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OSHA’s concern arises from the fact that there are millions
You must be signed in to read the rest of this article.
Registration on CDEWorld is free. You may also login to CDEWorld with your DentalAegis.com account.
OSHA’s concern arises from the fact that there are millions of healthcare workers in the United States who need to be protected. According to the US Bureau of Labor Statistics, there are an estimated 11 million healthcare workers, and that number includes dentists, dental assistants, dental hygienists, and dental technicians.1
The Bloodborne Pathogen Standard describes how employers must protect workers from exposure to potentially infectious items. Along with this standard, an excellent resource for how to protect workers is the Centers for Disease Control and Prevention’s (CDC) Guidelines for Infection Control in Dental Health-Care Settings–2003. These recommendations have had a significant impact on dental settings, including dental laboratories.
This review of the basic components of an Exposure Control Plan, the risk areas in a dental laboratory, and communicable diseases will assist in eliminating and minimizing cross contamination.
Part One: Components of an Exposure Control Plan
OSHA requires employers to develop an Exposure Control Plan that covers the following:2
Category I and II job classifications (Category I consists of athletic healthcare trainers, school custodians, plumbers, registered professional nurses and Category II consists of teachers and educational assistants who work with handicapped students, houseparents, dormitory attendants, and building maintenance workers).
Method of Compliance
Refers to use of Standard Precautions that must be observed to prevent contact with blood or other potentially infectious materials.
Engineering and Work Practice Control
Used to eliminate or minimize employee exposure. Where occupational exposure remains after institution of these controls, then personal protective equipment (PPE) shall be used. Work practices could include handwashing, no eating/drinking in risk areas, and good housekeeping.
An employer must also develop:
Infection Control Protocols
- Covering and identifying all risk areas
- Prepare written procedures and post in risk areas
- Train workers upon hire and at a minimum annually, plus enforce procedures
Examine Exposure Controls
- Document an annual review of the Exposure Control Plan and exposure controls
- Assess in writing if controls are being followed—if not, what corrective action is required?
Provide Hepatitis B Vaccine
- Educate workers in risk areas of potential occupational exposure
- Offer immediately upon hire at no cost to employee
- Document acceptance or refusal
Post Exposure Management
- Follow Post Exposure Evaluation and follow-up procedures
- Document actions
Part Two: Risk Areas in the Dental Laboratory
Pick-up and Delivery Personnel
Many dental laboratories employ drivers to transport cases between the laboratory and the dental office. The employer must train these workers about the risks they may encounter and how to protect himself or herself. Some of the risks can be:
Risk: The dentist or dental staff attempts to hand the driver an impression that is not packaged properly. The laboratory employee needs to be instructed on how to handle this situation. Solution: Instruct the driver not to handle these items unless packaged properly. OSHA and Department of Transportation (DOT) set these guidelines, ie, liquid-tight, tamper-evident, secondary container with biohazard emblem (Figure 1).2,4
Risk: Bags and/or boxes picked up at dental office are wet. Solution: Provide drivers with a plastic container that they can use to place the bags/boxes. Also train drivers that handwashing is still the cornerstone of all infection control. When handwashing is not possible, use an alcohol-based hand gel. Also consider supplying that product in company pick-up vehicles.
Most of the items delivered to the dental laboratory from dental offices are impressions, bites, and other items that have been in a patient’s mouth. The workers in this area must be instructed on the use of standard precautions. All items must be disinfected.
Some dentists provide certain medical information about the patient that is not needed by the dental laboratory to manufacture the prosthesis. Communication with the dentist is important to explain that the laboratory uses standard precautions and has no need to know the medical condition of the patient. Dental laboratories should inform their dental clients not to provide any medical history or condition of the patient on the prescription.
The fit of restorations can be compromised by disinfecting techniques.3 An effective infection-control protocol is not only important for the dental laboratory, but also for the dental office. Communication with the dental practice about the type of disinfectant that they are using and their method of disinfecting can help eliminate distortion.6
- Wear a mask, gloves, safety eyewear, and gown while disinfecting (Figure 2).
- Even if the dental staff disinfected the items before shipment, the dental laboratory must protect its workers by performing its own disinfection.
- Select an appropriate disinfectant. Check with the manufacturers of the impression material and the disinfectant to ensure that they are compatible.
- Read the label and use the disinfectant according to manufacturer’s recommendations.
- The CDC recommends using a