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FAQ's Needlesticks and Sharps Safety

Frequently Asked Questions (FAQs) on Dental Infection Control


Top|Instruments & Equipment|Needlesticks and Sharps Safety


Frequently Asked Questions for Needlesticks and Sharps Safety

Q What should one do if a puncture injury occurs, resulting in bleeding?

Q Are there laws to protect dental workers from needlesticks?

Q How dangerous are needlesticks?

Q What is the opinion of OSAP on the issue of needlesticks versus safety sharps?

Q Is there an existing list of all available safety needles and are there studies on these needles?

Q Is there a way to disinfect anesthetic cartridges before touching them with sterile gloves?

Q If a sterile needle is inserted into the rubber of the anesthetic cartridge without decontamination, is there any risk of infection?

Q What exactly is the 1999 California-OSHA regulation regarding disposable needles?

Q Is it proper for the doctors or hygienists to wrap gauze around their finger in order to clean the instruments they are using?

 

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Q What should one do if a puncture injury occurs, resulting in bleeding?

A If the injury involves exposure to a patient's blood, saliva, or other potentially infectious materials, the dental worker must report the injury to the designated person in the practice as soon as possible. Steps to follow include administering basic first aid, ensuring the device involved in the injury is not reused on the patient, and referral to an appropriate healthcare provider as soon as possible for evaluation and follow-up. More detailed recommendations are provided in the document Exposures to Blood, What Healthcare Workers Need to Know (1). The healthcare provider (usually an occupational health professional) should be knowledgeable in the current Centers for Disease Control and Prevention (CDC) recommendations for post-exposure prophylaxis (2).

References:
(1) CDC. Exposures to Blood, What Healthcare Workers Need to Know. Available at www.cdc.gov/ncidod/hip/BLOOD/exp_blood.htm
(2) CDC. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Morbid Mortal Weekly Rep 2001;50(RR-11). Available at www.cdc.gov/mmwr//preview/mmwrhtml/rr5011a1.htm

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Q Are there laws to protect dental workers from needlesticks?

A While legislation alone cannot prevent needlestick-type injuries, activities in recent years have been targeted at preventing injuries and exposure incidents from occurring. OSHA requires that devices with engineered sharps injury protection be provided by the employer and used in the practice, if such devices are available and effective. OSHA has developed a special FAQ sheet to answer common questions regarding this area of the bloodborne pathogens rule (1).

References:
(1) OSHA. Frequently Asked Questions May 9, 2001. Available at www.osha.gov/needlesticks/needlefaq.html

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Q How dangerous are needlesticks?

A The risk of bloodborne disease transmission depends on the source patient's serologic status, the nature of the exposure, and the healthcare worker's susceptibility. Also, different disease agents have different levels of virulence and therefore pose different degrees of risk. For workers that are unprotected against hepatitis B virus (i.e., those that have not been vaccinated or have not obtained naturally immunity due to resolved infection), the risk of developing serological evidence of infection following exposure to the blood of an HBV-infected patient may range from 23%-62%, depending upon the nature of the exposure (e.g., whether the injury is a puncture wound or a splash to the mucosa, the depth and severity of any percutaneous injuries, the amount of patient material involved, etc.), and the hepatitis B e-antigen (HbeAg) status of the source patient. The average incidence of hepatitis C virus (HCV) seroconversion following a percutaneous exposure to an HCV-infected source is 1.8%. The average risk of HIV seroconversion after percutaneous exposure to infected blood is estimated to be 0.3%. (1)

References:
(1) CDC. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Morbid Mortal Weekly Rep 2001;50(RR-11). Available at www.cdc.gov/mmwr//preview/mmwrhtml/rr5011a1.htm

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Q What is the opinion of OSAP on the issue of needlesticks versus safety sharps?

A Since the use of engineered sharps injury prevention devices is no longer optional, it is important to know the currently available devices and evaluate each for implementation in the individual setting. These devices are not limited to needles, but encompass any sharp device with the potential to expose workers to patient's blood or other potentially infectious materials. At least two resources exist for evaluation of sharps devices in dentistry (1,2). Devices should be carefully screened before being used in clinical practice. Only those devices that appear to work well in "bench testing” outside of patient treatment should be introduced during patient care, and staff must be fully trained in their use.

References:
(1) TDICT. Evaluation tools for dental safety syringes, dental handpiece delivery systems, safety dental gloves and safety dental goggles. Available at http://www.tdict.org/criteria.html
(2) CDC. Sample screening and device evaluation forms. Available at http://www.cdc.gov/oralhealth/infection_control/forms.htm

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Q Is there an existing list of all available safety needles and are there studies on these needles?

A As of June 18, 2002, two safety needles or safety syringes intended for dental use are available. They are the Safe Mate and the Safety Plus. Two studies of safety needles in dentistry have appeared in the peer-reviewed literature to date(1,2). A list of available safety devices are maintained by the University of Virginia's International Health-Care_Worker Safety Center at http://www.med.Virginia.EDU/medcntr/centers/epinet/products.html

References:
(1) Zakrzewska JM, Greenwood I, Jackson J. Introducing safety syringes into a UK dental school--a controlled study. Br Dent J 2001;190:88-92
(2) Cuny E.J., Fredekind, R.E., Budenz, A.W. Dental safety needles' effectiveness: results of a one-year evaluation. JADA 2000 Oct;131:1443-8

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Q Is there a way to disinfect anesthetic cartridges before touching them with sterile gloves?

A Remember that the product inside the cartridge is already sterile. Anesthetic cartridges should not be sterilized because exposure to high temperatures can affect the cartridge contents. Application of chemical germicides likewise is not recommended because of the potential for the germicide to leak into the cartridge. Store anesthetic cartridges in a manner that prevents cross-contamination and eliminates the need for disinfection. Contaminated cartridges should be discarded.

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Q If a sterile needle is inserted into the rubber of the anesthetic cartridge without decontamination, is there any risk of infection?

A With single-use cartridges, the risk of infection is negligible as long as the anesthetic cartridges have been stored in a manner that prevents cross-contamination and standard infection control precautions are applied during handling and use.

Separate precautions may be indicated for multi-use vials in, for example, medical or surgical settings.

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Q What exactly is the 1999 California-OSHA regulation regarding disposable needles?

A
California now requires the use of devices with engineered sharps injury protection (ESIP). The safety device must have built-in injury protection. Safety needles are not required if the employer-practitioner can show objective information that demonstrates the needles are not safer than the devices and practices currently in use in the practice, the devices are not available in the marketplace, or the devices interfere with the delivery of patient care. Employers must evaluate available devices if no reasonably specific and reliable information is available regarding the clinical use of the devices.(1) Evaluation forms and instructions for their use are available online at the CDC Oral Health website (2).

References:
(1) California Department of Industrial relations. CCR Title 8, Section 5193. Bloodborne Pathogens. Available at http://www.dir.ca.gov/title8/5193.html
(2) http://www.cdc.gov/oralhealth/infectioncontrol/forms.htm

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Q Is it proper for the doctors or hygienists to wrap gauze around their finger in order to clean the instruments they are using?

A Wrapping gauze around the finger in order to clean instruments during use is often viewed as an unsafe work practice by dental infection control experts.

While OSAP is not aware of an established official procedure for debridement of instruments at chairside, it is important to keep worker safety foremost in mind.

One suggestion is to try taping four cotton rolls to the bracket tray first. Next, only moisten the two inner cotton rolls. This may solve the problem of the tape not adhering to the bracket tray cover. Although this will not totally eliminate the need to stop during the procedure to remove residual debris, it may be helpful to remove residual debris before picking up the instruments and/or when they are placing it back on the tray.

Other practitioners have suggested taping moistened cotton balls to the edge of the bracket tray as a debridement tool. There are also commercial products, such as sponges with adhesive backing that are available for instrument debridement. You may check with your local dental supplier for vendors in your area.

The authors of OSAP's Interactive Training System states the following:

" Never wipe debris from instrument tips by holding gauze in your hand or with a gauze wrapped around your finger. In addition, you should avoid wiping instruments on your patient's bib. Tape four cotton rolls on the bracket tray cover and wipe debris on these cotton rolls. If you wet one or two of the cotton rolls, it will be easier to clean the instrument tip or blade." (1)

Resource:

1) OSAP's Interactive Training System, 2nd. edition. By Eklund and Bednarsh. Copyright 1999

 

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