There is a large number of questions that you can ask to help identify infection-control risks.
Chris Miller
I dentifying possible situations that may put office personnel or patients at risk is an important aspect of infection control and office safety. Making a special effort to periodically identify such risks may avoid disasters.
This identification can be accomplished through discussions involving all office personnel and by direct observation of the workplace and work activities. When risks are identified, they should be assessed to determine why they occur. Then, solutions need to be identified and put into place to control the risks. Control may include changing a work practice, changing or adding an engineering control, and/or education or retraining.
One approach to risk identification is to formulate questions about procedures, products and equipment used, and about the office environment. Then, the questions are discussed and workplace observations are made to determine if risks exist. There is a large number of questions that can be asked to help identify risks - those given below serve as a beginning. In some instances, the questions presented here are followed by brief explanations.
Reducing sharps injuries
* Are sharps containers replaced before they are full? When in the process of discarding a sharp, the last thing you want to encounter is a full sharps container. One may be tempted to add just one more sharp, risking injury from protruding items; to lay the sharp down and have to handle it again later; or to improperly discard the sharp where it may be a danger to someone else.
* Are needles being recapped by hand or by an otherwise unsafe procedure?
* Can sharps containers easily be knocked over and spill their contents? Sharps containers should not have a narrow base and should be in a location where they won`t be knocked over with an elbow or by having to reach across its top to retrieve something.
* Are sharps containers closed before moving? Chances are that one will not drop a full sharps container, but if that happens, unnecessary risk or injury/contamination may occur during the pick-up.
* Are sharps containers located where sharps are used or likely to be found?
* Are contaminated sharp instruments being routinely hand-scrubbed? Ultrasonic or washer/disinfector cleaning can reduce the direct handling of contaminated sharps.
* Are instruments being placed back into trays or cassettes at chairside in a stable fashion?
* Does everyone look before reaching for a sharp or before returning one to its resting place in the tray or cassette?
Reducing other injuries
* Are floors wet or slick?
* Are electrical cords cracked or frayed?
* Are outlets or outlet covers loose?
* Is there an emergency-exit plan for the office?
*Are fire extinguishers and smoke alarms readily available?
* Are flashlights available near circuit breakers and exits?
* Is there an eyewash station close to where hazardous chemicals may be used?
* Are heat-resistant gloves readily available next to the sterilizers?
* Are loose clothing and long hair being kept away from rotary equipment in the operatories and lab?
* Are staff members opening the steam sterilizer doors while standing on the side opposite the hinges? Standing on the hinged side of the door provides more protection against steam exiting the chamber.
* Is a mechanism available for the medical evaluation of staff exposed to blood or saliva?
* Is there a copy of the OSHA bloodborne-pathogens standard available in the office?
* Does the office have a written exposure-control plan?
* Are MSDS available in the office for all hazardous chemicals used?
Reducing cross-contamination
* Are the sterilizers being routinely spore-tested? Spore testing helps assure that sterilizers are being used correctly and are functioning properly to provide instruments that are safe for use.
* Are sterilizers being loaded by stacking items one upon the other? Stacking or layering inside the sterilizer chamber may prevent ready access to the steam, dry heat, or chemical vapor. Placing packages and cassettes on their edges provides better access to the sterilizing agent.
* Are steam-sterilized packs being handled while wet? Handling wet paper packs can compromise sterility of the package contents by tearing or by wicking through the wet packaging material.
* Are sterilized instrument packages intact when brought to chairside for use?
* Are chemical indicators used to monitor whether instruments brought to chairside have indeed been processed through the sterilizer?
* Are contaminated instruments being properly cleaned before packaging and sterilization? Improper cleaning increases the risk of sterilization failure.
* Are contaminated surfaces being properly cleaned before being disinfected? Improper cleaning increases the risk of disinfection failure.
* Are utility gloves cracked or torn?
* Does the protective eyewear used have side shields?
* Is protective eyewear available where chemicals are being used, mixed, or discarded?
* Are contaminated gloves being removed or covered before leaving chairside?
* Are gloves, masks, and eyewear being removed in the appropriate order? Gloves are removed last.
These are but a few questions that can be asked to identify infection-control and office-safety risks. See if you can come up with additional questions to help the risk assessment in your office.
Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.
