Category:

OSHA in Dental Practice

Course Outline

  1. The OSHA Bloodborne Pathogens Standard 29 CFR 1910.1030

    • Occupational Exposure to Bloodborne Pathogens

  2. Exposure to Blood. What Health-Care Workers Need to Know

    • Occupational Exposures to Blood
    • If An Exposure Occurs Risk of Infection After Exposure
    • Treatment for the Exposure
    • Follow-Up After An Exposure
    • Other Sources of Information

  3. Safer-Needle Devices: Protecting Health-Care Workers

  4. A Best Practices Approach For Reducing Bloodborne Pathogens Exposure

    • Identifying and Selecting Appropriate and Currently Available Engineering Control Devices
    • Methods of Compliance
    • Hepatitis B Vaccination and Bloodborne Pathogens Post-Exposure Evaluation and Follow-up
    • Communication of Hazards to Employees
    • Record-keeping
    • Resources
    • Definitions of Regulated Waste

Learning Objectives

After completing this course you’ll be able to:

The OSHA Blood borne Pathogens Standard

  1. List the steps that an employer is required to take to protect workers against needle sticks and other exposures to blood and other body fluids that contain blood at work.
  2. Define terms such as engineering controls, needleless system and sharps.

Exposure to Blood: What Health-Care Workers Need to Know

  1. Explain the importance of hepatitis B vaccination for all DHCWs who have direct or indirect contact with patient’s blood and/or saliva. Describe handwashing and hand care techniques for DHCWs.
  2. Explain the correct use of personal protective equipment such as gloves, surgical masks, protective eye wear, protective clothing and utility gloves in a dental office.
  3. Describe proper instrument sterilization techniques.
  4. Describe appropriate waste disposal methods for regulated and unregulated items.
  5. Outline radiographic asepsis procedures.
  6. Discuss barrier precautions to be used to minimize infection.
  7. Demonstrate the proper use of gloves, eyewear, gowns and other protective equipment.
  8. Select appropriate chemical germicides with FDA and EPA classifications to disinfect contaminated environmental surfaces.
  9. Identify proper sterilization methods for handpieces.
  10. Follow the proper procedure for the disposal of sharp instruments and infectious waste.
  11. Follow practice recommendations for health-care facilities implementing the U.S. Public Health Service Guidelines for management of occupational exposures to bloodborne pathogens.
  12. Define an occupational exposure that may place a worker at risk for HIV or HBV infection.
  13. Identify factors that may determine the overall risk for occupational transmission of a bloodborne, pathogen and quantify the risk of infection following an exposure.
  14. List the things to do following an exposure to the blood of a patient.
  15. Quantify the risk of infection for HBV, HCV and HIV after an occupational exposure to the blood of a patient.
  16. Describe the treatment for occupational exposure to bloodborne pathogens using vaccination and drugs.
  17. Implement the six recommendations made by the CDC to minimize the risk of HIV or HBV transmission.
  18. Recognize the importance of making available to all employees the hepatitis B vaccine and vaccination series to all employees who have occupational exposure to bloodborne pathogens.

Safer-Needle Devices: Protecting Health-Care Workers

  1. Identify five primary activities associated with the majority of needlestick injuries.
  2. List reported percutaneous and mucocutaneous blood exposures by job category.
  3. Explain the occupational risk posed by HBV, HCV and HIV to a health-care worker.
  4. Cite statistics to indicate the occupational risk of needlestick injuries to health-care workers.
  5. Follow specific guidelines provided to evaluate and select safer-needle devices.
  6. As a health-care employer, develop and implement a comprehensive needlestick program.

A Best Practices Approach for Reducing Bloodborne Pathogens Exposure

  1. Set up a process to identify and select appropriate and effective engineering controls.
  2. Identify precautions that employees should take when cleaning and decontaminating dental instruments.
  3. Establish policies and methods of compliance to eliminate or reduce bloodborne pathogens exposures in the workplace.
  4. Define and differentiate between engineering controls and work-practice controls.
  5. List four exceptions to the use of engineering controls.
  6. Write policies and procedures that detail required work-practice controls.
  7. Discuss requirements for handling contaminated sharp.

Handling Specimens of Blood or OPIM

  1. Describe procedures for handling specimens of blood or other potentially infectious material.
  2. Describe the procedure for cleaning and decontaminating equipment and surfaces.
  3. Define contaminated laundry and describe the procedure for handling contaminated laundry.

Hepatitis B Vaccination and Bloodborne Pathogens Post-Exposure Evaluation and. Follow-Up

  1. Formulate a policy for hepatitis B vaccination series.
  2. Execute an employee declination of hepatitis B vaccination form.
  3. Formulate for your organization post-exposure evaluation and follow-up policy.
  4. Implement warning-labels policy to identify containers of regulated waste, blood or OPIM.
  5. Create an appropriate training program for employees with occupational exposure to bloodborne pathogens
  6. Define and differentiate between regulated waste, medical waste and biohazardous waste.

Table of Contents

1. The OSHA Bloodborne Pathogens Standard 29 CFR 1910.1030

  • What actions led to 0SHVs Bloodborne Pathogens Standard and the Needlestick Safety and Prevention Act?
  • Who is covered?
  • What does the Standard require?
  • Are there other laws to prevent needlesticks?

Occupational Exposure to Bloodborne Pathogens

2. Exposure to Blood. What Health-Care Workers Need to Know

Occupational Exposures to Blood

  • Introduction
  • How can occupational exposures be prevented?

If an Exposure Occurs

  • What should I do if I am exposed to the blood of a patient?

Risk of Infection after Exposure

  • What is the risk of infection after an occupational exposure?
  • How many health-care workers have been infected with bloodborne pathogens?

Treatment for the Exposure

  • Is vaccine or treatment available to prevent infections with bloodborne pathogens?
  • What about exposures to blood from an individual whose infection status is unknown?
  • What specific drugs are recommended for post-exposure treatment?
  • How soon after exposure to a bloodborne pathogens should treatment start?
  • Has the FDA approved these drugs to prevent bloodborne pathogen infection following an occupational exposure?
  • What is known about the safety and side effects of these drugs?
  • Can pregnant health-care workers take the drugs recommended for post-exposure treatment?

Follow-Up After An Exposure

  • What follow-up should be done after an exposure?
  • What precautions should be taken during the follow-up period?

Other Sources of Information

3. Safer-Needle Devices: Protecting Health-Care Workers

Q. What is the purpose of this packet?
Q. What are some questions that may be asked about safer-needle devices and needlestick prevention programs?
Q. What is the epidemiology of needlestick injuries?

  • Figure 1: Locations Where, Percutaneous Injuries and Mucocutaneous Blood
    • Exposures Occurred, U.S. EPINet, 1995
  • Table 1: Health-Care Workers Reporting Percutaneous and Mucocutaneous Blood
    • Exposures, by Occupation, U.S. EPINet, 1995

Q. How serious is the occupational risk of needlestick injuries to health-care workers?

  • Figure 2: Items Most Frequently Causing Sharp­ Object Injuries, U.S. EPINet, 1995

Q. What occupational risk does hepatitis B pose to the health-care worker?
Q. What occupational risk does hepatitis C pose to the health-care worker?
Q. What occupational risk does HIV pose for the health-care worker?

  • Table 2: Health-Care Workers with Documented and Possible Occupation­ally
    • Acquired AIDS/HIV Infection, by Occupation, Reported through December 1998, United States

Q. Why are universal precautions and personal protective equipment not adequate to protect the health-care worker against needlestick injuries?
Q. What is a safer-needle device?
Q. Can safer-needle devices prevent needlestick injuries?

  • Figure 3: Health-Care Workers with Occupationally Acquired AIDS/HIV
    • Infection Cumulative Cases, 1987 through 1996

Q. What are the design features of a safer-needle device?
Q. What are some of the types of safety features used in safer-needle devices?
Q. How can health-care employers evaluate and select safer-needle devices?
Q. What are the steps a health-care employer should consider in developing a comprehensive needlestick prevention program and implementing safer-needle devices?
Q. What is OSHA’s position on safer-needle devices?
Q. What are some resources one can use to update their knowledge of safer-needle devices, needlestick prevention programs, and current statistics about bloodborne pathogens?
Q. What conclusions can be drawn from this information?
References

4. A Best Practices Approach For Reducing Bloodborne Pathogens Exposure

Identifying and Selecting Appropriate and Currently Available Engineering Control Devices

Examples of Engineering Controls

  1. Set Up a Process
    • Participants
    • Participants to Involve in the Process
  2. Define Needs

Needs Assessment Worksheet

  1. Gather Information
    • Categories of Engineering Controls
    • Blood-Collection Devices
    • Blunted Suture Needles
    • Catheter-Securing Products
    • HuberLokTm (for removal of implanted port needles)
    • Injection Equipment
    • I.V. Insertion Devices
    • I.V. Medication Delivery Systems
    • Laboratory Equipment
    • Lancets
    • Medication Access Devices
    • Sharps Disposal Containers
    • Surgical Products
    • Useful Ideas
  2. Test and Select Products
    • Using Screening Criteria
    • Screening Worksheet for Medical Products
    • General Criteria
      • Conclusions
    • Screening Worksheet for Medical Products
    • General Criteria
      • Conclusions
    • Product Testing Worksheet
    • The Testing Process
    • Education and Training
    • “Tools”
    • Protocols
    • Testing Protocol Worksheet
    • Preparatory Stage
    • Design Stage
    • The Selection Process
    • Product Selection Worksheet
      • Conclusions
  3. Use New Products
    • Product Implementation Policy
    • Description of Policy
    • Education and Training
    • Methods
    • Content
  4. Conduct Follow-up

Methods of Compliance

  • Work-Practice and Engineering Controls
  • Engineering and Work-Practice Controls-General Requirements
  • Engineering and Work-Practice Control Improvements
  • Engineering Controls-Specific Requirements
  • New Technology
  • Exceptions to the Use of Engineering Controls
    • Exception 1: Market Availability
    • Exception 2: Patient Safety
    • Exception 3: Safety Performance
    • Exception 4: Availability of Safety Performance Information
  • Work-Practice Controls
  • Work-Practice Controls-Prohibited Practices
  • Requirements for Handling Contaminated Sharps
  • Containers for Contaminated Sharps
  • Regulated Waste-Containers for Disposal
  • Containers for Disposal of Sharps
  • Containers for Disposal of Other Regulated Wastes and Secondary Containers
  • Exceptions to Labeling Requirements for Containers of Regulated Waste
  • Bags of Regulated Waste
  • Handling Specimens of Blood or Other Potentially Infectious Materials
  • Cleaning and Decontaminating Equipment and Surfaces
  • Servicing or Shipping Contaminated Equipment
  • Cleaning and Decontamination of the Worksite
  • General Requirements
  • Specific Requirements
  • Hygiene
  • Laundry
  • Alternative Labeling or Color-Coding of Laundry
  • Personal Protective Equipment
  • Policy on Use
  • Cleaning, Laundering, Repair, Replacement, and Disposal of Personal Protective Equipment
  • Removal of Personal Protective Equipment
  • Masks, Eye Protection, Face Shields, and Respirators
  • Gowns, Aprons, and Other Protective Body Clothing

Hepatitis B Vaccination and Bloodborne Pathogens Post-Exposure Evaluation and Follow-up

  • Hepatitis B Vaccination Series
  • Serological Testing
  • Declining the Hepatitis B Vaccination Series
  • Employee Declination of Hepatitis B Vaccination
  • Post-Exposure Evaluation and Follow-up
  • Confidential Medical Evaluations and Follow-up
  • Information Provided to the Health-Care Professional
  • Health-Care Professional’s Written Opinion
  • Counseling

Communication of Hazards to Employees

  • Warning Labels
  • Alternatives to Warning Labels
  • Information and Training
  • Training Program Elements
  • Frequency of Training

Record-keeping

  • Medical Records
  • Training Records
  • Sharps Injury Log Records
  • Availability of Records
  • Transfer of Records
  • Access to Employee Exposure and Medical Records

Resources

  • Web Sites
  • Scientific and Professional Publications
  • Organizations
  • Governmental Agencies
  • Other Sources

Definitions of Regulated Waste