General Clinic Safety, Hazardous Waste & Infection Control

GENERAL CLINICSAFETY

HAZARDOUS WASTE&

INFECTION CONTROL

Roseman University College of Dental Medicine

FIRE EMERGENCY PROCEDURES

IF YOU DISCOVER FIRE OR SMOKE

Remove anyone from immediate danger

Confine the fire by closing doors as you leave the area

Activate the closest fire alarm to alert building occupants

Call Security at 801.870.1589

Give the following information:

• Building Name: CODM College of Dental Medicine

• Floor or Room Number

• Size or type of fire

• Your Location


Attempt to put the fire out with a extinguisher ONLY when:

You have been properly trained

The fire is small (wastebasket size)

You are not alone

A safe escape route is present

If this is not true, simply close the door and evacuate.


Evacuate by the nearest exit or exit stairwell. Do not block/wedge exit doors in an open position and keep stairwells safe for evacuation and fire personnel

Go to your pre-determined Evacuation Assembly Point, located in parking lost adjacent to building depending on exit used.

Once assembled, help to account for personnel and report to the emergency staff if any occupants are unaccounted for and may be still in the building


If you hear a fire alarm

Never assume the fire alarm is a false alarm

Move to the safest exit or stairwell

Close doors as you leave the area

Exit building

SAFETY HAZARD

• Fatigue

• Ignorance

• Haste

• Defective Equipment

• Carelessness

• Clutter

• Inadequate Space

• Inadequate Lighting

• Improper Storage

• Stupidity

• Inattentiveness

Dental Clinic Electrical Safety

Ensure floors are kept dry and clean

Ensure electrical equipment is in good repair

Report shocks – don’t try to fix them yourself!

Check cords for worn insulation or defective plugs

Properly remove plugs from outlets

If you think equipment is faulty DO NOT USE it; report to supervisor

Dental Clinic Eye Protection

Eye protection is mandatory for staff and patients

During operatory procedures

During laboratory procedures

• Grinding and handpiece procedures

• Dark glasses and goggles during casting

In Dental Instrument Processing area(s)

Eyewash areas identified to all personnel and tested weekly

Dental Chemical Safety

Don’t take any dental chemicals or materials for granted

Keep exterior of containers clean and labeled

Avoid direct contact with skin

Use appropriate PPE

Latex gloves provide minimal protection

Material Safety Data Sheets (MSDS)

Must be located for accessibility by everyone

Dental Instrument Processing

Use eye protection, protective clothing & rubber utility gloves when handling contaminated instruments

Do not open sterilizers until pressure drops to zero; allow steam to dissipate after opening

Use care when handling hot instruments/ packs

Dental Sharps

Visible sharps container in every operatory, laboratory and the instrument processing area

Wall mount preferable

Must be above level accessible to children

Replace when ‘Fill line’ is reached (e.g. ¾ full) to avoid sharps protruding from the top

Dental Sharps

Use care with loading, passing, breaking down and cleaning sharp instruments including:

Scalpels

Needles

Endo Files

Burs

Instruments

After sterilizing, take broken instruments to dental logistics

Recapping Guidelines

Know and use local needle recapping guidelines

Do not pass unsheathed needles

Us a mechanical recapping device

Do not use two hands to recap

Use a one handed scoop technique

Reporting Occupational Exposure Incidents

Occupational Exposure Incident

Needlestick, Cut or mucous membrane (eyes, mouth, or nasal) splash resulting in exposure of a health care worker to blood or body fluids from a patient.

Each CPT Coordinator has a packet to be completed by the Exposed and the Exposure.

Fire/Flammables

Common sense is most important fire preventive measure

Never leave burning Bunsen burners or portable torches unattended

Flammables must be kept in manufacturer’s original container or an approved and properly labeled safety container

Fire Safety R Rescue –

Immediately stop what you are doing and remove anyone in immediate danger from the fire to a safe area

A Alarm –

Activate the nearest fire alarm pull stations (if applicable)

Call 911 and/or the front desk (if applicable) to report the location and current extent of the fire

C Contain –

Close all doors and windows that you can safely reach to contain the fire

During evacuation close the doors behind you)

E Evacuate –

to an area of refuge

Extinguish – Only attempt to extinguish the fire if it is safe for you to do so.

Retrieve the nearest fire extinguisher and follow the ‘P.A.S.S’ procedure

Fire Safety

P Pull the pin breaking the plastic seal

A Aim the hose at the base of the fire

S Squeeze the handles together

S Slowly sweep side to side at the base of the fire

General Clinic Safety

Be aware of general hazards

Sharp corners from drawers and cabinets

Cords or hoses on the floor

Spilled liquids

Jewelry and loose clothing around machinery

Ask for help

Lift properly

Use proper lifting techniques

Store heavier items on lower shelves

ASK FOR HELP


Mercury Hygiene

Risk is low but sill exists; is cumulative

Keep amalgamator lid closed during mixing

Avoid direct skin contact

Store dry amalgam scrap in airtight container

Never heat amalgam

• Turn clogged/obstructed carriers in to supply

In case of mercury spill

Contact supervisor

Use spill kit or contact Bioenvironmental Engineer (BEE)

Back to Quiz


Nitrous Oxide (N2O)

Pregnant (or attempting to become) technicians should not assist if N2O is being used.

Ensure proper room ventilation and scavenger system.

Exposure Control Plan

Key Elements

Determination of employee exposure to blood/OPIM

Implementation of various methods of exposure control

• Standard precautions• Engineering work practice controls• Personal Protective Equipment• Housekeeping• Hepatitis B vaccination• Post-Exposure evaluation & follow-up

Communication of hazards to employees and training

Recordkeeping

Procedures for evaluating circumstances surrounding exposure incidents

Occupational Exposure Determination

Reasonably anticipated:

Skin

Eye

Mucous membrane

Puncture wound (parenteral) contact with blood

OPIM that may result from the performance of employee duties

Standard Precautions

The same IC procedures are used for all patients

Assume all patients are potentially infectious

Infection control policy are determined by the procedure, not the patient

Engineering & Work Practice Controls

Primary methods used to control transmission of HBV/HCV/HIV

Primary strategy for protection of DHCP & Patients

Eliminates or isolates the hazard

Commonly used in combination with work practice control & PPE to prevent exposure

Must be examined, maintained or replaced on scheduled basis

Engineering Controls Examples

Puncture resistant sharps container

Safer medical devices

Sharps with engineered sharps injury protection Y needleless systems

• Non-needle devices

• Devices with built-in safety features

Engineering Controls

2001 OSHA revised the BBP Standard

Employers should identify, evaluate, & select safer medical devices as they become available

Annually

Involve employees directly responsible for patient care in identifying and choosing such devices

• Dentists• Hygienists• Dental Assistants

Follow local MTF policy regarding device selection, Use, Documentation

Work Practice Controls

Reduce likelihood of exposure by altering the manner in which task is performed

Placing used disposable syringes & needles, scalpel blades & other sharp items in puncture resistant containers located as close as practical to the point of use

Using a one-handed ‘scoop’ technique or a mechanical device to facilitate needle recapping

Not passing unsheathed needles

Using engineered sharps injury protection devices during use or disposal

Work Practice Requirements

Wash hands immediately after

skin contact with blood/OPIM

After removing gloves or other PPE

Flush mucous membranes immediately if splashed with blood/OPIM

Do not bend or break needles before disposal

Do not pass needles unsheathed

Recap needles with a one-handed technique before removal from non-disposable aspirating syringes


Discard disposable sharps

Endo Files

Orthodontic wires

Anesthetic/suture needles

Designated sharps container

Closable

Puncture resistant

Leak-proof

Colored red or labeled with biohazard symbol


Place contaminated, reusable sharp instruments in containers that are

Puncture-resistant

Leak-proof

Colored Red or labeled with biohazard symbol

Until reprocessed

Do not store or process instruments in a way that would require DHCP to reach by hand into the container to retrieve instruments


Do not do the following in areas where there is risk for occupational exposure

Eat Drink Smoke Apply cosmetics Handle contact lens

Do not do store food/drinks where blood/OPIM are present

Refrigerators Cabinets Shelves countertops

Personal Protective Equipment (PPE)

Specialized clothing or equipment to protect

Skin, Mucous membranes, Eyes, Nose, Mouth

Protect DHCP from exposure of infectious or potentially infectious materials

PPE must not allow blood/OPIM to pass through clothing, skin or mucous membrane

Based on degree of anticipated exposure & procedure performed

Remove PPE before leaving the work area and immediately if penetrated by blood/OPIM

PPE

Gloves

Surgical Mask

Long-sleeved protective clothing

Long-sleeved lab coat

Long-sleeved gown

Protective eyewear with solid side shields

Chin-length face shield worn with a surgical mask

PPE - Gloves

Gloves Wear gloves when contact with blood or OPIM is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than

one patient Do not wash or disinfect patient-care gloves Do not use petroleum-based hand lotions with latex gloves

(causes deterioration of the glove material. Removal: grasp at wrist and strip off ‘inside-out’

Sequence for Donning & Removing PPE, CDC 2004

PPE – Utility Gloves

Used for cleaning instruments, surfaces, handling laundry, or housekeeping

May be washed, autoclaved, or disinfected and reused as long as integrity is not compromised

After washing with soap, pull off by finger tips

PPE - Eyewear

Wear when splash, spray, or spatter is anticipated

Eyewear must have solid side shields

A chin-length face shield may be worn withy a mask if additional protection is desired

Remove by headband or side arms

Do not touch shield or lens area

If reusable, may be decontaminated and reused


PPE - Clothing

Long sleeves required by OSHA if worn as PPE

Wear when splash, spray, or spatter is anticipated

Remove immediately if penetrated by blood/OPIM

Use tie strings to remove and peel off

Minimize contact during removal

If reusable, place in marked laundry container


PPE – Employer Responsibility

Provide, maintain and replace

Ensure accessibility in appropriate sizes

Provide alternative products

Latex-free gloves

Powderless gloves

Ensure employee use

Launder or discard if appropriate

Contaminated Laundry

Place in bags or containers that are red or marked with biohazard symbol

If clinic uses Standard Precautions for handling soiled laundry

Alternative labeling is permitted

Ensure all employees are trained and recognize bags containing contaminated laundry

Housekeeping

Employer must ensure clean/sanitary workplace

Work surfaces, equipment, and other reusable items must be decontaminated upon completion of procedure when contaminated with blood/OPIM

Barriers protecting surfaces/equipment must be replaced between patients

Housekeeping

Reusable receptacles (bins pails, cans)

Must be inspected/decontaminated on a regular basis and when visibly soiled

Broken glass that may be contaminated

Cleaned up with brush/tongs

Never picked up with hands, even if gloves are worn

Contaminated equipment must be decontaminated before servicing or labeled as biohazard

Regulated Waste

Liquid or semi-liquid blood or OPIM

Items contaminated with blood/OPIM that would release these substances in a liquid or semi-liquid stat if squeezed

Items caked with dried blood/OPIM and capable of releasing these materials during handling

Contaminated sharps

Pathological/microbiological waste containing blood/OPIM

Extracted teeth

Regulated Waste Disposal

Sharps

Place in container that is closable, puncture-resistant, leak-proof, and colored red or labeled with biohazard symbol

Other regulated waste

Must be contained in closable bags or containers that prevent leakage and colored red or labeled with the biohazard symbol

If contaminated on outside, use secondary container with same features

Biohazard Label

Symbol accompanied by the word BIOHAZARD

Must be fluorescent orange or orange/red with lettering and symbols in contrasting colors

Red or orange/red bags or containers may substitute for labels

Decontaminated regulated waste does not need to be labeled or placed in red bags

Biohazard Label

Sharps container

Regulated waste container

Contaminated laundry bags

Refrigerators/freezers containing blood/OPIM

Containers used to ship blood/OPIM

Contaminated equipment

NOTE: Red or Orange/Red bags or containers may substitute for labels

Hepatitis B Vaccination

Effective in preventing Hepatitis B

Three Dose vaccination series

Titer Test for antibodies to HBsAG 1 to 2 months after 3-dose vaccination series completed

Revaccinate DHCP who do not develop adequate antibody response

Safe, effective and long-lasting

Booster doses not necessary for vaccine responders

Occupational Exposure Incident

Specific eye, mouth, other mucous membrane non-intact skin or parenteral contact with blood/OPIM resulting from performance duties

Percutaneous Injury

• Needlestick, puncture wound, or cut

Splash of blood or body fluid on

• Mucous membranes (eye, nose or mouth)• Non-intact skin (chapped, abraded, dermatitis)

Employer

Responsible for establishing procedure for evaluating exposure incident

Through assessment and confidentiality are critical

Post Exposure Management

Goal: prevent infection after an occupational exposure incident to blood

A qualified health-care professional should evaluate any occupational exposure to blood or OPIM including saliva, regardless of whether blood is visible in dental settings

• A qualified health-care professional is any health-care provider who can provide counseling and perform all medical evaluations and procedures in accordance with the most current recommendations of the US Public Health Service, including post exposure chemotherapeutic prophylaxis when indicated


Wound Care

Clean wounds with soap and water

Flush mucous membranes with water

No evidence of benefit for

• Application of antiseptics or disinfectants

• Squeezing (‘milking’) puncture sites

Avoid use of bleach and other agents caustic to skin


Overview

Immediately report exposure incident to initiate timely follow-up process by health care professional

Exposed individual must be directed to a qualified health care professional

Initiate prompt request for evaluation of source individual’s HBV/HCV/HIV status


Exposure Report

Date and time of exposure

Procedure details – what, where, how, with what device

Exposure details – route, body substance involved, volume/duration of contact

Information about source person

Information about the exposed person

Exposure management details


Unknown or Untestable Source

Consider information about exposure

• Where and under what circumstances

• Prevalence of HBV/HCV/HIV in the population group

Testing of needles and other sharp instruments not recommended

• Unknown reliability and interpretation of findings

• Hazard of handling sharp


Evaluating the Source

If the HBV/HCV/HIV status of the source is unknown, testing should be done

Testing should be preformed as soon as possible

Consult your laboratory regarding most appropriate test to expedite obtaining results

Informed consent should be obtained in accordance with state and local laws

Recordkeeping

Medical Records

Requirement for each employee with potential occupational exposure

Confidential and separate from other personnel records

Kept on-site or retained by HCP providing services to clinic

Occupational exposure reports included

Maintained for 30 years past last date of employment

Confidentiality is critical

CDC. Updated US Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for post exposure prophylaxis. MMWR 2001;50(No. RR-11).

CDC. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for post exposure prophylaxis. MMWR 2005;54(No. RR-9):1–17.

US Department of Labor, Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; needle sticks and other sharps injuries; final rule. Federal Register 2001;66:5317–25. As amended from and includes 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; final rule. Federal Register 1991;56:64174–82. Available at ww.osha.gov/SLTC/dentistry/index.html.

References

Occupational injury and illness recording and reporting requirements; Final Rule. Title 29 CFR Parts 1904 and 1952, Federal Register 66 (13): 5916-6135, January 19, 2001.

OSHA Directive CPL 2-2.44D-Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, November 5, 1999.

OSHA Brochure, Medical and Dental Offices: A Guide to Compliance with OSHA Standards, 2003.

References

Healthcare

General Clinic Safety, Hazardous Waste & Infection Control