OSHA
The Occupational Health and Safety Administration (OSHA) is a federal agency that operates under the U.S. Department of Labor. They are a law regulating agency that enforces laws that are put in place to protect employees in their place of work. The mission of OSHA is to ensure that businesses provide safe and healthy working environments for all their employees. In 1974 OSHA was developed and established by congress. In the 1960s there was a 20% rise in work-related accidents and injuries and something needed to be done to keep these numbers from increasing. House Representative William A. Steiger successfully passed a bill that would create OSHA. President Richard M. Nixon signed The Occupational Safety and Health Act of 1970 on December 29th of 1970. OSHA was open for business in April of 1971. OSHA covered 56 million workers at 3.5 million various industries and businesses. OSHA created and organized standards at foundations such as the National Fire Protection Organization, American National Standards Institution, and the American Conference of Governmental Industrial Hygienist.
OSHA developed its first training program in Chicago in the mid-1970s. The training programs purpose was to educate its inspectors, and administer employers and employees training on safety standards. In 1975 OSHA had state authorities instruct onsite consolation programs at no cost. In the 1980’s OSHA started to make medical and exposure records the main focal point. In the 80’s OSHA vigorously began to target companies and organizations that dealt with hazardous materials. In 1986 OSHA began to enforce severe penalties on companies that were repetitive in violating their hazardous material codes. Twenty five states during the 80s established their own OSHA programs that held up to the OSHA standards.
In the 90’s OSHA re-evaluated all of their rules and regulations and attempted to find more suitable ways to re-define their standards. This time OSHA began to target on the businesses that had the most extensive track records with employee injury and illness. They began to respond more immediately to employee complaints.
In 2000 OSHA turned their focus to educating employers and employees. The website began to grow and became a convenient tool for companies to provide literature and knowledge for their employees and vice versa. OSHA also developed a convenient way through their website that allowed workers to report all violation and not just the life treating issues.

Employer and Employee Responsibilities and Rights

OSHA states that among other responsibilities, an employer must:
• Inspect and evaluate your workplace for potential hazards.
• Take effective steps to eliminate or minimize hazards.
• Comply with OSHA standards and keep records of workplace injuries and illness.
• Train employees to recognize safety and health hazards and take precautions to prevent accidents.
OSHA says employees must:
• Comply with all applicable OSHA standards.
• Follow the organization's safety and health rules and regulations.
• Wear assigned PPE.
• Report hazardous conditions.
• Report any job-related injury or illness and seeking treatment.
• Cooperate with OSHA compliance officers conducting inspections. Employees have the right to:
• Review copies of OSHA regulations and request information about workplace hazards, precautions, and procedures.
• Gain access to relevant employee exposure and medical records.
• Request an OSHA inspection if they believe hazardous conditions or violations of standards exist in the workplace.
• Accompany an OSHA compliance officer during the inspection tour and respond to questions from the inspector.
• Observe any monitoring or measuring of hazardous materials and see the resulting records, as specified under the OSH Act and required by OSHA standards.
• Review your OSHA 300 Log of Work-Related Occupational Injuries and Illnesses.
• Refuse to be exposed to the danger of death or serious physical harm.

OPIM
OPIM:
OPIM is the acronym for Other Potentially Infectious Materials
Some materials that may fall under this category aside from blood include but are not limited to:
 Semen
 Vaginal secretions
 Cerebrospinal fluid (fluid surrounding the brain and spinal cord)
 Synovial fluid (fluid surrounding bone joints)
 Pleural fluid
 Pericardial fluid
 Peritoneal fluid
 Amniotic fluid
 Any pathogenic micro-organism
 Human cell lines
 Saliva in dental procedures
 Any body fluid that is visibly contaminated with blood
 All body fluids in situations where it is difficult or impossible to differentiate between body fluids
 Any unfixed tissue or organ (other than intact skin) from a human (living or dead)
 HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV

How does OPIM relate to the dental field?
A dental professional should know and understand the risks of infection because dental professionals face a significant health risk as a result of occupational exposure to blood and other potentially infectious materials (OPIM), because they contain BBPs (blood borne pathogens).

A few examples of how the dental staff can protect themselves from being at risk of becoming infected are:
• Treat all blood and bodily fluids as if they are infectious.
• Using the appropriate PPE while in exposure situations.
• Remove PPE immediately if it becomes punctured or torn, and replace with new PPE
• Washing hands thoroughly after becoming exposed to OPIM
• Storing, labeling, and handling OPIM in the correct manner
• Staying up to date on your vaccination series against the hepatitis B virus which will decrease your susceptibility to HBV infection if you are exposed to the virus.

In the dental profession it is very critical that you know what OPIM consists of and how to protect your own health as well as the health of others.

OSHA STANDARDS

The two main OSHA standards:
1. Blood-borne Pathogens Standard (BBP)
2. Hazard Communication Standard (HCS)

Bloodborne Pathogen Standard (BBP)

- What are blood-borne pathogens
Blood-borne pathogens are disease-causing organisms transferred through either direct or indirect contact with blood or other body fluids. Exposure to these pathogens could lead to infection and even death. These pathogens include but are not limited to HBV, HCV, and HIV. Blood-borne pathogens are an extreme concern for dental office due to the extensive contact with saliva that often contains blood.

OSHA’s Blood-Borne Pathogen standard declares that all employers must protect employees who are occupationally exposed to blood or OPIM (Other potentially infectious materials).

OSHA’s Blood-Borne Pathogen Standard requires employers to:

- Establish an exposure control plan
This is a written plan that reduces or even eliminates occupational exposures to employees. The employer must list and identify job classifications, tasks and procedures that an employee may be exposed to blood-borne pathogens and other potentially infectious materials. The plan must be available to employees and also accessible to OSHA. The exposure plan must be updated at minimum annually, but more often to accommodate to workplace changes.

- Use universal precautions. Treating all body fluids and potentially contaminated materials and instruments as if contaminated with blood-borne pathogens.

- Recognize and use engineering controls
Employers should use and also keep up to date on apparatus that serves to isolate or abolish blood-borne pathogen hazards from the business. These devices consist of contaminated sharps disposable containers, and safer medical equipment.

- Identify and establish the use of work practice controls.
Be sure to carry out a task in a way that minimizes the possibility of exposure.

- Supply personal protective equipment (PPE).
PPE essentially consists of protective eye wear, protective gowns, gloves and facemasks.
Employers are responsible for the cleaning, repairing, and replacing of PPE at no cost to the employee.

- Make the Hepatitis B vaccination available to employees who may be occupationally exposed to BBP’s and other potentially infectious materials.
This vaccination must be provided to an employee after completing the mandatory BBP training.

- Post-Exposure evaluations must be available to any employee that happens to be involved with an exposure incident. Employers must also offer follow-up evaluations after an employee’s exposure incident.
All incidents and follow-up evaluations must be documented. Once the source individual of the incident is determined, they can consent to be tested for HBV and HIV, along with employee that was exposed and potentially infected. It is required that all medical results remain confidential.

- Apply labels and signs to warn of hazards in the work-place.
Warning labels must be attached to containers that store regulated waste and OPIM.

- Administer education and training to employees.
Employers must educate and train workers the details of OSHA’s standard. Training must take place at least once a year, and more if needed if there are changes in the workplace.

- File and maintain employee medical and training documentation.
It is also required that an employer document and maintain a sharps injury record log.

Hazardous Communication Standard (HCS)
The Hazard Communication Standard (HCS) is an OSHA regulation that governs the communication of hazards associated with chemicals in the workplace. The HCS requires employers to understand the hazards associated with chemicals in their workplace and requires the employer to communicate those hazards to their employees. Knowing and understanding the HCS will help employers maintain safer workplaces for their employees. When employers have facts about the chemicals being used, they can take steps to minimize exposures, substitute less hazardous substances, and mandate proper work practices. These accomplishments will help prevent the development of work-related illnesses and injuries caused by chemicals.
Under these regulations, employers must develop, implement, and keep up to date, a written hazard communication program which includes:
- Labeling of containers that store and hold hazardous chemicals.
- Obtaining and maintaining an updated list of all hazardous chemicals incorporated in the office. In addition to a catalog of chemicals, a file of Material Safety Data Sheets (MSDSs) for each product must be maintained and made available to employees.
- Providing training and information to employees on conditions of handling hazardous materials which will be encountered in the office.
- Maintaining records to include all training provided to employees on handling hazardous materials and an incident log of any occupational injury.

Labeling:

- Manufacturers are required to properly label all chemical containers. Labels must contain information which properly identifies the chemicals, provides the appropriate hazard warning, and gives the name and address of the manufacturer or other responsible party.
- The name of the chemical identified on the label must be consistent with the name of the chemical on the corresponding MSDS.
- Containers that are properly labeled by the manufacturer do not need additional labels. If labels are missing or incomplete, the manufacturer must be notified immediately.
- Materials subject to Food and Drug Administration (FDA) labeling requirements are not covered by these regulations, but have similar labels in most instances.
- If a chemical is transferred to another container for storage purposes, the container must be appropriately labeled. If transferred to another container for immediate use, no label is required.

List of Hazardous Chemicals and MSDSs:
- The written hazard communication program must contain a list of all hazardous chemicals which may be encountered in the workplace. This list must be accurate and current. An MSDS must be kept on file for each chemical identified on the list. The name of the chemical as it appears on the MSDS must be the same as used on the container label.
- Manufacturers and suppliers are required to provide MSDSs for products which contain hazardous chemicals. If MSDS are not supplied, they must be obtained from the supplier or other sources. If questions arise about the hazard potential of a specific product, the manufacturer or supplier should be contacted immediately.
- The file containing the MSDS should be readily available to employees. These sheets describe the chemical composition, physical properties, type of hazard, safe handling, and emergency procedures for a hazardous chemical. The information provided on these sheets should provide the basis for training employees to handle any given hazardous material.
Training and Information:
- Employers are required to take specific measures to inform employees about their rights under these regulations and to provide training in handling hazardous materials which will be encountered in the workplace.
- One of the first things an OSHA inspector will look for is OSHA poster 2203, entitled, “Job Safety and Health Protection.” This poster (or equivalent agency poster) should be prominently displayed in the clinic. It specifies employee rights as defined by the Occupational Safety and Health Act and meets the requirement of that Act to provide such information.
- Employees must also be trained to handle all hazardous materials they will encounter in the workplace. This training must be provided at the time of initial employment and whenever a new hazardous material is introduced into the workplace or when procedures for safe handling or emergency precautions change.
- The information contained on the MSDS serves as the information basis for such training. However, merely having employees read these sheets does not satisfy the intent of this regulation. Training should consist of the following:

• A description of how the hazard communication program is implemented in that workplace
• Instruction on how to read and interpret information on labels and on MSDSs
• Instruction on how employees can obtain and use the available hazard information
• Instruction on the specific hazards of chemicals present in that workplace
• A description of measures that employees can take to protect themselves from the hazards
• Information on specific procedures put into effect by the employer to provide protection, such as engineering controls, work practices, and the use of personal protective equipment
• Information on methods and observations, such as visual appearance or smell, which workers can use to detect the presence of a hazardous chemical to which they may be exposed

This training can be accomplished at staff meetings or in-service training, through continuing dental education, or by audiovisual presentation. Training sessions should always include an opportunity for employees to ask questions to ensure that they understand the information presented.
Recordkeeping:
To comply with these regulations, the following conditions of recordkeeping are essential:

• Each training conference should be documented. The documentation should contain the date the training was completed, what issues were covered, who conducted the training, and the signatures of each employee who had received the training.
• An incident log should be kept for the entire business and is most commonly maintained by the facility’s Safety Officer.

The Blood-borne Pathogen Standard is the #1 cited standard in dentistry and the OSHA Hazard Communication Standard is the #2 cited standard in dentistry.

Training for the BBP, and the HCS should be before the initial assignment for employment starts, when new chemicals and procedures enter the workplace, and at least once a year.

CHAPTER 2

Infection Control

What is infection control?
- Efforts to prevent and control the spread of infections within dental health facilities or those involving provision of dental care.
Dental professionals and patients may be in danger to being exposed to an array of microorganisms by way of blood, oral and respiratory emissions. These microorganisms can include hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus types 1 and 2, human immunodeficiency virus (HIV), tuberculosis, staphylococci, streptococci, and other viruses and bacteria. Infections may be transmitted in the dental operatory through various routes, including direct contact with blood, oral fluids, or other secretions, indirect contact with contaminated instruments, operatory equipment, or environmental surfaces, or contact with airborne contaminants present in either droplet spatter or aerosols of oral and respiratory fluids. Infection via any of these routes requires that all three of the following conditions be present (commonly referred to as "the chain of infection"): a susceptible host, a pathogen with sufficient infectivity and numbers to cause infection, and a portal through which the pathogen may enter the host. Effective infection-control strategies are intended to break one or more of these links in the chain, thereby preventing infection.
A set of infection-control strategies common to all health care delivery settings should reduce the risk of transmission of infectious diseases caused by blood-borne pathogens such as HBV and HIV. Because all infected patients cannot be identified by medical history, physical examination, or laboratory tests, CDC recommends that blood and body fluid precautions be used consistently for all patients. This extension of blood and body fluid precautions, referred to as universal precautions, must be observed routinely in the care of all dental patients. In addition, specific actions have been recommended to reduce the risk of tuberculosis transmission in dental and other ambulatory health-care facilities.

Steps the Dental professional must take to achieve asepsis as well as safeguarding their personal health.

Hand Hygiene:
- Dental professionals must always wash their hands before and immediately after removing gloves.
- If dental professional happens to touch contaminated objects or surfaces without gloves on they must wash their hands immediately.
- Always use liquid soap as opposed to bar soap because bar soap may transmit contamination.
- It is important to dry hands well before putting on gloves.

PPE:
Protective Clothing:
Protective clothing protects the skin and underclothing from exposure to saliva, blood, aerosol, and other contaminated materials.
Examples of protective clothing are:
- Smocks
- Pants
- Skirts
- Lab coats
- Surgical scrubs
- Hats
- Shoe covers
• Protective clothing should be made of fluid resistant material.
• Protective clothing should be long sleeved and also have a high neckline to avoid unnecessary skin exposure.
• The sleeve should be fitted and ribbed so that the dental professional is able to pull gloves over the sleeve.
• During surgical procedures lab coats or other protective clothing should cover the dental professional at least to the knees when seated
• Dental professionals should avoid protective clothing that has numerous buttons, zippers and other ornamentation, because those things may harbor pathogens.
Protective Masks: A mask is worn by a dental professional when performing treatments that may involve spraying of the handpiece or splashing of fluids that may contain blood. The mast is put on over the nose and mouth to protect the dental professional from breathing in infectious organisms.
Guidelines for Protective Masks:
- Masks should be replaced for every patient or more often if excessive spatter is produced during treatment, or if the mask becomes moist.
- Masks should be handled by contacting only the side frame to avoid contact with the more heavily diluted body of the mask.
- Masks should form to the contour of the face.
- Masks should not touch the mouth when worn because the moisture developed will diminish the mask filtration efficiency. A damp or wet mask is not a productive mask.
- Masks should not be worn beneath the nose or mouth.
Protective Eyewear:
Eyewear is worn to protect the eyes from being damaged by aerosolized pathogens such as herpes simplex viruses and Staphylococcus. Protective eyewear also protects against airborne debris such as scrap amalgam and tooth particles as well as harm from splattered solutions and caustic chemicals. Such mishap may be non-reparable and may lead to forever visual deterioration or complete loss of eyesight. The Blood-borne Pathogen Standard requires that protective eyewear have both front and side shields during treatments that may result in exposure.

Gloves: There are many different types of gloves used in dentistry. The type of glove you use will be based upon which type of procedure you will be doing.
The types of gloves used in dentistry include:
1. Examination Gloves:
Usually latex or vinyl and are the most common type of glove worn during patient care.
2. Sterile Surgical Gloves:
These gloves are used most in hospital settings.
3. Utility Gloves:
These gloves are not used for direct patient treatment. They are worn while cleaning treatment areas, handling and cleaning contaminated instruments, and cleaning surface areas.
4. Overgloves:
These gloves of constructed of lightweight clear plastic. They are worn over contaminated treatment gloves the retrieve items from non-contaminated areas, and instruments.
Universal Precautions
Definition:
The CDC defines Universal Precautions as a set of precautions designed to prevent transmission of HIV, hepatitis B virus (HBV), and other blood-borne pathogens when administering first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other blood-borne pathogens.

Standard Precautions
Definition:

Standard precautions are designed to lessen the risk of transmission of blood-borne and other pathogens from both recognized and unrecognized sources. They are the basic level of infection control precautions which are to be used, as a minimum, in the care of all patients.

HIV
Definition:
HIV is the abbreviation for human immunodeficiency virus which is the cause of AIDS. Two strains have been identified: HIV-1 and HIV-2

Symptoms:

• Lack of energy
• Weight loss
• Frequent fevers and sweats
• Persistent or frequent yeast infections
• Persistent skin rashes or flaky skin
• Short-term memory loss
• Mouth, genital, or anal sores from herpes infections.
• Cough and shortness of breath
• Seizures and lack of coordination
• Difficult or painful swallowing
• Mental symptoms such as confusion and forgetfulness
• Severe and persistent diarrhea
• Fever
• Vision loss
• Nausea, abdominal cramps, and vomiting
• Weight loss and extreme fatigue
• Severe headaches with neck stiffness
• Coma

How is HIV transmitted?
• Unprotected sexual intercourse with infected person (either heterosexual or homosexual)
• Transfusion of infected blood or blood products
• Infected mother to her baby during pregnancy, birth process and through breast – feeding
• Use of infected needles and instruments without sterilization or sharing of needles and syringes by HIV drug addicts

HBV
Definition:
HBV is the abbreviation for "hepatitis B virus." HBV is a virus that infects the liver and causes the acute (sudden and sometimes short-lived) and chronic (long-lasting) types of hepatitis B. Most adults with acute hepatitis B will recover without complications. However, people who acquire acute hepatitis at a young age are more at risk for developing chronic hepatitis B. Chronic hepatitis B can lead to health issues such as cirrhosis, and liver cancer.
Symptoms:
- Appetite loss
- Feeling tired (fatigue)
- Nausea and vomiting
- Itching all over the body
- Pain over the location of the liver (on the right side of the abdomen, under the lower rib cage)
- Jaundice (a condition in which the skin and the whites of the eyes turn yellow in color
- Dark urine (the color of cola or tea)
- Pale-colored stools (grayish or clay colored)
- Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (hepatic encephalopathy)
- Sudden collapse with fatigue
- Extreme weakness
- Confusion or trouble concentrating

How is HBV transmitted?
The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to another via blood or fluids contaminated with blood. Another important route of transmission is from an infected mother to a newborn child, which occurs during or shortly after birth.
- The virus may be transmitted when these fluids come in contact with broken skin or a mucous membrane (in the mouth, genital organs, or rectum) of an uninfected person.

HCV
Definition:
HCV is the abbreviation for hepatitis C virus

Symptoms:
A very high percentage of newly infected patients have no symptoms.
A very low percentage of newly infected patients have symptoms that include:
- fatigue
- abdominal pain
- nausea
- loss of appetite
- jaundice
- tinting the whites of the eyes and skin
- urine may take on a dark brown color
- stools may become gray or light tan.

Chronic Infection:
Most often, the human body's immune system cannot recover itself from the virus. Among patients who acquire HCV, nearly 75% to 85% will be unsuccessful to clear it from their bodies and will become chronically infected. Most chronically contaminated patients do not have symptoms or have only light symptoms such as fatigue. However, even asymptomatic patients may have active or progressive liver damage.

How is HCV Transmitted?

- blood transfusions
- injection drug use
- health care employment with frequent exposure to blood
- personal contact with others who had hepatitis
- multiple sexual partners
- low socioeconomic status

Occupational Exposure

Definition:

Any reasonably anticipated skin, eye, or mucous membrane contact or percutaneous injury involving blood or any other potentially infectious material.

Three main categories an employee falls under if they are subjet to any occupational exposure.

• Category I:
Consistently in danger of being exposed to blood, saliva, or both
• Category II:
May periodically be in danger of being exposed to blood, saliva or both
• Class III:
Not at any time exposed to blood, saliva, or both

Exposure Protocol:

1. Record the routes of exposure and the conditions which the incident occurred.
2. Recognize and record the source individual unless prohibited by law, or not possible.
3. Request that the source individual have his or her blood tested for HIV and HBV. The source can legally refuse to be tested.
4. Recommend that the employee have his or her blood analyzed for HIV and HBV. The employee can refuse to be tested and if they do get tested the law states that all results are held confidential from the employer.
5. Provide medical treatment such as needed injections of gamma globulin, HBV vaccine booster, tetanus booster, or a combination.
6. Provide necessary counseling.
7. Assess reported illnesses after the incident.

After an exposure incident an employer is required to keep exposure forms in most cases for at least 30 years in an incident log that is available upon request.

The information posted on the following exposure form is required to be answered by the employee after an exposure incident.

Chapter 3

Decontamination and Sterilization

• Decontamination:
The process of removing foreign material such as blood, body fluids, or radioactivity. It does not eliminate microorganisms but is a necessary step preceding disinfection or sterilization. Decontamination is the removal of all gross contamination.
• Sterilization:
Process that kills all micro-organisms

Decontamination in the dental office is often done to contaminated instruments by acceptable processes like hand scrubbing, and ultrasonic cleaning. Sterilization is often accomplished by using acceptable sterilization methods such as a steam autoclave, unsaturated chemical vapor sterilization, dry heat sterilization, ethylene oxide sterilization, and liquid chemical sterilants.

Unacceptable forms of disinfecting and sterilization techniques:
• Never use sterilization techniques and devices that are not approved by the FDA
• Never use sterilants that are not approved by the FDA
• Do not use single-use disposable instruments on more than one patient
• Do not use liquid chemical sterilants/high-level disinfectants for environmental surface disinfection or as holding solutions.
Approved Chemical Sterilants and Disinfectants:
• Glutaraldehyde – High level disinfectant/cold sterilization sterilant
• Orth-phthalaldehyde – High level disinfectant
• Peracetic Acid - Sterilant
• Hydrogen Peroxide – High level disinfectant/sterilant

Biologic Monitoring
Biologic Monitoring Definition:
Verifies sterilization by confirming that all spore-forming microorganisms have been destroyed.

How is Biologic Monitoring Done:
Along with the correct sterilization of instruments and materials, sterilizer monitoring is an important and necessary part of any in-office infection control program. Sterilization is best monitored using a combination of mechanical, chemical, and biological indicators.
Mechanical Monitoring
• Record cycle time, temperature, and pressure as shown on the sterilizer gauges for each instrument load.
Chemical Indicators
• Use chemical indicators like indicator tapes with each instrument load. These indicators change color after introduced to the appropriate sterilization environment.
• Failure of the indicator to turn a different color indicates that it was not presented to the appropriate sterilization environment. In such cases, the instrument load should be sterilized again.
• Indicator tapes are sterilizer specific (tapes for steam sterilizers can’t be used to confirm sterilization in chemical vapor sterilizers).
• Chemical indicators should not take the place of biological indicators, as only a biological indicator consists of bacterial endospores can measure the microbial killing ability of the sterilization method.
- When performing a biologic monitoring test on your sterilization equipment, the date the test was performed, your initials and signature need to be sent in along with the biological monitoring strip. You need to file a copy of what you sent to the biological monitoring company and the results that they sent back to you in the sterilization log. The results need to be kept available upon request for a minimum of three years.

Biological Indicators:
• The CDC recommends that you monitor sterilizers at least weekly with biological indicators.
• Biological monitoring can be done in two ways:
1. In-office incubator and spore monitoring strips. This method usually gives results in 24-48 hours.
2. Mail-in spore monitoring programs. This process usually takes a week. Although it takes longer to get results using a service, third-party monitoring programs may offer more credibility than in-house monitoring.
• A positive spore test result indicates that sterilization failed.
• Maintain a log of spore test results.

DUWL’s

How often do DUWL suction hoses and traps need disinfected/changed?

In accordance with the USAF Guidelines for Infection Control in Dentistry the HVE and saliva ejector suction lines and traps are to be cleaned every day by use of an evacuation system cleaner according to manufacturer directions. Numerous line cleaner products have oxidative potential to liberate mercury ions into liquids from amalgam. Commodities that do not include bleach, or chlorine, decrease the dissolution of amalgam. Therefore, only non-chlorinated line cleaning products can be incorporated unless the trap has no chance of including amalgam residue. Replacing the trap daily is most likely not directed. The length of time that you conclude to keep it will be based upon on the quantity of debris that collects.

Chapter 4

MSDS
MSDS Definition:
Form that provides health and safety information regarding materials that contain chemicals.

Purpose of MSDS’s
A Material Safety Data Sheet (MSDS) is a legal form includes information on the probable effects on your health from exposure to chemicals. The MSDS document includes dealing with toxicity, use, storage, handling and emergency procedures involving any products that the government feels that they need to control. It explains the potential hazards involved with the product, how to use it safely, and what to anticipate when the safety recommendations are not followed. In addition, it tells you what to do when mishaps occur and how to recognize symptoms of overexposure.

What are the requirements for labeling primary and secondary containers?

OSHA standards require that all chemical storage containers be labeled with the identification of their contents and particular information about the hazards that are involved with the chemical. When a chemical is bought, the container it is in is a primary container and often will already have an adequate label. Any container that the chemical is converted to from the primary container is a secondary container. Both primary and secondary containers must to be labeled correctly.

Secondary container labels should have the name(s) of the chemical(s) in the container as well as hazard guidance and information specific to the ingredients.

How are hazardous chemicals identified?
Hazardous chemicals in dentistry are identified by knowing where to find, and how to understand MSDS’s, along with incorporating a functional Hazard Communication Program.
Why is storage and inventory of chemicals important?
Chemical inventory is a list of all products used in the office that contain chemicals. When the office receives a new product that contains chemicals it must be added the chemical inventory list, and the MSDS for the new product must be added to the MSDS log.
When storing new products that you receive in the dental office you should always place the new product behind the older (non-expired) products so that you use the use up the oldest expiration dates first. You should always make sure that you are not storing products that are expired so that they are not accidentally used on a patient.
Most often the program coordinator of the Hazard Communication Program is responsible for keeping these records and inventory up to date.

Work Practice Controls:

Work Practice Controls Definition:
Occupational safety An OSHA term for controls that lessen the risk of exposure to blood-borne pathogens by altering the manner in which a task is performed.
EX:
Prohibition of 2-handed needle recapping, mouth pipetting, other high-risk practices

Engineering Controls:
Engineering Controls Definition:
Eliminate or reduce exposure to a chemical or physical hazard through the use or substitution of engineered machinery or equipment.
Examples:
Self-capping syringe needles, ventilation systems such as a fume hood, sound-dampening materials to reduce noise levels, safety interlocks, and radiation shielding.

Chapter 5

PPE
PPE Definition:
Personal protective equipment.

Types of PPE:
Protective Clothing:
Clothing designed to shield, or guard the wearer from infectious, toxic, or harmful substances while engaged in employment. Federal and state statutes govern the use of such apparel.
Examples:
Smocks, pants, skirts, laboratory coats, surgical scrubs, scrubs, hats, and shoe covers.
Protective Clothing Requirements:
- The BBP Standard prohibits the employee from taking protective clothing home to be washed. Washing contaminated protective clothing is the employer’s responsibility.
- Should be made of fluid-resistant material.
- Should have long sleeves and a high neckline.
- Should allow the cuff to be tucked inside the band of the glove.
- Must cover dental personnel at least to the knees when seated during a high-risk procedure.
- Buttons, trim, zippers, and other ornamentation should be kept to a minimum.

Protective Mask:
Worn over the nose and mouth to protect the dental employee and dentist from inhaling infectious organisms that are spread by the aerosol spray of the hand-piece or air-water syringe and by accidental splashes and splatter.
Types of Masks:
Dome shaped and flat types.
Proper Application: It is important for a mask to fit well and always worn over the nose and mouth to prevent inhaling infectious organisms.
Proper Disposal: Slide the fingers of each hand under the elastic strap in front of your ears and remove the mask. Discard the mask into the waste basket.
Protective Eyewear:
Worn to protect the eyes from damage from aerosolized pathogens such as herpes simplex viruses, Staphylococcus, splattered solutions, caustic chemicals, and also from debris like scrap amalgam and tooth fragments.
Examples:
Glasses with protective side shields and face shields.
Proper Application: Use eyewear with both front and side protection. If you wear prescribed glasses, you must add protective side and bottom shields. If you wear contact lenses, it is required that you wear protective eyewear with side shields or a face shield.
Proper Disposal: Remove eyewear by touching only on the ear rests Place the eyewear on a disposable towel until it can be properly cleaned and disinfected

Gloves:
Sterile or clean fitted coverings for the hands, usually with a separate sheath for each finger and thumb. Clean gloves are worn to protect health care personnel from urine, stool, blood, saliva, and drainage from wounds and lesions of patients and to protect patients from health care personnel who may have cuts. Sterile gloves are worn when there is contact with sterile instruments or a patient's bodily secretions.

Types of Gloves:
Examination Gloves:
- Usually made of latex or vinyl and often referred to as “exam glove” or “procedure gloves”.
- These types of gloves are most often worn by dental personnel during patient care.
Overgloves:
- Made of inexpensive, lightweight, clear plastic.
- May be worn over contaminated treatment gloves to prevent the contamination of clean objects handled during treatment. Sterile Surgical Gloves:
- The type of glove used in hospital settings, involving the cutting of bone or significant amounts of blood or saliva such as oral surgery or periodontal treatment.
Utility Gloves:
- Not used for direct patient care.
- Worn when cleaning the treatment room, and disinfecting between patients.
- Worn while cleaning, or handling contaminated instruments.
- Worn while cleaning and disinfecting surfaces. Non-Latex Containing Gloves:
- Used when patients or healthcare providers experience allergic reactions to latex.
- Can substitute latex gloves with gloves made from vinyl, nitrile, and other non-latex materials.

Proper Application:
Wash and dry hands thoroughly
Hold one glove at the cuff, place your opposite hand inside the glove, and pull it onto your hand. Repeat with a new glove for your other hand.

Proper Disposal:
Use your gloved hand to grasp the other glove at the outside cuff.
Pull downward, turning the glove inside out as it pulls away from your hand.
For the other hand, use your ungloved fingers to grasp the inside of the cuff of the remaining glove.
Pull downward to remove the glove, turning it inside out.
Discard the gloves into the waste receptacle.

Proper Hand Washing Techniques

Hand-Washing Definition:
A fundamental part of standard precaution procedures and disease control for dental personnel. Hand-washing helps reduce or prevent infection and transmittal of microbes among people and objects.
For regular dental procedures, liquid soap and water is sufficient but for surgical procedures, antimicrobial cleansers should be used.

Hand-Washing Techniques:
1. Remove Gloves if you have completed a surgery / before attending a surgery and putting on gloves.
2. Wet hands with running water.
3. Apply soap and rub to lather well
• Rub palm to palm
• Rub the back of both hands
• Rub palms again with fingers interlaced
• Rub backs of interlaced fingsrs
• Wash back of thumbs
• Rib both palms with fingertips
• Wash your wrists
These steps should be done for 15-30 seconds
4. Rinse the Hands under clean running water until all the soap is gone.
5. Bloat your hands dry with a clean towel.
Do not close the tap with your own hands ask your attender to do so or use a paper napkin

Approved Anti-Microbial Agents

Water-Based Cleaning Agents
Water-based cleaning agents contain chlorhexidine, iodophors, and alcohol along with the active antimicrobial ingredients approved for hand-washing. Products which use aqueous quaternary ammonium such as those that have dilute benzalkonium chloride, are not approved. Outbreaks of nosocomial infection related to the use of aqueous quaternary ammonium compounds have been found. Two of the most accepted water-based cleaning agents are iodophors and chlorhexidine gluconate.
IODOPHORS
These are water dissolvable complexes of iodine with organic compounds that are effective against all gram-positive and gram-negative bacteria and viruses. Iodophors generally do not have a long-acting germicidal action and, if used often, may cause extreme drying of the skin.
CHLORHEXIDINE GLUCONATE
This antiseptic is often marketed as 4 percent chlorhexidine gluconate with 4 percent isopropyl alcohol in a sudsy base. Chlorhexidine gluconate is an effective antiseptic for lessening transient and resident microbial hand flora, and possesses a sustained antimicrobial effect. It does not seem to affect the skin adversely. Also, it is approved as a surgical scrub.
Waterless Hand-washing Agents
Waterless hand-washing agents are made of 70 percent isopropyl alcohol and effectively disinfect the skin in 20 seconds. They are work against tubercle bacilli, fungi, and viruses. Unfortunately, they are volatile, flammable, evaporate fast, and dry the skin. Alcohol-based, waterless hand-washing agents can be used in places where there are no hand-washing sinks available.

Surgical Scrub
Surgical scrubs should be performed in dentistry when the dental team will be performing an oral surgery.

The procedure for the timed five minute scrub consists of:
• Remove all jewelry (rings, watches, bracelets).
• Wash hands and arms with anitmicrobial soap. Excessively hot water is harder on the skin, dries the skin, and is too uncomfortable to wash with for the recommended amount of time. However, because cold water prevents soap from lathering properly, soil and germs may not be washed away.
• Clean subungual areas with a nail file.
• Start timing. Scrub each side of each finger, between the fingers, and the back and front of the hand for two minutes.
• Proceed to scrub the arms, keeping the hand higher than the arm at all times. This prevents bacteria-laden soap and water from contaminating the hand.
• Wash each side of the arm to three inches above the elbow for one minute.
• Repeat the process on the other hand and arm, keeping hands above elbows at all times. If the hand touches anything except the brush at any time, the scrub must be lengthened by one minute for the area that has been contaminated.
• Rinse hands and arms by passing them through the water in one direction only, from fingertips to elbow. Do not move the arm back and forth through the water.
• Proceed to the operating room suite holding hands above elbows.2
• If the hands and arms are grossly soiled, the scrub time should be lengthened. However, vigorous scrubbing that causes the skin to become abraded should be avoided.
• At all times during the scrub procedure care should be taken not to splash water onto surgical attire.2
• Once in the operating room suite, hands and arms should be dried using a sterile towel and aseptic technique. You are now ready to put on your gown and sterile gloves.

Chapter 6

Sharps
Sharps Definition:
Pointed or cutting instruments, including needles, scalpel blades, orthodontic wires, and endodontic instruments.
Items Place in a Sharps Container:
• Needles, syringes, lancets, broken glass with blood on it
• Suture needles, scalpel blades, butterflies (both traditional and safety)
• Vacutainer tubes (both plastic and glass)
• Phlebotomy needles with vacutainer tube holder attached
• Capillary tubes (both plastic and glass)
• IV catheters
• Dental anesthetic carpules with blood
• Dental wires and endodontic files
• Other sharp objects contaminated with blood such as box cutters and broken glass
-All infectious waste-
Items That Do Not Go Into A Sharps Container:
- Scrap Amalgam
- Radiographic Fixer
- Radiographic Developer
- Lead Foil
- Disinfectants

-All hazardous waste-

What do you do when sharps container is full?
When your sharps containers are full you need to contact a contaminated waste company to come and pick up the containers and dispose of them according to the state law.

Dental Waste
Categories of Dental Waste:
- General Waste:
General waste includes all non-hazardous, non-regulated waste and should be thrown away in covered containers made of strong material such as plastic or metal. General waste consists of disposable paper towels, paper mixing pads, and empty food containers.

- Contaminated Waste:
Waste that has been in contact with blood or other body fluids.

- Hazardous Waste:
Waste that poses a danger to humans or to the environment.
Examples of hazardous waste are; scrap amalgam, spent fixer solution, and lead foil.

You should dispose of hazardous waste by contracting with a waste management company that will dispose of the waste as regulated by the laws of the state.

- Infectious Waste:
Waste that is capable of transmitting an infectious disease.
Examples of infectious waste are; blood and blood soaked materials, pathologic waste, and sharps.

Extracted teeth should be disposed of as infectious waste in most states unless given back to the patient in which the tooth or teeth came from.

You should dispose of hazardous waste by contracting with a waste management company that will dispose of the waste as regulated by the laws of the state.