#17 – Safe Handling of Hazardous Materials | Dental Practice Coaching

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#17 – Safe Handling of Hazardous Materials

General Policy Statement

HAZARD COMMUNICATION PROGRAM COMMITMENT

This dental office is firmly committed to providing each of its employees a safe and healthy work environment. It is a matter of office policy as well as an important public program under the OSHA Act. We have implemented this Hazard Communication Program as outlined herein. Safe handling of hazardous materials is like wearing a seatbelt – expensive and uncomfortable, then, one day, it will save your life. Dr. ________ will have the overall responsibility for coordinating the program for the office located at ______________________. ACCESS TO THE WRITTEN PROGRAM All, or any part of this written Hazard Communication program is available to employees, their designated representatives, the Assistant Secretary of Labor for Occupational Safety and Health (OSHA), and the Director of the National Institute for Occupational Safety and Health (NIOSH). This is available from the person named above for review and copying. GENERAL A. Our office will rely on material safety data sheets (MSDS) from our suppliers to meet hazard determination requirements. B. The purpose of this program is to ensure that this office is in compliance with the OSHA Hazard Communication Standard (HCS) 29 CFR 1910.1200. C. Every hazardous substance known to be present in the workplace will be listed on the “hazardous chemicals Inventory”. D. The identity of the substance appearing on the “Hazardous Chemicals Inventory” will be the same name that appears on the manufacturer’s label, in house label, and the MSDS for that substance. E. The “Hazardous Chemicals Inventory” will serve as an index to the MSDS’s files.

MATERIAL SAFETY DATA SHEETS

A. A material safety data sheet (MSDS) containing the information required by the Hazard Communication Standards will be kept for each substance listed on our “Hazardous Chemicals Inventory.” The MSDS will be the most current one supplied by the chemical manufacturer, importer, or distributor. You have the right to view these. B. For each new chemical ordered an MSDS shall be required with the shipment. The chemical’s name shall be added to the “Hazardous Chemicals Inventory” and the MSDS to the MSDS book. C. The MSDS’s are filed in __________ and are readily accessible to employees during working hours. MSDS DEFINITIONS A material safety and data sheets (MSDS) containing the information required by the Hazard Communication Standards will be kept for each substance listed on our “Hazardous Chemicals Inventory”. Many words have very specific uses in hazardous communications. The following definitions will make it easier for you to read these manufacturers sheets. Don’t try to memorize them. If you see one of those words on a label, use this as a dictionary reference.

Acute Effect An adverse effect with severe symptoms occurring very quickly, as a result of a single excessive over exposure to a substance.

Acute Toxicity – The adverse effects resulting from a single excessive overexposure to a substance. Usually a figure denoting relative toxicity.

Asphyxiant – A vapor or gas that can cause unconsciousness or death by suffocation. Most are associated with a lack of sufficient oxygen to promote life.

Boiling Point – Temperature at which a liquid turns to a vapor state. This term is usually associated with the temperature at sea level pressure when a flammable liquid gives off sufficient vapors to promote combustion.

“C” or Ceiling – In terms of exposure concentrations, this is the number that should never be exceeded even for a short period, for a substance.

Carcinogen – A substance capable of producing cancer in mammals.

CC Cubic Centimeter – A volume measurement usually associated with small quantities of liquid. One quart has 946 cubic centimeters.

Chronic Effect – An adverse effect with symptoms that develop or recur very slowly, or over long period of time.

Chronic Toxicity – The adverse effects resulting from prolonged or repeated exposures to a substance, usually used as an indicator or relative toxicity for exposures over great lengths of time.

Combustible – A term used to classify liquids, gases or solids that will burn readily. This term is often associated with “flash point”, which is a temperature at which a given material will generate sufficient vapors to promote combustion.

Concentration – A figure used to define relative quantity of a particular material. Such as a mixture in air of 5 ppm acetone in air.

Corrosive – A material with the characteristic of causing irreversible harm to human skin or steel by contact.

Decomposition – The breakdown of materials or substances into other substances or parts of compounds. Usually associated with heat or chemical reactions.

Dermal – Used on or applied to the skin.

Dermal Toxicity – The adverse effects resulting from exposure of a material to the skin usually associated with lab animal tests.

Distributor – a business, other than a chemical manufacturer or importer, which supplies hazardous chemicals to other distributors or to manufacturing purchasers.

Evaporation Rate – The rate at which a liquid material is known to evaporate, usually associated with flammable materials. The faster a material will evaporate, the sooner it will become concentrated in the air, creating either an explosive/combustible mixture or toxic concentration, or both.

Exposure/ Exposed – an employee is subjected to a hazardous chemical in the course of employment through any route of entry (inhalation, ingestion, skin contact or absorption, etc.) and includes potential (e.g., accidental or possible) exposure.

Flammable – a chemical that falls into one of the following categories: 1. Aerosol, flammable an aerosol that, when tested by the method described in 16 CFR 1500.45, yields a flame projection exceeding 18 inches at full valve opening, or a flashback (a flame extending back to the valve) at any degree of valve opening. 2. Gas, flammable a. A gas that, at ambient temperature and pressure, forms a flammable mixture with air at a concentration of thirteen (13) percent by volume or less; or b. A gas that, at ambient temperature and pressure, forms a range of flammable mixtures with air wider than twelve (12) percent of volume, regardless of the lower limit; 3. Liquid, flammable any liquid having a flashpoint below 100 degrees F (37.8 C), except any mixture having components with flashpoints of 100 F (37.8 C) or higher, the total of which make up 99 percent or more of the total volume of the mixture. 4. Solid, flammable a solid, other than a blasting agent or explosive as defined in 1910.109(a), that is liable to cause fire through friction, absorption of moisture, spontaneous chemical change, or retained heat from manufacturing or processing, or which can be ignited readily and when ignited burns so vigorously and persistently as to create a serious hazard. A chemical shall be considered to be a flammable solid if, when tested by the method described in 16 CFR 1500.44, it ignites and burns with a self sustained flame at a rate greater than one tenth of an inch per second along its major axis. Flashpoint the minimum temperature at which a liquid gives off a vapor in sufficient concentration to ignite. Foreseeable emergency any potential occurrence such as, but not limited to, equipment failure, rupture of containers, or failure of control equipment which could result in an uncontrolled release of a hazardous chemical into the workplace.

General Exhaust – A term used to define a system for exhausting or ventilating air from a general work area. Not as site specific as localized exhaust.

“G” Gram – A unit of weight. One ounce equals about 28.4 grams.

Hazard Chemical – Any chemical, which is either a physical or health hazard.

Hazard – warning any words, pictures, symbols, or combination thereof appearing on a label or other appropriate form of warning which convey the hazards of the chemical(s) in the container(s).

Health hazard – one that include cancer causing, toxic, or highly toxic agents, reproductive toxins, irritants, corrosives, sensitizers, hepatoxins, nephrotoxins, agents that act on hemopoetic system, and agents that damage the lungs, skin, eyes, or mucous membranes. The term “health hazard” includes chemicals which are carcinogens, toxic, or highly toxic agents, reproductive toxins, irritants, corrosives, sensitizers, hepatotoxins, nephrotoxins, neurotoxins, agents which act on hematopoietic system, and agents which damage the lungs, skin, eyes, or mucous membranes. Appendix A provides further definitions and explanations of the scope of health hazards covered by this section, and Appendix B describes the criteria to be used to determine whether or not a chemical is to be considered hazardous for purposes of this standard.

Ignitable – A term used to define any liquid, gas, or solid which has the ability to be “ignited” which means having a flash point of 140 degree F or less. Immediate use that the hazardous chemical will be under the control of and used only by the person who transfers it from a labeled container and only within the work shift in which it is transferred. Incompatible Materials that could cause dangerous reactions from direct contact with one another.

Ingestion – Taking in of a substance through the mouth.

Inhalation – The breathing in of substance in the form of a gas, liquid, vapor, dust, mist, or fume.

Inhibitor – A chemical added to another substance to prevent an unwanted change from occurring.

Irritant – A chemical that causes a reversible inflammatory effect on the site of contact however is not considered a corrosive. Normally, irritants affect the eyes, nose, skin, mouth, and respiratory system.

LC Lethal Concentration – In lab animal tests, this is the concentration of a substance which is sufficient to kill the tested animal.

LC50 Lethal Concentration 50 – In lab animal tests, this is the concentration of a substance required to kill 50% of the group of animals tested.

LD Lethal Dose – The single dose concentration of a substance required to kill 50% of the lab animals tested.

L.E.L. Lower Explosive Limit – The lowest concentration, or percentage in air, of a vapor or gas that will produce a flash fire when an ignition source is introduced.

Local Exhaust – The system for ventilating or exhausting air from a specific area such as in welding operations. More localized than general exhaust.

Material safety data sheet (MSDS) – means written or printed material concerning a hazardous chemical, which is prepared in accordance with paragraph of this section.

Melting Point – The temperature at which a solid changes to a liquid.

mg Milligram – A unit of measurement of weight. There are 1000 mg in one gram of a substance.

mg/m3 Milligrams per Cubic Meter – A unit of measurement usually associated with concentrations of dust, gases, or mists in air.

mppcf Million Particles per Cubic Foot – A unit of measure usually used to describe airborne particles of a substance suspended in air. Mixture any combination of two or more chemicals if the combination is not, in whole or in part, the result of a chemical reaction.

Mutagen – A substance or agent capable of altering the genetic material in a living cell. Normally associated with carcinogens

NFPA National Fire Protection Associated – An organization that promotes fire protection/prevention, and establishes safeguards against loss of property and/or life by fire. The NFPA has established a series of codes identifying hazardous materials in order of flammability, with 0 being non burnable up to 4 which means it will burn spontaneously at room temperature.

Olfactory – Relating to the sense of smell.

Oral – Used in or taken through the mouth into the body.

Oral Toxicity – A term used to denote the degree at which a substance will cause adverse health effects when taken through the mouth. Normally associated with lab animal tests.

Oxidizer – a chemical other than a blasting agent or explosive as defined in 1910.109(a), that initiates or promotes combustion in other materials thereby causing fire either of itself or through the release of oxygen or other gases.

Oxidizing Agent – A chemical or substance that brings on oxidation reactions by providing the oxygen to promote oxidation.

PEL Permissible Exposure Limit – An exposure concentration established by the Occupational Safety & Health community, which indicates the maximum concentration for which no adverse effects will follow.

Physical hazard – a chemical for which there is scientifically valid evidence that it is a combustible liquid, a compressed gas, explosive, flammable, an organic peroxide, an oxidizer, pyrophoric, unstable (reactive) or water reactive.

PPB Parts per Billion – A unit of measurement for the concentration of a gas or vapor in air. Usually expressed as number of parts per million parts of air.

PPM Parts per Million – A unit of measurement for the concentration of a gas or vapor in air. Usually expressed as number of parts per million parts of air.

Pyrophoric – a chemical that will ignite spontaneously in air at a temperature of 130 F (54.4 C) or below.

Reactivity – The term, which describes the tendency of a substance to undergo a chemical change with the release of energy, often as heat.

Reducing Agent – In an oxidation reaction, this is the material that combines with oxygen.

Respiratory System – The breathing system, including the lungs and air passages, plus their associated nervous and circulatory components.

Responsible party – someone who can provide additional information on the hazardous chemical and appropriate emergency procedures, if necessary.

Sensitizer – A substance that on first exposure causes little or no reaction, however, with repeated exposure would induce a marked response not necessarily to the exposure site. Usually associated with skin sensitization.

Specific chemical identity – the chemical name, Chemical Abstracts Service (CAS) Registry Number, or any other information that reveals the precise chemical designation of the substance.

Specific Gravity – The weight of a material compared to the weight of an equal volume of water. Usually expresses a material’s heaviness. A material with a specific gravity of greater than 1.0 will sink to the bottom of water, whereas a material with a specific gravity of less than 1.0 will float on top of water.

STEL Short Term Exposure Limit – The maximum allowable concentration of a substance that one can be exposed to for less than 15 minutes and not produce adverse health effects.

Teratogen – A substance or agent, usually associated with cancer, that when exposed to a pregnant female will cause malformation of the fetus. Usually associated with lab animal tests.

TLV Threshold Limit Value – A term used by the Occupational Safety & Health community to describe the airborne concentration of a material to which nearly all persons can be exposed to day in and day out, and not develop adverse health effects.

Toxicity – The sum of adverse effects of exposure to materials generally by mouth, skin, or respiratory tract.

TWA Time Weighted Average – The airborne concentration of a material to which a person can be exposed over an 8 hour work day (an average).

UEL Upper Explosive Limit – The highest concentration of a gas or vapor in air that will sustain or support combustion, when an ignition source is present.

Unstable (reactive)-  a chemical which in the pure state, or as produced or transported, will vigorously polymerize, decompose, condense, or will become self reactive under conditions of shocks pressure or temperature.

Vapor Density – A term used to define the weight of a vapor or gas as compared to the weight of a vapor or gas as compared to the weight of an equal volume of air. Materials lighter than air have a vapor density of less than 1.0, whereas materials heavier than air have a vapor density greater than 1.0.

Vapor Pressure – A number used to describe the pressure that a saturated vapor will exert on top of its own liquid in a closed container. Usually, the higher the vapor pressure, the lower the boiling point, and therefore the more dangerous the material can be, if flammable. Water reactive a chemical that reacts with water to release a gas that is either flammable or presents a health hazard.

Carcinogen – a chemical that can cause cancer Corrosive a chemical that causes visible destruction of, or irreversible alterations in, living tissue by chemical action at the site of contact following an exposure period of four hours. This term shall not refer to action on inanimate surfaces.

Highly toxic – a chemical that can kill you more quickly than a chemical labeled toxic (sed toxic)

Irritant – a chemical, which is not corrosive, but which causes a reversible inflammatory effect on living tissue by chemical action at the site of contact.

Sensitizer – a chemical that causes a substantial proportion of exposed people or animals to develop an allergic reaction in normal tissue after repeated exposure to the chemicals

Toxic – a chemical falling within any of the following categories: 1. A chemical that can kill you when taken orally When administered by continuous contact for 24 hours (or less if death occurs within 24 hours) with the bare skin 3. When breathed Target organ effects the following is a target organ categorization of effects, which may occur, including examples of signs and symptoms and chemicals that have been found to cause such effects. These examples are presented to illustrate the range and diversity of effects and hazards found in the workplace, and the broad scope employers must consider in this area, but are not intended to be all inclusive.

Labeling

It is impossible to remember all of the hazardous materials you’ll come in contact with. For this reason, we use hazardous labels. Here are some precautions for our labels. 1. Never remove or deface a hazardous label from a container 2. Make sure the bottle is labeled 3. Make sure all labels are easy to read

DENTAL OFFICE SAFETY

The following general descriptions deal with several groups of chemicals that may be in products handled in the dental office. The hazard potential depends on the amount of exposure and individual sensitivity. In most dental offices the amounts of chemicals and the risks should be small. The risks and hazards can be further reduced if recommended procedures and precautions are taken. For information on specific products, always refer to the material safety data sheets (MSDS) . If any of the information here varies from that on an MSDS, always rely on the MSDS first and foremost.

General Precautions – Handle chemicals properly in accordance with manufacturer instructions. Avoid skin contact with chemicals. Minimize chemical vapor in the air. Do not leave chemical bottles open. Do not use flame near flammable chemicals. Do not eat or smoke in areas where chemicals are used. When appropriate, wear protective eyewear and masks. Know proper cleanup procedures. Dispose of all hazardous chemicals in accordance with MSDS instructions and applicable local, state and federal regulations.

List of Hazardous Chemicals – Here is a list of the hazardous materials we use in dentistry and their hazardous component. It is the responsibility of the chemical manufacturer or importer to determine if their material will be hazardous to us. They will note those hazards on their labels (flammable, causes skin irritation, etc.) Review this section for updates once or twice a year. A similar list can be found on the wall next to the staff bathroom.

CHEMICAL NAME                MAY BE FOUND IN

Acetic acid                                Photographic solutions

Acetone Solvents                    Adhesives Impression kits

Aluminum oxide                     Polishing disks

Articaine, Asbestos                Some cast ring liners

Battery fluids                          Batteries

Benzene, Benzoyl peroxide    Resin systems, denture resins

Beryllium                               Nickel based casting alloys

Butane
Calcium carbonate                 Polishing agents

Carbon tetrachloride               Solvents

Catalysts                                    Caustics

Chloroform                               Solvents

Chromium                                Casting alloys

Cleaning agents

Cobalt                                        Casting alloys

Copper                                       Amalgam, casting alloys

Cresol, all isomers                    Endodontic materials

Cyanide as CN                           Plating solutions

Detergents

Dibutylphthalate                       Impression materials

Etching agents

Ethyl acetate                               Solvents

Ethyl acrylate                             Resins

Ethyl alcohol                              Solvents, sterilizing agents

Ethyl chloride                            Solvents, topical refrigerants

Ethyl silicate                              Silicate investments, impression materials (condensation silicones)

Ethylene oxide                         Sterilizing agents

Flammables

Fluoride dust                          Fluoride containing composites

Formaldehyde                          Sterilizing agents

Glutaraldehyde                        Sterilizing agents

Hydrochloric acid                   Pickling solutions, bleaching agents

Hydrogen fluoride                  Etching agents for porcelain

Hydroquinone                        Methacrylate and denture base resins, photographic solutions

Iodine                                      Iodophor disinfectants and antimicrobial hand cleansers

Isopropyl alcohol

Solvents, wiping agents

Janitorial supplies

Lead/inorganic lead                impression materials (some compounds polysulfides)

Lidocaine

LPG (liquid petroleum Burners gas)

Mercury                                   Amalgam

Mercury, organic                   Topical antiseptics

Methyl acetate                         Solvents

Methyl alcohol                           Denatured alcohol

Methyl methacrylat                  Denture base resins

Methylene chloride                     Solvents

Molybdenum, insoluble              Casting alloys (chromium compounds cobalt alloys, stainless steel)

Nickel, metal                         Nickel based casting alloys, soluble compounds stainless steel orthodontic appliances

Nitric acid                              Pickling solutions, some bleaching solutions

Nitrous oxide                        Nitrous oxide

Oil mist, mineral                    Handpiece lubricants

Petroleum distillates             Solvents, waxes, jellies

Phenol                                     Disinfectants

Phosphoric acid                    Etching agents, phosphate cements

Phthalic anhydride               Resins

Picric acid                              Pickling agents

Plastics

Platinum, soluble salts            Impression materials (addition silicones)

Platinum                              Casting alloys

Propane                                Burners

Resins,  Rouge                    Polishing agent

Silica, amorphous            Composite resins, impression including natural materials diatomaceous earth

Silica, crystalline              Composite resins, porcelain;(quartz) investments

Silicon carbide                 Polishing disks, cutting wheels

Silver, metal                 Amalgam, endodontic points, soluble compoundscasting alloys,
photographic solutions

Solvents, Sulfuric acid          Etchant for alloys, copper plating solutions

Talc, nonasbestos form           Gloves

Tantalum                                 Nickel chromium cobalt alloys

Tin, inorganic compounds      Amalgam, polishing pastes

Tin, organic compounds              Impression materials (condensation silicones)

Titanium dioxide                    Porcelain, impression materials

Toluene                                    Solvents

Trichloroethane                    Solvents

Uranium, insoluble                Porcelain compounds

Vinyl chloride                            Maxillofacial plastics, mouth guard trays

Xylene                                       Solvents

Zirconium compounds            Porcelain, polishing pastes

Look for other chemicals that are potential hazardous using these resources: 1. Regulated by OSHA in 29C FR Part 110, Subpart 2, Toxic and Hazardous Substances 2. Included in the American Conference of Government Industrial Hygienists latest edition of Threshold limit values for Chemical Substances and Physical Agents In the Work Environment. 3. Found to be suspected or confirmed carcinogens by the National Toxicological Program in the latest edition of the Annual Report on Carcinogens, or by the International Agency for Research on Cancer in the latest edition of their monograms. Current Inventory of Chemicals
Updated February 2004
Acclean Foam Fluoride
Aerospence Iso Alcohol
AH 26 Complete Kit
Alginate flavors
Alginate impression material (Aquasyl / Splash/ Blue Bite) Aluminum oxide abrasive Aluwax bite and impression wax Amalgam bond adhesive agent Ancef (cefazolin)
Anti Bacterial hand soap
Atropine .4mg/ml 20ml MDV
Arestin
Auto A developer Auto B fixer
Autoclave Cleaner
Bacatifoam Hand Disinfectant
Bio Gide Membrane
Bite wax(white)
Caries Indicator
Cavity varnish
Cefazolin 1gm/10ml
Cetacaine
Clearfil Liner Bond
Clearfil Repair Kit Cleocin (clindamycin)
Clorox bleach Coe comfort tissue conditioner Coe Soft Lubricant
Condensation Putty
Coperwax Bite Wafers Crest White Strips
Dino Fluoride toothpaste
Denta-phene instrument cleaner – disinfect Dentastone Yellow
Dentin Block
Denmat Desensitizer
DieKeen Green
Disinfectant spray Duraflor Sodium varnish
Duraphat
DXXS Developer and Fixer
Endo Ice
Ephedrine 50mg/ml 1ml amp c5
Esthet-x Flow
Esthet-x Improved Easy Twist
Etch-rite bulk Etching gel
Eucalyptus oil Eugenol USP Expa-sys retraction system
First Aide Save A Tooth
Fixodent samples
Fluoridex Daily Defense
Fugi lining Cement
Fugi Lining Liquid
Gelclair Unit dose
General-purpose cleaner Germicide concentrate Gloves –Nitrile, Synthetic, Latex
Gluteraldehyde 2.5%
Hard inlay wax Heat Cure denture base acrylic liquid Heat cure denture base acrylic powder Hemodent Impression compound Impression tray adhesive Insta Dent Developer and Fixer
Insure Poreclain Bond system
Isocaine 3% Plain
Isopropyl rubbing alcohol Jet Fresh prophy paste powder Lab plaster Lidocaine hydrochloride 2% & epinephrin Liquid Dial
Marcaine HCI 0.50% w/ Epinephrine 1.2 Metaplex-calc Hydrdo w lodoform
Methyl Alcohol Micro torch Butane refill
Midazolam 1gm/ml 5 ml
Midwest Handpiece cleaner MQ Lurbricant
Nabuphine 10mg/ml 5ml
Naloxone 4mg/ml 1ml
Nitrous oxide One touch Topical anesthetic gel
Opalescence Toothpaste
Opalescence Whitening Gel
Opotow temporary cement Orange solvent Orthodontic Powder
Orthodontic resin liquid Orthodontic resin separator Osteograph boen fill material
Oxygen Panavia F Kit light
Pascord w/Aluminum Sulfate
Perioglass
Perioxide
Perio RX oral rinse Pink base plate wax Prep Wet Kit
PT Pulp treatment #1 liquid
Quattrocare spray
RC prep
Red Coat Disclosing Tabs
RelyX Temp Ne Temporary Cement Non-Eugenol
Rembrant plus Tp
Rembrant Virtual Lightening Kit
Romazicon .1 mg/5ml C4
Sani/vac Septocaine 4% w EPI
Silane Primer
Sticky wax sticks SureFil Refill
Swissdent wax
Tartar, stain & cement remover Temp-Bond NE
Temporary cement accel. Temporary cement base
Tetric Ceram Cavifil
Ti-core Ultradent U seal light curing pit & fissure sealant
Ultradent Perma Dry
Valiant snap-set amalgam alloy capsules Visco-gel Tissue treatment kit Yellow bite wax Zilactin

Examples of Safe Handling of Hazardous Materials

The following pages list various hazardous materials and our safety procedures. Learn them. When you know how to handle these materials safely, have one of the dentists “check you out.” Material Safety Data Sheets are available.

The following pages (F1 to Fg) are furnished by OSHA to help you understand the MSDS.
Here are some general precautions: Handle chemicals properly in accordance with manufacturer instructions.  Avoid skin contact with chemicals. Minimize chemical vapor in the air. Do not leave chemical bottles open. Do not use flame near flammable chemicals. Do not eat or smoke in areas where chemicals are used. When appropriate, wear protective eyewear and masks. Know proper cleanup procedures. Dispose of all hazardous chemicals in accordance with MSDS instructions and applicable local, state, and federal regulations. Never throw away any material safety data sheets that come with materials give them to your dentist. He will review them to make sure they are complete. Manufacturers MSDS are available labeled “MSDS”. All incoming hazardous materials/chemicals need to be labeled when unpacked.

Acid Etch solutions and gels Examples: Solutions and gels for acid etch techniques associated with placement of composites, sealants, and orthodontic brackets usually contain phosphoric acid. Hazards: Acid burns and possibly sloughing of tissue, eye damage. DO: Handle acid soaked material with forceps or gloves. Clean spills with a commercial acid spill cleanup kit. Avoid skin or soft tissue contact. Rinse with a large amount of running water in case of eye or skin contact.

Flammable Gases Examples: Nitrous oxide and oxygen, liquefied petroleum gas (LPG). Hazards: Fire. DO: Test periodically for leaks. Avoid contact between compressed oxygen gas and lubricants or grease. Avoid having sparks or flames near flammable gases.

Flammable liquids Examples: Solvents such as acetone and alcohol. Hazards: Fire or explosion. DO: Store flammable liquids in tightly covered containers. Provide adequate ventilation. Have fire extinguishers available at locations where these liquids are used. Avoid sparks or flames in areas where flammable liquids are used.

METALS Beryllium Examples: Beryllium dust and fumes arise from the melting, grinding and milling of some base metal alloys. Hazards: Contact dermatitis, corneal burns, inflammation and scarring of respiratory tissues. DO: Wear gloves, eye protection and NIOSH approved mask when casting, polishing or grinding these alloys. Provide adequate local exhaust ventilation for all operations in casting areas. Use power suction methods rather than air hoses to remove dust from clothing and to clean machinery. Dispose of wastes, storage materials or contaminated clothing in sealed bags.

Amalgam (mercury) Examples: Bulk mercury; precapsulated alloy; scrap amalgam. Hazards: Fine tremors, nausea, and loss of appetite, diarrhea, depression, fatigue, increased irritability, allergic manifestations, contact dermatitis, pneumonitis, nephritis, headache, insomnia, dark pigmentation of marginal gingiva, loosening of teeth. DO: Work in well ventilated spaces. Avoid direct skin contact with mercury. Store mercury in unbreakable, tightly sealed containers away from any source of heat. Salvage amalgam scrap; clean out the dental traps in the assistant carts. Never flush amalgam scraps down the drain. Clean up spilled mercury using appropriate procedures and equipment; do not use a household vacuum cleaner. Place contaminated disposable materials in polyethylene bags, seal, and label. Recycle these bags with a qualified recycler.

Nickel Examples: Nickel containing dental alloys, gold alloys, solders. Particles released during fabrication and grinding of nickel containing alloys. Hazards: Allergic manifestations, irritation to eyes and respiratory systems. DO: Use protective eyewear and NIOSH approved mask when grinding nickel containing alloys. Use high velocity evacuation systems. Nitrous Oxide Hazards: Based on laboratory animal studies, high exposure may cause adverse health effects. DO: Steps should be taken to minimize the vapor concentration of nitrous oxide in the dental suite. Use a scavenging system. Check nitrous oxide machines, lines, hoses, and masks for leakage. Maintain adequate ventilation.

Other Metals Examples: Casting alloys and alloys for amalgam. Hazards: Metal dusts and fumes may irritate eyes and respiratory systems. Contact dermatitis. DO: Wear protective eyewear and NIOSH approved mask while grinding metal prostheses.

Organic Chemicals Examples: Alcohols, ketones, esters, solvents, and monomers such as methyl methacrylate and dimethacrylates. The halogen containing organic liquids used in dental offices primarily include chloroform and carbon tetrachloride and some solvents and cleaners. Hazards: Fire, allergic manifestations, contact dermatitis, irritation to mucous membranes, respiratory problems, central nervous system depression, headache, drowsiness, loss of consciousness, nausea, liver and kidney damage, possible mutagenesis. DO: Avoid skin contact Avoid excessive inhalation of vapors. Work in well ventilated areas. Use forceps or gloves when handling contaminated gauze or brushes. Keep containers tightly closed when not in use. Store containers on flat sturdy surfaces. Clean outside surfaces of containers after use to prevent residual material from contacting the next user. Use a commercially available flammable solvent cleanup kit in case of spills. Photographic Chemicals Hazards: Contact dermatitis, irritation of eyes, nose, throat and respiratory system from vapors and fine particulates of chemicals. DO: Use protective eyewear. Minimize exposure to dry powder during mixing of solution. Avoid skin contact with photographic chemicals and solutions by wearing heavy duty rubber gloves. Work in well ventilated areas. Clean up spilled chemicals immediately. Wash off chemicals with large amounts of water and a pH balanced soap if contact occurs. Store photographic solutions and chemicals in tightly covered containers.

Plaster and other gypsum products Examples: Gypsum products contain silica and calcium sulfate. Hazards: Irritation and impairment of respiratory system. Silicosis. Irritation of the eyes. DO: Use plaster and other gypsum products in areas equipped with an exhaust system. Use protective eyewear and NIOSH approved mask while handling powders or trimming models. Minimize exposure to powder during handling. Caution Every liquid should be in a marked container. The container must have a warning label clearly displayed. If you transfer a liquid from one container that has a warning label to a second container, it is your responsibility to make sure that this second container has the same warning label affixed to it also.

H. Safety Hotlines Chemical Emergency Preparedness Hotline CERCLA (SARA Title III) ……………………. 1 800 535 0202 Chemical Transportation Emergency Center (CHEMTREC) 24 Hour ………………………… 1 800 424 9300 CMA Chemical Referral Center ………………… 1 800 CMA 8200 EPA RCRA, Superfund, Hazardous Waste Hotline Office of Solid Waste and Emergency Response ……………….. 1 800 424 9346 EPA, Small Business Hotline …………………. 1 800 368 5888 National Response Center ……………………. 1 800 424 8802 (Report chemical releases, radiological incidents) National Safety Council …………………….. 312 527 4800 NIOSH National Institute of Occupational Safety and Health ……………… 1 800 356 4674 OSHA, Health Standards ……………………… 800-582-1708 Safe Drinking Water Hotline …………………. 1 800 426 4791 Substance Identification ……………………. 1 800 848 6538 US DOT HOTLINE …………………………….. 1 202 366 4488

J. Proper Labeling Many chemicals used in dentistry are dangerous. The label on the bottle helps you to know when to be careful handling an item. To protect yourself and others: 1. Never deface or remove a Label from a container 2. If you change a liquid or other dangerous material from one container to another, be sure to duplicate and fix a copy of the label on the new container. 3. Some items will need a label a. Any waste container that could hold contaminated waste b. Any container holding reusable contaminated instruments c. The refrigerator that contains dental supplies d. Washer 4. If a container is not labeled let your dentist know. You and he will decide on the proper label. The dentist is responsible for assuring compliance with this labeling requirement in accordance with 29CFR 1910. 1200. 5. All containers of hazardous chemical, which are the responsibility of this office, will be labeled with at least the following information: Identity of the hazardous chemical(s) Appropriate hazard warnings Manufacturer’s or distributor’s name and address 6. Such containers may also be placed in a designated location where the location is labeled and the containers are returned to that designated location after use. Incoming shipments of chemicals shall be reviewed for appropriate labeling and then determine if there is an MSDS available for each chemical received. 7. Read the label on every material the first time you use it 8. The words “caution,” “danger,” “harmful if absorbed by skin,” etc. are precautionary statements and do no identify specific hazards. 9. No hazardous chemicals will be accepted for use in the facility, or shipped to any outside location, unless labeled with at least the following information: 10. When transferring a product to an unlabeled container place a copy of the original label on the new container Identity of the hazardous chemical(s) Appropriate hazard warnings Name and address of the chemical manufacturer, importer, or other responsible party Labels can be confusing to read. Here are some hints to help you. 1. The effectiveness of a disinfectant is determined by how quickly (if at all) it can kill M. Tuberculosis. The contact kill time can vary from 3 to 9 minutes. 2. Some disinfectants need to be diluted. Others are used full strength. Read carefully. 3. Many disinfectants work better at higher temperatures. Never heat a disinfectant. Centigrade can be converted to Fahrenheit if you remember 20 degrees Celsius = 68 degrees Fahrenheit and 25 degrees Celsius = 77 degrees Fahrenheit.

If a label doesn’t include all the necessary information, send them a copy of the following letter:
Dear Sir or Madam: I purchased ____________________ of (amount/size) _______________________________ on ______________ (name of product) (date) from your company. I took delivery of the product on ____________ (date) but did not receive any Material Safety Date Sheets (MSDS) with my order. Please send me the appropriate MSDS immediately so I will be in compliance with OSHA regulations regarding training of my employees about the hazards of this product. Thank you for your cooperation. Sincerely,

K. Hazardous Waste Pick Up At present we use sharps containers (red plastic container on each C&S area). For pick up, sharps containers sealed with red cap go in Biohazard box located ____________. Pick ups are _______________.

L. Training As in the rest of dentistry, the safe handling of hazardous materials information will improve and change rapidly. You will be kept up to date on these changes by 1. Staff meetings 2. Updates in the manuals 3. An annual staff meeting

These topics will be covered as per 1910. 1200(h) 1. Provisions of the Hazardous Communication Standard 2. Hazardous chemicals in your work area 3. Location and availability of our hazard communication program, MSDS’s, and chemical lists 4. How to detect presence of a hazardous chemical in the workplace 5. The physical and health hazards of chemicals in the workplace 6. How to protect yourself from these hazards a. Information on work practices b. Emergency procedures c. Required personal protective equipment 7. Details of our program a. Labeling b. MSDS’s c. How to read and use MSDS information 8. Accidents and their management 9. Value of vaccination for Hepatitis B

EMPLOYEE INFORMATION AND TRAINING PROGRAM POLICY We will provide employees with training when new hazardous chemicals are introduced and added to the “chemical inventory list”, or before non routine tasks are to be performed that could involve exposure to hazardous chemicals. The extent of information transmitted to employees during training sessions will be dictated by the degree of hazard presented by the chemicals. The applicable MSDS’s the text of the OSHA Hazard Communication Standard (1910.1200), the inventory list of hazardous chemicals, and this written program will be used as sources of information during the training sessions.

CONTRACTOR POLICY Outside contractors must be provided with all necessary information concerning the potential hazards of the substances to which they may be exposed and appropriate protective measures required to minimize their exposure. Whenever possible, the contractor or agency management should be provided with a list of the hazardous chemicals and the safety data sheets for the materials their employees will be using in the course of their work in our area. Outside contractors shall also provide MSDS for all hazardous chemicals not considered consumer products used within this establishment, which could potentially expose our employees.

M. CERTIFICATION OF TRAINING ON HAZARD COMMUNICATION This is to certify that I have been trained and informed on the hazards and precautions associated with the use of hazardous chemicals in my work as required in the companies written hazard communication program. Please have the following areas checked to indicate your understanding: [ ] Overview of the requirements contained in the Hazard Communication Rules, 1910.1200. [ ] Aware of location of copy of OSHA’s Occupational Exposure to Blood born Pathogens; Final Rule. This is the definitive source for all in Formation on infection control.  [ ] Understand what an MSDS is and the meaning of its various sections. [ ] Chemical hazards present in my workplace operation. [ ] Location and availability of our written hazard communications program, the list of hazardous chemicals, and the MSDS’s for these chemicals. [ ] Physical and health effects of these chemicals. [ ] Methods and observation techniques used to determine the presence or release of hazardous chemicals in the work area. [ ] How to lessen or prevent exposure to these chemicals through usage of control/work practices and personal protective equipment. [ ] Steps the company has taken to lessen or prevent exposure to these chemicals. [ ] Safety or emergency procedures to follow in the event of exposure to these chemicals. [ ] How to read container labels, review and interpreted MSDS’s to obtain appropriate hazard information.

Employee signature ______________________ Date ________________

Trainer _________________________________ Date ________________

Doctor __________________________________ Date ________________

Now it’s time to see what you’ve learned so far in this manual. Please answer the following questions. Bring them to your next meeting with your doctor. Your safety here  will be determined by how well you learn, understand, and practice the information presented in this manual.

  1. What blood born microorganism should you worry about infecting you the most? What is the best way to prevent this infection?
  2. When should you wear household type gloves?
  3. How often should you wash your hands?
  4. What should you do if you tear a glove during the treatment?
  5. How should you handle extracted teeth?
  6. What waste should be treated as infected?
  7. Where should you empty a suction trap?
  8. Which decontamination processes kill all microorganisms?
  9. What are the “rules” in choosing the right way to decontaminate instruments, equipment, and surfaces?
  10. What should be written on the label of a chemical used for high-level disinfections?
  11. What is the first step in every decontamination process?
  12. When should you wear a mask? Answers are found later in this manual

Make sure you have accomplished the following:

  1. Read a copy of the Blood borne Disease Standard
  2. Understand how blood borne diseases occur, are treated, and prevented 
  3. Understands how blood borne diseases are transmitted
  4. Understands our infection control program
  5. Know, which tasks may lead to infection
  6. Understands work practice procedures, equipment safety, and personal protective equipment 
  7. Understands the value of hepatitis B vaccine
  8. Knows whom to contact in case of an emergency
  9. Understands the procedure to follow in case of an accidental exposure to a possibly infectious material
  10. Understands our labeling process

 

Trainer _________________________________ Date ________________

Stays on schedule for ideal day most of the time.

Trainer __________________________________ Date ________________

Here are the questions with the correct answers. 1. What blood born microorganism should you worry about infecting you the most? What is the best way to prevent this infection? Hep B Virus Vaccination 2. When should you wear household type gloves? Clean instrument 3. How often should you wash your hands? Start, end of day, every glove change 4. What should you do if you tear a glove during the treatment? Change gloves 5. How should you handle extracted teeth? Place in contaminated waste dispenser 6. What waste should be treated as infected? Blood soaked, sharps 7. Where should you empty a suction trap? Into amalgam container (to save old amalgam), rinse the trap and spray with Dentaphene 8. Which decontamination processes kill all microorganisms? Steam, 8 hours chemical 9. What are the “rules” in choosing the right way to decontaminate instruments, equipment, and surfaces? Penetrate gums, bone, touch saliva, surfaces 10. What should be written on the label of a chemical used for high-level disinfections? Kills tuberculosis spores 11. What is the first step in every decontamination process? Cleaning 12. When should you wear a mask? When blood or saliva could splatter.