#7 – Practices all safety procedures

General Policy Statement

AIDS! HEPATITIS! INFECTIOUS DISEASES!

You will be expected to take all necessary precautions to protect yourself while working in our office. It has been estimated that in every 7 working days when you see 20 clients each day you will see: 2 clients with oral herpes, one who is a carrier of Hepatitis (and only 20% will know they are carriers and be able to warn us!), and 1 in 400 may test AIDS antibody positive. You hear a lot of talk about AIDS, but Hepatitis is our primary risk. Almost all of these infectious risks are spread through blood and/or saliva. You stop the risk by cleaning and disinfecting everything and wearing protection so blood and saliva don’t touch you.

Epidemiology of blood borne diseases

a. Hepatitis

  1. 1. 18,000 health care workers will get hepatitis B in 1992 (out of 1,00,000)
  2. 56,000 of them will be hospitalized
  3. 200 will die
  4. Dentistry is high risk because of needle sticks and body fluid contamination

b. HIV

  1. 200,000 diagnosed in U.S. (entire population)
  2. 60% die
  3. One dental worker infected on job

Symptoms of these diseases

a. HB

  1. 1/3 no symptoms
  2. 1/3 flu like symptoms that won’t be diagnosed as Hepatitis
  3. 1/3 severe symptoms: jaundice, fatigue, anorexia, nausea, and rash, fever

b. HIV

  1. 89% of time get virus
  2. Fever, diarrhea, rash, fatigue, joint pain, muscle pain, lymphadnopathy

Modes of transmission of blood borne pathogens

a. HB

  1. Blood
  2. Saliva (but only 1/1000 concentration of blood)
  3. Lesions, dermatitis, needles

b. HIV

  1. Blood
  2. Blood transfusion
  3. Needle stick with HIV contaminated needle (.3%)

Our program will protect you!  This program will tell you how to select, remove, handle, decontaminate, and dispose of personal protective clothing and equipment.

How to recognize occupational exposure
Personal Protection:  When you are working with instruments or emptying the trash, you should wear gloves, mask, and eye protection. Let’s discuss correct procedure.

1. Gloves Remove all jewelry and wash your hands and scrub your nails with an antimicrobial soap (in containers) for 20 30 seconds before putting your gloves on. Change gloves when you change clients. Never wear gloves to front desk area! Take gloves off before picking up folder.

Every time you change gloves, use the aerosol cleaner. Dry your hands completely. This prevents bacterial buildup under the gloves. Change your gloves at least every 1 2 hours. If they begin to feel sticky, it’s time to change. Pick a glove that fits your hand comfortably. We keep several sizes in the PC room. To see if your glove brand is ok, blow up the glove, put it underwater and check for air bubbles. Pin size holes have been found in 1.7 9% of new gloves. The longer a glove is worn, the more holes you will develop. Any chemical that touches the gloves (anesthetic, eugenol, cavity varnish, etc.) speeds this “holing” process.

We keep some dermatological lubricants (lotion) by the sinks behind the operatories. Be sure to clean, dry, and use some of this lubricant to keep your hands healthy. These lubricants should not contain petroleum or oil emollients. These could react with the gloves. If your hands become red, itchy, or scaly, you are experiencing an allergic reaction to either the latex of the glove or the powder. Since there are only three cornstarch manufacturers in the world, all gloves use one of these three brands. That means the allergy is almost always to the latex not the powder.

There are 3 levels of allergic reactions:
1. Contact Dermatitis
a. Up to 50% of glove users experience this
b. Symptoms – redness, dryness, irritation, even cracking in severe cases (within 3-4 minutes)
c. Causes
i. a frequent hand washing
ii. Incomplete rinsing/drying
iii. Cornstarch powder irritation
iv. Heavy perspiration
d. Care
i. Ideal hand washing procedure
ii. Lotions
iii. Gloves with less powder

2. Type IV sensitivity (like poison Ivy)
a. Caused by contact with a specific chemicals added to the latex when manufactured
b. Symptoms – immune reaction 48-72 hours after contact
i. Red, itchy rash
ii. Vesicles or blisters in severe cases
c. Heals in 3-4 days
d. Cure
i. Confirm sensitivity with patch test
ii. Switch to non-latex gloves

3. Type I allergic reaction
a. Caused by contact with latex
b. Symptoms – reaction within 3-4 minutes
i. Itching, burning
ii. Blisters within minutes
iii. Rash, itching
iv. Extreme reaction can be lung spasms and death
c. When gloves are removed, returns to normal in 30 minutes

Try these steps in order to relieve the allergy: 1. Make sure gloves aren’t past expiration date. 2. Switch to another brand of glove that is powder free   3. Use a vinyl glove   4. Use steroid creams or petroleum jelly that contains 2n0   5. Try a cotton liner   6. Never wear the same gloves longer than 1-2 hours   7. Don’t use petroleum based lotions

Warning – In severe allergies, latex particles in the air can cause a reaction.

Uniforms – wear your jacket over your uniform to protect yourself from spatter. Your uniforms will be washed in hot water at the office (140 158 degrees). Bleach is optional. When you get home, ideally shower and change clothes.

Shoes – Leave one pair of shoes in the office and use them during working hours.

Goggles – with polycarbonate lenses or your prescription glasses with side shields.
Wear them at all times when treating clients or cleaning instruments. Wash with glutaraldehyde between clients and rinse with water. Should have side shields

Masks – Worn at all times when cleaning instruments or working with clients. Don’t touch your mask while working with a client. Change your mask twice daily or sooner if visibly soiled or wet due to aerosol spray. Must be able to filter particles 1-5 microns

Minor cuts – Squeeze out blood, wash area, coat with merthiolate, cover with a band-aid, no matter how small

Hair – Clean and away from the face. Don’t touch your hair with gloved hand.

Fingernails – Cut short ¼” long, well manicured, no rings, no false fingernails.

Don’t eat, drink, apply make up, or touch contact lenses in the operatories, business office, or lab areas. Only put food in the refrigerator reserved for food. The other refrigerator contains dental materials that might be contaminated.

Wash your hands with DIAL soap to remove any visible debris, dry your hands, and then use the alcohol based aerosol to control bacteria- continue rubbing until hands are dry. a. At the beginning of the day 1. Remove all rings 2. Wet hands with water 3. Dispense soap onto hands 4. Wash vigorously for 10 seconds using scrubber to get under nails, etc. 5. Rinse for 10 seconds 6. Turn off faucet with paper towel, then dry hands
Use aerosol spray – Between clients
1. Removes old gloves
2. If hands dirty wash with soap
3. No visible soil use aerosol spray
Also at End of shift

Why should we go to all this trouble, we’re wearing gloves anyway?
1. Gloves can be perforated sometimes too small an area for you to notice. 2. Bacteria can multiply under the gloves. 3. If your hands perspire, removes gloves, use aerosol spray, reglove 4. Change gloves a. When they are punctured b. Between clients c. After 1 2 hours with the same client 5. Store gloves in a cool, dry, dark place to protect them

Working in Laboratory

1. Wear gloves, mask, and eye protection 2. Place impressions in separate receiving area 3. Disinfect all impressions before pouring 4. Autoclave ragwheels after each use and change pumice 5. Disinfect all cases when finished before return to client 6. Wear a lab jacket when in the lab

Fire Extinguishers

If a fire breaks out, don’t panic. Tell your doctor. Have a secretary call the fire department. If the fire is large, don’t be a heroine, get out. If the fire is small, you can help your doctor use a fire extinguisher. Fire extinguishers are located: _____________ . They are checked annually to make sure they are still full. If you are using the fire extinguisher, aim the nozzle at the fire. Push hard. It takes more strength than you would imagine. Be ready for a big recoil. Brace yourself. The first burst may not put the fire out. Use a second or third burst if any flames are seen. To check the fire extinguisher, make sure the wire on the gauge is in the white range.

Cuts

If you are stuck or cut, tell your dentist immediately. Excuse yourself from the client. Remove your glove. Squeeze out as much blood as possible. Wash with bactericidal soap and water. Dry. Paint on Merthiolate or triple antibiotic. Put on a Band-Aid and reglove.

Review the client’s medical history. Explain you stuck yourself. Ask if they have any communicable diseases. Hopefully your client is healthy and the above procedure was followed. Tell the office manager and your team leader. Most needlesticks involve a tiny amount of blood. An OSHA form will have to be filled out. However, if the client has a history of hepatitis or other communicable diseases, the client should see a physician. A blood sample will be taken to make sure s/he doesn’t have Hepatitis/AIDS, etc.

Steps to avoid sticks

1. Point sharp ends away from yourself 2. Never recap needles while holding the cap in your hand 3. Always pass sharps with the cutting edge toward you 4. Never pick up sharps by the handful

Material in your eye – If something in your eye causes redness, pain, tears, blurring, or swelling, go to the eye wash station located: _________________.  a. Don’t rub your eyes b. Hold eyelids open and flush for 15 minutes with cold water. c. More eye up/down and side to side to better reach all parts. d. Avoid contaminating your other eye. e. Don’t put any medication in the eye without medical okay.
f. Tell the dentist & Team Leader so an OSHA form can get filled out.
g. You might be sent to an optometrist.

Exposure to chemicals on your skin 1. Remove contaminated clothing 2. Rinse exposed skin with much lukewarm water for 15 minutes 3. If pain or rash continues, seek medical help immediately

Food Management – I believe it is a great idea to have a meal at the office with other members of the staff. This is a great way to get to know people.

Here are some rules to follow for your safety: 1. Don’t eat, drink, apply cosmetics, or handle contact lenses in areas that could be contaminated (operatories, lab area, etc) 2. Don’t store food in the refrigerator that contains dental supplies. 3. Use the microwaves at your convenience 4. Store food in the large refrigerator 5. If you don’t eat in, change your clothes before leaving 6. If you do eat in, it’s best to change your clothes, but at least wear a patient napkin and roll up your uniform sleeves.

Training Sessions – We will provide annual exposure control training sessions. If new information is brought to the doctors’ attention, a special session will be called, or the information will be discussed at a staff meeting. Our annual training session will review the material in the level one manual that relates to your safety here.

This session will include, but not be limited to: 1. What is the OSHA blood borne Pathogens Standard 2. Exposure control for all members of the staff OSHA requires that attendance at these annual sessions be documented. You will be required to sign an attendance sheet that will be part of your permanent file. If you miss this meeting, you will be required to listen to a tape of the meeting and pass a written quiz.

CERTIFICATE OF EMPLOYEE TRAINING IN PPE USE
PURSUANT TO 29 CFR 1910.132

The training required under OHSA’s standard on personal protective equipment has been completed.

As part of this training, employees were informed of the personal protective equipment selected by this office for their use.

I further certify that the employee has demonstrated his/her understanding of this training.

________________________________ _______________ Signature / Date ________________________________ _______________ Trainer / Date