf
Device evaluation form:
http://www.cdc.gov/oralhealth/infectioncontrol/pdf/device.pdf
The history of needlesticks has given us all fine models, resources, and strategies for prevention. As you develop a protocol in your office using history for evaluating and screening devices and preventing sharps injuries, you can help make sharps injuries a thing of the past.
Noel Brandon Kelsch, 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.
Correction
In the November 2011 “Infection Control” column, the author stated, “CDC guidelines indicate, ‘only the portion of the attachment that comes in contact with patient tissue” is required to be sterilized or disposed of. It is not necessary to sterilize the motor if a barrier is used. If you are not autoclaving motors, make sure they are removed from the tubing and lubricated at least once a week. Not removing motors at some interval leads to the accumulated disinfectant corroding the threads onto the tubing permanently.’
The 2008 Guideline for Disinfection and Sterilization in Healthcare Facilities, however, states, “Handpieces can be contaminated internally with patient material and should be heat sterilized after each patient. Handpieces that cannot be heat sterilized should not be used.
We regret the error.
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