Infection Control- Ch 23/TEST-COMPLETED

What is an example of a short-term discomfort exposure?

rash, burn

What is an example of a life-threatening condition?

Cancer, sterility, organ failure

For all the chemicals used in the dental office, it is important for a dental assistant to understand proper:

Use

Storage

Handling

Cleanup of spills

Disposal methods

Hazardous Chemicals

any chemical that can cause a physical or a health hazard

A chemical is considered hazardous if it:

Can ignite (catch fire)

Can react or explode when mixed with other substances

Is corrosive

Is toxic

What are some hazardous chemicals used in dentistry?

Mercury, powdered natural-rubber latex, disinfectants, nitrous oxide, volatiles from resin-based materials, x-ray chemicals, cleansers, methyl methacrylate monomer, and elastomeric impression materials

What chemical is of the greatest concern in the dental office?

Mercury

Three primary methods of exposure:

• Inhalation

• Skin contact

• Ingestion

Gases, vapors, and dusts of chemicals can cause direct damage to the lungs

Acute and Chronic Chemical Toxicity

Acute chemical toxicity: Results from a high level of exposure over a short period

• caused by a chemical spill

Chronic chemical toxicity: Results from many repeated exposures, generally to lower levels, over a much longer time—months or even years

Hand Protection

When using chemical disinfectants, wear a utility-type glove made from a chemical-resistant material.

Latex gloves worn during patient care do not provide adequate protection when one is handling chemicals

Eye Protection

Eye Protection: Serious damage to the eyes, even blindness, can result from chemical accidents

Protect the eyes from fumes and splashes while pouring chemicals, such as processing solutions for x-rays, ultrasonic solutions, disinfectants, and sterilants

A variety of safety eyewear is available

Protective Clothing

Protective Clothing: When caustic or staining chemicals are used, it is best to wear a rubber or neoprene apron when mixing or pouring the chemical

Safety data sheet (SDS, formerly material safety data sheet, or MSDS) for each product provides specific information regarding the need for additional personal protective equipment (PPE)

Inhalation Protection

Depending on the quality, patient care mask may or may not provide adequate protection when one is working with chemicals

The proper face mask should be fluid repellent and should provide respiratory protection

If your job requires you to pour or mix chemicals frequently, or if you are sensitive or allergic to substances, you might require a mist respirator mask approved by the National Institute of Occupational Safety and Health (NIOSH)

Control of Chemical Spills

Refer to the safety data sheet (SDS) for the specific product for accurate information on how to manage spills

Mercury Spill Kit

Should be available in all dental offices in which amalgam is used

Exposure to even small amounts of mercury is very hazardous to the health of dental personnel

Mercury can be absorbed through the skin or through the inhalation of mercury vapors

Eyewash Units

OSHA regulations require an eyewash unit in every place of employment in which chemicals are used

When turned on, the eyewash unit will irrigate the eyes with the soft, wide flow of water necessary to bathe away contaminants without causing additional damage

Employees must be trained in the proper use of the eyewash station, and the unit should be inspected every 3 months to ensure that it is functional

Ventilation

Good ventilation is a necessity when dealing with any type of chemical

Many dental offices are equipped with special exhaust systems in the laboratory and sterilization and darkroom areas for fumes and dust

General Precautions for Storing Chemicals

All dental materials contain chemicals, and the chemical components in some are more hazardous than others

When changes in the chemical composition of materials occur, the product may no longer retain its effectiveness

A basic safe policy is to store dental medications and chemicals in a dry, cool, dark place where they are not exposed to direct sunlight

Follow: Follow instructions

• The manufacturer's instructions for storage can be found on the SDS and should be followed

Avoid: Avoid exposure to light

• Light is the primary cause of the deterioration of sodium hypochlorite, epinephrine, and hydrogen peroxide

• Change in color is a common sign that the chemical has deteriorated

Check: Check expiration date

Rotate: Rotate inventory to ensure older products are used first

Disposal of Empty Containers

Empty containers may hold residues that can burn or explode

Never fill an empty container with another substance because a dangerous chemical reaction could occur

Follow the label and the SDS for guidance in disposing of empty containers

Hazardous Waste Disposal

Ignitable waste: Flammable or combustible

Corrosive waste: Highly acidic or basic with a pH less than 2.0 or greater than 12.5, respectively (water has a pH of 7.0)

Reactive waste: Chemically unstable or explosive, reacts violently with water, or is capable of giving off toxic fumes when mixed with water

Toxic waste: Contains arsenic, barium, chromium, mercury, lead, silver, or certain pesticides

These types of hazardous waste are listed by the EPA

Hazard Communication Program

OSHA issued the Hazard Communication Standard because employees have the right to know the identity and hazards of chemicals that they use in the workplace

Also known as the Employee Right-to-Know Law

Requires employers to implement a hazard communication program

Revision of the HCS Standard

In 2012, OSHA revised the HCS and adopted the Globally Harmonized System of Classification and Labelling of Chemicals (GHS)

Major Changes to the Hazard Communication Standard

Hazard Classification: Chemicals are classified into categories that compare hazard severity within a hazard class. Each chemical that falls into the same category will have the same label requirements and language

Labels: All labels will now include a harmonized signal word, pictogram, and hazard statement for each hazard class and category

Safety Data Sheets: Will now have a specified 16-section format

Hazard Communication Standard

• Written program

• Inventory of hazardous chemicals

• SDS for every chemical

• Proper labeling of containers

• Employee training

What are the responsibilities of the dental assistant as the coordinator of the office Hazard Communication Program, (HCP)?

Read and understand the OSHA Hazard Communication Standard and implement the written HCP. Compile a chemical inventory, obtain the SDSs, and update the SDS file as new products are added to the inventory. Inform other employees of the location of the SDSs. Also label appropriate containers and provide training to other employees.

What three major areas does the Hazard Communication Program make up?

Hazard Labels, SDS and Labels

Written Program

Identify: Identify all employees who are exposed to hazardous chemicals

Identify: Identify the individual who is responsible for the program

Describe: Describe staff training

Describe: Describe how chemicals are handled in the office

Provide: Provide a description of all labeling and safety measures

Describe: Describe how to respond to chemical emergencies such as spills and exposures

Chemical Inventory

Chemical Inventory : A comprehensive list of every product used in the office is required

When a new product containing a hazardous chemical is added to the office’s inventory, it must be added to the chemical list, and the SDS for that product must be placed in the SDS file

The manufacturer or distributor must provide an updated SDS when appropriate

Safety Data Sheets

Contains health and safety information about every chemical in the office

Provide comprehensive technical information and are a resource for employees working with chemicals

Describe the physical and chemical properties of a chemical, health hazards, routes of exposure, precautions for safe handling and use, emergency and first-aid procedures, and spill-control measures

The manufacturers of products that contain hazardous chemicals are required to provide SDSs

The SDSs should be organized in binders

Employee Training

Staff training is required:

• When a new employee is hired

• When a new chemical product is added to the office

• Once a year for all continuing employees

Records of each training session must be kept on file

Training records are to be retained for at least 5 years

Labeling of Chemical Containers

Containers must be labeled to indicate what chemicals they contain and any hazards that may be associated

• When a chemical is transferred to a different container, the new container also must be labeled

No “official” labeling system is required, and many approaches are available

The two most important considerations are that:

• The labeling system is easy to use

• All employees are properly trained to understand and read the label

National Fire Protection Association Labels

The National Fire Protection Association has a labeling system that is frequently used to label containers of hazardous chemicals

This system involves the use of four diamonds (blue, red, yellow, and white) that are filled with numeric ratings from 0 to 4

The categories are health hazard (blue), flammability (red), reactivity (yellow), and OXY for oxidizers (white)

Classification of Medical Waste

OSHA regulations apply to the handling of waste in the dental office for the protection of employees

• When waste leaves the dental office, EPA regulations apply to the disposal

All dental waste should be classified according to EPA guidelines as regulated or nonregulated

Regulated waste: 

• Includes sharps, such as disposable needles, scalpel blades, contaminated broken glass, disposable dental burs, and endodontic files and reamers

• Other regulated waste includes blood, blood-soaked and blood-caked items, human tissue, and pathologic waste

• Regulated waste requires special disposal

Nonregulated Waste

Includes contaminated waste materials, as well as saliva-soaked gauze, used patient bibs, and surface barriers

All waste containers that hold potentially infectious materials must be labeled with a biohazard symbol

OSHA requires this label to protect the employees, and the EPA requires this label to inform the public

Extracted Teeth

Extracted teeth are considered to be potentially infectious materials

• They are regulated waste if they are not disinfected and returned to the patient

Teeth that do not contain amalgam and are going to be used for educational purposes must first be heat-sterilized

Extracted teeth that contain amalgam restorations should never be heat-sterilized because the high temperatures may create toxic mercury vapors

Sharps

OSHA, the Centers for Disease Control and Prevention (CDC), and the EPA classify sharps as infectious waste

According to OSHA, disposable sharps must be placed in a closable, leakproof, puncture-resistant container immediately after use

This container must be labeled with the biohazard symbol and color coded for easy identification

State regulations differ regarding how frequently sharps containers must be picked up

Scrap Amalgam

Collected and stored in a designated, dry, airtight container

• Scrap amalgam that is not recycled must be managed as hazardous waste

• The container of scrap amalgam that is recycled must be labeled with the name, address, and telephone number of the dental office and the date on which you first started collecting material in the container

Photochemical Waste

Radiographic fixer: On-site treatment requires installation of silver recovery systems. Off-site treatment involves storing used fixer and contracting with a disposal company to have it picked up

Radiographic developer: Products with a high or a low pH are likely to be considered hazardous waste and must be managed according to local regulations

Lead Contamination

Lead foil

Easily recyclable but cannot be disposed in the garbage

Disinfectants

Small quantities of spent germicidal solution that contain 2% or less of glutaraldehyde can usually be poured down the drain

Germicidal solutions with greater than 2% glutaraldehyde may need to be managed as a hazardous waste

Check with local authorities on disposal methods for these chemicals

Nonhazardous Waste Management

Regular dental office waste should be recycled whenever possible

Aluminum, glass, newspapers, corrugated fiber, office paper, and mixed paper

Waste Disposal

The EPA enforces the disposal of regulated waste

• If state and local regulations are more stringent than federal rules, state and local regulations must be followed

Dentist is responsible for proper packaging, labeling, transportation, and ultimate disposal of waste generated in the dental office

Health Hazard

• Carcinogen

• Mutagenicity

• Reproductive Toxicity

• Respiratory Sensitizer

• Target Organ Toxicity

• Aspiration Toxicity

Flame

. Flammables

. Pyrophorics

. Self-Heating

. Emits Flammable Gas

. Self-Reactives

. Organic Peroxides

Exclamation Mark

. Irritant (skin and eye)

. Skin Sensitizer

. Acute Toxicity (harmful)

. Narcotic Effects

. Respiratory Tract Irritant

. Hazardous to Ozone Layer (Non-Mandatory)

Gas Cylinder

Gases Under Pressure

Corrosion

Skin Corrosion/Burns

Eye Damage

Corrosive to Metals

Exploding Bomb

. Explosives

. Self-Reactives

. Organic Peroxides

Flame Over Circle

Oxidizers

Environment (Non-Mandatory)

Aquatic Toxicity

Skull and Crossbones

Acute Toxicity (fatal or toxic)

Toxic Organ Guide- What does A, B, C, D, E, F mean?

A: Harmful to Kidneys

B: Harmful to Liver

C: Harmful to Lungs

D: Harmful to the central and/or peripheral nervous system

E: Causes skin damage, irritation or dermatitis

F: Harmful to blood, eyes, and reproductive system