Chris Miller, PhD
Exposures may occur through direct contact (touching) with blood or saliva in a patient`s mouth, contact with spatter generated from the patient`s mouth, touching surfaces, or contacting items contaminated with blood or saliva. OSHA indicates that blood and saliva should not pass through to or contact the "employees` work or street clothes, undergarments, skin, eyes, mouth, or other mucous membranes." [U.S. Department of Labor. OHSA Occupational exposure to bloodborne pathogens; final rule. Federal Register; 1991; 56[No, 235: December 6]:64175-64182; and Enforcement procedures for the occupational exposure to bloodborne pathogens standard. OSHA Instruction, Directives #CPL 2-2.44D, November 5, 1999, p. 26].
We are aware of the usual activities in the office that may lead to exposures if proper controls are not in place (e.g., intraoral activities, operatory clean-up, instrument cleaning and packaging, managing waste, handling impressions and appliances, or repairing equipment). However, we cannot always predict when some exposures may occur, such as sharps injuries, when a barrier fails, or when a patient may express saliva. We must be on our guard at all times.
We attempt to prevent exposures by using engineering controls such as sharps containers or instrument cassettes to isolate or remove the hazard. We also use work practice controls such as handling sharps very carefully to make a task safer, and barriers to prevent contact with potentially hazardous materials. As you know, these preventive approaches are the main tenets of OHSA`s Bloodborne Pathogens Standard.
There are a variety of ways exposure to patient`s blood or saliva can occur. Some examples are when:
* Gloves are not worn or when gloves are torn during intraoral care.
* Gloves are not worn during operatory cleaning and disinfection.
* Gloves are not worn when handling contaminated instruments, waste, or other contaminated items.
* Eye protection and a face mask are not worn, are too small, or do not have side shields. During intraoral care, splashing may occur from rinsing, ultrasonic cleaning of contaminated instruments, or when changing contaminated ultrasonic cleaning solutions.
* Protective clothing is not worn or gives inadequate protection during intraoral care, operatory clean-up, or instrument cleaning. s Gloves, mask, eye protection, and protective clothing are not used when manipulating contaminated dental appliances in the laboratory.
* Contaminated sharps are not handled carefully.
* Biohazards may not be properly identified with signs or labels.
* Sharps containers overflow or are spilled.
One of the most serious types of exposure is a sharps injury. While their occurrence is not predictable, there are several things that can be done to reduce their chance of occurring.
Set a goal of no more sharps injuries in the office.
> Devise an in-office education program called OBe SharpO to prevent sharps injuries. Use signs, posters, special monitoring, rewards for identifying dangerous situations, and celebrations for successful accomplishments.
> Routinely discuss sharps safety in staff meetings.
> Position containers where sharps are used (chairside, for example) and where they may be found if not disposed of immediately after use, such as the sterilizing room.
> Do not overfill a sharps container and close it before it is moved.
> Use tongs to pick up spilled sharps or broken glass.
> Use a one-handed scoop technique or a safe recapping device when recapping needles. Do not cut, bend, or try to break needles before disposal.
> Slow down when handling sharps. Always look first before picking up a sharp item.
> Handle a sharp as little as possible. For example, use it, then safely put it down or dispose of it immediately. The more times a contaminated sharp is handled, the greater the chance for injury.
> Avoid putting others at risk. If someone else must handle a contaminated sharp that you have used, place it in a position that will not create a danger for the next user. For example, place used instruments back on the tray in a stable fashion with bent tips pointing down.
> Don?t hand-sharpen a contaminated scaler. Reduce the need for chairside sharpening by providing several sharp scalers or other instruments on the tray set-up.
> Avoid routinely hand-scrubbing contaminated sharp instruments. Use mechanical cleaners such as ultrasonic cleaners or instrument washers.
> If contaminated instruments must be directly handled during processing, wear heavy utility gloves.
> Handle sharps carefully!
In summary, set a goal for your office to have no more exposures to patient?s blood or saliva. In particular, strive for no more sharps injuries and set up a program in your office to achieve these goals.
Chris Miller, PhD, is professor of oral microbiology and associate dean at the Indiana University School of Dentistry.