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HAZARD CONTROL
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GOVERNMENT REGULATORY
AGENCIESAffecting the dental
office with regards toprotection of employeesand patients frompotential hazardsassociated with tx
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1. Occupational Safety and
Health Administration (OSHA)Requires employers, including those in
the healthcare profession: 1. to establish and carry out a wide
range of procedures designed to protectemployees,
2. implement and maintain employeeexposure-incident records for the
duration of employment plus 30 years,and 3. provide specific protective equipment
(PPE) to protect staff from infectiousdiseases & other potential hazards
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Set specific guidelines for infectioncontrol & disease containment.
Does not have enforcement powerover dental practices but the OSHA
is charged with investigation andenforcement of the CDCsguidelines.
2. Centers for Disease Control
& Prevention (CDC)
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3. Environmental Protection
Agency (EPA) Regulates and registers certain
products used in dental practices,
including surface disinfectants.
It requires products to undergo
and pass specific testingrequirements prior to approval forregistration.
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4. Food and Drug
Administration (FDA) Regulates marketing of medical
devices that include equipment
and disposables items.
It reviews product labels for false
or misleading information andsufficient directions for use.
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Examples of chemicalgermicides regulated by FDA:
1.Antiseptics
2. Disinfectants3. Drugs
4.
Sterilizers
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5. Organization for Safety and
Asepsis Procedure (OSAP) National organization of teachers
practitioners, dental healthcareworkers, and manufacturers, anddistributors of dental equipment andproducts.
Develops and communicates standards
and information on aseptic techniqueto dental practices and educationalinstitutions to assist them in theefficacy of their infection controlprogram
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HAZARD COMMUNICATION
STANDARD EMPLOYEE RIGHT TO KNOW
LAW
-addresses the right of everyemployee to know the possibledangers associated with hazardous
chemicals & other related hazardsin the workplace.
- it requires employers to provide
methods for corrective action.
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Requisites to comply w/ HCS1. The dentist must develop &
implement a written compliance
program which include:a. exposure control plan
b. written hazard communication
programc. waste and sharp handlingmanagement
d. injury & illness prevention
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2. The dentist must also ensure thathazardous chemicals used in theoffice are properly labeled andhazardous substances havecorresponding MSDS available forstaff training and review.
3. The dentist must designate aprogram coordinator to providestaff training to new employees &once annually thereafter.
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Common hazardous materials
used in the dental office1. Mercury- used in silver filling
material to create amalgam2. Nitrous oxide sedation gases-
used for conscious sedation
3. Chemicals for dental x-rayprocessing- developer & fixer
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If mercury spill occurs, ADA
recommends the ff:1. If the spill occurs on carpeted floors, do
not use a vacuum cleaner to pick upthe droplets.
2. Pick up all visible droplets with anarrow bore tubing connected by awash-bottle trap to a low volume
aspirator on the dental unit. The trapbottle connections keep the mercuryin the bottle and prevent it from beingsucked back into the dental unit.
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3. Use adhesive tape to cleanup small spills.
4. If the spilled mercurydroplets cannot be reached,
dust sulfur powder on themto form a film coating ontop of the droplets
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5. Keep a commercialmercury spill kit on
hand. Follow themanufacturersdirections & documentthe circumstances of
the spill with the dateand the cleanupprocedure used.
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* Warning labelsmust beattached tocontainers,products andotherhazardousmaterials usedin the dentaloffice
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Label of these products mustinclude:
1. Identity of the chemical
2. Appropriate hazard warning
( including route of entry &target
organ)3. Name & address of themanufacturer
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Members of the dental healthteam should familiarize
themselves with the labels ofhazardous substances & beaware of how to clean up spills
or handle other emergenciesthat may arise when handlingthese products.
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Hazardous spill kit includes:
A. Absorbent material - to soak upthe liquid
B. Scooping device- for a no-touchmethod to pick up the material
C. Hazardous waste bag with abiohazard warning label
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MSDS-(Material Safety DataSheets)
- provides written information about thecontent & potential hazard of specificproducts
- Each potentially hazardous productmust have a corresponding MSDS onfile in the office
- Must be provided by the manufacturersor suppliers of products but it is thedentists responsibility to ensure thatthese sheets are obtained & kept up to
date
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OSHA requires each MSDScontain:
1. Identification (chemical andcommon names)
2. Hazardous ingredients3. Physical and chemicalcharacteristics(boiling point, vapor pressure,etc)
4. Fire and explosion data5. Health hazard data6. Reactivity data
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7. Spill and disposal procedures
8. Protection information
9. Handling and storage precautions,including waste disposal
10. Emergency and first aid
procedures11. Date of preparation of the MSDS
12. Name and address of the
manufacturer
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When is this conducted:
A. Provide for new employeesat the beginning ofemployment
B. Whenever a new
hazardous material isintroduced into the office
C. At least annually
thereafter
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Training must include:
a. Hazards of chemical & properhandling
b. The operation where hazardouschemicals are used
c. The availability of MSDSs
d. An explanation of the labeling ofhazardous chemicals
e. An explanation of OSHAguidelines
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Reducing Hazards in theDental Office
1. Keeping the number of hazardousmaterials to a minimum
2. Reading all product labels andfollowing direction for use
3. Storing hazardous chemicals in theiroriginal containers
4. Keeping containers tightly closed orcovered when not in use
5. Avoiding the combination of 2 or more
known hazardous chemicals
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6. Wearing appropriate personalprotective equipment (PPE) when usinghazardous chemicals or when there is
potential for accidental exposure oncontact with body fluids
7. Washing and thoroughly drying hands
before and after wearing gloves8. Keeping the office well ventilated and
avoiding skin contact with knownhazardous substances
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9. Keeping a
functionalfireextinguisher
in the office
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10. Knowing proper cleanupprocedures in the event of a
chemical spill
11. Disposing of all hazardous
chemicals and othersubstances in the accordancewith MSDS instructions or theproduct label
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Blood borne PathogensFinal Standard
- the most significant OSHA regulationaffecting healthcare practices.
- designed to protect dental officeemployees by limiting exposure toblood, saliva & other PIMS (potentiallyinfectious materials)
BBP- producing microorganism thatmay infect human
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Waste Management
Regulated medical waste
- liquid or semi-liquid body fluid
- this includes any items in the dentaloffice contaminated with regulatedwaste (ex. Cotton rolls or gauze) thatreleases bioburden when compressed
- items caked with dried body fluid thathave the potential to release bioburdenduring handling, contaminated sharps,and pathological & microbial wastes
containing body fluid
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Disposable sharps
Ex.- needles, scalpels,
burs, ortho wiresMust be disposed of in
puncture- resistant,
color-coded or labeled,red, closable, leak proofcontainers.
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Needles must berecapped using aone-handedscooping methodor a mechanical
device
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OSHA requires that full sharpscontainers be removed from the
office within 7 days of reaching thefill line on the container
Other regulated waste products,including those items saturated orvisibly caked with blood or saliva,must be disposed of in closable,leak-proof bags or covered
containers.
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The containersmust either be
red or have abiohazardwarning label ortag affixed tothem, readablefrom a distance of5 feet.
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- Contaminated refuse must bekept covered at all times.
- Receptacles must have a
properly fitting lid, preferablyone that can be opened usinga foot pedal
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Types of waste
Basic types:
1. Regulated medicalwaste
2. Non-regulatedmedical waste
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Contaminated waste
Items that have hadcontact with blood or
other body secretions
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Hazardous waste
Waste posing a risk
or peril to humanbeings or theenvironment
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Infectious waste
Waste capable ofcausing an infectious
disease
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Regulated waste
Infectious medical
waste that requiresspecial handling,
neutralization, anddisposal
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HEPATITIS B VACCINE
Required by OSHA to beadministered to all full-time
employees who are potentialrisk for bloodbornepathogens.
Must be made to allemployees at nocost/charge.
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Exposure Incidents
Consists of specific eye,mouth, or other mucous
membranes, non-intact skinor parenteral contact withblood or other PIMS that
directly results from theperformance of anemployees duties
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What to do? 1.Stop immediately
2.If it involves hands, remove the gloves
3.Injury should be treated with scrupulousfirst aid measures including the the ff.
a. if bleeding, squeeze it gently until a small
amount of blood is releasedb. wash hands thoroughly with antimicrobialsoap and water that is comfortably warm tohot
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c. after drying, apply a smallamount of antiseptic and coverwith bandage
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Waterline biofilms- these are film-forming microbes whichexcrete a glue-like substance that
anchors to the metals, plastic, tissue &soil particles.
- they attach themselves to the innersurfaces of plastic tubings used to keephandpieces cool and supply air-watersyringes where they create an idealenvironment for growth
Measures to improve the quality of
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Measures to improve the quality ofwater in their lines and minimize
disease transmission At the start of each day, run and discharge
water from the dental unit waterlines forseveral minutes
Run highspeed handpieces to release air andwater for 20-30 seconds after each patient
Always follow the manufacturers instructionsfor proper maintenance of handpieces and
waterlines Consider the options to improve water quality
such as special filters, chemical therapeutics,and separate water reservoirs
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FIRE AND EMERGENCYEVACUATION PROCEDURES
Employers are required by OSHA to have awritten fire safety policy consisting of training& the use & maintenance of fire extinguishers
Diagram must be provided that clearly marksthe exit routes in the event of fire
Posting of emergency phone #s forpolice,fire, and rescue is also required
Written evacuation & safety proceduresshould be provided in the areas susceptible toweather conditions, including hurricane,tornadoes, floods, and earthquakes
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The dentist has the legal responsibilityof looking after the protection of
employees & patients from potentialhazards associated with dentaltreatment but may delegate it to his
office manager or safety coordinator