chapter 6 - infection control and management of hazardous materials

Centers for Disease Control and Prevention (CDC)

Not a regulatory agency. Its roles is to issue specific recommendations based on sound scientific evidence on health-related matters

Occupational Safety & Health Administration (OSHA)

Regulatory agency. Its role is to issue specific regulations, also called standards, to protect the health of employees in the United States

Bloodborne Pathogens (BBP) Standard

The most important infection control law in dentistry. It is designed to protect employees against occupational exposure to blood-borne, disease-causing organisms, such as the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV)

Universal Precautions

Referred to in OSHA's BBP standard. Based on the concept that all human blood and certain fluids (including saliva) are to be treated as if known to be infected with the bloodborne diseases such as HBV, HCV or HIV infection

Standard Precautions

The CDC expanded on the concept of Universal Precautions and changed the term. It does not only apply to contact with blood but also with all body fluids (except sweat), non-intact skin and mucous membranes

Occupational exposure

Defined by the BBP Standard as "any reasonably anticipated skin, eye or mucous membrane contact, or percutaneous injury, with blood or any other potentially infectious materials"

Percutaneous

Through the skin, such as needle-sticks, cuts, and human bites

Permucosal

Contact with mucous membranes, such as the eyes or mouth

BBP Standard

Requires the dentist and/or employer to provide training in infection control and safety issues to all personnel who can come in contact with blood, saliva, or contaminated instruments or surfaces. Requires the dentist and/or employer to offer the HBV vaccination series to all employees whose assignments include category I or II tasks (the vaccine must be offered within 10 days of assignment to an occupational exposure category I or II). Prohibits an employee from taking protective clothing home to be laundered. Laundering contaminated protective clothing is the responsibility of the employer

Sharps

Contaminated needles and other disposable ___ such as scalpel blades, orthodontic wires, and broken glass, must be placed into a container that is puncture resistants, closable, leakproof, and color-coded or labeled with the biohazard symbol

Before and immediately after wearing gloves

When wearing gloves, when should you wash your hands?

Personal protective equipment (PPE)

OSHA's BBP Standards requires the employer to provide (without charge) employees with appropriate ____ such as protective clothing, surgical masks, face shields, protective eyewear, disposable patient treatment gloves, and heavy-duty utility gloves

Protective eyewaer

Worn to protect the eyes against damage from aerosolized pathogens, such as herpes simplex viruses and staphylococci, and from flying debris, such as scrap amalgam and tooth fragments and splattered solutions and caustic chemicals

Sterile surgical gloves

Gloves worn for invasive procedure involving the cutting of bone or significant amounts of blood or saliva, such as oral surgery or periodontal treatment

Utility gloves

Gloves used when the treatment room is being cleaned or disinfected, where contaminated instruments are being cleaned or handled and for surface cleaning and disinfecting

Hazardous waste

Waste that presents a danger to humans or the environment (eg. toxic chemicals). Handling requirements: follow specific state and local regulations

Contaminated waste

Waste that has been in contact with blood or other body fluids (eg. used barriers, patients napkins). Disposed with general waste (in most states)

Infectious waste or regulated waste (biohazard)

Waste that is capable of transmitting an infectious disease, eg. blood and blood-soaked materials, pathologic waste and sharps. Handling requirements: follow specific state and local regulations. Containers must be labeled with the biohazard label

Infectious waste or regulated waste (biohazard)

• Blood and blood-soaked materials

Blood or saliva that can be squeezed out, or dried blood that may flake of an item. Handling requirements: follow specific state and local regulation

Infectious waste or regulated waste (biohazard)

• Pathologic waste

Soft tissue and extracted teeth. Handling requirements: follow specific state and local regulation. Never dispose of extracted teeth with amalgam restorations with waste that will be incinerated (burned)

Infectious waste or regulated waste (biohazard)

• Sharps

Contaminated needles, scalpel blades, orthodontic wires, endodontic instrument (eg. reamers files). Containers should be closable, leakproof, puncture resistant and color coded red and marked with the biohazard symbol. Container should be located as close as possible to the work area

Hazards Communication Standard (HCS)

Issued by OSHA and requires employers to inform their employees about the identity and hazards of chemicals that they see in the workplace. Also known as the "Employee Right-to-Know Law"

Globally Harmonized System (GHS) of Classification and Labeling of Chemicals

In 2012, OSHA revised the HCS and adopted the

Hazard Communication Standard

1. Written program

2. Chemical inventory

3. Safety data sheets (SDSs)

4. Labeling

5. Employee training

Safety Data Sheet (SDSs)

Contains health and safety information about every product in the office that contains chemicals. Provides comprehensive technical information and are a resource for employees working with chemicals and describe the physical and chemical properties of a chemicals, its health hazards, routes of exposure, and precautions for safe handling and use, as well as emergency and fist-aid procedures and spill control measures. The manufacturer is required to supply the dental office with an __ for the product

Signal word, pictogram and hazard statement

As of June 1, 2015, all labels will be required to have a harmonized ___, ____ and ___ for each hazard class and category. Secondary containers that hold chemicals are also require labeling, such as automatic x-ray film processors and manual processing tanks, ultrasonic cleaning tanks, and chemical vapor sterilizers

Hazard classification

Chemicals are classified into categories that compare hazard severity within a hazard class. Once a chemical is classified, warnings are automatically assigned so that each chemical in the same category will have the same label requirement and language. The two most important considerations are that: 1. OSHA HCS labels are used.

2. All employees are properly trained to undersand and read the label

Mask, protective eyewear, gloves

Order of putting on PPE

Gloves, protective eyewear, mask

Order of taking off PPE