Risk of Sharps

Steps to take to avoid injuries from needlesticks

by OLIVIA WANN, RDA, JD

Needlesticks and sharps injuries are a serious hazard in the dental office. Such injuries may expose the dental worker to a potentially grave, lethal risk. The Centers for Disease Control and Prevention (CDC) estimated that health-care workers sustain 385,000 needlestick and other related sharps injuries in hospital-based settings annually, amounting to 1,000 sharps injuries daily.¹ Gathering data in private practice settings is impossible due to a lack of surveillance systems, yet people estimate that these injuries would raise the numbers to well over 500,000.

The most common infections occupationally transmitted via sharps injuries during patient care include hepatitis B, hepatitis C, and HIV. The CDC also notes that the risk includes herpes, malaria, and tuberculosis.²

I founded Modern Practice Solutions in 2000, a compliance firm specializing in dental practices. Therefore, having been a dental employee, a consultant, and now an attorney, I understand the perspectives both of the dental workers and their employers, and the challenges they each face in their day-to-day operations, including the issue of safety. Our company analyzes workflow, audits documentation, and conducts hazard assessments.

We work with dental practices throughout the nation, and we've met hygienists and dental assistants who tell us that they've experienced needlesticks and sharps injuries, and unfortunately, they did not have a protocol in place to ensure proper follow-up as required by law. Some workers fear that an injury imputes poor work performance. Others fear the practice might incur an unnecessary expense.

Recently, the U.S. Department of Labor filed suit against a dentist in Massachusetts. The suit alleges the dentist fired an employee for filing a health hazard complaint with OSHA. According to the complaint filed in U.S. District Court in Boston, the dentist discharged a dental assistant in November 2010 after the employee expressed concerns about an office procedure that required employees to remove protective caps from contaminated needles prior to disposal. The lawsuit seeks the employee's reinstatement and payment of lost wages, benefits, interest, compensatory, and punitive damages.

An inspection resulted in the dentist being cited for eight alleged serious violations of OSHA's Bloodborne Pathogens Standard. The dentist contested those citations and the accompanying $26,400 in proposed fines to the independent Occupational Safety and Health Review Commission. Employers feel the impact of costs related to post-exposure management of health-care personnel ranging from $500 to $3,000 per incident.³

Our goal as consultants is to promote safety. Remember, safety is not optional. Training, policy development, safer medical devices, and engineering controls are important components in compliance with the OSHA Bloodborne Pathogens Standard and in promoting worker safety.

According to the Organization for Safety, Asepsis and Prevention (OSAP), the application of four basic principles of infection control guides workers and patients in staying safe. These include:

1. Take action to stay healthy.
2. Avoid contact with blood and body fluids.
3. Limit the spread of blood and body fluid contamination.
4. Make objects safe for use.⁴

In analyzing the workplace, offices can easily achieve improvements by using a cassette system such as IMS (Instrument Management System) by Hu-Friedy. Whether the dental office is struggling with space issues or endeavoring to achieve greater organization and better time management, practices benefit from the system.

Beyond these benefits, practices promote safety by using cassettes. Injury to workers is significantly minimized when instrument handling is reduced. After use, the contaminated instruments are returned to the cassette and locked into place for transport to the instrument processing area. The cassette is then automatically cleaned in an ultrasonic cleaner or dental instrument washer, followed by drying, wrapping/pouching, and heat sterilization. There is no more time consuming sorting into pouches or pulling individual pouches to prep a tray.

Dental practices can minimize the risk of sharps injuries by avoiding the following safety hazards:

• Not having the proper procedures in place, including step-by-step instrument management and instrument processing protocols.
• Working in a high volume dental setting with insufficient time allotted for treatment room turnaround.
• Transporting loose instruments and sharps on trays through the office and risking bumping into another worker or patient. This is very dangerous and could lead to a sharps injury that could have been prevented through the use of cassettes. According to the CDC, collision with a worker or a sharp represents 10% of the circumstances associated with needlestick injuries.⁵
• Handling contaminated loose instruments with patient exam gloves in the sterilization area rather than with heavy duty, utility gloves.
• Using ponytail holders to retain instrument set-ups during instrument processing. This is a safety issue and also prohibits effective cleaning between instruments during ultrasonic use.
• Improperly retrieving instruments and patient care items with contaminated gloved hands in the office cabinets and drawers. This is a common occurrence because many times there are necessary instruments missing from the tray and the assistant must get up during a procedure to retrieve them.

OSHA refers to engineering and work practice controls to eliminate or minimize employee exposure. According to an OSHA Regional Notice, citation guidelines include:6

(d)(2)(i) — Engineering and work practice controls were not used to eliminate or minimize employee exposure.

(d)(2)(ii) — The employer did not have a system for regularly checking the engineering controls to ensure that safer devices functioned effectively.⁷

Is it a cost burden or a money saver? In analyzing the investment versus the expense, IMS actually saves money through time management. Valuable clinical staff time is best devoted to patient care and infection control rather than sorting instruments into set-ups. Additionally, practices save money by preventing breakage of the instrument tips and loss of instruments as the cassette secures the instruments into place.

We interviewed a few practices that use IMS to get their input on how the cassettes integrate into their instrument processing protocol and instrument management program.

Olivia: Meet Cannon Doan, DDS, of Family Dentistry, PC in Cordova, Tenn. (located near Memphis). Dr. Doan, how long have you been using the Hu-Friedy's Instrument Management System?

Dr. Doan: We've used the system since the fall of 1997. Implementing cassettes into our practice gave us the opportunity to keep up with the latest infection control and safety standards.

Olivia: What are your favorite features of the cassettes?

Dr. Doan: There are many. We love the consistency of instrument set-up for each procedure type. The set-ups are now color-coded and that helps us stay organized. We've observed fewer injuries caused by instrument sticks during instrument processing. Overall, the efficiencies gained in the central sterilization area from using IMS leaves more time for the staff to spend with patients, which contributes to the practice's quality of care and profitability.

Olivia: Dr. Mao is a dentist in Springfield, Tenn. Dr. Mao and I discussed space issues of her central sterilization area. She converted a house into a dental office that features a beautiful reception area and spacious treatment rooms. We talked about the space issues of the small sterilization area. Following an annual OSHA training, Dr. Mao, the staff, and I agreed that incorporating IMS would overcome the challenges of working in a small space. Three years later, they all agree it was a great decision. Dr. Mao, what do you like best about IMS?

Dr. Mao: The organization! It totally makes sense to use the cassettes to save time and maximize space. Our sterilization area is very small; therefore organization is key. Cassettes have eliminated the need to search through cabinets and drawers for instruments, which is very time consuming. From a safety perspective, we're pleased to report a reduction in sharps injuries and potential cross contamination. The system gives me confidence that I'm doing everything I can to make the assistants' and hygienists' jobs easier and safer. In addition, our patients have an improved office perception and sense of security knowing that the instruments are always organized and have been cleaned, packaged, and sterilized.

Olivia: Meet Dr. John Stritikus, a pedodontist and co-owner of Dickson Pediatrics and Brentwood Pediatrics in Tennessee. How have the cassettes helped the efficiency of your practice?

Dr. Stritikus: All instruments needed for a procedure are included in the cassette, sterilized and accessible. Less time is needed to set up for a procedure, which helps increase production, especially in our high-volume pediatric dental practice.

Olivia: Do you feel like parents notice?

Dr. Stritikus: Anyone, parent or otherwise, can see that all cassettes are wrapped and marked "clean" with sterilization tape to ensure safety. This safety component is a big part of our practice philosophy. We treat our patients as if they were our kids.

Olivia: Please elaborate on safety for employees.

Dr. Stritikus: All instruments are held within the cassette, which decreases the chances of injuries when handling instruments. It also helps ensure proper handling. Even in the worst case scenario, if the cassette is dropped, the instruments are still contained because the cassette is locked.

Olivia: Compare using cassettes to not using cassettes.

Dr. Stritikus: Our initial cost is recouped through less time spent sorting instruments or workplace injuries; fewer instruments have been replaced due to breakage compared to before using IMS; fewer mirror heads are scratched; we're more likely to have the instruments we need in the set-up; the system is very simple to learn, and new employees grasp the system from day one.

In summary, when implementing cassettes such as Hu-Friedy's IMS, your office can save time, money, and best of all, promote safety among your clinical team members. Here are some timely reminders to close the gap in your office's safety program and minimize the risk of sharps injuries:

• Provide annual training for your staff on bloodborne pathogens, and retain documentation.
• Carefully review your sharps injury prevention program, including engineering and work practice controls.
• Update your work exposure control plan and ensure workers have access to it.
• Provide annual safe medical device evaluations.
• Implement a post-exposure management plan and carefully review the protocol with your staff.
• Ensure that medical records for employees are current, including documentation on hepatitis B vaccine status, post-exposure reports, and related documentation.

Safety training does not have to be boring. Include the input from each team member whose perspective may provide valuable insight to the practice's safety program. Whether you elect to work with a professional consulting company or launch your own safety program, promote safety every day to ensure your that dental workers have long, healthy careers in dentistry. For more information on OSHA's Bloodborne Pathogen Standard and preventing needlestick injuries, go to http://www.osha.gov/SLTC/bloodbornepathogens/index.html. RDH

Olivia Wann, RDA, JD, attended Tennessee Technology Center as an RDA and graduated from St. Joseph's College with a bachelor of science degree in health-care administration. She graduated from the Nashville School of Law, and is licensed to practice law in Tennessee. She founded Modern Practice Solutions in 2000. For more information, visit www.modernpracticesol.com or email [email protected].

References

1. p. 4, "Sharps Injury Prevention Workbook," CDC, available at www.cdc.gov/sharpssafety/pdf/WorkbookComplete.pdf
2. (same as #1)
3. p. 6, "Sharps Injury Prevention Workbook," CDC, available at http://www.cdc.gov/Sharpssafety/pdf/WorkbookComplete.pdf
4. OSAP, p. 2, "From Policy to Practice: OSAP's Guide to the Guidelines," 2007
5. P. 9, "Sharps Injury Prevention Workbook," CDC, available at http://www.cdc.gov/Sharpssafety/pdf/WorkbookComplete.pdf
6. OSHA, Bloodborne Pathogens Standard, 29 CFR 1910.1030(d)(2)(i)
7. http://www.osha.gov/dep/leps/RegionIV/Sharps-Injuries.doc, accessed on March 22, 2012