Chemical Waste Management Chapter 23

Compare "regulatory" and "advisory" agencies.

Regulatory agencies issue rules and regulations with which dental offices must comply. Advisory agencies have no authority for enforcement, they issue recommendations based on strong scientific evidence.

What are the penalties for not complying with regulations?

Include fines, imprisonment, or suspension or revocation of licenses.

What is the role of professional organizations in infection control?

A valuable resource for current infection control and other professional information.

What is the professional organization for dentists that makes recommendations for infection control and published informational reports on issues of interest to the dental community?

The American Dental Association(ADA).

What is the not-for-profit organization composed of dentists, dental hygienists, dental assistants, government representative, dental manufacturers, university professors, researchers, and dental consultants with a collective mission to promote infection control and related science-based health and safety policies and practices?

The Organization for Safety, Asepsis and Prevention(OSAP).

--- is the premier infection control education organization in dentistry.

The Organization for Safety, Asepsis and Prevention(OSAP).

How do state and local dental societies (including dental assisting) assist in complying with regulatory issues?

By answering questions and working with you or acting as liaisons to the regulatory agencies.

What agency of the U.S. Department of Health and Human Services is recognized as the lead federal agency for protecting the health and safety of people at home and abroad?

The Centers for Disease Control and Prevention(CDC).

Does the CDC make recommendations or regulations?

It makes recommendations but it does not make regulations.

What document is issued by the CDC outlining the infection control procedures that should be practiced in dentistry?

Guidelines for Infection Control in Dental Healthcare Settings.

What additional functions of the CDC support the practice of dentistry?

Its Oral Health Services section that studies oral diseases, fluoride application, and infection control in dentistry; it has published guidelines on preventing transmission of tuberculosis in healthcare settings.

What information is provided in the Morbidity and Mortality Weekly Report published by the CDC?

Provides data on health and disease trends based on reports by state health departments.

What are the functions of the U. S. Food and Drug Administration (FDA) in relation to infection control?

Regulates the manufacturing and labeling of medical devices; in dentistry, they must approve sterilizers, biologic and chemical indicators, ultrasonic cleansers and cleaning solutions, liquid sterilants, gloves, masks, protective eyewear, dental handpieces and instruments, dental chairs, and dental unit lights; regulates antimicrobial handwashing products and mouth rinses; review safety and effectiveness of drugs and medical devices; review claims on the labels of products to be certain the claims are true.

What are the functions of the U. S. Environmental Protection Agency (EPA) associated with dentistry?

Ensures the safety and effectiveness of disinfectants; involved in regulating waste materials, such as chemicals and medical waste, after they are sent from the dental office to a final disposal site.

What federal regulatory agency is a division of the U. S. Department of Labor and is responsible to ensure the safety and health of America's workers?

The U.S. Occupational Safety and Health Administration(OSHA).

How does OSHA accomplish its mission?

By setting and enforcing protective standards that employers must follow so as to provide a safe workplace for their employees. In addition, they provide training and outreach education and encourage continual improvement in workplace safety and health.

What are the two most important OSHA standards in dentistry?

Include the Blood-borne Pathogens Standard and the Hazard Communication Standard.

How many states administer their own OSHA programs?

22.

How do state OSHA standards compare with federal standards?

Must meet or exceed federal standards.

How does OSHA monitor compliance with its standards?

Through a process of investigation of the workplace.

Under what circumstances may a dental office inspection occur by OSHA?

May occur when an employee or patient complaint is made, randomly in an office with 11 or more employees, and upon request of the dentist for a consultation visit.

What is the primary federal agency for conducting and supporting medical research?

The National Institutes of Health(NIH).

What are the specific functions of the NIH?

Include investigating ways to prevent disease and researching the causes, treatments, and even cures for common and rare diseases; provide leadership and financial support to researchers in every state and nation throughout the world; translate research into practice and communicate research findings to patients and their families, healthcare providers, and the general public.

What is the dental research institute of the NIH whose mission it is to promote the general health of the American people by improving their oral, dental, and craniofacial health?

The National Institute of Dental and Craniofacial Research(NIDCR).

What is the only federal institute responsible for conducting research and making recommendations for the prevention of work-related disease and injury but does not have regulatory authority?

The National Institute for Occupational Safety and Health(NIOSH).

What, in general, is NIOSH responsible for?

Conducting research on the full scope of occupational disease and injury.

List the specific duties of NIOSH.

Include investigating potentially hazardous conditions when requested by employees or employers, making recommendations and disseminating information on preventing workplace disease, injury, and disability; and providing training to occupational safety and health professionals.

At a local dental assisting society meeting, the conversation turned to infection control. Several of the dental assistants had different opinions regarding local dental waste disposal regulations. How would you obtain accurate information regarding local regulations about dental waste removal?

By referencing the policies and procedures for dental waste removal put out by EPA.

You have been asked by a local women's group to speak about children's dental health. Where can you obtain current information on this topic to prepare for your presentation?

Information on children's dental health can be found in the policies and procedures put out by OSAP.

When you become a certified dental assistant or a registered dental assistant, you will need to maintain your credential with continuing education. Where will you find sources of continuing education?

Sources of continuing education can be found through the ADAA.

Describe the variety of chemicals that the dental assistant may be exposed to.

Include those used for treatment procedures, cleaning of instruments and surfaces, disinfection and sterilization, laboratory procedures, and dental x-ray processing.

Why is knowledge of chemical hazards important to the dental assistant?

Chemicals are capable of causing serious health consequences if they are absorbed into the body in sufficiently large amounts.

What types of health consequences can occur?

Include serious damage to the heart, kidney, liver, and lung tissues as well as short-term discomfort, such as burns or rashes, and life-threatening conditions, such as cancer or organ failure.

What information must the dental assistant understand regarding all chemicals used in the dental office?

Includes proper use, storage, handling, spill cleanup, and disposal methods; they must understand the first aid procedures associated with chemicals and be aware of the hazardous materials that may be regulated under federal, state, or local environmental guidelines and the requirements associated with the disposal of these hazardous materials.

What is a hazardous chemical?

Any chemical that can cause a physical or a health hazard. A chemical is considered hazardous if it can ignite, can react or explode when mixed with other substances, is corrosive, or is toxic.

What are the three primary methods of chemical exposure?

Include inhalation, skin contact, and ingestion.

Describe the damage that may occur through inhalation of gases, vapors, or dusts of chemicals.

Can cause direct damage to the lungs; some chemicals may not affect the lungs but are absorbed by them and are then sent through the blood to other organs where they may cause damage.

How does absorption through the skin occur?

Through direct skin contact.

What may be the damage of repeated skin contact with chemicals?

Can cause a skin condition known as dermatitis to develop.

What are common ways of ingesting harmful chemicals in the workplace?

Include eating lunch in an area in which chemicals are used or eating with hands that are contaminated with chemicals.

What is an important step in avoiding ingesting harmful chemicals?

Washing your hands thoroughly.

What factors will determine whether a chemical will be harmful and the extent of the harm?

Include the amount of the dose and the duration of exposure to the chemical.

What results from high levels of exposure over a short period of time, such as a chemical spill, where exposure is sudden and in large amounts?

Acute chemical toxicity.

What are the symptoms of an acute overexposure to chemicals?

Include dizziness, fainting, headache, nausea, and vomiting.

What results from many repeated exposures, generally of lower levels, over a much longer time?

Chronic chemical toxicity.

What may be the effects of chronic toxicity?

May include liver disease, brain disorders, cancer, and infertility.

What type of gloves should be worn when using chemicals?

Utility gloves made of a chemical-resistant material such as natural rubber, neoprene, or industrial grade nitrile.

Do the latex exam gloves worn during patient care provide adequate protection when handling chemicals? Why?

No, because when they are exposed to chemical disinfectants, the latex in the glove degrades and creates a wicking, or sucking, action that will actually pull contaminants and chemicals through the glove and onto the hands.

Ideally, what type of eyewear should be worn to protect the eyes from fumes and splashes while pouring chemicals such as x-ray processing solutions, ultrasonic solutions, disinfectants, and sterilants?

Goggles with soft, vinyl rims at the top and bottom that fit the face snugly.

What type of protective clothing should be worn when mixing or pouring caustic or staining chemicals?

A rubber or neoprene apron.

What document will provide specific information regarding the need for personal protective equipment (PPE)?

The material safety data sheet(MSDS).

What type of mask is required when working with chemicals?

Should be fluid repellent and should provide respiratory protection.

What type of mask may be required when pouring or mixing chemicals or if you are sensitive or allergic to substances?

A mist respirator face mask.

How should chemical spills be managed?

According to the information found in the material safety data sheet, or MSDS, for the specific product.

What should be used to clean up spilled mercury in the dental office?

Mercury spill kits.

Which methods of chemical exposure may occur with mercury?

Include absorption through the skin or through inhalation of mercury vapors.

What will be included in the mercury spill kit?

Mercury-absorbing powder, mercury-absorbing sponges, and a disposal bag.

What PPE should be worn whenever cleaning up a mercury spill?

Include a mask and utility gloves.

List the precautions for working with mercury.

Include working in a well-ventilated space, avoiding direct skin contact and inhaling mercury vapor, and store mercury in unbreakable, tightly sealed containers, away from heat; when preparing amalgam for restorations, use preloaded capsules; when mixing amalgam, always close the cover before starting the amalgamator; reassemble amalgam capsules immediately after dispensing the amalgam mass; and leftover scrap amalgam, that was not used, is stored dry in a tightly closed container; scrap amalgam that has been retrieved from dental unit traps is disinfected in a solution of bleach and water, then it is placed in the container with other scrap amalgam; clean spills using appropriate procedures and equipment, and place contaminated disposable materials into polyethylene bags and seal, and dispose according to the regulations specific to your area.

What are OSHA's regulations regarding eyewash units?

Require installation in every workplace where chemicals are used; the unit should be inspected monthly to ensure that it is functional; depending on the manufacturer, it may need to be flushed weekly to reduce the microbial content in the waterline.

What type of ventilation is necessary for fumes and dust in the laboratory, sterilization, and darkroom areas?

Special exhaust systems.

What factors are important to ensure that dental materials retain their effectiveness?

Careful use and storage of dental materials.

What is the basic "safe" policy for storage of dental medications and chemicals?

Keep them in a dry, cool, dark place where they are not exposed to direct sunlight.

What is the best method for packaging and storing dental materials?

Outlined on the MSDS.

What is a prime cause for deterioration of sodium hypochlorite (household bleach), epinephrine, and hydrogen peroxide?

Light.

What is a common sign of deterioration of a material?

Change in color.

What information, listed on the product, should be checked frequently?

The expiration date.

What process should be followed when stocking new supplies?

Consists of stocking fresh supplies behind the current inventory to ensure that the oldest product is used first.

List the guidelines for minimizing exposure to chemical hazards in the dental office.

Includes keeping a minimum of hazardous chemicals in the office, reading the labels and using only as directed, storing according to the manufacturer's directions, keeping containers tightly covered, and avoiding mixing chemicals unless consequences are known; wear appropriate personal protective equipment when handling hazardous substances, wash hands immediately after removing gloves, avoid skin contact with chemicals and immediately wash skin that has come in contact with chemicals, maintain good ventilation, and do not eat, drink, smoke, apply lip balm, or insert contact lenses in areas in which chemicals are used; keep chemicals away from open flames and heat sources, always have on hand an operational fire extinguisher, know and use proper cleanup procedures, keep neutralizing agents available for strong acid and alkaline solutions, and dispose of all hazardous chemicals according to material safety data sheet instructions.

Why may empty containers be hazardous?

They often hold residues that can burn or explode.

Why should empty containers NOT be filled with another substance?

A dangerous chemical reaction can occur.

How should empty containers be disposed of?

According to the regulations specific to the area.

What classifies a substance as being hazardous?

If it has certain properties or contains chemicals that could pose dangers to human health and the environment after they are discarded.

List the characteristics that classify waste as hazardous.

Include if it is ignitable, corrosive, reactive, toxic, or listed by the EPA.

What is the basic concept of OSHA's Hazard Communication Standard?

It requires employers to inform their employees about the identity and hazards of chemicals that they use in the workplace.

What is another term for OSHA's Hazard Communication Standard?

The "Employee Right-to-Know Law".

What are the five parts of a mandatory hazard communication program?

Include a written program, inventory of hazardous chemicals, a material safety data sheet for every chemical, proper labeling of containers, and employee training.

What is an important aspect of the hazard communication program?

Good record keeping.

List the responsibilities of the dental assistant as coordinator of the hazard communication program.

Include reading and understanding the Occupational Safety and Health Administration's Hazard Communication Standard, implementing the written hazard communication program, compiling a list or chemical inventory of products in the office that contain hazardous chemicals, obtaining material safety data sheets, and updating the material safety data sheet file as new products are added to the office inventory; inform other employees of the location of the material safety data sheets, label appropriate containers, and provide training to other employees.

Describe the information that must be included in the written program.

Includes identifying, by name, all the employees in the office who are exposed to hazardous chemicals and identifying the individual who is responsible for the program; the program describes staff training, how chemicals are handled in the office, including information on all labeling and safety measures, and how to respond to chemical emergencies such as spills or exposures.

What is a chemical inventory?

A list of all products used in the office that contain chemicals.

Who will the dentist often appoint to be the program coordinator?

The dental assistant.

Who is required to provide an MSDS for each product?

The manufacturer of a product.

What are the staff training requirements for a hazard communications program?

Include training when a new employee is hired, when a new chemical product is introduced to the office, and once a year for all continuing employees.

What information is included in each material safety data sheet (MSDS)?

Includes health and safety information about every chemical in the office.

How long do the records of the training sessions need to be kept on file?

At least 5 years.

Who is responsible to provide the training?

The dentist.

What is the dental assistant's responsibility?

To routinely follow safety precautions.

What are the areas of the training program for employees?

Include the use of hazardous chemicals, all safety practices including all warnings, required PPE, and safe handling and disposal methods.

What hazards are identified by the following color coded diamonds as specified by the National Fire Protection Association? Blue:

The health hazard.

What hazards are identified by the following color coded diamonds as specified by the National Fire Protection Association? Red:

The flammability.

What hazards are identified by the following color coded diamonds as specified by the National Fire Protection Association? Yellow:

The reactivity.

What hazards are identified by the following color coded diamonds as specified by the National Fire Protection Association? White:

The special hazard symbols.

What chemicals are exempt from the labeling standard?

Include tobacco and tobacco products, wood and wood products, food, drugs, cosmetics, and alcoholic beverages sold and packaged for consumer use; drugs dispensed by a pharmacy to a healthcare provider for direct administration to a patient, over-the-counter drugs, and drugs intended for personal consumption by employees while in the workplace are also exempt.

What dental materials may be regulated by federal, state, or local environmental regulations?

Include mercury and dental amalgam, elemental mercury, amalgam capsules, scrap amalgam, amalgam traps, lead foil and shields, disinfectant solutions, x-ray fixer solutions, and x-ray developer solutions.

Why may disposal of these materials be regulated?

If they are discharged into a sewer system, they may impact the wastewater treatment plant and bypass the treatment plant into the bay, ocean, river, or other waters.

What does the dental assistant need to understand about dental waste?

The types of dental waste, how to comply with regulations, and ways to minimize the costs associated with disposal.

What agency regulates handling of waste in the dental office for the protection of employees?

The Occupational Safety and Hazard Administration.

What agency regulates waste that leaves the dental office?

The Environmental Protection Agency.

What are the two classifications of waste as classified by the EPA guidelines?

Include regulated and nonregulated.